Intervention strategy to improve hand hygiene in small animal hospitals

Background

In small animal hospitals, it can happen that animals become infected with multidrug-resistant organisms during their stay. This can be avoided with improved infection prevention. Infections acquired in the hopsital can pose a serious threat to hospitalised animals and potentially also to veterinary staff. 

For example, highly problematic carbapenem-resistant E.coli were found in hospitalised dogs and cats in a small animal hospital (Nigg et al., 2019). Carrying a multidrug-resistant organism can persist for up to 136 days after discharge (Dazio et al., 2021). In addition, multidrug-resistant organisms have been detected on frequently touched surfaces in various small animal hospitals (Schmidt et al., 2020). Even some staff in veterinary facilities were affected by multidrug-resistant organisms (Endimiani et al., 2020; Fessler et al., 2018). 

The documented contamination of patients, the hospital environment and even hospital staff requires measures in veterinary facilities. In human medicine, extensive instruments are available to monitor and promote hand hygiene. Today, it is unclear whether these istruments can be transferred to veterinary medicine. 

In this project, we aimed to develop suitable instruments for small animal clinics. To do this, we used the first three steps of our approach (definition, diagnosis, design).

Definition

The target group as well as the target behavior were defined on the basis of observations, preliminary talks as well as the literature analysis.

Target group

Good hand hygiene is difficult to maintain in everyday practice. The keeping of dogs and cats in kennels and boxes on the wards as well as in the intensive care unit offer particularly poor conditions for proper hand hygiene compliance (workload/stress, number of patients). This means that all professional groups working in these rooms (veterinary practice assistants as well as physicians) belong to the target group of this project. 

Target behavior

It is most difficult to maintain hand hygiene before and after actions without contact with body fluids as well as before and after contact with materials or the environment. This concerns several working steps of the target group and the target behaviour could therefore not be broken down to a few selected actions. For this reason, this project focused on the holistic process of correct hand hygiene and all working steps performed on the wards and in the intensive care unit were defined as target behaviour.

Diagnosis

The second step was to look for reasons why the actual behaviour does not match the desired behaviour. To identify the barriers that hinder hand hygiene compliance and the benefits that drive it, interviews (focus groups: veterinary practice assistants and physicians) were conducted with all professional groups concerned.

Design

Based on the results of the interviews, an intervention mix was developed to promote hand hygiene compliance in small animal hospitals. 

The three most important fields of action were identified. Then, habit formation was defined as a theoretical framework. A model for the design of the intervention strategy was then selected for the formation of habits. Based on the theoretical framework and the model, 5 individual intervention measures could be derived for the implementation in small animal hospitals.