1
|
Park JY, Pardosi JF, Islam MS, Respati T, Nurhayati E, Charania N, Chowdhury KIA, Seale H. Supporting patients and their carers to participate in infection prevention and control activities: The views of patients, family members, and hospital staff from Bangladesh, Indonesia, and South Korea. Am J Infect Control 2024; 52:200-206. [PMID: 37394183 DOI: 10.1016/j.ajic.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Hand hygiene reminders for healthcare workers (HCWs) are commonly used to empower patients. However, this approach overlooks the role of family carers in delivering direct contact care in Asian countries. Limited knowledge exists regarding empowerment strategies for patients and their family carers in infection prevention and control (IPC) recommendations. This study aimed to provide a comprehensive exploration of IPC empowerment within the context of family involvement in care provision across Bangladesh, Indonesia, and South Korea. METHODS In-depth interviews were conducted in 5 tertiary-level hospitals in Bangladesh, Indonesia, and South Korea. A total of 64 participants were interviewed through 57 interviews, including 6 group interviews, comprising 2 groups: (1) patients and their family and private carers; and (2) HCWs. RESULTS The study identified barriers to engaging patients and family carers in IPC measures. These included concerns about the patient-HCW hierarchical relationship, lack of knowledge about healthcare-associated infection, IPC, and patient zone, perceptions of IPC as a barrier to family connections, and disempowerment of patients in IPC due to family bonds. CONCLUSIONS This study provides diverse perspectives on IPC empowerment, revealing challenges faced by patients, family carers, and HCWs. The interlaced relationship established by social norms of family carer provision hinders the empowerment of family carers. Acknowledging the cultural influence on health care arrangements and its implication for IPC empowerment is crucial in mitigating these barriers.
Collapse
Affiliation(s)
- Ji Yeon Park
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
| | - Jerico Franciscus Pardosi
- School of Public Health & Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Md Saiful Islam
- Emerging Infections Program, International Centre for Diarrhoeal Disease Research, Bangladesh; Department of Global Health Program, Kirby Institute, UNSW, Sydney, Australia
| | - Titik Respati
- Public Health Department, Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - Eka Nurhayati
- Public Health Department, Faculty of Medicine, Universitas Islam Bandung, Bandung, Indonesia
| | - Nadia Charania
- Department of Public Health, Auckland University of Technology, Auckland, New Zealand
| | | | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Gaube S, Walton K, Kleine AK, Däumling S, Rohrmeier C, Müller S, Bonrath E, Schneider-Brachert W. Examining outpatients' hand hygiene behaviour and its relation to COVID-19 infection prevention measures. J Hosp Infect 2023; 141:55-62. [PMID: 37634601 DOI: 10.1016/j.jhin.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The increasing demand for outpatient care is associated with a higher risk of infection transmission in these settings. However, there is limited research on infection prevention and control practices in ambulatory clinics, and none focuses on patients. AIM To examine outpatients' hand hygiene behaviours, their determinants, and their associations with other infection prevention measures during the COVID-19 pandemic. METHODS We observed the hand hygiene behaviour of one cohort of patients in one outpatient clinic and surveyed a separate sample in five clinics about their hand hygiene practice in outpatient facilities. A questionnaire based on the Theoretical Domains Framework (TDF) was used to examine predictors of the behaviour. Moreover, patients indicated their compliance with COVID-19 infection prevention measures, vaccination status, disease risk perception, and vaccine hesitancy. FINDINGS Observed hand hygiene rates among 618 patients were low (12.8%), while 67.3% of the 300 surveyed patients indicated sanitizing their hands upon entering the clinic. The TDF domains 'memory, attention, and decision processes' and 'emotions' significantly predicted both current (today's) and general hand hygiene behaviour in outpatient clinics. Hand hygiene behaviour and compliance with COVID-19 infection prevention showed a positive association; however, no significant connection was found with patients' vaccination status, suggesting different behavioural motivators. CONCLUSION Hand hygiene among outpatients should be improved through interventions focusing on helping patients remember to clean their hands. More research on infection prevention in outpatient facilities is needed to ensure patient safety.
Collapse
Affiliation(s)
- S Gaube
- Global Business School for Health, University College London, London, UK.
| | - K Walton
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A-K Kleine
- LMU Center for Leadership and People Management, LMU Munich, Munich, Germany
| | - S Däumling
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - C Rohrmeier
- Faculty of Medicine, University of Regensburg, Regensburg, Germany; HNO-Gemeinschaftspraxis, Straubing, Germany
| | - S Müller
- Clinic and Polyclinic for Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany; MKG-Praxis im Turm, Straubing, Germany
| | - E Bonrath
- Praxis für Chirurgie & Handchirurgie, Regensburg, Germany
| | - W Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
3
|
Investigating the Mediating Effect of Patient Self-Efficacy on the Relationship between Patient Safety Engagement and Patient Safety in Healthcare Professionals. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:8934444. [PMID: 36865682 PMCID: PMC9974308 DOI: 10.1155/2023/8934444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/25/2022] [Accepted: 11/24/2022] [Indexed: 02/23/2023]
Abstract
Patient safety and involvement of the patients in their safety engagement activities are considered the most important elements in the healthcare professions due to their impact on various individual and organizational outcomes. The study used responses of 456 patients. The simple random sampling (SRS) technique was used to collect data from the respondents. The researcher used individuals as the unit of analysis in this study. The results revealed that patient safety engagement had a positive significant effect on patient safety. When the mediating variable of self-efficacy was analyzed, it showed a significant mediated effect on patient safety. Therefore, it was concluded that self-efficacy mediated the relationship between patient safety engagement and patient safety. The findings of the current study convey that engagement of the patient in the practices for patient safety is predicted through the level of self-efficacy of the patient. The study discussed various implications for theory and practice. The study also discussed potential avenues for future research.
Collapse
|
4
|
Wang Q, Lai X, Zheng F, Yu T, Wang L, Wu Y, Wang K, Zhang X, Zhou Q, Tan L. The impacts of self-expectation leadership and organizational commitment on hand hygiene behavior of medical staff based on the theory of implicit leadership. Front Psychol 2022; 13:992920. [DOI: 10.3389/fpsyg.2022.992920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022] Open
Abstract
Hand hygiene behavior (HHB) in healthcare settings remains suboptimal globally. Self-expectation leadership and organizational commitment are emphasized as important factors influencing HHB. However, there are no studies to support any relationship between self-expectation leadership and organizational commitment to HHB. This study will fill the gap by applying implicit leadership theory (ILT) to support the further promote HHB among medical staff. A cross-sectional study of 23,426 medical staff was conducted in all second-level and third-level hospitals in Hubei province, China. Based on ILT, an online self-administered and anonymous questionnaire was designed for measuring the medical staff’s self-expectation leadership, organizational commitment, and HHB based on Offermann’s 8 dimensions scale, Chang’s 3 dimensions scale, and the specification of hand hygiene for healthcare workers, respectively, in which self-expectation leadership was divided into positive traits and negative traits parts. The structural equation model was used to examine the direct, indirect, and mediating effects of the variables. Positive traits of self-expectation leadership had a positive effect on organizational commitment (β = 0.617, p < 0.001) and HHB (β = 0.180, p < 0.001). Negative traits of self-expectation leadership had a negative effect on organizational commitment (β = –0.032, p < 0.001), while a positive effect on HHB (β = 0.048, p < 0.001). The organizational commitment had a positive effect on HHB (β = 0.419, p < 0.001). The mediating effect of the organizational commitment showed positively between positive traits of self-expectation leadership and HHB (β = 0.259, p < 0.001), while negatively between negative traits of self-expectation leadership and HHB (β = –0.013, p < 0.001). Positive traits of self-expectation leadership are important predictors of promoting organizational commitment and HHB, while negative traits of self-expectation leadership have a limited impact on organizational commitment and HHB in the field of healthcare-associated infection prevention and control. These findings suggest the need to focus on positive traits of self-expectation leadership; although negative traits of self-expectation leadership can also promote HHB to a lesser degree among medical staff, it will reduce their organizational commitment.
