title: Simulation education as a single intervention does not improve hand hygiene practices: A randomized controlled follow-up study.
abstract: To evaluate how critical nurses' knowledge of and adherence to current care hand hygiene (HH) guidelines differ between randomly allocated intervention and control groups before and after simulation education in both a simulation setting and clinical practice during a 2-year follow-up period. It was hypothesized that intervention group knowledge of and adherence to current HH guidelines might increase compared with a control group after simulation education.
  
  
  
  A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Oulu, Finland. Thirty out of 40 initially randomized critical care nurses participated in the baseline measurements; of these, 17 completed all the study procedures. Participants' HH adherence was observed only in high-risk contact situations prior to and postendotracheal suctioning events using a direct, nonparticipatory method of observation. Participants' HH knowledge was evaluated at the end of each observational session.
  
  
  
  The overall HH adherence increased from a baseline value of 40.8% to 50.8% in the final postintervention measurement at 24 months (P = .002). However, the linear mixed model did not identify any significant group (P = .77) or time-group interactions (P = .17) between the study groups after 2 years of simulation education. In addition, simulation education had no impact on participants' HH knowledge.
  
  
  
  After a single simulation education session, critical care nurses' knowledge of and adherence to current HH guidelines remained below targeted behavior rates.
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Unit of Nursing Science and Health Management, University of Oulu, Finland; Medical Research Center Oulu, Oulu, Finland. Electronic address: miia.jansson@oulu.fi.
authors.forename: Miia M
authors.initials: MM
authors.lastname: Jansson
authors.affiliation: Medical Research Center Oulu, Oulu, Finland.
authors.forename: Hannu P
authors.initials: HP
authors.lastname: Syrjälä
authors.affiliation: Department of Infection Control, Oulu University Hospital, Oulu, Finland.
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Ohtonen
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Merja H
authors.initials: MH
authors.lastname: Meriläinen
authors.affiliation: Unit of Nursing Science and Health Management, University of Oulu, Finland; Northern Ostrobothnia Hospital District, Medical Research Center Oulu, Oulu, Finland.
authors.forename: Helvi A
authors.initials: HA
authors.lastname: Kyngäs
authors.affiliation: Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland.
authors.forename: Tero I
authors.initials: TI
authors.lastname: Ala-Kokko
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003422:Critical Care; D004501:Education, Medical / Q000379:methods*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009726:Nurses; D011446:Prospective Studies; D000066908:Simulation Training / Q000379:methods*
keywords: Hand hygiene; infection control; nursing education; simulation