The impact of the hand hygiene role model project on improving healthcare workers' compliance: A quasi-experimental observational study.

BACKGROUND: The World Health Organization (WHO)'s multimodal strategy for improving hand hygiene (HH) compliance was endorsed in 2009 and was implemented by every hospital in Oman. There was variation in adherence to the practice even within the same facility and in sustaining improvement after the intervention. OBJECTIVES: Evaluate the impact of national HH role model project on health care worker's immediate and long term compliance with HH practices. MATERIAL AND METHODS: A pretest-posttest quasi-experimental observational study was conducted in four hospitals, including 16 (medical/surgical/psychiatry) departments. The study consisted of four phases: Baseline assessment, intervention, three-month post-intervention assessment, and follow-up assessment after 15 months for sustainability. The intervention (role model in hand hygiene) consisted of four components: Leadership involvement as a role model for HH, posting HH messages with photos of role model leaders, a weekly selection of staff as HH role models, and conducting HH education and training from the focal point of each ward/department. RESULTS: There were 5796 observations recorded during the study for Moments 1 and 4 of HH. HCWs' overall compliance rate significantly increased from a baseline of 52.6% before the intervention to 74.1% after three months from the intervention, and 70.0% on follow-up after more than one year (p < 0.001). All the hospitals included, regardless of their baseline compliance, had a significant improvement in HH compliance post-intervention and were able to sustain compliance (> 60%) after 15 months from the start of the intervention. The likelihood of improvement in HH compliance with the intervention remained low for the moment before patient contact (AOR, 0.34; 95% CI = 0.27-0.44) during the weekend (AOR, 0.44; 95% CI = 0.32-0.59) in the psychiatry wards (AOR, 0.22; 95% CI = 0.15-0.34) and by the non-medical and nursing professions (AOR, 0.99; 95% CI = 0.61-1.66). CONCLUSIONS: Implementation of a role model as a behavioral intervention, in addition to the WHO's multimodal strategy, successfully improved and sustained HCWs' HH compliance rates. Understanding healthcare culture in the context of the driving factors of behavioral changes and regular follow-ups are essential to sustain adherence to safe HH practices.

The role of supporting services in driving SARS-CoV-2 transmission within healthcare settings: A multicenter seroprevalence study.

OBJECTIVE: To determine the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare workers (HCWs) based on risk of exposure to COVID-19 patients. METHOD: This was a SARS-CoV-2 seroprevalence cross-sectional study in risk-stratified HCWs randomly selected from three main district hospitals in Oman. RESULTS: 1078 HCWs were included, with an overall SARS-CoV-2 seroprevalence of 21%. The seropositivity rates in low-, variable-, and high-risk groups were 29%, 18%, and 17%, respectively (p-value < 0.001). The study found higher positivity in males (crude odds ratio [COR] 1.71, 95% confidence interval [CI] 1.28-2.3), and workers residing in high-prevalence areas (COR 2.09, 95% CI 1.42-3.07). Compared with doctors, workers from supporting services, administration staff, and nurses were more likely to test positive for SARS-CoV-2 antibodies (COR 9.81, 95% CI 5.26-18.27; 2.37, 95% CI 1.23-4.58; 2.08 95% CI 1.14-3.81). The overall rate of previously undetected infection was 12%, with higher values in low-risk HCWs. High district prevalence was a driving factor for seropositivity in the low-risk group (adjusted odds ratio [AOR] 2.36, 95% CI 1.0-5.59). CONCLUSION: Low-risk supporting services workers can drive SARS-CoV-2 transmission in hospitals. More attention and innovation within this area will enhance the safety of health care during epidemics/pandemics.