2. Results from studies evaluating interventions other than multimodal interventions.
| Study | Comparison | Estimate of compliance | Measure of difference or change |
| Intervention: Performance feedback | |||
| Armellino 2012 | ITS · 16‐week baseline · Intervention: video recording and feedback of hand hygiene rates · 16‐week post · 75‐week maintenance |
Outcome: Observed mean hand hygiene compliance: Baseline: 6.5% (weekly range: 3.5% to 9.8%) Post‐feedback period: 81.6% (weekly range: 30.8% to 91.2%) Maintenance phase: 87.9% (weekly range: 83.5% to 91.6%) |
Segmented regression analysis: · In week after start of intervention, estimated increase in compliance of 17.5% with additional 4% increase in each following week · In maintenance period, small weekly decrease of ‐0.04% |
| Fisher 2013a | Cluster‐randomised trial Intervention: wireless monitoring and feedback Control: No intervention |
Outcome: Mean hand hygiene compliance on entry as recorded by electronic monitor: Intervention group: · Baseline: 28% (21% ‐ 37%) · Phase 2: real time reminders: 33% (25% ‐ 41%) · Phase 3: feedback: 28% (16% ‐ 40%) Control group: · Baseline: 28% (21% ‐ 37%) · Phase 2: real time reminders: 26% (22% ‐ 32%) · Phase 3: feedback: 24% (19% ‐ 33%) Similar increases in compliance on exit Variation by study ward, professional category and opportunity load |
Unclear reporting of regression Not reported by researchers Calculated differences1 in percentage points between baseline and phase 2 real time reminders: · intervention group: 5 · control group: ‐2 Calculated differences1 in percentage points between baseline and phase 3 feedback: · intervention group: 0 · control group: ‐4 |
| Fuller 2012 | Stepped‐wedge RCT Intervention: feedback and personalised action planning Control: Clean Your Hands campaign |
Outcomes reported: · Estimated relative change in liquid soap procurement · Hand hygiene compliance Estimates of volume of soap use or observed hand hygiene compliance were not reported |
Estimated relative change in liquid soap: ACE: 1.133, 95% CI 0.987 to 1.3) ITU: 1.314, 95% CI 1.114 to 1.548 Absolute increase in compliance: ACE wards: · 13% if pre‐hand hygiene compliance was 50% · 10% if pre‐hand hygiene compliance was 70% ITU wards · 18% if pre‐hand hygiene compliance was 50% · 13% if pre‐hand hygiene compliance was 70% OR (compared to baseline) ACE wards: · 1.67, 95% CI 1.26 to 2.22 ITU wards: · 2.09, 95% CI 1.55 to 2.81 |
| Moghnieh 2016 | NRCT Intervention 1: Incentive Intervention 2: Audit and feedback Control: Usual hand hygiene campaign |
Outcome: Hand hygiene compliance Variation by week: · Baseline all groups: 16% ‐ 20% · During intervention 1: 60% at week 8 and 77% at week 14 · During intervention 2: 43% at week 8 and 51% at week 14 · Control group: unchanged from baseline Decreased post‐intervention at week 21: · Intervention 1: 34% · Intervention 2: 48% · Control: unchanged |
Not reported by researchers Calculated differences1 in percentage points between baseline and week 8: · intervention 1: 40 ‐ 44 · intervention 2: 23 ‐ 27 · control group: unchanged Calculated differences1 in percentage points between baseline and week 14: · intervention 1: 57 ‐ 61 · intervention 2: 31 ‐ 35 · control group: unchanged |
| Stewardson 2016 | Cluster‐randomised trial Intervention 1: Enhanced performance feedback Intervention 2: Enhanced performance feedback plus patient participation Control: Usual WHO‐based hand hygiene campaign |
Outcome: Hand hygiene compliance Performance feedback: · Baseline: 65% · Intervention period:75% · Follow‐up:72% Feedback plus patient participation: · Baseline: 66% · Intervention period: 77% · Follow‐up: 72% Control: · Baseline: 66% · Intervention period: 73% · Follow‐up: 70% |
Absolute change for performance feedback: · Intervention period: 10% with OR 1.61, 95% CI 1.41 to 1.84 · Follow‐up:7% with OR 1.38, 95% CI 1.19 to 1.60 Absolute change for feedback plus patient participation: · Intervention period: 11% with OR 1.73, 95% CI 1.51 to 1.98 · Follow‐up: 6% with OR 1.36, 95% CI 1.18 to 1.57 Absolute change for Control: · Intervention period: 7% with OR 1.41, 95% CI 1.21 to 1.63 · Follow‐up: 4% with OR 1.21, 95% CI 1.00 to 1.47 |
