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Hand hygiene is one of the most important measures to prevent healthcare associated infections. A hand hygiene technique consisting of three steps may be superior to the 6-step technique outlined by the World Health Organization (WHO) in terms of compliance with both indications and technique. Therefore, the aim of this study is to compare compliance with hand hygiene indications and technique between a 3-step and the 6-step technique for applying hand rub in an international multicenter cluster randomized trial.
Hand hygiene is one of the most important measures to prevent transmission of pathogens between healthcare workers and patients, and ultimately, healthcare-associated infections. However, compliance with both hand hygiene indications and technique (outlining the steps for applying hand rub to ensure coverage of all surfaces of the hands) remains insufficient at most institutions worldwide. It was previously demonstrated that a hand hygiene technique consisting of three steps is superior to the 6-step technique outlined by the World Health Organization (WHO) in terms of compliance with both indications and technique in a single center study. Furthermore, the 3-step technique was non-inferior regarding microbiological efficacy in two experimental studies and during daily clinical practice. To further investigate the external validity and generalizability of these findings to different settings, this study compares both compliance with hand hygiene indications and technique between the 3-step and the 6-step technique for applying hand rub in an international multicenter cluster randomized trial.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 3-step hand hygiene technique | Active Comparator | Wards assigned to this study arm will receive instructions, educational materials and tutorials about the 3-step hand hygiene technique. |
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| 6-step hand hygiene technique | Active Comparator | Wards assigned to this study arm will receive instructions, educational materials and tutorials about the 6-step hand hygiene technique. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Study intervention: 3-step hand hygiene technique | Procedure | 3-step hand hygiene technique:
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| Measure | Description | Time Frame |
|---|---|---|
| Compliance with hand hygiene indications | Compliance with the five hand hygiene indications defined by the WHO:
| Up to one year |
| Compliance with the assigned hand hygiene technique | Compliance with the assigned technique, defined as performance of the proposed three steps in the intervention group and of all six steps in the control group. | Up to one year |
| Measure | Description | Time Frame |
|---|---|---|
| Compliance with performance of the two steps for applying hand rub to the thumbs and the fingertips | Compliance with performance of the two steps for applying hand rub to the thumbs and the fingertips, which are part of both the 3-step and the 6-step technique for applying hand rub. | Up to one year |
| Duration of the hand hygiene action |
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Inclusion Criteria:
Health Care Workers (HCW) working at the randomized wards during the pre-defined timeframe
Exclusion Criteria:
Individuals, who are no HCWs
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sarah Tschudin Sutter, Prof.Dr.med. | Contact | +41 61 328 68 10 | sarah.tschudin@usb.ch |
| Name | Affiliation | Role |
|---|---|---|
| Sarah Tschudin Sutter, Prof.Dr.med. | University Hospital, Basel, Switzerland | Principal Investigator |
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All participating wards will be randomly assigned with a 1:1 allocation to either the intervention (3-step hand hygiene technique) or the control group (6-step hand hygiene technique). Randomization will be stratified by participating institution for balanced allocation. Within each stratum, block randomization will be applied to assign wards to the two study groups. Blocking will be used to ensure close balance of the number of wards assigned to each group at any time during the study. Stratified randomization will be performed to ensure balance of the two groups within each institution.
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| Control intervention: 6-step hand hygiene technique | Procedure | 6-step hand hygiene technique (according to the WHO Guidelines on Hand Hygiene in Health Care, First Global Patient Safety Challenge):
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Duration of the hand hygiene action, the time spent for the application of hand rub will be measured and compared between the two assignments. |
| Up to one year |