Audits and feedback or incentives: Which will boost hand hygiene compliance more?

When it comes to boosting hand hygiene compliance rates, incentives are a quick fix, but auditing and providing feedback results in sustained high compliance levels, according to a study in the American Journal of Infection Control.

As part of the study, nurses at a Lebanese hospital participated in a lecture about the World Health Organization's My 5 Moments for Hand Hygiene and then were divided into three groups: a control, an incentive-based group and an audit-feedback group.

The incentive-driven group included 33 nurses who were evaluated by auditors. Then, a staff meeting was held every week in which the two winners — who had the second highest and highest hand hygiene score — were given money as prizes. The winner received the equivalent of one overtime shift payment, and the nurse in second received 75 percent of that amount. However, the nurses in this group received no detailed feedback.

In the audit-feedback group, 29 nurses received feedback on hand hygiene compliance as a group and also individually during weekly meetings. The feedback included giving them their scores, their missed hand hygiene moments and a reminder about the importance of hand hygiene compliance.

The audits took place over a 21-week period, but feedback and incentives were only given through week 14.

During the 14-week intervention period, hand hygiene compliance improved in both groups — from 21 percent to 77 percent for the incentive group, and from 23 percent to 51 percent in the audit-feedback group.

However, after the interventions stopped, the incentive-based group's compliance rate dropped to 34 percent, while the audit-feedback group's compliance rate hovered around 48 percent.

The study's authors concluded multifaceted interventions are the best way to achieve and sustain hand hygiene compliance.

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