Evaluation of an Intervention to Improve Waterless Surgical Hand Antisepsis Accuracy in a Tertiary Hospital of East China: A prospective Pre-Post Intervention Study

Yonghui Ma¹Xia Yue¹Ning Li¹Jixia Wang¹Juan Wang¹Yujie Xia¹Xing Zhang¹Min Zhang¹Peng Wang¹Shuangshuang Wang¹Luhan Wen¹Zhenghui Liu¹Dingding Zhang¹Tong Zhang¹Lili Liu¹Li Kong¹Yusen Li¹Yue Zhang^1,2Yirong Wang²Xiujuan Meng^1*

• ¹Affiliated Hospital of Jining Medical University, Jining, China
• ²Jining Medical University, Jining, Shandong, China

BACKGROUND: Surgical site infections (SSIs) are the most frequent type of healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs). Effective surgical hand antisepsis is a critical step in the prevention of SSIs. Limited research on clinician interventions regarding accuracy in waterless surgical hand antisepsis (WSHA) is available. This study evaluated the effect of a tailored, multifaceted improvement strategy on WSHA in a tertiary hospital in East China. We also performed a process evaluation to explore the mechanisms through which our strategy brought about change.METHODS: A prospective, pre-post intervention study was performed from January 2024 through December in 28 departments. Data from the pre-post intervention studies were collected using a specially designed score checklist and video surveillance (≥4 per department). In addition to the score collection, the mid-term assessment also used a questionnaire that included demographic characteristics and cultural climate surveys. A number of customized interventions were conducted before and after the mid-term assessment.RESULTS: The scores of pre-intervention, mid-term assessment, and post-intervention were 71.4±16.8, 92.7±9.2, and 78.7±19.4, respectively. There were statistical differences between the scores of pre-intervention and mid-term assessment (P<0.001), mid-term assessment and post-intervention (P<0.001), and pre-intervention and post-intervention (P=0.002). There were statistical differences among different genders, ages, positions, years of working experience, and departments (P<0.05). Lower scores appeared in males, orthopedics, and internal medicine. The psychological comfort score was more than 4 points when being reminded to standard WSHA. The number of times the score was less than 2 points was reduced.CONCLUSIONS: Our interventions have been successful in improving WSHA accuracy. In the future, it will be necessary to closely monitor and supervise WSHA practices to determine the long-term effectiveness of current intervention strategies.