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

Suboptimal hand hygiene compliance (HHC) among operating room (OR) nurses contributes to surgical site infections (SSIs). Conventional interventions often lack sustainability. We evaluated an intervention leveraging social network analysis (SNA) to engage key influencers (KIs) for HHC improvement.

We conducted a 12-month cluster randomised controlled trial across two hospital campuses (86 OR nurses) in Nanjing, China. The intervention campus received an SNA-informed strategy; the control received standard education. Six KIs, identified via weighted in-degree and betweenness centrality within the professional advice-seeking network, were trained as peer champions to model best practices. The primary outcome was HHC rates (covert observation) at baseline and 3, 6, and 12 months. Secondary outcomes included SSI rates and team climate.

Baseline HHC was similar between groups (41.8% vs 42.6%; P=0.62). Identified KIs had centrality scores 2.4-fold higher than the network average. At 12 months, intervention HHC increased to 79.2% (+37.4%) versus 59.3% (+16.7%) in controls. The mixed-effect model confirmed a significant group-by-time interaction (P<0.001). The intervention was associated with reduced SSI rates (1.3 vs 2.2 per 1000 procedures; 43.2% relative reduction) and significantly improved nurse knowledge and team climate scores (P<0.01).

An intervention targeting KIs identified through SNA is a highly effective strategy for sustaining HHC among OR nurses. This precision approach offers a resource-efficient alternative to traditional infection control programmes.