Collapse
|
5
|
Clavel NC, Lavoie-Tremblay M, Biron A, Briand A, Paquette J, Bernard L, Fancott C, Pomey MP, Dumez V. Patient and family engagement in infection prevention in the context of the COVID-19 pandemic: defining a consensus framework using the Q methodology - NOSO-COVID study protocol. BMJ Open 2022; 12:e056172. [PMID: 35868827 PMCID: PMC9315236 DOI: 10.1136/bmjopen-2021-056172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Healthcare-associated infections are an important patient safety concern, especially in the context of the COVID-19 pandemic. Infection prevention and control implemented in healthcare settings are largely focused on the practices of healthcare professionals. Patient and family engagement is also recognised as an important patient safety strategy. The extent to which patients and families can be engaged, their specific roles and the strategies that support their engagement in infection prevention remain unclear. The overarching objective of the proposed study is to explore how patients and families can effectively be engaged in infection prevention by developing a consensus framework with key stakeholders. DESIGN AND METHODS The proposed study is based on a cross-sectional exploratory study at one of the largest university hospitals in North America (Montreal, Canada). The targeted population is all healthcare professionals, managers and other non-clinical staff members who work on clinical units, and the in-patients and their families. The study is based on Q methodology that takes advantage of both quantitative and qualitative methods to identify the consensus among the various stakeholders. This exploratory Q research approach will provide a structured way to elicit the stakeholders' perspectives on patient and family engagement in infection prevention. ETHICS AND DISSEMINATION The research ethics board approved this study. The research team plans to disseminate the findings through different channels of communication targeting healthcare professionals, managers in healthcare settings, and patients and family caregivers. The findings will also be disseminated through peer-reviewed journals in healthcare management and in quality and safety improvement.
Collapse
Affiliation(s)
| | | | - Alain Biron
- McGill University Health Centre, Montreal, Québec, Canada
| | - Anaick Briand
- McGill University Health Centre, Montreal, Québec, Canada
| | - Jesseca Paquette
- Ingram School of Nursing, McGill University Faculty of Medicine, Montreal, Québec, Canada
| | - Laurence Bernard
- Faculty of Nursing, University of Montreal, Montreal, Québec, Canada
| | - Carol Fancott
- Patient Engagement & Partnerships, Healthcare Excellence Canada, Ottawa, Ontario, Canada
| | | | - Vincent Dumez
- Centre of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada
| |
Collapse
|
6
|
Obadan-Udoh EM, Gharpure A, Lee JH, Pang J, Nayudu A. Perspectives of Dental Patients About Safety Incident Reporting: A Qualitative Pilot Study. J Patient Saf 2021; 17:e874-e882. [PMID: 34009866 DOI: 10.1097/pts.0000000000000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient reporting of safety incidents is one of the hallmarks of an effective patient safety protocol in any health care setting. However, very little is known about safety reporting among dental patients or effective strategies for engaging them in activities that promote safety. The goal of this study was to understand the perceptions of dental patients about the barriers and benefits of reporting safety incidents. We also sought to identify strategies for improving patient reporting of safety incidents in the dental care setting. METHODS We conducted 3 focus group sessions with adult dental patients (n = 16) attending an academic dental center from November 2017 to February 2018. Audio recordings were transcribed and analyzed using a hybrid thematic analysis approach with NVivo software. RESULTS Dental patients mainly attributed safety incidents to provider-related and systemic factors. They were most concerned about the financial implications, inconvenience of multiple visits, and the absence of an apology when an incident occurred. The major recommended strategies for engaging patients in safety-related activities included the following: proactive solicitation of patient feedback, what-to-expect checklists, continuous communication during visits/procedures, after-visit summary reports, clear incident reporting protocols, use of technology, independent third-party safety incident reporting platforms, and a closed feedback loop. CONCLUSIONS This study offers a roadmap for proactively working with dental patients as vigilant partners in promoting quality and safety. If properly engaged, dental patients are prepared to work with dental professionals to identify threats to safety and reduce the occurrence of harm.
Collapse
Affiliation(s)
- Enihomo M Obadan-Udoh
- From the Department of Preventive and Restorative Dental Sciences, University of California San Francisco (UCSF) School of Dentistry, San Francisco, California
| | | | | | | | | |
Collapse
|
7
|
Wendt B, Huisman-de Waal G, Bakker-Jacobs A, Hautvast JLA, Huis A. Exploring infection prevention practices in home-based nursing care: A qualitative observational study. Int J Nurs Stud 2021; 125:104130. [PMID: 34839222 DOI: 10.1016/j.ijnurstu.2021.104130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Home-based nursing care continues to expand, delivering care to increasingly older clients with multiple, chronic and complex conditions that require the use of additional and more numerous invasive medical devices. Therefore, the prevention of infections poses a challenge for nurses, professional caregivers and clients. OBJECTIVE This article explores infection prevention practices and related behavioural factors in both nurses and clients to identify barriers and facilitators of infection prevention practices in home-based nursing care. DESIGN A qualitative, exploratory design. SETTING Four healthcare organisations providing home-based nursing care in the Netherlands. METHODS Participant observations were used as the main source of data collection complemented with focus group discussions and semi-structured interviews. PARTICIPANTS Participant observations: 16 nurses, three professional caregivers and 80 clients. Semi-structured interviews: 11 clients. Focus group discussions: 15 nurses and four professional caregivers. RESULTS A total of 87 unique care delivery situations were observed for 55 h, complemented with three focus group discussions and 11 individual semi-structured client interviews. Infection prevention practices in home-based nursing care appeared to be challenged by 1. The specific context or environment in which the care occurred, which is more autonomous, less structured, less controlled and less predictable than other care settings; 2. Suboptimal and considerable variation in professional performance concerning the application of hand hygiene and the proper use of personal protective equipment such as face masks, barrier gowns and disposable gloves; 3. Extensive use in and outside the client's surroundings of communication devices that are irregularly cleaned and tend to interrupt nursing procedures; and 4. Inadequate organisational support in the implementation and evaluation of new information or policy changes and fragmentation, variation and conflicting information regarding professional guidelines and protocols. CONCLUSIONS From a first-hand observational viewpoint, this study showed that the daily practice of infection prevention in home-based nursing care appears to be suboptimal. Furthermore, this research revealed considerable variation in the work environment, the application of hand hygiene, the proper use of personal protective equipment, the handling of communication devices and organisational policies, procedures and support. Finally, the study identified a number of important barriers and facilitators of infection prevention practices in the work environment, professional and team performance, clients and organisations.
Collapse
Affiliation(s)
- Benjamin Wendt
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101 (114), 6500 HB, Nijmegen, the Netherlands.
| | - Getty Huisman-de Waal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101 (114), 6500 HB, Nijmegen, the Netherlands.
| | - Annick Bakker-Jacobs
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101 (114), 6500 HB, Nijmegen, the Netherlands.
| | - Jeannine L A Hautvast
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, PO box 9101 (149), 6500 HB, Nijmegen, the Netherlands.
| | - Anita Huis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101 (114), 6500 HB, Nijmegen, the Netherlands.
| |
Collapse
|
8
|
Marquer C, Guindo O, Mahamadou I, Job E, Rattigan SM, Langendorf C, Grais RF, Isanaka S. An exploratory qualitative study of caregivers' knowledge, perceptions and practices related to hospital hygiene in rural Niger. Infect Prev Pract 2021; 3:100160. [PMID: 34647010 PMCID: PMC8498679 DOI: 10.1016/j.infpip.2021.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background The risk of healthcare-associated infections is exacerbated by poor hygiene practices in health care facilities and can contribute to increased patient morbidity and mortality. In low-income settings, caregivers play a key role in maintaining proper hygiene during inpatient stays. We aimed to explore caregivers' knowledge, perceptions and practices related to hospital hygiene in a rural, sub-Saharan African setting. Methods We conducted an exploratory qualitative study among caregivers of children admitted to an inpatient therapeutic feeding center in Madarounfa, Niger. Individual interviews with 28 caregivers of hospitalized children were conducted to explore their knowledge, perceptions and practices of hygiene in the health facility. Findings Caregivers described a broad understanding of hygiene and reported knowledge of its importance in the hospital, particularly to prevent disease transmission and protect child health. Hygiene was perceived as a collective rather than individual responsibility. Caregivers reported on the poor hygiene practice of others and cited a lack of space and hygiene materials as barriers to correct hygiene practice. Caregivers described educational sessions and informal sharing with other caregivers as tools to gain knowledge and improve practice. Conclusion This exploratory study is unique in describing the perspective of caregivers in a low-resource hospital setting, a group often underrepresented when designing health interventions to improve hospital hygiene. Our findings suggest a strong knowledge of hospital hygiene among caregivers in this setting, with positive perception of its importance in health promotion. Poor individual practice was reported but may be improved through additional education and provision of hygiene materials.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Sheila Isanaka
- Department of Research, Epicentre, Paris, France
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, USA
- Corresponding author. Address: 14-34 Avenue Jean Juarès, Paris, 75019, France. Tel.: +33 (0)1 4021 5498; fax: +33 (0)1 4021 5100.
