Cynthia Haanappel (Erasmus MC University Medical Center)

Summary of presentation:
Introduction
Increasing hand hygiene compliance (HHC) among healthcare workers remains a challenge. While multimodal strategies have been shown to improve HHC, few have incorporated friendly competition. This study aimed to foster collaboration and improve HHC among nurses and physicians across hospitals, part of the Infection Prevention and Antimicrobial Resistance Care Network South-Western Netherlands, by introducing friendly competition in a regional context as part of a multimodal strategy.
Methods
We conducted a multicentre observational cohort study in 15 Dutch hospitals, including inpatient and short-stay departments. Participation was decided at hospital board level and implemented by wards and infection control teams. The multimodal strategy, included interventions in facilities, education, communication, feedback, and as main intervention friendly competition, with hospitals ranked based on HHC results. Rankings were shared with hospital directors and managers to encourage motivation. HHC was assessed at 16 time points over 10 years using direct, unobtrusive observation. A generalized linear mixed model assessed temporal trends, and the specific influence of friendly competition, through HHC relative to hospital ranking.
Results
All 15 hospitals showed an increase in HHC, from a mean HHC of 44.8% (SD 15·99) to 77.54% (SD 10.38) across 65,459 opportunities. Each additional year was associated with higher odds of HHC: 1.08 by time from inclusion (95% CI 1.00–1.16) and 1.21 by calendar time (95% CI 1.09–1.36). Hospitals with low or medium rank showed higher increases in HHC than high ranking ones, with the friendly competition effect showing in an aOR 1.24 (95% CI 1.18–1.31) and 1.12 (95% CI 1.06–1.18), respectively. Compliance improved across all five WHO moments and among both nurses and physicians.
Conclusion
We demonstrated a sustained improvement of HHC over time, from 44.8% to 77.5%, achieved through a regionally coordinated multimodal strategy, with friendly competition as a significant contributor to success.