Testing The Effect Of A Resident-focused Hand Hygiene Intervention In A Long-term Care Facility: A Mixed Methods Feasibility Study

Abstract

In the United States of America (U.S.) approximately 3 million people in all healthcare settings develop healthcare-associated infections annually (Centers for Disease Control [CDC], 2016; Office of Disease Prevention and Health Promotion [ODHP], 2013). Hand hygiene is the most effective measure to prevent healthcare-associated infections, making it a clear strategy to prevent healthcare-associated infections. While there is a wealth of evidence regarding the efficacy of healthcare provider’s hand hygiene, there is a paucity of research available related to the role of residents’ hand hygiene in preventing healthcare-associated infections. Many long-term care facilities lack specialized infection control staff, creating a challenge for infection control and surveillance in this setting. The purpose of this study was to test the feasibility and acceptability of a resident-focused hand hygiene intervention within a long-term care facility, using a mixed methods design.

The study followed an exploratory sequential design. The strands were implemented sequentially, starting with qualitative data collection and analysis. The qualitative strand began with direct observation which is the gold standard to monitor hand hygiene adherence. Next, interviews of six residents and six staff members were completed using a semi-structured interview guide. Qualitative findings informed the second strand, which had a quantitative emphasis. The quantitative strand of the study was a quasi-experimental clinical trial (n=12 residents), implemented with a pre-test/post-test design with one experimental group and no control group. Participants in the quantitative strand were recruited and completed pre-intervention questionnaires on day one. Pre-observation occurred on day two with the educational intervention on day three. Post-intervention observation and questionnaires were completed on day four, which was 24 hours post- intervention and 72 hours after the pre-intervention data collection. The educational intervention revealed clinically important and positive changes in hand hygiene related health beliefs. While findings suggested the educational intervention improved respiratory hygiene, meal-related hand hygiene demonstrated only a minimal increase. Qualitative data revealed hand hygiene may be less amenable to change because of meal-related hand hygiene habits formed in childhood. A resident-focused hand hygiene intervention actively promotes self-efficacy rather than passive reliance on healthcare staff to assure clean hands during meals. Findings from both the quantitative and qualitative strands provide key information for future piloting of a resident-focused hand hygiene intervention on a larger scale.