Simulation education as a single intervention does not improve hand hygiene practices : a randomized controlled follow-up study

Abstract

<div lang="en" class="abs"><p class="abs_header">Abstract</p><p><em>Background:</em> To evaluate how critical nurses’ knowledge of and adherence to current care hand hygiene (HH) guidelines differ between randomly allocated intervention and control groups before and after simulation education in both a simulation setting and clinical practice during a 2-year follow-up period. It was hypothesized that intervention group knowledge of and adherence to current HH guidelines might increase compared with a control group after simulation education.</p><p><em>Methods:</em> A prospective, parallel, randomized controlled trial with repeated measurements was conducted in a 22-bed adult mixed medical-surgical intensive care unit in Oulu, Finland. Thirty out of 40 initially randomized critical care nurses participated in the baseline measurements; of these, 17 completed all the study procedures. Participants’ HH adherence was observed only in high-risk contact situations prior to and postendotracheal suctioning events using a direct, nonparticipatory method of observation. Participants’ HH knowledge was evaluated at the end of each observational session.</p><p><em>Results:</em> The overall HH adherence increased from a baseline value of 40.8% to 50.8% in the final postintervention measurement at 24 months (<em>P</em> = .002). However, the linear mixed model did not identify any significant group (<em>P</em> = .77) or time-group interactions (<em>P</em> = .17) between the study groups after 2 years of simulation education. In addition, simulation education had no impact on participants’ HH knowledge.</p><p><em>Conclusions:</em> After a single simulation education session, critical care nurses’ knowledge of and adherence to current HH guidelines remained below targeted behavior rates.</p></div>