| |
Collapse
|
9
|
Chong CY, Catahan MA, Lim SH, Jais T, Kaur G, Yin S, de Korne D, Thoon KC, Ng KC. Patient, staff empowerment and hand hygiene bundle improved and sustained hand hygiene in hospital wards. J Paediatr Child Health 2021; 57:1460-1466. [PMID: 33908109 DOI: 10.1111/jpc.15526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022]
Abstract
AIM We piloted a hand hygiene (HH) project in a ward, focusing on World Health Organization moments 1 and 4. Our aim was to design highly reliable interventions to achieve >90% compliance. METHODS Baseline HH compliance was 57 and 67% for moments 1, 4, respectively, in 2015. After the pilot ward showed sustained improvement, we launched the 'HH bundle' throughout the hospital. This included: (i) appointment of HH champions; (ii) verbal/visual bedside reminders; (iii) patient empowerment; (iv) hand moisturisers; (v) tagging near-empty handrub (HR) bottles. Other hospital-wide initiatives included: (vi) Smartphone application for auditing; (vii) 'Speak up for Patient Safety' Campaign in 2017 for staff empowerment; (viii) making HH a key performance indicator. RESULTS Overall HH compliance increased from a baseline median of 79.6-92.6% in end-2019. Moments 1 and 4 improved from 71 to 92.7% and from 77.6 to 93.2%, respectively. Combined HR and hand wash consumption increased from a baseline median of 82.6 ml/patient day (PD) to 109.2 mL/PD. Health-care-associated rotavirus infections decreased from a baseline median of 4.5 per 10 000 PDs to 1.5 per 10 000 PDs over time. CONCLUSIONS The 'HH Bundle' of appointing HH champions, active reminders and feedback, patient education and empowerment, availability of hand moisturisers, tagging near-empty hand rub bottles together with hospital-wide initiatives including financial incentives and the 'Speak Up for Patient Safety' campaign successfully improved the overall HH compliance to >90%. These interventions were highly reliable, sustained over 4 years and also reduced health-care-associated rotavirus infection rates.
Collapse
Affiliation(s)
- Chia Yin Chong
- Infectious Diseases, Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Siok Hong Lim
- Infection Control, Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Thuraiya Jais
- Ward 55, Urgent Obstetric and Gynecology Centre, Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Gian Kaur
- Specialty and Ambulatory Services, KK Women's and Children's Hospital, Singapore
| | - Shanqing Yin
- Chairman Medical Board Office, KK Women's and Children's Hospital, Singapore
| | - Dirk de Korne
- Medical Innovation & Care Transformation, KK Women's & Children's Hospital, Singapore.,Department of Care and Welfare, SVRZ Cares in Zeeland, Middelburg, Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Koh Cheng Thoon
- Infectious Diseases, Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kee Chong Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Chairman Medical Board Office, KK Women's and Children's Hospital, Singapore
| |
Collapse
|
10
|
Increasing patient participation in hand hygiene practices in adult surgical wards in a tertiary institution: a best practice implementation project. JBI Evid Implement 2021; 20:53-62. [PMID: 34369896 DOI: 10.1097/xeb.0000000000000290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The WHO states that hospital-acquired infections may be transmitted through contaminated hands. Practicing hand hygiene using alcohol-based handrub or soap and water reduces harmful organisms. The Joanna Briggs Institute (JBI) best practice recommends empowering patients with hand hygiene knowledge and engaging their involvement to strengthen hand hygiene practices. AIMS The aim of this project was to improve hand hygiene among surgical inpatients. METHODS This evidence-based quality improvement project was conducted in three phases: the baseline audit, implementing best practice, and the postimplementation audit. Participants were patients hospitalized in three surgical wards of a 1200-bed acute care tertiary hospital. This project utilized the online JBI Practical Application of Clinical Evidence System and The Getting Research into Practice program to identify barriers and strategies. Nurses provided patients with an education pamphlet and regularly reminded them to improve their hand hygiene practices. RESULTS Ninety-four patients were audited between April and June 2018. Patients' hand hygiene practices improved from 19.1% at baseline audit to 61.7% (P < 0.01) at first follow-up audit. Patients' hand hygiene improved from 48.9 to 72.3% (P = 0.03) before meals, and from 92.6 to 98.9% (P = 0.65) after toileting. The proportion of patients who received a hand hygiene information leaflet in an appropriate language increased from 64.9 to 89.4% (P < 0.01). CONCLUSION Patients' involvement in the hand hygiene program has significantly improved their hand hygiene practices. Patient education and patient information leaflet continue to be an effective strategy to improve knowledge and practices.
Collapse
|
11
|
Bale TL, Ramukumba TS, Mudau LS. Evaluation of compliance to the World Health Organization’s five moments of hand hygiene: Cross-sectional observation of healthcare professionals. S Afr J Infect Dis 2021. [DOI: 10.4102/sajid.v36i1.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
12
|
Loveday HP, Tingle A, Wilson JA. Using a multimodal strategy to improve patient hand hygiene. Am J Infect Control 2021; 49:740-745. [PMID: 33352252 PMCID: PMC8807075 DOI: 10.1016/j.ajic.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The role of health care worker hand hygiene in preventing health care associated infections (HCAI) is well-established. There is less emphasis on the hand hygiene (HH) of hospitalized patients; in the context of COVID-19 mechanisms to support it are particularly important. The purpose of this study was to establish if providing patient hand wipes, and a defined protocol for encouraging their use, was effective in improving the frequency of patient HH (PHH). DESIGN Before and after study. SETTIN General Hospital, United Kingdom. PARTICIPANTS All adult patients admitted to 6 acute elderly care/rehabilitation hospital wards between July and October 2018. METHODS Baseline audit of PHH opportunities conducted over 6 weeks. Focus group with staff and survey of the public informed the development of a PHH bundle. Effect of bundle on PHH monitored by structured observation of HH opportunities over 12 weeks. RESULTS During baseline 303 opportunities for PHH were observed; compliance with PHH was 13.2% (40/303; 95% confidence interval 9.9-7.5). In the evaluation of PHH bundle, 526 PHH opportunities were observed with HH occurring in 58.9% (310/526); an increase of 45.7% versus baseline (95% confidence interval 39.7%-51.0%; P < .001). CONCLUSION Providing patients with multiwipe packs of handwipes is a simple, cost-effective approach to increasing PHH and reducing the risk of HCAI in hospital. Health care workers play an essential role in encouraging PHH.
Collapse
|
13
|
Ragusa R, Marranzano M, Lombardo A, Quattrocchi R, Bellia MA, Lupo L. Has the COVID 19 Virus Changed Adherence to Hand Washing among Healthcare Workers? Behav Sci (Basel) 2021; 11:53. [PMID: 33920791 PMCID: PMC8071195 DOI: 10.3390/bs11040053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
The aim of the study was to assess adherence to hand washing by healthcare workers (HCWs) and its variations over time in hospital wards. We wanted to check whether the pandemic had changed the behavior of HCWs. The study was conducted between 1 January 2015, and 31 December 2020. The HCWs were observed to assess their compliance with the Five Moments for Hand Hygiene. We described the percentage of adherence to World Health Organization (WHO) guidelines stratified per year, per specialty areas, per different types of HCWs. We also observed the use of gloves. Descriptive data were reported as frequencies and percentages. We observed 13,494 hand hygiene opportunities. The majority of observations concerned nurses who were confirmed as the category most frequently involved with patients. Hospital's global adherence to WHO guidelines did not change in the last six years. During the pandemic, the rate of adherence to the procedure increased significantly only in Intensive Care Unit (ICU). In 2020, the use of gloves increased in pre-patient contact. The hand-washing permanent monitoring confirmed that it is very difficult to obtain the respect of correct hand hygiene in all opportunities, despite the ongoing pandemic and the fear of contagion.
