Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Study protocol

The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections

Authors: Vicki Erasmus, Anita Huis, Anke Oenema, Pepijn van Empelen, Matthijs C Boog, Elise HE van Beeck, Suzanne Polinder, Ewout W Steyerberg, Jan Hendrik Richardus, Margreet C Vos, Ed F van Beeck

Published in: BMC Public Health | Issue 1/2011

Login to get access

Abstract

Background

Public health authorities have recognized lack of hand hygiene in hospitals as one of the important causes of preventable mortality and morbidity at population level. The implementation strategy ACCOMPLISH (Actively Creating COMPLIance Saving Health) targets both individual and environmental determinants of hand hygiene. This study aims to evaluate the cost-effectiveness of a multicomponent implementation strategy aimed at the reduction of healthcare associated infections in Dutch hospital care, by promotion of hand hygiene.

Methods/design

The ACCOMPLISH package will be evaluated in a two-arm cluster randomised trial in 16 hospitals in the Netherlands, in one intensive care unit and one surgical ward per hospital.

Intervention

A multicomponent package, including e-learning, team training, introduction of electronic alcohol based hand rub dispensers and performance feedback.

Variables

The primary outcome measure will be the observed hand hygiene compliance rate, measured at baseline and after 6, 12 and 18 months; as a secondary outcome measure the prevalence of healthcare associated infections will be measured at the same time points. Process indicators of the intervention will be collected pre and post intervention. An ex-post economic evaluation of the ACCOMPLISH package from a healthcare perspective will be performed.

Statistical analysis

Multilevel analysis, using mixed linear modelling techniques will be conducted to assess the effect of the intervention strategy on the overall compliance rate among healthcare workers and on prevalence of healthcare associated infections. Questionnaires on process indicators will be analysed with multivariable linear regression, and will include both behavioural determinants and determinants of innovation. Cost-effectiveness will be assessed by calculating the incremental cost-effectiveness ratio, defined here as the costs for the intervention divided by the difference in prevalence of healthcare associated infections between the intervention and control group.

Discussion

This study is the first RCT to investigate the effects of a hand hygiene intervention programme on the number of healthcare associated infections, and the first to investigate the cost-effectiveness of such an intervention. In addition, if the ACCOMPLISH package proves successful in improving hand hygiene compliance and lowering the prevalence of healthcare associated infections, the package could be disseminated at (inter)national level.

