Table 3 Description of the implementation strategies with the planned activities
State-of-the-art strategy | Team and leaders-directed strategy |
|---|---|
Education | All elements of the state-of-the-art strategy |
Distribution of educational material/ written information (leaflet) about HH that contained: | • Education, reminders, feedback, facilities and products, see above |
• The importance of HH | Setting norms and targets within the team |
• Misconceptions about alcohol-based HH disinfection | • Three interactive team sessions (1 h-1.5 h each) that included goal setting in HH performance at group level. Team sessions were guided by the team manager and a external coach. |
• Theory and practical indications for the use of HH |   ◦ Exploring nurses’ knowledge and perception of current HH behaviour (individual- and team level) and discussing actual HH compliance rates |
Website http://www.gewoonhandenschoon.nl |   ◦ Transition from individual responsibility to a shared team responsibility |
• Educational material/ written information about HH |   ◦ Creating a participatory and non-threatening climate for team interaction |
• Knowledge quiz with feedback. Visitors could test their knowledge about HH |   ◦ Commitment to high standards of HH performance |
• The nursing ward with the highest number of visitors to the website was rewarded |   ◦ Defining and documenting improvement activities |
Educational sessions on prevention of hospital acquired infections | • Analysis of barriers and facilitators to determine how nurses could best adapt their behaviour in order to reach their goal. |
• Launching hospital-wide campaign with practical demonstrations of HH | • Nurses address each other in case of undesirable HH behaviour |
Reminders | Gaining active commitment and initiative of ward management |
• Distribution of posters that emphasised the importance of HH, particularly alcohol-based hand disinfection. Posters were displayed in several strategic areas within the units and replaced by another poster after 12 weeks. | • Ward manager designated HH as a priority |
• Interviews and messages in newsletters or hospital magazines | • Ward manager actively supported team members and informal leaders |
• General reminders by opinion leaders/ ward management | • Ward manager discussed HH compliance rates with team members |
Feedback | Modeling by informal leaders at the ward |
• Bar charts of HH rates of every nursing ward were sent to the ward manager twice. This also included a comparison of ward performance and hospital performance | • Informal leaders demonstrated good HH behaviour |
Facilities and products | • Informal leaders modeled social skills of team members in addressing HH behaviour of colleagues |
• Screening and if necessary adapt products and appropriate facilities | • Informal leaders instructed and stimulated their colleagues in providing good HH behaviour |