Collapse
Affiliation(s)
- Rosalia Ragusa
- Health Technology Assessment Committee, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95123 Catania, Italy
| | - Marina Marranzano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Via Santa Sofia, 87 95123 Catania, Italy; (M.M.); (L.L.)
| | - Alessandro Lombardo
- Committee for the Control of Hospital Infections, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95128 Catania, Italy;
| | - Rosalba Quattrocchi
- U.O. Health Education, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95128 Catania, Italy;
| | - Maria Alessandra Bellia
- School of Specialization in Microbiology, University of Catania, Via Santa Sofia, 78 95123 Catania, Italy;
| | - Lorenzo Lupo
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Via Santa Sofia, 87 95123 Catania, Italy; (M.M.); (L.L.)
| |
Collapse
|
14
|
Barriers and Facilitators of Adverse Event Reporting by Adolescent Patients and Their Families. J Patient Saf 2021; 16:232-237. [PMID: 28272293 DOI: 10.1097/pts.0000000000000290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The objectives were (1) to describe barriers and facilitators of adverse event reporting by adolescent patients and parents in a pediatric hospital and (2) to identify characteristics the participants wished to have in a formal reporting system of adverse events. METHODS We used a qualitative design in which 6 focus groups, 3 with parents and 3 with adolescents, were conducted. The transcripts of audio recordings, notes of team debriefings, and written field notes of group behaviors were analyzed using NVivo software for qualitative data analysis. RESULTS Participants reported that the quality of the experience with the health care system, type of communication with health care providers, and degree of personal self-confidence in communication within the health care system were 3 interacting factors influencing willingness to report adverse events. Preferred reporting mechanisms were different for different participants and included face-to-face meetings with hospital representatives, Web sites, smart phone capability, phone calls from a human, and paper mail. Reporting systems should be easy to use, ensure confidentiality, and provide user feedback. CONCLUSIONS Experience, communication, and confidence are 3 factors that can engage an adolescent patient and parents in their health care. Confident adolescent patients and parents in turn have a possibility of reporting an adverse safety event given an opportunity.
Collapse
|
15
|
Gaube S, Fischer P, Lermer E. Hand(y) hygiene insights: Applying three theoretical models to investigate hospital patients' and visitors' hand hygiene behavior. PLoS One 2021; 16:e0245543. [PMID: 33444410 PMCID: PMC7808666 DOI: 10.1371/journal.pone.0245543] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Improving hand hygiene in hospitals is the most efficient method to prevent healthcare-associated infections. The hand hygiene behavior of hospital patients and visitors is not well-researched, although they pose a risk for the transmission of pathogens. Therefore, the present study had three aims: (1) Finding a suitable theoretical model to explain patients' and visitors' hand hygiene practice; (2) Identifying important predictors for their hand hygiene behavior; and (3) Comparing the essential determinants of hand hygiene behavior between healthcare professionals from the literature to our non-professional sample. METHODS In total N = 1,605 patients and visitors were surveyed on their hand hygiene practice in hospitals. The employed questionnaires were based on three theoretical models: a) the Theory of Planned Behavior (TPB); b) the Health Action Process Approach (HAPA); and c) the Theoretical Domains Framework (TDF). Structural equation modeling was used to analyze the data. To compare our results to the determinants of healthcare workers' hand hygiene behavior, we searched for studies that used one of the three theoretical models. RESULTS Among patients, 52% of the variance in the hand hygiene behavior was accounted for by the TDF domains, 44% by a modified HAPA model, and 40% by the TPB factors. Among visitors, these figures were 59%, 37%, and 55%, respectively. Two clusters of variables surfaced as being essential determinants of behavior: self-regulatory processes and social influence processes. The critical determinants for healthcare professionals' hand hygiene reported in the literature were similar to the findings from our non-professional sample. CONCLUSIONS The TDF was identified as the most suitable model to explain patients' and visitors' hand hygiene practices. Patients and visitors should be included in existing behavior change intervention strategies. Newly planned interventions should focus on targeting self-regulatory and social influence processes to improve effectiveness.
Collapse
Affiliation(s)
- Susanne Gaube
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Peter Fischer
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Eva Lermer
- LMU Center for Leadership and People Management, LMU Munich, Munich, Germany
- FOM University of Applied Sciences for Economics & Management, Munich, Germany
| |
Collapse
|
16
|
Diedrich S, Görig T, Dittmann K, Kramer A, Heidecke CD, Hübner NO. Active Integration of Patients into Infection Control, as perceived by Health Care Professionals: Results of the AHOI Pilot Study. Infect Drug Resist 2020; 13:4009-4019. [PMID: 33204118 PMCID: PMC7667167 DOI: 10.2147/idr.s261343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
Objective Medical professionals have a key role in active patient involvement in infection control and prevention (ICP). ICP of hospital-associated infections is critical for patient safety and requires targeted integration of patients and their relatives. The possibilities of proper involvement are identified, tested and realized in the innovative AHOI project. Its acronym stands for Activation, Help, Open communication and Infection prevention. The project is based on the three dimensions acceptance, empowerment and adherence. The results presented here are from a health-care professional (HCP) focused part of a pilot study to implement AHOI intervention. This section aimed at the HCPs’ evaluation of the intervention material, their perception and acceptance of the adherence and empowerment of patients, as well as the perception of their and colleagues’ own behavior. Methods The cross-sectional survey was conducted with a questionnaire at two surgical wards of a third-level hospital for 14 weeks. All HCPs with contact to patients were entitled to voluntarily participate in the study. AHOI instruments such as visual reminder, videos for patients and the AHOI-box were implemented on the wards. Additionally, the ward personnel received a psychological and practical train-the-trainer curriculum. Results Sixty-nine questionnaires were handed out and 29 returns were analyzed. The results show a strong identification and acceptance of HCPs with their role in the AHOI project. No additional workload was perceived by implementing AHOI. Teaching of medical professionals and information materials are seen as good supports. HCPs are empowering hygienic behavior in patients and colleagues. HCPs observed increasing adherence of patients. Conclusion HCPs positively perceived acceptance, support and identification with the ideas of the AHOI project. Therefore, since HCPs are key for patients and their relatives, AHOI intervention seems to be a feasible instrument and aid in implementing national and international recommendations for hygienic behavior.
Collapse
Affiliation(s)
- Stephan Diedrich
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Tillmann Görig
- Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Kathleen Dittmann
- Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Claus-Dieter Heidecke
- Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Nils-Olaf Hübner
- Central Unit for Infection Prevention and Control, Universitätsmedizin Greifswald, Greifswald, Germany
| |
Collapse
|
17
|
Mody L, Washer LL, Kaye KS, Gibson K, Saint S, Reyes K, Cassone M, Mantey J, Cao J, Altamimi S, Perri M, Sax H, Chopra V, Zervos M. Multidrug-resistant Organisms in Hospitals: What Is on Patient Hands and in Their Rooms? Clin Infect Dis 2019; 69:1837-1844. [PMID: 30980082 PMCID: PMC6853699 DOI: 10.1093/cid/ciz092] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The impact of healthcare personnel hand contamination in multidrug-resistant organism (MDRO) transmission is important and well studied; however, the role of patient hand contamination needs to be characterized further. METHODS Patients from 2 hospitals in southeast Michigan were recruited within 24 hours of arrival to their room and followed prospectively using microbial surveillance of nares, dominant hand, and 6 high-touch environmental surfaces. Sampling was performed on admission, days 3 and 7, and weekly until discharge. Paired samples of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the patients' hand and room surfaces were evaluated for relatedness using pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec, and Panton-Valentine leukocidin typing. RESULTS A total of 399 patients (mean age, 60.8 years; 49% male) were enrolled and followed for 710 visits. Fourteen percent (n = 56/399) of patients were colonized with an MDRO at baseline; 10% (40/399) had an MDRO on their hands. Twenty-nine percent of rooms harbored an MDRO. Six percent (14/225 patients with at least 2 visits) newly acquired an MDRO on their hands during their stay. New MDRO acquisition in patients occurred at a rate of 24.6/1000 patient-days, and in rooms at a rate of 58.6/1000 patient-days. Typing demonstrated a high correlation between MRSA on patient hands and room surfaces. CONCLUSIONS Our data suggest that patient hand contamination with MDROs is common and correlates with contamination on high-touch room surfaces. Patient hand hygiene protocols should be considered to reduce transmission of pathogens and healthcare-associated infections.
