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Does Changing Point-of-Use Reminder Signs More Frequently Improve Hand Hygiene Compliance?

Reisinger HS, Vander Weg MW, Goedken CL, Vaughan-Sarrazin MS, Franciscus CL, Perencevich EN. Does Changing Point-of-Use Reminder Signs More Frequently Improve Hand Hygiene Compliance? Paper presented at: Society for Healthcare Epidemiology of America Spring Conference; 2016 May 18; Atlanta, GA.


Background: Visual reminders, such as point-of-use, theoretically-informed signs, are used to improve hand-hygiene (HH) compliance. To date, little attention has been paid to how frequently signs should be changed to reduce healthcare worker habituation-or lack of response after repeated exposure-to reminder signs. The objective of this study was to test the impact of the frequency of changing signs on HH compliance. Methods: The study was a cluster-randomized trial (CRT) conducted in 58 wards/units in 9 geographically distinct acute-care hospitals. Starting in Oct 2014, baseline HH data were collected under existing HH signage conditions. In Jun 2015 theoretically-informed signs were placed by the HH dispenser at the entry to patient rooms. 19 wards/units were randomized to change signs weekly, 20 monthly, and 19 never. HH compliance was determined by covert direct observations of entry/exit compliance. A mixed-effects model with a logit link was used. The model accounted for with within-unit and within-site correlation, while also adjusting for number of beds and ward/unit type. Result: During baseline data collection, 9791 HH opportunities were observed with an overall compliance rate of 46% for entry and 65% for exit. 6117 HH opportunities were observed during the intervention period (entry compliance = 47%; exit compliance = 65%). Comparing pre- and post-intervention rates, changing signs monthly was the only intervention with a significant increase of 18% (p = 0.01). Compliance rates decreased slightly under conditions of weekly sign changes and compliance rates increased slightly when signs were not changed, but neither was statistically significant. When comparing the degree of change from baseline, only monthly v. weekly was statistically significant (p = 0.004). Conclusion: Overall, the frequency of changing theoretically-informed, point-of-use signs led to minimal improvement in HH compliance. Changing signs monthly showed the most potential, but it is difficult to interpret what factors contributed to this result as weekly sign changing had no effect on HH compliance. Given the abundance of signs on hospital wards/units the frequency of changing signs may be too weak of a signal to have a clinically meaningful effect.

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