# COVID-19 prevention training with video-based feedback in nursing homes: impact on staff safety behaviors

## TL;DR

A training program with video feedback improved safety behaviors like hand hygiene and mask use among nursing home staff during the pandemic.

## Contribution

Demonstrated that direct-to-staff training with video feedback effectively reduces unsafe behaviors in nursing homes.

## Key findings

- Hand hygiene errors decreased by 7.6% per month during the intervention.
- Masking and face/mask-touching errors also significantly decreased over time.
- Error reductions were consistent across different areas and shifts in nursing homes.

## Abstract

Evaluate impact of COVID-19 prevention training with video-based feedback on nursing home (NH) staff safety behaviors.

Public health intervention

Twelve NHs in Orange County, California, 6/2020-4/2022

NHs received direct-to-staff COVID-19 prevention training and weekly feedback reports with video montages about hand hygiene, mask-wearing, and mask/face-touching. One-hour periods of recorded streaming video from common areas (breakroom, hallway, nursing station, entryway) were sampled randomly across days of the week and nursing shifts for safe behavior. Multivariable models assessed the intervention impact.

Video auditing encompassed 182,803 staff opportunities for safe behavior. Hand hygiene errors improved from first (67.0%) to last (35.7%) months of the intervention, decreasing 7.6% per month (OR = 0.92, 95% CI = 0.92–0.93, P < 0.001); masking errors improved from first (10.3 %) to last (6.6%) months of the intervention, decreasing 2.3% per month (OR = 0.98, 95% CI = 0.97–0.99, P < 0.001); face/mask touching improved from first (30.0%) to last (10.6%) months of the intervention, decreasing 2.5% per month (OR = 0.98, 95% CI = 0.97–0.98, P < 0.001). Hand hygiene errors were most common in entryways and on weekends, with similar rates across shifts. Masking errors and face/mask touching errors were most common in breakrooms, with the latter occurring most commonly during the day (7A.M.–3P.M.) shift, with similar rates across weekdays/weekends. Error reductions were seen across camera locations, days of the week, and nursing shifts, suggesting a widespread benefit within participating NHs.

Direct-to-staff training with video-based feedback was temporally associated with improved hand hygiene, masking, and face/mask-touching behaviors among NH staff during the COVID-19 pandemic.