Collapse
Affiliation(s)
- Lona Mody
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Detroit, Michigan
- Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Detroit, Michigan
| | - Laraine L Washer
- Department of Infection Prevention and Epidemiology, Michigan Medicine, Detroit, Michigan
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Detroit, Michigan
| | - Keith S Kaye
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Detroit, Michigan
| | - Kristen Gibson
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Detroit, Michigan
| | - Sanjay Saint
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Detroit, Michigan
- Division of Hospital Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Detroit, Michigan
| | - Katherine Reyes
- Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
| | - Marco Cassone
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Detroit, Michigan
| | - Julia Mantey
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Detroit, Michigan
| | - Jie Cao
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Detroit, Michigan
| | - Sarah Altamimi
- Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
| | - Mary Perri
- Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Detroit, Michigan
- Division of Hospital Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Detroit, Michigan
| | - Marcus Zervos
- Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
| |
Collapse
|
18
|
O'Donoghue M, Ho JMC, Pittet D, Suen LKP. Acceptability and tolerability of alcohol-based hand hygiene products for elderly residents in long-term care: a crossover study. Antimicrob Resist Infect Control 2019; 8:165. [PMID: 31673354 PMCID: PMC6819464 DOI: 10.1186/s13756-019-0610-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/21/2019] [Indexed: 01/28/2023] Open
Abstract
Background Hand hygiene is a critical component of infection control. Much of the focus on improving hand hygiene in healthcare settings has been directed towards healthcare worker compliance but its importance for patients, including those in long-term care facilities (LTCFs), is increasingly being recognised. Alcohol-based hand rub (ABHR) can lead to improved compliance. We aimed to determine acceptability and tolerability of two ABHRs for hand hygiene of elderly LTCF residents using a modified version of the WHO protocol. Methods Thirty six elderly LTCF residents participated in this crossover study. A modified and translated (Chinese) version of the WHO protocol for evaluation of two or more ABHRs was used to determine product acceptability and tolerability for one gel (bottle with reclosable cap) and one foam (pump). During the 3-day testing period, participants were provided with their own portable bottle of ABHR. A research nurse objectively assessed the skin integrity of the hands at baseline and throughout the study. Skin moisture content was determined using a Scalar Moisture Checker Probe (Science Technology Resources, Ca, USA). Participants rated ABHR tolerability and acceptability using the WHO checklist at the end of each test period. Results Both products passed the WHO criteria for acceptability and tolerability. The foam (86%) scored higher than the gel (51%) for ease of use possibly because some participants found the cap of the gel bottle difficult to open due to finger stiffness. No evidence of damage to skin integrity was observed. Overall, skin moisture content had improved by the end of the study. Residents preferred either of the test products to the liquid formulation currently in use by the LTCF. Conclusions Overall, the elderly were willing to use ABHR for hand hygiene. Both products were well tolerated and preferred over the usual product provided by the LTCF. However, forgetfulness and difficulty rubbing the product over the hands due to finger stiffness posed a challenge for some residents. This could be overcome by using healthcare worker-assisted hand hygiene at specified times each day and prompts to serve as reminders to perform hand hygiene.
Collapse
Affiliation(s)
- Margaret O'Donoghue
- 1Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University. Hung Hom, Kowloon, Hong Kong
| | - Jacqueline M C Ho
- 1Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University. Hung Hom, Kowloon, Hong Kong
| | - Didier Pittet
- 2Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Lorna K P Suen
- 1Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University. Hung Hom, Kowloon, Hong Kong
| |
Collapse
|
19
|
Li Y, Liu Y, Zeng L, Chen C, Mo D, Yuan S. Knowledge and practice of hand hygiene among hospitalised patients in a tertiary general hospital in China and their attitudes: a cross-sectional survey. BMJ Open 2019; 9:e027736. [PMID: 31189679 PMCID: PMC6575675 DOI: 10.1136/bmjopen-2018-027736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We aimed to gain a better understanding of patients' practice of hand hygiene (HH) and their knowledge and attitudes. DESIGN A cross-sectional survey. SETTING A 3500-bed university-affiliated medical hospital in China. PARTICIPANTS Inpatients and their family members or caregivers. METHODS An anonymous, self-reported questionnaire were used to collect data. RESULTS A total of 376 questionnaires were issued, and 310 respondents completed it. Of the 310 respondents, 47.4% had received HH education, and 13.5% had a completing understanding of HH. A majority of patients believed that handwashing was important for disease recovery, and that it could prevent infection development. A total of 62.3% of patients washed their hands <5 times a day and 49.0% spent <1 min every time. With regards to the seven steps of handwashing, 96.45% of the respondents adhered to the first step (washing the palms), but only 20.6% adhered to the fifth step (thumbs) and 17.7% to the sixth step (fingertips). Most respondents washed their hands only when visibly dirty. Few patients washed their hands before drinking fluids, and before and after interacting with visitors. HH compliance was lower among intensive care unit patients than medical patients. CONCLUSIONS In conclusion, this study demonstrated that patients had a positive attitude towards HH. However, their levels of knowledge and practice were unsatisfactory. A systematical education about patientHH is needed in future to correct this knowledge and behaviour.
Collapse
Affiliation(s)
- Yunxia Li
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Yaohong Liu
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Li Zeng
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Chong Chen
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Dan Mo
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Sue Yuan
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| |
Collapse
|
20
|
Andersen BM. Background Information: Isolation Routines. PREVENTION AND CONTROL OF INFECTIONS IN HOSPITALS 2019. [PMCID: PMC7122118 DOI: 10.1007/978-3-319-99921-0_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The isolation of patients with suspected or documented infections—to not spread to others—has been discussed for hundreds of years. Guidelines are many, methods are different, attitudes show vide variations, routines and procedures are still changing, regulations by law may be absent, and some healthcare professionals may be afraid of adverse outcomes of isolation [1–44]. Microbes that are spread in the environment, on the hands and equipment are invisible. The invisible agent does not call on attention before the infection; clinical disease, hospital infection or nosocomial infection is a factum that can be registered [23, 28, 29, 35–37]. How to stop the transmission is often “to believe and not believe” in infection control.
Collapse
|
21
|
Mishra SR, Haldar S, Khelifi M, Pollack AH, Wanda P. Must We Bust the Trust?: Understanding How the Clinician-Patient Relationship Influences Patient Engagement in Safety. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1425-1434. [PMID: 30815187 PMCID: PMC6371248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although patients desire safe care, they are reluctant to perform safety-related behaviors when they worry it could harm the relationships they have with clinicians. This influence of the clinician-patient relationship on patient engagement in safety is poorly understood, and most patient-facing safety interventions ignore its influence, focusing instead on helping patients access information about their care and report errors. We conducted semi-structured interviews with hospitalized patients to uncover their needs for patient-facing information systems that could help them prevent medical errors. We found that the clinician-patient relationship could either encourage or discourage patients and caregivers from engaging in patient safety actions. We describe our findings and discuss the implications for the design of patient-facing interventions to promote patient engagement in safety. Our findings shed light on how patient-facing safety interventions can be designed to effectively engage patients and caregivers.
Collapse
Affiliation(s)
| | | | | | - Ari H Pollack
- University of Washington, Seattle, WA
- Seattle Children's Hospital, Seattle, WA
| | | |
Collapse
|
22
|
Knighton SC, Dolansky M, Donskey C, Warner C, Rai H, Higgins PA. Use of a verbal electronic audio reminder with a patient hand hygiene bundle to increase independent patient hand hygiene practices of older adults in an acute care setting. Am J Infect Control 2018; 46:610-616. [PMID: 29502883 DOI: 10.1016/j.ajic.2018.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND We hypothesized that the addition of a novel verbal electronic audio reminder to an educational patient hand hygiene bundle would increase performance of self-managed patient hand hygiene. METHODS We conducted a 2-group comparative effectiveness study randomly assigning participants to patient hand hygiene bundle 1 (n = 41), which included a video, a handout, and a personalized verbal electronic audio reminder (EAR) that prompted hand cleansing at 3 meal times, or patient hand hygiene bundle 2 (n = 34), which included the identical video and handout, but not the EAR. The primary outcome was alcohol-based hand sanitizer use based on weighing bottles of hand sanitizer. RESULTS Participants that received the EAR averaged significantly more use of hand sanitizer product over the 3 days of the study (mean ± SD, 29.97 ± 17.13 g) than participants with no EAR (mean ± SD, 10.88 ± 9.27 g; t73 = 5.822; P ≤ .001). CONCLUSIONS The addition of a novel verbal EAR to a patient hand hygiene bundle resulted in a significant increase in patient hand hygiene performance. Our results suggest that simple audio technology can be used to improve patient self-management of hand hygiene. Future research is needed to determine if the technology can be used to promote other healthy behaviors, reduce infections, and improve patient-centered care without increasing the workload of health care workers.
