E-learning and hygiene quick scan to improve personal hygiene

Background: wearing uniforms with short sleeves, no rings or other jewelries, and wrist watches and the availability of alcoholic hand rub are prerequisites for good hand hygiene. To improve adherence to these rules, we developed a simple, non labor-intensive method to give health care workers regular feedback on their performance and we introduced e-learning on principles of hospital hygiene.

Objective: the objective was to improve adherence to at least 90%.

Methods: for the hygiene quick scan infection control nurses visit every department four times a year for 30 min to observe 10 nurses and 5 doctors checking whether they are correctly dressed, wear rings, jewelry or a wrist watch and check whether hand rub dispensers are filled. The results are summarized and reported to the heads of the departments in a way that they can compare performance of their departments with the other ones. They are asked to communicate the results to the personnel they are responsible for and are asked to take measures to improve adherence according to their responsibility for quality of care. After having given feedback for three times all employees of the hospital involved in patient care were invited by the head of their department to do an e-learning about the basic hygiene rules of the hospital.

Results: the three quick scans before the offer of the e-learning showed no improvement. Nurses performed better than doctors. Ninety percent of the nurses were correctly dressed against 65% of the doctors. Eighty-five percent of the nurses did not wear rings jewelry or a wrist watch against 40% of the doctors. Dispensers were filled in 100% of the cases. A quick scan four months after the e-learning campaign showed that nearly 100% of the nurses were correctly dressed. Nurses performed already near to the objective of at least 90% correctness before the e-learning campaign. Doctors improved their behavior but remained far below the objective with 60% correct for rings, jewelry and wrist watches, and 75% correct for dressing. As a result of the regular feedback and e-learning, several departments are now taking their responsibility and take initiatives to improve hygiene in their departments.

Conclusions: regular feedback itself did not improve adherence. Improvement was seen after introduction of e-learning about the basic hygiene rules of the hospital. Hygiene quick scans will be continued but probably have to be combined with reminder campaigns to maintain and improve the effect.