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

Summary

A 12-month cluster RCT showed that training peer champions identified via social network analysis nearly doubled hand hygiene compliance among OR nurses and reduced SSI rates by 43%. The approach also improved team climate and knowledge, demonstrating a sustainable and resource-efficient infection prevention strategy.

Key Findings

• Hand hygiene compliance rose from 41.8% to 79.2% in the intervention group versus 42.6% to 59.3% in controls over 12 months (p<0.001 interaction).
• SSI rates decreased from 2.2 to 1.3 per 1,000 procedures in the intervention hospital (43.2% relative reduction).
• Key influencers identified via SNA had 2.4-fold higher centrality and, once trained, improved team climate and knowledge (p<0.01).

Clinical Implications

Hospitals can deploy SNA to identify influential nurses and train them as peer champions to sustain hand hygiene and reduce SSIs without major resource investments.

Limitations

• Single metropolitan setting with 86 nurses may limit generalizability
• Organizational unblinding and observer effects, despite covert methods, cannot be fully excluded

Future Directions

Multisite cluster RCTs assessing scalability, cost-effectiveness, and integration with broader OR safety bundles are warranted.