Collapse
|
23
|
Barker AK, Alagoz O, Safdar N. Interventions to Reduce the Incidence of Hospital-Onset Clostridium difficile Infection: An Agent-Based Modeling Approach to Evaluate Clinical Effectiveness in Adult Acute Care Hospitals. Clin Infect Dis 2018; 66:1192-1203. [PMID: 29112710 PMCID: PMC5888988 DOI: 10.1093/cid/cix962] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022] Open
Abstract
Background Despite intensified efforts to reduce hospital-onset Clostridium difficile infection (HO-CDI), its clinical and economic impacts continue to worsen. Many institutions have adopted bundled interventions that vary considerably in composition, strength of evidence, and effectiveness. Considerable gaps remain in our knowledge of intervention effectiveness and disease transmission, which hinders HO-CDI prevention. Methods We developed an agent-based model of C. difficile transmission in a 200-bed adult hospital using studies from the literature, supplemented with primary data collection. The model includes an environmental component and 4 distinct agent types: patients, visitors, nurses, and physicians. We used the model to evaluate the comparative clinical effectiveness of 9 single interventions and 8 multiple-intervention bundles at reducing HO-CDI and asymptomatic C. difficile colonization. Results Daily cleaning with sporicidal disinfectant and C. difficile screening at admission were the most effective single-intervention strategies, reducing HO-CDI by 68.9% and 35.7%, respectively (both P < .001). Combining these interventions into a 2-intervention bundle reduced HO-CDI by 82.3% and asymptomatic hospital-onset colonization by 90.6% (both, P < .001). Adding patient hand hygiene to healthcare worker hand hygiene reduced HO-CDI rates an additional 7.9%. Visitor hand hygiene and contact precaution interventions did not reduce HO-CDI, compared with baseline. Excluding those strategies, healthcare worker contact precautions were the least effective intervention at reducing hospital-onset colonization and infection. Conclusions Identifying and managing the vast hospital reservoir of asymptomatic C. difficile by screening and daily cleaning with sporicidal disinfectant are high-yield strategies. These findings provide much-needed data regarding which interventions to prioritize for optimal C. difficile control.
Collapse
Affiliation(s)
- Anna K Barker
- Department of Population Health Sciences, School of Medicine and Public Health, Madison, Wisconsin
| | - Oguzhan Alagoz
- Department of Population Health Sciences, School of Medicine and Public Health, Madison, Wisconsin
- Department of Industrial and Systems Engineering, College of Engineering, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| |
Collapse
|
24
|
Barker AK, Zellmer C, Tischendorf J, Duster M, Valentine S, Wright MO, Safdar N. On the hands of patients with Clostridium difficile: A study of spore prevalence and the effect of hand hygiene on C difficile removal. Am J Infect Control 2017; 45:1154-1156. [PMID: 28964347 DOI: 10.1016/j.ajic.2017.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 02/04/2023]
Abstract
The prevalence of Clostridium difficile spores was assessed in 48 observations of infected inpatients. Participants were randomized to hand hygiene with either alcohol-based handrub or soap and water. C difficile was recovered in 14.6% of pre-hand hygiene observations. It was still present on 5 of these 7 participants after hand hygiene (3/3 using alcohol-based handrub; 2/4 using soap and water).
Collapse
Affiliation(s)
- Anna K Barker
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Caroline Zellmer
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Jessica Tischendorf
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Megan Duster
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Susan Valentine
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Marc Oliver Wright
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Nasia Safdar
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI; William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI.
| |
Collapse
|
25
|
Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department. CAN J EMERG MED 2017; 20:104-111. [PMID: 28756779 DOI: 10.1017/cem.2017.361] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Emergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training. In this first of three articles meant as a QI primer for EM clinicians, we will introduce QI methodology and strategic planning using a fictional case study as an example. We will review how to identify a QI problem, define components of an effective problem statement, and identify stakeholders and core change team members. We will also describe three techniques used to perform root cause analyses-Ishikawa diagrams, Pareto charts and process mapping-and how they relate to preparing for a QI project. The next two papers in this series will focus on the execution of the QI project itself using rapid-cycle testing and on the evaluation and sustainability of QI projects.
Collapse
|
26
|
Knighton SC, McDowell C, Rai H, Higgins P, Burant C, Donskey CJ. Feasibility: An important but neglected issue in patient hand hygiene. Am J Infect Control 2017; 45:626-629. [PMID: 28189410 DOI: 10.1016/j.ajic.2016.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/23/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient hand hygiene may be a useful strategy to prevent acquisition of pathogens and to reduce the risk for transmission by colonized patients. Several studies demonstrate that patients and long-term-care facility (LTCF) residents may have difficulty using hand hygiene products that are provided; however, none of them measure feasibility for patients to use different hand hygiene products. METHODS A convenience sample of 42 hospitalized patients and 46 LTCF residents was assessed for their ability to use 3 hand sanitizer products (8-oz pushdown pump bottle, 2-oz pocket-sized bottle with a reclosable lid, and alcohol-impregnated hand wipes). The time (seconds) required for accessing each product was compared among acute-care patients and LTCF residents. Participants provided feedback on which product they preferred and found easiest to use. RESULTS Of 88 participants, 86 (97.7%) preferred the pushdown pump, 2 (2.3%) preferred the bottle with the reclosable lid, and none preferred the hand wipes. For both hospitalized patients and LTCF residents, the average time required to access the pushdown pump was significantly less than the time required to access the other products (pushdown pump, 0.45 seconds; bottle with reclosable lid, 3.86 seconds; and wipes, 5.66 seconds; P < .001). CONCLUSIONS Feasibility and ease of use should be considered in the selection of hand hygiene products for patients and LTCF residents.
Collapse
|
27
|
A Randomized Trial to Determine the Impact of an Educational Patient Hand-Hygiene Intervention on Contamination of Hospitalized Patient's Hands with Healthcare-Associated Pathogens. Infect Control Hosp Epidemiol 2017; 38:595-597. [PMID: 28052790 DOI: 10.1017/ice.2016.323] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We conducted a non-blinded randomized trial to determine the impact of a patient hand-hygiene intervention on contamination of hospitalized patients' hands with healthcare-associated pathogens. Among patients with negative hand cultures on admission, recovery of pathogens from hands was significantly reduced in those receiving the intervention versus those receiving standard care. Infect Control Hosp Epidemiol 2017;38:595-597.
Collapse
|
28
|
Affiliation(s)
- Amy Tran
- In Cincinnati, Ohio, Amy Tran is an RN in the renal/transplant unit at the University of Cincinnati Medical Center and Jody Miniard is a visiting instructor at the University of Cincinnati College of Nursing
| | | |
Collapse
|
29
|
Boyle ML, Ruth-Sahd LA, Zhou Z. Fecal microbiota transplant to treat recurrent Clostridium difficile infections. Crit Care Nurse 2016; 35:51-64; quiz 65. [PMID: 25834008 DOI: 10.4037/ccn2015356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The prevalence of recurrent or refractory Clostridium difficile infection has been steadily increasing since 2000. Consequently, alternative treatments to the standard antibiotic therapies are now being considered. One alternative treatment is fecal microbiota transplant. Although fecal microbiota transplant is relatively new--and not appealing to most people--it has been around for many years and has great promise as an inexpensive, safe, and efficient treatment of refractory and recurrent C difficile infection. With a better understanding of the intricacies of the colonic microbiome and its role in colonic physiology and pathophysiology, critical care nurses will recognize that fecal microbiota transplant has the potential to become the standard of care for treatment of recurrent or refractory C difficile infection. The American College of Gastroenterology and the Infectious Diseases Society of America provide the latest treatment guidelines for care of patients with these clostridial infections.
