Investigation of Fluorescent Concretization Intervention on Intensive Care Nurses' Hand Hygiene Training

Aim: Nurses have a pivotal role in preventing and managing healthcare-acquired/associated infections by effective hand washing. The primary objective was to assess the effect of fluorescent concretization intervention on intensive care nurses' hand-washing efficiency, skill performance, and duration scores during the training process. A secondary objective was to investigate the intensive care nurses to determine their level of hand hygiene knowledge before and after the training.

Design: Cluster-randomised controlled pretest-posttest and follow-up research design was used.

Methods: This study was conducted at a tertiary hospital in XX province, Türkiye. Seventy-six nurses from intensive care units participated in hand hygiene training. In addition to routine hand hygiene training, the participants in the intervention group (n=39) had their hand washing efficiency evaluated using ultraviolet A light. The dirty spots were shown to the participants, and the reasons were discussed. The participants in the control group (n=37) received hand washing training without fluorescent concretization and ultraviolet light intervention. The Hand Hygiene theoretical information is an evidence-based workplace intervention delivered by trained facilitators across two training. Hand Hygiene Information Forms were administered upon registration and before randomisation of all participants immediately after the final training. Two independent researchers observed Hand Washing Skill Checklist and Efficacy forms in three follow-ups (before training, 15 days after training, and four months after training).

• With fluorescent concretization group (Behavioral), also known as fluorescent concretization group: Nurses were given the fluorescent lotion and asked to apply it all over their hands. The CE-certified test lotion is in gel form and is safety-approved. The lotion disperses particles the same size as bacteria on the skin. These particles settle on the skin, similar to the behavior of microorganisms, but disappear with hand washing under the influence of fluorescent light. They were then asked to wash their hands with 4 ml of soap. Two researchers marked the hand washing steps independently using the "Hand Washing Skill Checklist." The duration of hand washing was recorded with a mobile stopwatch for each participant. Hand washing efficiency was evaluated using the "Derma Litecheck" device. UV rays were used after using the test lotion and drying the hands. Since any fluorescent material left on the hands would shine under UV light, it was possible to judge how well the hands were cleansed. The dirty spots were shown to the participants, and the reason for this was discussed.

Primary outcomes

• Hand Washing Skill Efficacy (HWSE) [through study completion, an average 1 year]: The hands were examined in seven areas: the palm, the back of the hand, and between the fingers, specifically the thumb, fingertips, nails, the anterior side of the wrist, and the posterior side. Under the UV light, dirty spots were marked separately for the right and left hands. The dirty spot was calculated as 1 point, and the clean spot was calculated as 0 points. 0-3-point range was considered clean; 4-7 point range was considered dirty (Škodová et al., 2015). ICC coefficient was 0.98 for the right HWSE before training, 1.0 after 15 days, and 1.0 at four months after training. The ICC coefficient was 0.96 for the left HWSE before training, 1.0 at 15 days after training, and 1.0 at four months after training. Two independent researchers completed this form in three repeated follow-ups.

Secondary outcomes

• Hand Hygiene Information Form (HHIF) [through study completion, an average 1 year]: The form was prepared in line with the literature to determine participants' socio-demographic characteristics and knowledge of hand hygiene. In line with the training content, the items in the information form consisted of the history of hand hygiene, transmission of microorganisms, bacterial flora, glove use, surgical hand washing and scrubbing, hand hygiene products, hand hygiene compliance, and HAIs. The HHIF items created by the research team were presented to experts (n=10), including an assessment and measurement expert. As a result of expert evaluations, the Content Validity Index (CVI) was calculated as 1.0. Items with low CVI were excluded. Then, "HHIF" and "Hand Hygiene Training Guide for Intensive Care Nurses" were finalized after the pilot application with five intensive care nurses outside the study group. The form consisted of 19 items on HH topics. The lowest and highest scores that can be obtained from the form were 0 and 100, respectively.

Sex: All, ages: 18 Years to 65 Years, accepts healthy volunteers

Inclusion Criteria:

* nurses who have not received previous training on UVA-supported hand hygiene devices
* nurses who have not visibly damaged skin integrity on the hands
* Nurses are willing to participate in the study and take primary responsibility for patient care.
* nurses who have six months or more of intensive care experience

Exclusion Criteria:

* nurses who have received previous training on UVA-supported hand hygiene devices.
* nurses who do not have visibly damaged skin integrity on the hands.
* Nurses are willing to participate in the study and take primary responsibility for patient care.
* nurses who have six months or less of intensive care experience

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• Results publication: Yilmaz H, Ayhan D, Yilmaz D, Ozen Y. Investigation of Fluorescent Concretisation Intervention on Intensive Care Nurses' Hand Hygiene Training According to the Kirkpatrick Model: A Cluster Randomised Controlled Study. Nurs Crit Care. 2025 Sep;30(5):e70141. doi: 10.1111/nicc.70141. PMID 40814898

• Hülya YILMAZ, Phd, Msc, Principal investigator, Bursa Uludag University, Faculty of Health Sciences
• Dilan Ayhan, Msc, Study chair, Health Research and Application Center, Faculty of Medicine, Bursa Uludag University
• Dilek YILMAZ, Phd, Msc, Study chair, Bursa Uludag University, Faculty of Health Sciences
• Yılmaz Özen, Professor, Study chair, Health Research and Application Center, Faculty of Medicine, Bursa Uludag University