Nursing students led simulations to improve healthcare workers’ hand hygiene compliance

Figures & data

Table 1. Number of students leading HH simulation sessions, and percentage of HCWs participation, by period.

Period	Years of intervention	Number of students	Participants in HH simulation sessions (% of division HCWs)
I	2013–2014	17	70/189* (37%)
I I	2014–2015	15	31/288* (10.8%)
I I I	2015–2016	18	85/132**(64.4%)
IV	2016–2017	17	100/445** (22.6%)
Total participation		67	286/1054 (27.1%)

*Nurses and nursing aides only participated in the simulation sessions; ** Nurses, nursing aides, and physicians participated in the simulation sessions.

Figure 1. Hand hygiene compliance rates, adjusted for month, by period of study.

Table 2. Increase in hand hygiene compliance rate by period* 2013–2017.

Period	Compliance	Incidence Rate Ratio (95%CI)	Significance
I	36%	Reference
I I	48%	1.336 (1.278–1.397)	< 0.001
I I I	64%	1.803 (1.785–1.820)	< 0.001
IV	76%	2.139 (2.136–2.143)	< 0.001

* Adjusted for study month.

Table 3. Hand hygiene compliance before and after simulation sessions in each division and control, by period* 2013–2017.

	Compliance (95%CI) and total no. of opportunities				Incidence Rate Ratio (95%CI) improvement rate in intervention vs. control group	p value for interaction
	Before		After
	Compliance rate	No. of opportunities	Compliance rate	No. of opportunities
Period I (2013–2014)
Division A intervention	28%	1325	33%	2761	1.409 (1.239–1.602)	<0.001
All other divisions: control	40%	3096	34%	14580
Period I I (2014–2015)
Division B intervention	46%	1702	54%	1581	1.032 (1.025–1.040)	<0.001
All other divisions: control	46%	18138	53%	15343
Period I I I (2015–2016)
Division C intervention	57%	2136	55%	981	0.79 (0.757–0.825)	<0.001
All other divisions: control	57%	12974	70%	5383
Period IV Division D (2016–2017)
Division D intervention	64%	1449	67%	3475	1.045 (1.025–1.065)	<0.001
All other divisions: control	61%	6294	61%	14491

* Adjusted for month.

Table

Directions	Minimal expected behaviour	Answers/events	Hand hygiene indications
Nurse measures vital signs of Mrs. Dahan	Nurse hand hygiene before measurements	vital signs normal	Before patient contact
Records	Hand hygiene, wipes blood pressure device, records		After patient contact
Checks bandage and empties drain	Hand hygiene, gloves, checks and empties	30 cc serotic fluid	Before aseptic procedure
Records	Remove gloves, hand hygiene, records		After contact with bodily fluids
Mrs. Zinger complains of shortness of breath	Nurse asks aide to help position patient, hand hygiene, calls doctor, measures saturation	Oxygen Sat 92%	Before patient contact
Aide joins nurse	Raise patient		Aide hand hygiene before patient contact

Table

Directions (continue)	Minimal expected behaviour	Answers/events	Hand hygiene indications
Records	Nurse hand hygiene, wipes device, record		After patient contact
Doctor enters, examines patient	Hand hygiene, listens to lungs, requests oxygen mask	Irregular sounds Lt. lung	Before patient contact
Records	Hand hygiene, records		After patient contact
Aide brings mask from supply room	Hand hygiene, leaves room		After contact with surroundings