Leveraging agents of change to improve the use of an electronic hand hygiene monitoring system

Abstract

Background

We evaluated the effectiveness of an “agents of change” intervention in enhancing hand hygiene compliance (HHC) with an electronic hand hygiene monitoring system (EHHMS), and improving perceptions of the EHHMS among health care workers.

Methods

Two intervention units and 1 control unit were selected. Thirteen agents received training, then worked independently on the intervention units to improve their colleagues’ perceptions and behaviors toward the EHHMS. Agents and unit health care workers were surveyed before and after the intervention to measure perceptions of the EHHMS and impact of the intervention. HHC was electronically monitored across all units 8 weeks before, 5 weeks during, and 8 weeks after the intervention.

Results

Postintervention, 70% of agents believed they influenced their colleagues’ behaviors, but 50% felt they changed attitudes. Unit-level surveys confirmed minimal change in attitudes and culture. Average HHC rates increased by 6.8% and 5% in the intervention units during the intervention (both P < .01), whereas the control did not. One intervention unit maintained improvement in the post period, whereas the other returned to baseline. Compliance rates for all units were similar in the post period.

Conclusions

Implementing an agents of change program to target EHHMS compliance is feasible, but sustained improvement is less certain.