A Cluster Randomized Trial of Immediate Hand Hygiene Compliance Feedback
Bibliographic record
Abstract
Background. Multimodal interventions including audit and feedback can improve hand hygiene compliance (HHC). Immediate, rather than periodic (e.g. monthly), feedback may result in further improvement. Methods. We conducted a cluster randomized controlled trial (RCT) of immediate feedback on 16 wards of a tertiary care hospital in Toronto, Canada. At baseline, all wards received monthly feedback on HHC. Units were randomized within pairs determined by baseline HHC over 1 year. Audits without feedback were performed 2 times/week on both control and intervention wards. Additionally, 2 feedback audits were performed weekly on intervention wards. During feedback audits, the auditor provided feedback on HH events and missed HH opportunities. After 10 weeks, feedback was initiated on the control units and stopped on the intervention units (i.e. crossed-over). A comparison of non-feedback audits between the intervention and control units was the primary outcome. Feedback audits were not included because we anticipated that there would be an increase HHC during feedback audits due to increased observation bias (i.e. Hawthorne effect). If immediate feedback resulted in sustained behavior change, improvements in HHC should be seen during the non-feedback audits on the intervention wards. Results. Baseline HHC was 65% and 67% for the intervention and control wards. Overall, 14,527 HH opportunities were observed, 9215 during the baseline period, 3161 during the intervention period, and 2151 during the cross-over period. HHC on the intervention wards did not change between the baseline and intervention phase (65% versus 65%) while HHC on the control wards increased 2% (67% to 69%). When both feedback and non-feedback audits are included, a 6% increase was observed on the intervention wards versus 2% on the control wards. This difference occurred because of a 6% increase in HHC on the intervention unit during the feedback versus non-feedback audits (71% versus 65%). Results. from the cross-over period were similar, with no substantial benefit to feedback seen but with persistent evidence of observation bias. Conclusion. We failed to identify any increase in HHC following the initiation of immediate feedback in a cluster RCT. Compliance was 6% higher during feedback versus non-feedback audits, likely due to an increase in observation bias. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".