The Feedback Intervention Trial (FIT)-Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial

Christopher Fuller; Susan Michie; Joanne Savage; John McAteer; Sarah Besser; Andre Charlett; Andrew Hayward; Barry D. Cookson; Ben S. Cooper; Georgia Duckworth; Annette Jeanes; Jenny Roberts; Louise Teare; Sheldon Stone

doi:10.1371/journal.pone.0041617

The Feedback Intervention Trial (FIT)-Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial

Christopher Fuller, Susan Michie, Joanne Savage, John McAteer, Sarah Besser, Andre Charlett, Andrew Hayward, Barry D. Cookson, Ben S. Cooper, Georgia Duckworth, Annette Jeanes, Jenny Roberts, Louise Teare, Sheldon Stone^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

Introduction: Achieving a sustained improvement in hand-hygiene compliance is the WHO's first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness.

Methods: Three year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%).

Results: All 16 trusts (60 wards) randomised, 33 wards implemented intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all wards) accounting for confounders, temporal trends, ward type and fidelity to intervention (forms/month used).

Intention to Treat Analysis: Estimated odds ratio (OR) for hand hygiene compliance rose post randomisation (1.44; 95% CI 1.18, 1.76; p

Conclusion: Despite difficulties in implementation, intention-to-treat, per-protocol and fidelity to intervention, analyses showed an intervention coupling feedback to personalised action planning produced moderate but significant sustained improvements in hand-hygiene compliance, in wards implementing a national hand-hygiene campaign. Further implementation studies are needed to maximise the intervention's effect in different settings.

Original language	English
Article number	41617
Number of pages	10
Journal	PLoS ONE
Volume	7
Issue number	10
DOIs	https://doi.org/10.1371/journal.pone.0041617
Publication status	Published - 23 Oct 2012

Keywords / Materials (for Non-textual outputs)

BEHAVIOR
STAFF
RISK

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10.1371/journal.pone.0041617

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Fuller, C., Michie, S., Savage, J., McAteer, J., Besser, S., Charlett, A., Hayward, A., Cookson, B. D., Cooper, B. S., Duckworth, G., Jeanes, A., Roberts, J., Teare, L., & Stone, S. (2012). The Feedback Intervention Trial (FIT)-Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial. PLoS ONE, 7(10), Article 41617. https://doi.org/10.1371/journal.pone.0041617

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title = "The Feedback Intervention Trial (FIT)-Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial",

abstract = "Introduction: Achieving a sustained improvement in hand-hygiene compliance is the WHO's first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness.Methods: Three year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%).Results: All 16 trusts (60 wards) randomised, 33 wards implemented intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all wards) accounting for confounders, temporal trends, ward type and fidelity to intervention (forms/month used).Intention to Treat Analysis: Estimated odds ratio (OR) for hand hygiene compliance rose post randomisation (1.44; 95% CI 1.18, 1.76; pConclusion: Despite difficulties in implementation, intention-to-treat, per-protocol and fidelity to intervention, analyses showed an intervention coupling feedback to personalised action planning produced moderate but significant sustained improvements in hand-hygiene compliance, in wards implementing a national hand-hygiene campaign. Further implementation studies are needed to maximise the intervention's effect in different settings.",

keywords = "BEHAVIOR, STAFF, RISK",

author = "Christopher Fuller and Susan Michie and Joanne Savage and John McAteer and Sarah Besser and Andre Charlett and Andrew Hayward and Cookson, {Barry D.} and Cooper, {Ben S.} and Georgia Duckworth and Annette Jeanes and Jenny Roberts and Louise Teare and Sheldon Stone",

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doi = "10.1371/journal.pone.0041617",

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Fuller, C, Michie, S, Savage, J, McAteer, J, Besser, S, Charlett, A, Hayward, A, Cookson, BD, Cooper, BS, Duckworth, G, Jeanes, A, Roberts, J, Teare, L & Stone, S 2012, 'The Feedback Intervention Trial (FIT)-Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial', PLoS ONE, vol. 7, no. 10, 41617. https://doi.org/10.1371/journal.pone.0041617

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AU - Michie, Susan

AU - Savage, Joanne

AU - McAteer, John

AU - Besser, Sarah

AU - Charlett, Andre

AU - Hayward, Andrew

AU - Cookson, Barry D.

AU - Cooper, Ben S.

AU - Duckworth, Georgia

AU - Jeanes, Annette

AU - Roberts, Jenny

AU - Teare, Louise

AU - Stone, Sheldon

PY - 2012/10/23

Y1 - 2012/10/23

N2 - Introduction: Achieving a sustained improvement in hand-hygiene compliance is the WHO's first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness.Methods: Three year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%).Results: All 16 trusts (60 wards) randomised, 33 wards implemented intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all wards) accounting for confounders, temporal trends, ward type and fidelity to intervention (forms/month used).Intention to Treat Analysis: Estimated odds ratio (OR) for hand hygiene compliance rose post randomisation (1.44; 95% CI 1.18, 1.76; pConclusion: Despite difficulties in implementation, intention-to-treat, per-protocol and fidelity to intervention, analyses showed an intervention coupling feedback to personalised action planning produced moderate but significant sustained improvements in hand-hygiene compliance, in wards implementing a national hand-hygiene campaign. Further implementation studies are needed to maximise the intervention's effect in different settings.

AB - Introduction: Achieving a sustained improvement in hand-hygiene compliance is the WHO's first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness.Methods: Three year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%).Results: All 16 trusts (60 wards) randomised, 33 wards implemented intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all wards) accounting for confounders, temporal trends, ward type and fidelity to intervention (forms/month used).Intention to Treat Analysis: Estimated odds ratio (OR) for hand hygiene compliance rose post randomisation (1.44; 95% CI 1.18, 1.76; pConclusion: Despite difficulties in implementation, intention-to-treat, per-protocol and fidelity to intervention, analyses showed an intervention coupling feedback to personalised action planning produced moderate but significant sustained improvements in hand-hygiene compliance, in wards implementing a national hand-hygiene campaign. Further implementation studies are needed to maximise the intervention's effect in different settings.

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KW - STAFF

KW - RISK

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ER -

The Feedback Intervention Trial (FIT)-Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial

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