Leading Practices for Training all Health Care Facility Staff in Infection Prevention and Control

Last Updated: September 8, 2020

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This Briefing Note was completed by the Research, Analysis, and Evaluation Branch (Ministry of Health) based on information provided by a member of the COVID-19 Evidence Synthesis Network. Please refer to the Methods section for further information.

Purpose

This note summarizes scientific evidence associated with the development of programs designed to train all hospital staff in infection prevention and control (IPAC) strategies, and guidance on the successful implementation of such programs.

*The full version of the Briefing Note including the Appendix can be accessed in the PDF file at the top of the page*

Key Findings

IPAC Design Tool

Analysis for Ontario

Supporting Evidence

This section below summarizes approaches to ensuring health care workers’ (HCWs) use of respiratory protection equipment (RPE) and adherence to ‘standard precautions’, evidence associated with hand hygiene compliance in patient care, and evidence for the barriers and facilitators to health care workers’ adherence to infection protection and compliance (IPAC) guidelines.

Scientific Evidence:

Improving Use of RPE and Adherence to standard precautions

There are mixed findings for the interventions that support the use of health care workers’ use of RPE and adherence to standard precautions:

  • A 2016 systematic review identified (low quality) evidence that behavioural interventions (e.g., various education and training programs) do not increase the numbers of workers that use respiratory protection equipment or that use RPE correctly.
  • A 2018 systematic review demonstrated that education, peer evaluation and communication interventions probably improved health care workers’ adherence to standard precautions in health care settings.
    • Education with visualization: A 2007 study showed that education programs that feature the visualization of respiratory particle dispersion improved nurses’ uses of masks during clinical interactions with patients with respiratory symptoms (post intervention only);
      • The intervention led to little or no difference in knowledge;
    • Peer evaluation: A 2000 study showed the use of peer evaluation tools improved handwashing and glove usage among 99 nursing staff (registered nurses, practical nurses, and patient care aides) in an acute care hospital in Thailand; and
    • Communication interventions: A 2013 study showed that use of checklists and visual cues that prompt health care workers to perform required actions improved adherence to glove use, hand hygiene, and gown use among radiology porters when transferring patients requiring contact precautions in an acute care hospital.
Strategies for Ensuring Hand Hygiene Compliance in Patient Care

Various single intervention strategies and different combinations of WHO-recommended strategies[1] may lead to increased hand hygiene compliance, reduced colonization rates, and improvements in methicillin-resistant Staphylococcus aureus (MRSA) infection rates regardless of the health care setting. There was insufficient evidence to identify which strategy or combination of strategies is most effective in a given context.

  • Strategies included increasing the availability of alcohol-based hand rub (ABHR); different types of education for staff; reminders (written and verbal); different types of performance feedback; administrative support; and staff involvement. For example:
    • Performance Feedback: Six studies suggest different types of performance feedback (e.g., wireless monitoring, personalized action planning) may improve hand hygiene compliance among HCWs in acute care hospitals and may slightly reduce infection rates;
    • Education and Training: Two studies suggested education may improve hand hygiene compliance;
    • Cues: Three studies reported cues (e.g., signs, scent) may slightly improve hand hygiene compliance; and
    • ABHR Placement: One study reported that placement of ABHR dispensers close to the point of use (i.e., on anaesthesia carts) probably slightly improves hand hygiene compliance.
Barriers and Facilitators Associated with Health Care Workers’ Adherence to IPAC Guidelines

A 2018 systematic review of qualitative and mixed methods studies suggests nurses, doctors, and other health care workers in hospitals and in primary and community care settings identified numerous factors that influenced their ability and willingness to follow IPAC guidelines when managing respiratory infectious diseases.

  • Organizational barriers: HCWs reported the following factors impact adherence:
    • A supportive management team; IPAC guidelines that were as short, specific, and practical as possible and updated only when necessary; clear communication via multiple platforms or methods; and availability of training for which the trainer does not feel that he or she is taken away from existing clinical responsibilities.
  • Environmental barriers: HCWs reported the following factors impact their adherence:
    • Adequate space, isolation facilities, ventilation, anterooms, showers, handwashing facilities, surface decontamination facilities, and adequate supplies of appropriate PPE tailored to varying needs at different stages of the outbreak.
  • Individual barriers: HCWs reported 10 main factors that impacted their adherence to IPAC guidance, including the following:
    • Knowledge: Learning a colleague or patient had contracted an infection; having knowledge of IPAC; and having access to evidence, rationale, and support to increase their IPAC knowledge.
    • Attitudes & Beliefs: Placing a high value on the importance of IPAC; and fear of infecting themselves or others.
    • PPE Discomfort: Discomfort of wearing PPE reduces HCWs’ adherence to their use

Methods

The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The Cochrane Library provided evidence synthesis products that were used to develop this Evidence Synthesis Briefing Note: