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ID: 331 (Conflict of Interest: K)

Nachhaltigkeit braucht Zeit: Effekte psychologisch maßgeschneiderter Interventionen auf die Händehygiene-Compliance im Zwei-Jahres-Follow-up der cluster-randomisierten kontrollierten PSYGIENE-Studie

I. F.Chaberny1, B.Lutze1, C.Krauth2, K.Lange2, J. T.Stahmeyer2, T.von Lengerke2
1Universitätsklinikum Leipzig, Leipzig
2Medizinische Hochschule Hannover, Hannover

Einleitung

First-year follow-up results of the PSYGIENE cluster-randomized controlled trial, a project funded by the German Federal Ministry of Health (grant no.: INFEKT-019) and conducted on the intensive care and hematopoietic stem cell transplantation units at Hannover Medical School, had shown increased alcoholic-based hand hygiene compliance both in the study arm using interventions psychologically tailored to wards based on the Health Action Process Approach (HAPA), and the study arm using the standard German Clean Care is Safer Care-campaign (Aktion Saubere Hände [ASH]) [1]. To test whether the psychologically tailored PSYGIENE-interventions lead to sustainable increases in hand hygiene compliance compared to the ASH after two years of follow-up. 

Material und Methoden

Tailored interventions targeted wards and were informed by problem-focused interviews with physicians and staff nurses (response rates: 100%) and a written survey on HAPA-factors (physicians: 71%; nurses: 63%). In educational sessions for physicians and nurses, and feedback discussions with staff nurses, 29 behaviour change techniques (BCTs) [2] were used in the “tailoring”-arm, and 15 in the ASH-arm. Compliance observations adhered to WHO-/ASH-standards. 

Ergebnisse

Given similar baseline compliance (tailoring: 54%, ASH: 55%, p=.581), tailoring was associated with increases in both follow-up years (2014: 64%, 2015: 70%, p=.001), while compliance in the ASH-arm decreased from 68% in 2014 to 64% in 2015 (p=.007). Comparisons of increases from 2013 to 2015 and compliance in 2015 were also in favour of the “tailoring”-arm (p=.005 and p=.001). While trends among nurses were similar, among physicians tailoring vs. ASH did not differ in increases from 2013 to 2015 (+15% and +12%, p=.658) and rates in 2015 (63% vs. 61%, p=.632). However, the increase of +6% in the “tailoring”-arm from 2014 to 2015 differed from the respective decrease of -9% in the ASH-arm (p=.016).

Schlussfolgerung

After two years, psychological tailoring based on the HAPA-model was associated with a more sustainable increase in hand hygiene compliance, despite limited didactic methods (educational training sessions and feedback discussions) and the restriction of the tailored interventions to one year. However, regarding physicians still more research on interventions geared to this target group is needed.

References

[1] von Lengerke T, Lutze B, Krauth C, et al. Promoting hygienic hand disinfection as an ongoing task: Results of the PSYGIENE cluster-randomized controlled trial to (re‑)raise compliance of physicians and nurses based on psychological tailoring in a tertiary intensive care setting [Abstract]. Int J Med Microbiol 2015; 305(Suppl 1): 27

[2] Michie S, Richardson M, Johnston M, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques. Ann Behav Med 2013; 46(1): 81-95