The effectiveness of computer image messages on hand hygiene compliance in intensive care units

Background: Although the CDC has recommended the appropriate hand hygiene procedures, the reported hand hygiene compliance is ranged from 15 to 80 %, and the average compliance rate has been estimated as 40%. There has been no evidence reported in Japan that continuous external stimulus results in improved hand hygiene compliance.

Objective: The objective of this study was to evaluate the effectiveness on hand hygiene compliance by using continuous visual stimulus through computer screensaver messages.

Methods: This study was conducted at a 20 bed ICU of a 1275 bed university hospital in Japan. The comparative study before and after intervention was carried out on 87 healthcare professionals.  After gaining cooperation from the relevant hospital managers, 16 images of practicing hand hygiene for screensaver were developed. In February 2009, baseline data was gathered using the direct observation method.  In March 2009, using the developed images for screensaver on all the computers placed at the ICU, the created images flushed every 10 seconds. The observation of hand hygiene behaviors during the intervention period took place the same way as the baseline data collection.  This study was conducted under the approval of the ethical committee of the researchers’ graduate school as well as the nursing ethical committee of the relevant hospital where the actual study took place.

Results: Compliance rate during the baseline period was 38.3% and during the intervention period 36.4%. It seems that soap and running water hand washing techniques were observed mostly during the survey period (both period 62.9%). The level of care necessity (p<.01) and inpatient bed occupancy rate (p<.01) of the ICU presented significant differences before and after the intervention.

The usage of alcohol-based hand rub and liquid soap for 1000 patient/day throughout the survey dramatically increased from 30000mls prior to the study to 70000mls. Transitioning from baseline period to the intervention period, the full usage amount raised to around 30000mls. Reduction of 3000mls was observed for usage of alcohol-based hand rub, whereas liquid soap usage showed the increase of more than 30000mls.

Conclusions: The results showed that hand hygiene compliance rates had no improvement during the intervention period compared to the baseline period. However, an actual increase of the usage amount of alcohol-based hand rub and liquid soap was already seen during the baseline period compared to before commencing this study. Thus researchers surmise that this increased data shows monitoring effectiveness. For future planning, if a similar intervention takes place, some ingenuity would be required in order to make the images more interesting and effective for healthcare professionals.