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Background <p>Hand hygiene is vital for infection prevention, yet compliance among medical staff remains low. This study assessed whether training medical students using a multimodal educational intervention, including their roles as 'hand hygiene covert observers' (HHCOs) in their pre-internship phase, could improve hand hygiene compliance during their internship.</p> Methods <p>A retrospective study was conducted at Queen Mary Hospital, Hong Kong, comparing two consecutive cohorts of medical interns: cohort A (historical control, starting July 1, 2024) and cohort B (intervention group, starting July 1, 2025). Cohort B participated in a half-day training workshop and covertly observed hand hygiene compliance as HHCOs during a 19-day pre-internship clinical attachment in June 2025. Hand hygiene compliance observed by HHCOs was compared with infection control nurses (ICNs) observations collected concurrently. Additionally, hand hygiene compliance among cohorts A and B was monitored by ICNs using World Health Organization audit tools. Baseline knowledge and attitudes of cohort B regarding hand hygiene were assessed by questionnaire.</p> Results <p>Seventy-four pre-interns in cohort B completed the baseline questionnaire; 38 (51.4%) identified alcohol-based hand rub (ABHR) as the most effective hand hygiene method, while 36 (48.6%) selected soap and water. Positive attitudes were evident, with 54 (73.0%) strongly agreeing on hand hygiene’s role in preventing healthcare-associated infections and 52 (70.3%) strongly agreeing that compliance impacts patient safety. During the pre-internship clinical attachment, hand hygiene compliance observed by HHCOs among cohort A was significantly higher than that observed by ICNs (96%, 682/713 vs. 59%, 144/244; <i>p</i> &lt; 0.001). Comparison of ICN-observed compliance showed a non-significant increase for cohort B versus cohort A (66%, 230/348 vs. 58%, 156/267; <i>p</i> = 0.051). However, cohort B demonstrated a significantly higher proportion of hand hygiene episodes using ABHR compared to cohort A (90%, 208/230 vs. 79%, 123/156; <i>p</i> = 0.001).</p> Conclusions <p>Engaging pre-interns in a multimodal educational intervention, including their roles as covert observers, did not significantly increase overall hand hygiene compliance compared to historical controls. However, there was a notable rise in ABHR use among the intervention group. This approach may promote awareness and foster a culture of patient safety.</p>

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Does a multimodal educational intervention involving pre-intern ‘hand hygiene covert observers’ improve hand hygiene compliance among medical interns?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月28日

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  • Shuk-Ching Wong,
  • Edwin Kwan-Yeung Chiu,
  • Kelvin Hei-Yeung Chiu,
  • Pui-Hing Chau,
  • Benny Yu Chau,
  • Wing Yan Ng,
  • Monica Oi-Tung Kwok,
  • Kwok-Yung Yuen,
  • Vincent Chi-Chung Cheng

摘要

Background

Hand hygiene is vital for infection prevention, yet compliance among medical staff remains low. This study assessed whether training medical students using a multimodal educational intervention, including their roles as 'hand hygiene covert observers' (HHCOs) in their pre-internship phase, could improve hand hygiene compliance during their internship.

Methods

A retrospective study was conducted at Queen Mary Hospital, Hong Kong, comparing two consecutive cohorts of medical interns: cohort A (historical control, starting July 1, 2024) and cohort B (intervention group, starting July 1, 2025). Cohort B participated in a half-day training workshop and covertly observed hand hygiene compliance as HHCOs during a 19-day pre-internship clinical attachment in June 2025. Hand hygiene compliance observed by HHCOs was compared with infection control nurses (ICNs) observations collected concurrently. Additionally, hand hygiene compliance among cohorts A and B was monitored by ICNs using World Health Organization audit tools. Baseline knowledge and attitudes of cohort B regarding hand hygiene were assessed by questionnaire.

Results

Seventy-four pre-interns in cohort B completed the baseline questionnaire; 38 (51.4%) identified alcohol-based hand rub (ABHR) as the most effective hand hygiene method, while 36 (48.6%) selected soap and water. Positive attitudes were evident, with 54 (73.0%) strongly agreeing on hand hygiene’s role in preventing healthcare-associated infections and 52 (70.3%) strongly agreeing that compliance impacts patient safety. During the pre-internship clinical attachment, hand hygiene compliance observed by HHCOs among cohort A was significantly higher than that observed by ICNs (96%, 682/713 vs. 59%, 144/244; p < 0.001). Comparison of ICN-observed compliance showed a non-significant increase for cohort B versus cohort A (66%, 230/348 vs. 58%, 156/267; p = 0.051). However, cohort B demonstrated a significantly higher proportion of hand hygiene episodes using ABHR compared to cohort A (90%, 208/230 vs. 79%, 123/156; p = 0.001).

Conclusions

Engaging pre-interns in a multimodal educational intervention, including their roles as covert observers, did not significantly increase overall hand hygiene compliance compared to historical controls. However, there was a notable rise in ABHR use among the intervention group. This approach may promote awareness and foster a culture of patient safety.