| Talbot 2013 | ITS · Baseline: 2004 ‐ 2009 · Intervention 2009 ‐ 10: feedback, leadership and incentives · Active accountability: 2010 ‐ 2012 |
Outcome: observed hand hygiene compliance Baseline: 52% Intervention: 75% Active accountability phase: 89% |
Segmented regression analysis done but no estimates of effect reported: · Increase in adherence in each phase · Changes in slope associated with each time period Calculated differences1 in percentage points between baseline and · intervention phase: 23 · active accountability phase 37 |
| Intervention: Education | |||
| Higgins 2013 | ITS Intervention: Education: E‐learning hand hygiene game |
Outcome: Observed mean hand hygiene compliance: · in 12 months pre‐e‐learning game: 42% · in 12 months post‐e‐learning game: 84% |
Appropriateness of analysis unclear: Did not specify statistical analysis done but only reported mean hand hygiene compliance Calculated differences1 in percentage points between pre and post: 42 |
| Huang 2002 | RCT Intervention: Education sessions on hand hygiene and UP Control: No intervention |
Outcome: % of nurses who performed hand hygiene Before patient contact: Intervention · Pre: 51.0% · Post: 85.7% Control · Pre: 53.1% · Post:53.1% After patient contact: Intervention · Pre: 75.5% · Post: 91.8% Control · Pre: 75.5% · Post: 71.4% |
Not reported by researchers Calculated differences1 in percentage points for before pt contact: · intervention: 24.5 · control group: no change Calculated differences1 in percentage points for after patient contact: · intervention: 16.3 · control group: 4.1 |
| Intervention: Cues | |||
| Diegel‐Vacek 2016 | NRCT Intervention: Light cue over sink Comparison: no light cue |
Outcome: Hand hygiene compliance Light cue: · Day 1: 23% · Day 2: 30% · Day 3: 23% No light cue: · Day 1: 7% · Day 2: 16% · Day 3: 23% |
Not reported by researchers Calculated differences1 in percentage points between day 1 and day 2: · light cue: 7 · no light cue: 9 Calculated differences1 in percentage points between day 1 and day 3: · light cue: 0 · no light cue: 16 |
| Grant 2011 | Pair‐matched cluster‐randomised trial Compared 2 signs: personal vs patient consequences as message |
Outcome: Observed mean hand hygiene compliance: Personal consequences sign: Pre‐test: 80.0% Post‐test: 79.71% Patient consequences sign: Pre‐test: 80.69% Post‐test: 89.2% Variation by type of practitioner but all had greater increase in hand hygiene in response to patient consequences sign |
Inappropriate analysis : Did not do a matched analysis Not reported by researchers Calculated differences1 in percentage points between pre and post test: · Personal consequences sign: ‐0.29 · Patient consequences sign: +8.51 |
| King 2016 | RCT Intervention: Olfactory cue (scent) or signs with male or female eyes Comparison: baseline without cues |
Outcome: Hand hygiene compliance · Baseline: 15.0% · Scent cue: 46.9% · Male eyes cue: 21.7% · Female eyes cue: 10.0% Some differences women vs men |
Not reported by researcher Calculated differences1 in percentage points between pre‐ and post‐test: · Scent cue: +31.9 · Stern male eyes: +6.7 · Female eyes: ‐5 |
| Intervention: Placement of ABHR | |||
| Munoz‐Price 2014 | RCT with cross‐over Intervention: placement of ABHR on cart Control: ABHR on wall |
Outcome: hand hygiene events per hour: Intervention: 0.84 Control: 0.54 |
Difference was an increase of 0.3 events per hour |
1 Where researchers did not report differences, the review authors calculated the differences based on the data reported by the researchers and summarized in the column "estimate of compliance". ABHR: alcohol‐based hand rub; ACE: acute care of the elderly; CI: confidence interval; ITS: interrupted time series; ITU: intensive care unit; NRCT: non‐randomised (controlled) trial; OR: odds ratio; RCT: randomised (controlled) trial