Social network analysis-informed peer champions for hand hygiene in the operating room: a cluster randomised controlled trial.

Summary

In a 12-month, two-campus cluster RCT (86 OR nurses), an SNA-guided key-influencer intervention raised covertly observed hand hygiene compliance from ~42% to 79% and reduced SSI rates by 43% relative to controls. Team climate and knowledge improved significantly, demonstrating a durable, resource-efficient strategy.

Key Findings

• Hand hygiene compliance improved to 79.2% at 12 months in the intervention vs 59.3% in controls; significant group-by-time interaction (p<0.001).
• Surgical site infection rates decreased from 2.2 to 1.3 per 1,000 procedures in the intervention campus (43.2% relative reduction).
• Key influencers had 2.4× higher centrality than network average; nurse knowledge and team climate improved (p<0.01).

Clinical Implications

Targeting network-identified peer champions can be integrated into OR quality programs to sustainably increase HHC, potentially reducing SSIs without major resource outlays.

Limitations

• Only two clusters, limiting causal inference and generalizability
• Single-city setting with modest sample size; potential residual observer effects

Future Directions

Replicate across multiple hospitals and specialties, assess cost-effectiveness, and integrate SNA-informed champions into broader OR safety bundles.