Collapse
Affiliation(s)
- Miriam L Boyle
- Lisa Ruth-Sahd is an associate professor of nursing at York College of Pennsylvania. She is also a nurse extern coordinator at Lancaster General Hospital, Lancaster, Pennsylvania.Zehao Zhou is an assistant professor and information services librarian of Schmidt Library, York College of Pennsylvania
| | - Lisa A Ruth-Sahd
- Lisa Ruth-Sahd is an associate professor of nursing at York College of Pennsylvania. She is also a nurse extern coordinator at Lancaster General Hospital, Lancaster, Pennsylvania.Zehao Zhou is an assistant professor and information services librarian of Schmidt Library, York College of Pennsylvania.
| | - Zehao Zhou
- Lisa Ruth-Sahd is an associate professor of nursing at York College of Pennsylvania. She is also a nurse extern coordinator at Lancaster General Hospital, Lancaster, Pennsylvania.Zehao Zhou is an assistant professor and information services librarian of Schmidt Library, York College of Pennsylvania
| |
Collapse
|
30
|
Patient-centred hand hygiene information in orthopaedics units: an evidence-based implementation project. INT J EVID-BASED HEA 2016; 15:22-29. [PMID: 27875344 DOI: 10.1097/xeb.0000000000000094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM This project aimed to improve patients' knowledge on the importance of hand hygiene. It involved providing patients with a patient and family education on the importance of hand hygiene using a patient information leaflet that introduces the rationale of hand hygiene, possible consequences of poor hand hygiene, and the seven steps of hand hygiene. METHODS This projected used a preimplementation and postimplementation audit strategy using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programs. The implementation occurred in three phases over a period of 6 months from January 2014 to June 2014. The audits took place in two orthopaedic wards in a large acute care setting tertiary hospital in Singapore and involved a sample size of 54 patients. It involved going through the medical records of the cases, assessment of patient knowledge based on the audit criteria, and checking if the patients received the patient information leaflet on hand hygiene. RESULTS The postimplementation audit found significant improvements in all three audit criteria. The percentage of patients who demonstrated knowledge in the importance of hand hygiene saw an improvement of 48.1%. There was an improvement of 44.5% in nurses' compliance to the documentation of patient education being carried out. The percentage of patients who received a patient information leaflet on hand hygiene saw an increase of 36.1%. CONCLUSION This project demonstrated that a preimplementation and postimplementation audit is a viable method to implement change and translate evidence into practice. Through this project, patients gained an understanding on the importance of hand hygiene and could take better ownership of their well being. This may potentially improve hospitalization experience and benefit health outcomes. The positive results of this project are contributed by the enthusiastic involvement of all the stakeholders, from patients and their caregivers to the bedside nurses and nursing leaders. The sustenance will be an ongoing challenge to the project.
Collapse
|
31
|
González-Estrada A, Fernández-Prada M, Martínez Ortega C, Lana Pérez A, López González M. Cumplimiento de las precauciones de aislamiento de contacto por microorganismos multirresistentes en un hospital de tercer nivel. ACTA ACUST UNITED AC 2016; 31:293-9. [DOI: 10.1016/j.cali.2016.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/20/2015] [Accepted: 01/08/2016] [Indexed: 12/01/2022]
|
32
|
Dawczynski K, Proquitté H, Roedel J, Edel B, Pfeifer Y, Hoyer H, Dobermann H, Hagel S, Pletz MW. Intensified colonisation screening according to the recommendations of the German Commission for Hospital Hygiene and Infectious Diseases Prevention (KRINKO): identification and containment of a Serratia marcescens outbreak in the neonatal intensive care unit, Jena, Germany, 2013-2014. Infection 2016; 44:739-746. [PMID: 27401691 DOI: 10.1007/s15010-016-0922-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE In 2013, the German Commission for Hospital Hygiene and Infectious Disease Prevention (KRINKO) stated that extending weekly colonisation screening from very low birth weight (VLBW) infants (<1500 g) to all patients in the Neonatal Intensive Care Unit (NICU) might be useful. METHODS After implementing this recommendation, we detected a previously unnoticed cluster of Serratia marcescens. Strains were typed by Pulsed Field Gel Electrophoresis (PFGE). RESULTS Over 6 months, 19 out of 159 infants acquired S. marcescens. Twelve of the nineteen patients with S. marcescens were non-VLBW infants, and they were colonised significantly earlier than were VLBW infants (median 17 vs. 28 days; p < 0.01). Molecular typing revealed a polyclonal outbreak with multiple strain types leading to one or two transmissions each and a dominating outbreak strains being involved in an explosive outbreak involving eight neonates. CONCLUSION The revised KRINKO recommendation may help identify unnoticed outbreaks. Colonised non-VLBW patients may be an underestimated source of S. marcescens.
Collapse
Affiliation(s)
- Kristin Dawczynski
- Unit Neonatology, Department of Paediatrics, Jena University Hospital, Jena, Germany
| | - Hans Proquitté
- Unit Neonatology, Department of Paediatrics, Jena University Hospital, Jena, Germany
| | - Jürgen Roedel
- Institute for Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Brigit Edel
- Institute for Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Yvonne Pfeifer
- Nosocomial Pathogens and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany
| | - Heike Hoyer
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany
| | - Helke Dobermann
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Germany
| | - Stefan Hagel
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Germany.
| |
Collapse
|
33
|
Caine LZ, Pinkham AM, Noble JT. Be seen and heard being clean: A novel patient-centered approach to hand hygiene. Am J Infect Control 2016; 44:e103-6. [PMID: 26856466 DOI: 10.1016/j.ajic.2015.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 11/18/2015] [Accepted: 11/19/2015] [Indexed: 11/29/2022]
Abstract
A quasiexperimental pre- and posttest design was used to evaluate hand hygiene (HH) rates on a medical-surgical unit. Data were collected by asking patients if they had seen or heard staff members cleaning their hands. Sixty-five percent of patients reported seeing or hearing staff perform HH preintervention and 93% reported observations postintervention (P < .001). Through incorporating an auditory cue we engaged patients while removing the burden placed on them to question health care worker behavior, and increased both staff and patient awareness of personal HH behavior.
Collapse
Affiliation(s)
- Lynda Z Caine
- Infection Prevention, Concord Hospital, Concord, NH.
| | | | - James T Noble
- Infectious Disease, Concord Hospital Medical Group, Concord, NH
| |
Collapse
|
34
|
Cheng VCC, Tai JWM, Li WS, Chau PH, So SYC, Wong LMW, Ching RHC, Ng MML, Ho SKY, Lee DWY, Lee WM, Wong SCY, Yuen KY. Implementation of directly observed patient hand hygiene for hospitalized patients by hand hygiene ambassadors in Hong Kong. Am J Infect Control 2016; 44:621-4. [PMID: 26777285 DOI: 10.1016/j.ajic.2015.11.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The importance of compliance with hand hygiene by patients is increasingly recognized to prevent health care-associated infections. METHODS This descriptive study observed the effects of an education campaign, targeted to increase patients' self-initiated hand hygiene, and a hand hygiene ambassador-initiated directly observed hand hygiene program on patients' hand hygiene compliance in a university-affiliated hospital. RESULTS The overall audited compliance of patients' self-initiated hand hygiene was only 37.5%, with a rate of 26.9% (112/416 episodes) before meals and medications, 27.5% (19/69 episodes) after using a urinal or bedpan, and 89.7% (87/97 episodes) after attending toilet facilities. Patients referred from a residential care home for older adults had significantly lower hand hygiene compliance (P = .007). Comparatively, the overall audited compliance of ambassador-initiated directly observed hand hygiene was 97.3% (428/440 episodes), which was significantly higher than patients' self-initiated hand hygiene via a patient education program (37.5%, 218/582 episodes, P < .001). CONCLUSIONS Directly observed hand hygiene can play an important role in improving compliance with hand hygiene by hospitalized patients.
Collapse
Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Josepha W M Tai
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - W S Li
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - P H Chau
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Simon Y C So
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Lisa M W Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Radley H C Ching
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Modissa M L Ng
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Sara K Y Ho
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Doris W Y Lee
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - W M Lee
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Sally C Y Wong
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - K Y Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
| |
Collapse
|
35
|
Kundrapu S, Sunkesula V, Jury I, Deshpande A, Donskey CJ. A Randomized Trial of Soap and Water Hand Wash Versus Alcohol Hand Rub for Removal of Clostridium difficile Spores from Hands of Patients. Infect Control Hosp Epidemiol 2016; 35:204-6. [DOI: 10.1086/674859] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
36
|
Efficacy of alcohol gel for removal of methicillin-resistant Staphylococcus aureus from hands of colonized patients. Infect Control Hosp Epidemiol 2015; 36:229-31. [PMID: 25633009 DOI: 10.1017/ice.2014.34] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Of 82 patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization, 67 (82%) had positive hand cultures for MRSA. A single application of alcohol gel (2 mL) consistently reduced the burden of MRSA on hands. However, incomplete removal of MRSA was common, particularly in those with a high baseline level of recovery.
