Professional hand hygiene compliance represents a multifaceted behaviour with various determinants. Thus, it has been proposed to apply psychological frameworks of behaviour change to its promotion. However, randomized controlled trials of such approaches, which also assess nosocomial infections (NIs), are rare. This study analyses data of the PSYGIENE-trial (PSYchological optimized hand hyGIENE promotion), which has shown improvements in compliance after interventions tailored based on the Health Action Process Approach (HAPA), on rates of NIs with multidrug-resistant organisms (MDROs).


A parallel-group cluster-randomized controlled trial was conducted on all 10 intensive care units and two hematopoietic stem cell transplantation units at Hannover Medical School, a German tertiary care hospital. Educational training sessions for physicians and nurses (individual-level intervention) and feedback discussions with clinical managers and head nurses (cluster-level) were implemented in 2013. In the “Tailoring”-arm (n = 6 wards), interventions were tailored based on HAPA-components, which were empirically assessed and addressed by behaviour change techniques. As active controls, n = 6 wards received untailored educational sessions of the local “Clean Care is Safer Care”-campaign (Aktion Saubere Hände: “ASH”-arm). From 2013 to 2015 compliance was assessed by observation following the World Health Organization, while alcohol-based hand rub usage (AHRU) and NIs with multidrug-resistant gram-negative bacteria, Methicillin-resistant Staphylococcus aureus or Vancomycin-resistant Enterococcus were assessed following national surveillance protocols. Data were analysed at cluster-level.

In the “Tailoring”-arm, interventions led to a decrease of 0.497 MDRO-infections per 1000 inpatient days from 2013 to 2015 (p = 0.015). This trend was not found in the “ASH”-arm (− 0 . 022 infections; p = 0.899). These patterns corresponded inversely to the trends in compliance but not in AHRU.

Klik hier voor volledig artikel, gepubliceerd in Antimicrobial Resistance and Infection Control (2019) 8:56

Auteurs: Thomas von Lengerke1*† , Ella Ebadi2†, Bettina Schock1,3, Christian Krauth4, Karin Lange1, Jona T. Stahmeyer4 and Iris F. Chaberny2,3

1Hannover Medical School, Centre for Public Health and Healthcare, Department of Medical Psychology, Carl-Neuberg-Str. 1, OE 5430, 30625Hannover, Germany. 
2 Hannover Medical School, Centre for Laboratory Medicine, Institute of Medical Microbiology and Hospital Epidemiology, Carl-Neuberg-Str. 1, OE 5214, 30625 Hannover, Germany. 
3 Leipzig University 18.Hospital – AöR, Department for Diagnostics, Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Johannisallee 34, 04103 Leipzig, Germany. 
4  Hannover Medical School, Centre for Public Health and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems 19.Research, Carl-Neuberg-Str. 1, OE 5410, 30625 Hannover, Germany.

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