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Searching for an Optimal Hand Hygiene Bundle: a Meta-Analysis

Schweizer ML, Reisinger HS, Ohl M, Formanek M, Blevins A, Ward M, Perencevich EN. Searching for an Optimal Hand Hygiene Bundle: a Meta-Analysis. Poster session presented at: Infectious Diseases Society of America Annual Meeting; 2013 Oct 4; San Francisco, CA.


Background: There are few evidence-based recommendations on which interventions should be implemented to improve hand hygiene compliance. The aim of this meta-analysis was to review all studies on interventions to improve hand hygiene compliance in order to evaluate existing compliance improvement bundles and identify areas of promise to target future intervention studies. Methods: We systematically searched PubMed, CINAHL, Cochrane Databases, Scopus/EMBASE, and PsycInfo via PsycNet to find all papers on interventions to improve hand hygiene compliance in healthcare settings published between 2000 and 2012. Two investigators independently assessed study eligibility and extracted data. Risk of bias was assessed using the Jadad or Larson scales. Adjusted risk ratios were pooled using fixed effects or random-effects models to assess common bundles. Heterogeneity was evaluated using the Cochran Q and the I2 statistics. Results: Of the 8,148 studies evaluated, 6 randomized controlled trials and 39 quasi-experimental studies met inclusion criteria for further evaluation. Three homogeneous studies evaluated the bundled interventions: education, reminders, feedback, administrative support and access to alcohol-based hand rub [ABHR]. This bundle was associated with improved hand hygiene compliance (pooled odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.69, 1.97). Additionally, a bundle that included education, reminders and feedback evaluated in 3 homogeneous studies of neonatal intensive care units was associated with improved compliance (pooled OR: 1.47; 95% CI: 1.12, 1.94). Finally, studies that assessed bundles that included fewer interventions had a stronger association between the intervention and improved hand hygiene compliance than did studies that assessed bundles with a greater number of component interventions. Conclusions: Bundles including education, reminders, feedback, administrative support and access to ABHR are supported by the current evidence. Importantly, including a greater number of interventions in hand-hygiene bundles does not appear to improve compliance. Before expanding current bundles, individual bundle components should be evaluated via clinical trials.

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