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Table 3 Description of the implementation strategies with the planned activities

From: Explaining the effects of two different strategies for promoting hand hygiene in hospital nurses: a process evaluation alongside a cluster randomised controlled trial

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