Investigation of Fluorescent Concretization Intervention on Intensive Care Nurses' Hand Hygiene Training

Investigation of Fluorescent Concretization Intervention on Intensive Care Nurses' Hand Hygiene Training According to the Kirkpatrick Model: A Randomised Controlled Study

Aim: The primary objective was to assess the effect of fluorescent concretization intervention on intensive care nurses' hand-washing efficiency, skill performance, and duration scores during the training process. A secondary objective was to investigate the intensive care nurses to determine their level of hand hygiene knowledge before and after the training.

Design: Cluster-randomised controlled pretest-posttest and follow-up research design was used.

Methods: This study was conducted at a tertiary hospital in XX province, Türkiye. Seventy-six nurses from intensive care units participated in hand hygiene training. In addition to routine hand hygiene training, the participants in the intervention group (n=39) had their hand washing efficiency evaluated using ultraviolet A light. The dirty spots were shown to the participants, and the reasons were discussed. The participants in the control group (n=37) received hand washing training without fluorescent concretization and ultraviolet light intervention. The Hand Hygiene theoretical information is an evidence-based workplace intervention delivered by trained facilitators across two training. Hand Hygiene Information Forms were administered upon registration and before randomisation of all participants immediately after the final training. Two independent researchers observed Hand Washing Skill Checklist and Efficacy forms in three follow-ups (before training, 15 days after training, and four months after training).

Study Overview

• Status: Completed
• Conditions: Health Care Associated Infection; Training Group, Sensitivity; Hand
• Intervention / Treatment: Behavioral: With fluorescent concretization group

Detailed Description

Aim: Nurses have a pivotal role in preventing and managing healthcare-acquired/associated infections by effective hand washing. The primary objective was to assess the effect of fluorescent concretization intervention on intensive care nurses' hand-washing efficiency, skill performance, and duration scores during the training process. A secondary objective was to investigate the intensive care nurses to determine their level of hand hygiene knowledge before and after the training.

Design: Cluster-randomised controlled pretest-posttest and follow-up research design was used.

Methods: This study was conducted at a tertiary hospital in XX province, Türkiye. Seventy-six nurses from intensive care units participated in hand hygiene training. In addition to routine hand hygiene training, the participants in the intervention group (n=39) had their hand washing efficiency evaluated using ultraviolet A light. The dirty spots were shown to the participants, and the reasons were discussed. The participants in the control group (n=37) received hand washing training without fluorescent concretization and ultraviolet light intervention. The Hand Hygiene theoretical information is an evidence-based workplace intervention delivered by trained facilitators across two training. Hand Hygiene Information Forms were administered upon registration and before randomisation of all participants immediately after the final training. Two independent researchers observed Hand Washing Skill Checklist and Efficacy forms in three follow-ups (before training, 15 days after training, and four months after training).

• Study Type: Interventional
• Enrollment (Actual): 76
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Bursa
    • Nilüfer, Bursa, Turkey, 16059
      • Bursa Uludag University Health Sciences Faculty of the Nursing Department

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• nurses who have not received previous training on UVA-supported hand hygiene devices
• nurses who have not visibly damaged skin integrity on the hands
• Nurses are willing to participate in the study and take primary responsibility for patient care.
• nurses who have six months or more of intensive care experience

Exclusion Criteria:

• nurses who have received previous training on UVA-supported hand hygiene devices.
• nurses who do not have visibly damaged skin integrity on the hands.
• Nurses are willing to participate in the study and take primary responsibility for patient care.
• nurses who have six months or less of intensive care experience

