The Efficacy of a Web-Based, Educational Quality Improvement Project on Hand Hygiene to Reduce Post-Cesarean Birth Surgical Site Infection

Written by Lilian A. Allen, Joseph D. Tariman, & Shannon D. Simonovich

doi: https://doi.org/10.13178/jnparr.2021.11.02.1106

Abstract

Background: The risk of surgical site infection is ever-present, and it is a significant driver of higher hospitalization costs among surgical patients. It is critical to flatten the curve of the surgical site infection (SSI) rates, and SSI has become the main focus of a quality improvement initiative among the infection control specialists and clinical leadership team in a large academic hospital setting.

Objective: This is a Quality Improvement Project (QIP) aimed to evaluate the effectiveness of a web-based educational training initiative on hand-hygiene (HH) for staff in the women’s care center in preventing surgical site infections (SSI). This QIP also aimed at identifying the knowledge gap, behavioral, and attitudinal issues related to hand hygiene and infection control among direct patient care providers at the women’s care center.

Methods: A descriptive, prospective, longitudinal design using quantitative measures was used in this QIP. A one-hour web-based educational training initiative on HH and essential infection control concepts adapted from the World Health Organization HH program was provided to the clinical staff of the women’s care center, which included the Labor and Delivery, Mother and Baby, and Obstetrics Emergency Room OB ER units at a large, urban, tertiary care hospital in the Midwestern region of the United States. The data collection points were before the web-based educational intervention was introduced (time 0), immediately after the web-based intervention completion (time 1), and one to six weeks after completion of the intervention
(time 2). Twenty-eight pre and post-intervention paired responses were included in the final data analysis, yielding an overall online survey response rate of 19.5%.

Results: A statistically significant difference between the post-intervention and pre-intervention post-surgical infection rates were found (p < 0.05) with 124 postpartum cesarean section (CS) cases having only one case with SSI (0.82%) when compared to pre-intervention data that showed 126 postpartum CS cases with four SSI reported (3.2%). However, there is no significant difference between the pre-intervention and immediately post-intervention (time 2) as well one to six weeks after time 2 in the participants’ mean scores for knowledge on hand hygiene (F = .230, df = 26, p = > 0.05) and behavioral and attitudinal mean scores (F = 1.81, df = 26, p = .18).

Conclusion: To maximize compliance and improve the clinical staff’s knowledge and skills on infection control and prevention measures, the leadership must provide support to staff and enforce training and skills development. We recommend combining a web-based educational intervention format with other influencers reported in the literature, such as performance feedback, frequent reminder, compliance observations, surveillance, monitoring, and auditing shares. QIP related to infection control within the hospital organization should be a mandatory process for all staff to reduce the financial burden of SSI to the institution, insurer, and the society at large.

Keywords: Postpartum, surgical site infection, quality improvement project, hand hygiene, patient safety, quality care