Trial registration

NTR2448
Appendix
Available only for authorised users
Literature
1.
WHO: The first Global Patient Safety Challenge: Clean Care is Safer Care. 2005
2.
Day M: Chief medical officer names hand hygiene and organ donation as public health priorities. British Medical Journal. 2007, 335 (7611): 113-
3.
Donaldson L: Dirty hands...the human cost. 2006, UK Department of Public Health.: London
4.
Pittet D: Effectiveness of a hospital-wide programme to improve compliance with hand hygiene (vol 356, pg 1307, 2000). Lancet. 2000, 356: 1307-10.1016/S0140-6736(00)02814-2.CrossRefPubMed
5.
Erasmus V, Daha TJ, Brug J, Richardus JH, Behdrendt MD, Vos MC, van Beeck EF: A systematic review of studies on compliance to hand hygiene guidelines in health care. Infection Control & Hospital Epidemiology. 2010, 31 (3): 283-94. 10.1086/650451.CrossRef
6.
Pittet D: Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol. 2000, 21 (6): 381-6. 10.1086/501777.CrossRefPubMed
7.
Grol R, Grimshaw J: From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003, 362 (9391): 1225-1230. 10.1016/S0140-6736(03)14546-1.CrossRefPubMed
8.
Jumaa PA: Hand hygiene: simple and complex. Int J Infect Dis. 2005, 9 (1): 3-14. 10.1016/j.ijid.2004.05.005.CrossRefPubMed
9.
Pittet D: The Lowbury lecture: behaviour in infection control. J Hosp Infect. 2004, 58 (1): 1-13. 10.1016/j.jhin.2004.06.002.CrossRefPubMed
10.
Erasmus V, Brouwer W, van Beeck EF, Oenema A, Daha TJ, Richardus JH, Vos MC, Brug J: A Qualitative Exploration of Reasons for Poor Hand Hygiene Among Hospital Workers: Lack of Positive Role Models and of Convincing Evidence That Hand Hygiene Prevents Cross-Infection. Infect Control Hosp Epidemiol. 2009, 30: 415-419. 10.1086/596773.CrossRefPubMed
11.
Gollwitzer PM, Sheeran P: Implementation intentions and goal achievement: a meta-analysis of effects and processes. Advances in Experimental Social Psychology. 2006, 38: 69-119.CrossRef
12.
Erasmus V, Kuperus MN, Richardus JH, Vos MC, Oenema A, van Beeck EF: Improving hand hygiene behaviour of nurses using action planning: a pilot study in the intensive care unit and surgical ward. Journal of Hospital Infection. 2010, 76: 161-164. 10.1016/j.jhin.2010.04.024.CrossRefPubMed
13.
Fleuren M, Wiefferink K, Paulussen T: Determinants of innovation within health care organizations. Int J Quality in Health Care. 2004, 16 (2): 107-123. 10.1093/intqhc/mzh030.CrossRef
14.
Bartholomew LK, Parcel GS, Kok G, Gottlieb NH: Planning Health Promotion programs; an Intervention Mapping approach. 2006, San Francisco: Jossey-Bass
15.
Ryan RM, Kuhl J, Deci EL: Nature and autonomy: organizational view of social and nuerobiological aspects of self-regulation in behavior and development. Development and Psychopathology. 1997, 9: 701-728.CrossRefPubMed
16.
Bandura A: Social Foundations of Thought and Action. 1986, New York: General Learning Press
17.
Mittman BS, Tonesk X, Jacobson P: Implementing clinical practice guidelines: social influence strategies and practitioner behavior change. QRB. 1992, 18 (12): 413-442.
18.
West MA, Farr JL: Innovation at work., in Innovation and creativity at work: Psychological and organizational strategies. Edited by: MAaFJL West. 1990, Wiley: Chichester, 3-13.
19.
Øvretveit J: The Leader's Role in Quality and Safety Improvement: A Review of Research and Guidance. 2004, Karolinska Institute Medical Management Center and The Swedish Association of County Councils: Stockholm
20.
Naikoba S, Hayward A: The effectiveness of interventions aimed at increasing handwashing in healthcare workers - a systematic review. J Hosp Infect. 2001, 47 (3): 173-80. 10.1053/jhin.2000.0882.CrossRefPubMed
21.
Sheeran P: Intention-behavior relations: A conceptual and empirical review. European review of social psychology. 2002, 12: 1-36. 10.1080/14792772143000003.CrossRef
22.
WHO: WHO guidelines on hand hygiene in health care. 2009, Geneva
23.
O'Boyle CA, Henly SJ, Duckett LJ: Nurses' motivation to wash their hands: a standardized measurement approach. Appl Nurs Res. 2001, 14 (3): 136-45. 10.1053/apnr.2001.24412.CrossRefPubMed
24.
Adair G: The Hawthorne effect: A reconsideration of the methodological artifact. Journal of Applied Psychology. 1984, 69 (2): 334-345.CrossRef
25.
Ajzen I: The theory of planned behavior. Organizational behavior and human decision processes. 1991, 50: 179-211. 10.1016/0749-5978(91)90020-T.CrossRef
26.
Oostenbrink JB, Bouwmans CAM, Koopmanschap MA, Rutten FFH: Handleiding voor kostenonderzoek; methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. 2004, College voor zorgverzekeringen
27.
Gold MR, Siegel JE, Russel LB, Weinstein MC: Cost-effectiveness in health and medicine. 1996, New York: Oxford University Press
28.
PREZIES: Eerste landelijk prevalentieonderzoek naar ziekenhuisinfectie. 2007
29.
Harbarth S, Sax H, Gastmeier P: The preventable proportion of nosocomial infections: an overview of published reports. Journal of Hospital Infection. 2003, 54 (4): 258-266. 10.1016/S0195-6701(03)00150-6.CrossRefPubMed
30.
Smits M, Christiaans-Dingelhoff I, Wagner C, van der Wal G, Groenewegen PP: The psychometric properties of the 'Hospital Survey on Patient Safety Culture' in Dutch hospitals. BMC Health Services Research. 2008, 8: 230-10.1186/1472-6963-8-230.CrossRefPubMedPubMedCentral
Metadata
Title
The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections
Authors
Vicki Erasmus
Anita Huis
Anke Oenema
Pepijn van Empelen
Matthijs C Boog
Elise HE van Beeck
Suzanne Polinder
Ewout W Steyerberg
Jan Hendrik Richardus
Margreet C Vos
Ed F van Beeck
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-721

Other articles of this Issue 1/2011

BMC Public Health 1/2011 Go to the issue

Study protocol

A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study

Research article

Family psychosocial characteristics influencing criminal behaviour and mortality - possible mediating factors: a longitudinal study of male and female subjects in the Stockholm Birth Cohort

Study protocol

Peripheral and central arterial pressure and its relationship to vascular target organ damage in carotid artery, retina and arterial stiffness. Development and validation of a tool. The Vaso risk study

Research article

Dental and prosthodontic status of an over 40 year-old population in Shandong Province, China

Study protocol

Evaluation of the impact of the voucher and accreditation approach on improving reproductive health behaviors and status in Kenya

Research article

Obesity, smoking, alcohol consumption and years lived with disability: a Sullivan life table approach