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental: With fluorescent concretization group; Nurses were given the fluorescent lotion and asked to apply it all over their hands. The CE-certified test lotion is in gel form and is safety-approved. The lotion disperses particles the same size as bacteria on the skin. These particles settle on the skin, similar to the behavior of microorganisms, but disappear with hand washing under the influence of fluorescent light. They were then asked to wash their hands with 4 ml of soap. Two researchers marked the hand washing steps independently using the "Hand Washing Skill Checklist." The duration of hand washing was recorded with a mobile stopwatch for each participant. Hand washing efficiency was evaluated using the "Derma Litecheck" device. UV rays were used after using the test lotion and drying the hands. Since any fluorescent material left on the hands would shine under UV light, it was possible to judge how well the hands were cleansed. The dirty spots were shown to the participants, and the reason for this was discussed.	Behavioral: With fluorescent concretization group; Nurses were given the fluorescent lotion and asked to apply it all over their hands. The CE-certified test lotion is in gel form and is safety-approved. The lotion disperses particles the same size as bacteria on the skin. These particles settle on the skin, similar to the behavior of microorganisms, but disappear with hand washing under the influence of fluorescent light. They were then asked to wash their hands with 4 ml of soap. Two researchers marked the hand washing steps independently using the "Hand Washing Skill Checklist." The duration of hand washing was recorded with a mobile stopwatch for each participant. Hand washing efficiency was evaluated using the "Derma Litecheck" device. UV rays were used after using the test lotion and drying the hands. Since any fluorescent material left on the hands would shine under UV light, it was possible to judge how well the hands were cleansed. The dirty spots were shown to the participants, and the reason for this was discussed.; Other Names: fluorescent concretization group
No Intervention: Control: Without fluorescent concretization group; The same interventions were repeated without fluorescent concretization and UV-A light intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hand Washing Skill Efficacy (HWSE)	The hands were examined in seven areas: the palm, the back of the hand, and between the fingers, specifically the thumb, fingertips, nails, the anterior side of the wrist, and the posterior side. Under the UV light, dirty spots were marked separately for the right and left hands. The dirty spot was calculated as 1 point, and the clean spot was calculated as 0 points. 0-3-point range was considered clean; 4-7 point range was considered dirty (Škodová et al., 2015). ICC coefficient was 0.98 for the right HWSE before training, 1.0 after 15 days, and 1.0 at four months after training. The ICC coefficient was 0.96 for the left HWSE before training, 1.0 at 15 days after training, and 1.0 at four months after training. Two independent researchers completed this form in three repeated follow-ups.	through study completion, an average 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hand Hygiene Information Form (HHIF)	The form was prepared in line with the literature to determine participants' socio-demographic characteristics and knowledge of hand hygiene. In line with the training content, the items in the information form consisted of the history of hand hygiene, transmission of microorganisms, bacterial flora, glove use, surgical hand washing and scrubbing, hand hygiene products, hand hygiene compliance, and HAIs. The HHIF items created by the research team were presented to experts (n=10), including an assessment and measurement expert. As a result of expert evaluations, the Content Validity Index (CVI) was calculated as 1.0. Items with low CVI were excluded. Then, "HHIF" and "Hand Hygiene Training Guide for Intensive Care Nurses" were finalized after the pilot application with five intensive care nurses outside the study group. The form consisted of 19 items on HH topics. The lowest and highest scores that can be obtained from the form were 0 and 100, respectively.	through study completion, an average 1 year

Collaborators and Investigators

• Sponsor: Uludag University
• Investigators: Principal Investigator: Hülya YILMAZ, Phd, Msc, Bursa Uludag University, Faculty of Health Sciences; Study Chair: Dilan Ayhan, Msc, Health Research and Application Center, Faculty of Medicine, Bursa Uludag University; Study Chair: Dilek YILMAZ, Phd, Msc, Bursa Uludag University, Faculty of Health Sciences; Study Chair: Yılmaz Özen, Professor, Health Research and Application Center, Faculty of Medicine, Bursa Uludag University

Publications and helpful links

General Publications

• Bounou L, Katelani S, Panagiotopoulou KI, Skouloudaki AI, Spyrou V, Orfanos P, Lagiou P. Hand hygiene education of Greek medical and nursing students: A cross-sectional study. Nurse Educ Pract. 2021 Jul;54:103130. doi: 10.1016/j.nepr.2021.103130. Epub 2021 Jun 28.
• Cambil-Martin J, Fernandez-Prada M, Gonzalez-Cabrera J, Rodriguez-Lopez C, Almaraz-Gomez A, Lana-Perez A, Bueno-Cavanillas A. Comparison of knowledge, attitudes and hand hygiene behavioral intention in medical and nursing students. J Prev Med Hyg. 2020 Apr 2;61(1):E9-E14. doi: 10.15167/2421-4248/jpmh2020.61.1.741. eCollection 2020 Mar.
• Diefenbacher S, Fliss PM, Tatzel J, Wenk J, Keller J. A quasi-randomized controlled before-after study using performance feedback and goal setting as elements of hand hygiene promotion. J Hosp Infect. 2019 Apr;101(4):399-407. doi: 10.1016/j.jhin.2019.02.001. Epub 2019 Feb 8.
• Du Q, Zhang D, Hu W, Li X, Xia Q, Wen T, Jia H. Nosocomial infection of COVID-19: A new challenge for healthcare professionals (Review). Int J Mol Med. 2021 Apr;47(4):31. doi: 10.3892/ijmm.2021.4864. Epub 2021 Feb 4.

Study record dates

Study Major Dates

• Study Start (Actual): July 17, 2021
• Primary Completion (Actual): November 15, 2021
• Study Completion (Actual): October 10, 2022

Study Registration Dates

• First Submitted: August 21, 2024
• First Submitted That Met QC Criteria: August 23, 2024
• First Posted (Actual): August 27, 2024

Study Record Updates

• Last Update Posted (Actual): August 27, 2024
• Last Update Submitted That Met QC Criteria: August 23, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: intensive care units; hygiene; fluorescent; health care associated infections
• Additional Relevant MeSH Terms: Pathologic Processes; Infections; Disease Attributes; Iatrogenic Disease; Cross Infection
• Other Study ID Numbers: 2021-7/18

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Concept: H.Y., D.A., D.Y., Y.Ö. Design: H.Y., D.A., D.Y., Y.Ö. Supervision: H.Y., D.A., D.Y., Y.Ö. Materials: H.Y., D.A., D.Y., Y.Ö. Data Collection and/or Processing: H.Y., D.A. Analysis and/or Interpretation: Statistician. Literature Search: H.Y., D.A., D.Y., Y.Ö. Writing: H.Y. Critical Reviews: D.A., D.Y.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No