Collapse
|
37
|
Infektionsprävention im Rahmen der Pflege und Behandlung von Patienten mit übertragbaren Krankheiten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:1151-70. [DOI: 10.1007/s00103-015-2234-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
38
|
Rinke ML, Chen AR, Milstone AM, Hebert LC, Bundy DG, Colantuoni E, Fratino L, Herpst C, Kokoszka M, Miller MR. Bringing central line-associated bloodstream infection prevention home: catheter maintenance practices and beliefs of pediatric oncology patients and families. Jt Comm J Qual Patient Saf 2015; 41:177-85. [PMID: 25977202 DOI: 10.1016/s1553-7250(15)41023-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A study was conducted to investigate (1) the extent to which best-practice central line maintenance practices were employed in the homes of pediatric oncology patients and by whom, (2) caregiver beliefs about central line care and central line-associated blood stream infection (CLABSI) risk, (3) barriers to optimal central line care by families, and (4) educational experiences and preferences regarding central line care. METHODS Researchers administered a survey to patients and families in a tertiary care pediatric oncology clinic that engaged in rigorous ambulatory and inpatient CLABSI prevention efforts. RESULTS Of 110 invited patients and caregivers, 105 participated (95% response rate) in the survey (March-May 2012). Of the 50 respondents reporting that they or another caregiver change central line dressings, 48% changed a dressing whenever it was soiled as per protocol (many who did not change dressings per protocol also never personally changed dressings); 67% reported the oncology clinic primarily cares for their child's central line, while 29% reported that an adult caregiver or the patient primarily cares for the central line. Eight patients performed their own line care "always" or "most of the time." Some 13% of respondents believed that it was "slightly likely" or "not at all likely" that their child will get an infection if caregivers do not perform line care practices perfectly every time. Dressing change practices were the most difficult to comply with at home. Some 18% of respondents wished they learned more about line care, and 12% received contradictory training. Respondents cited a variety of preferences regarding line care teaching, although the majority looked to clinic nurses for modeling line care. CONCLUSIONS Interventions aimed at reducing ambulatory CLABSIs should target appropriate educational experiences for adult caregivers and patients and identify ways to improve compliance with best-practice care.
Collapse
|
39
|
Różańska A, Bulanda M. Demographic characteristics of patients and their assessment of selected hygienic practices of hospital personnel in the context of safety climate of hospitalization. Am J Infect Control 2015; 43:354-7. [PMID: 25681306 DOI: 10.1016/j.ajic.2014.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hand hygiene (HH) is a key factor in hospital infection prevention and patient safety. The objectives of this article were to examine patients' observations concerning compliance with selected procedures for hospital hygiene among medical personnel and assess the correlation between patients' key demographic characteristics and their awareness and sense of safety associated with hospitalization. METHODS The study was conducted in January 2012 on a sample of 491 subjects by means of a standardized 10-minute computer-assisted telephone interview survey. RESULTS There was a statistically significant correlation between the sense of safety associated with hospitalization declared by patients and their observation of HH practices among health care personnel. A positive correlation was also found between the respondents experiencing personal complications in the form of health care-associated infections themselves or among their family members and the sense of safety associated with hospital treatment. CONCLUSIONS Performing HH among hospital staff is one of the factors affecting patients' increased sense of safety during their hospitalization; therefore, HH contributes to the perception of good quality of service provided. Knowledge of the risk of HH does not affect the patients' sense of safety, in contrast with their real-life experiences.
Collapse
|
40
|
Patients' perceptions of hospital-acquired infections in northern Queensland, Australia: a pilot study. Am J Infect Control 2015; 43:418-9. [PMID: 25721059 DOI: 10.1016/j.ajic.2015.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 11/24/2022]
|
41
|
Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35 Suppl 2:S48-65. [PMID: 25376069 DOI: 10.1017/s0899823x00193857] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. This document updates “Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
Collapse
|
42
|
Wyer M, Jackson D, Iedema R, Hor SY, Gilbert GL, Jorm C, Hooker C, O'Sullivan MVN, Carroll K. Involving patients in understanding hospital infection control using visual methods. J Clin Nurs 2015; 24:1718-29. [PMID: 25662176 DOI: 10.1111/jocn.12779] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This paper explores patients' perspectives on infection prevention and control. BACKGROUND Healthcare-associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front-line clinicians' practices; patients' roles have been less explored. DESIGN Video-reflexive ethnography. METHODS Fieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one-on-one reflexive sessions. FINDINGS Viewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency. CONCLUSION This study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient-provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care. RELEVANCE TO CLINICAL PRACTICE This study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self-care behaviour.
Collapse
Affiliation(s)
- Mary Wyer
- Faculty of Health, School of Health Sciences, University of Tasmania (Sydney Campus), Darlinghurst, NSW, Australia
| | - Debra Jackson
- Oxford Brookes University, Faculty of Health and Life Sciences, Oxford and University of New England, School of Health, Darlinghurst, NSW, Australia
| | - Rick Iedema
- Faculty of Health, School of Health Sciences, University of Tasmania (Sydney Campus), Darlinghurst, NSW, Australia.,Agency for Clinical Innovation, NSW Ministry of Health, Chatswood, NSW, Australia
| | - Su-Yin Hor
- Faculty of Arts and Social Sciences, University of Technology, Sydney, NSW, Australia
| | - Gwendolyn L Gilbert
- Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine, University of Sydney, Westmead, NSW, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine Jorm
- Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Claire Hooker
- Medical Humanities, Centre for Values, Ethics and the Law in Medicine, Faculty of Medicine, The University Of Sydney, Camperdown, NSW, Australia
| | - Matthew Vincent Neil O'Sullivan
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia.,Marie Bashir Institution for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW, Australia
| | | |
Collapse
|
43
|
O'Donnell M, Harris T, Horn T, Midamba B, Primes V, Sullivan N, Shuler R, Zabarsky TF, Deshpande A, Sunkesula VC, Kundrapu S, Donskey CJ. Sustained increase in resident meal time hand hygiene through an interdisciplinary intervention engaging long-term care facility residents and staff. Am J Infect Control 2015; 43:162-4. [PMID: 25637117 DOI: 10.1016/j.ajic.2014.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
Hand hygiene by patients may prevent acquisition and dissemination of health care-associated pathogens, but limited efforts have been made to engage patients in hand hygiene interventions. In a long-term care facility, we found that residents were aware of the importance of hand hygiene, but barriers, such as inaccessible products or difficult to use products, limited compliance. A dramatic and sustained improvement in meal time hand hygiene was achieved through engagement of staff and residents.
Collapse
|
44
|
Dubberke ER, Carling P, Carrico R, Donskey CJ, Loo VG, McDonald LC, Maragakis LL, Sandora TJ, Weber DJ, Yokoe DS, Gerding DN. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 Update. Infect Control Hosp Epidemiol 2015; 35:628-45. [PMID: 24799639 DOI: 10.1086/676023] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Erik R Dubberke
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
McInnes E, Phillips R, Middleton S, Gould D. A qualitative study of senior hospital managers' views on current and innovative strategies to improve hand hygiene. BMC Infect Dis 2014; 14:611. [PMID: 25407783 PMCID: PMC4237732 DOI: 10.1186/s12879-014-0611-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 11/04/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite universal recognition of the importance of hand hygiene in reducing the incidence of healthcare associated infections, health care workers' compliance with best practice has been sub-optimal. Senior hospital managers have responsibilities for implementing patient safety initiatives and are therefore ideally placed to provide suggestions for improving strategies to increase hand hygiene compliance. This is an under-researched area, accordingly the aim of this study was to identify senior hospital managers' views on current and innovative strategies to improve hand hygiene compliance. METHODS Qualitative design comprising face-to-face interviews with thirteen purposively sampled senior managers at a major teaching and referral hospital in Sydney, Australia. Data were analysed thematically. RESULTS Seven themes emerged: culture change starts with leaders, refresh and renew the message, connect the five moments to the whole patient journey, actionable audit results, empower patients, reconceptualising non-compliance and start using the hammer. CONCLUSIONS To strengthen hand hygiene programmes, strategies based on the five moments of hand hygiene should be tailored to specific roles and settings and take into account the whole patient journey including patient interactions with clinical and non-clinical staff. Senior clinical and non-clinical leaders should visibly champion and mandate best practice initiatives and articulate that hand hygiene non-compliance is culturally and professionally unacceptable to the organization. Strategies that included a disciplinary component and which conceptualise hand hygiene non-compliance as a patient safety error may be worth evaluating in terms of staff acceptability and effectiveness.
Collapse
Affiliation(s)
- Elizabeth McInnes
- />Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, de Lacy Building, 390 Darlinghurst Road, Darlinghurst, 2010 NSW Australia
- />School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 33 Berry Street, North Sydney, 2060 NSW Australia
| | - Rosemary Phillips
- />Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, de Lacy Building, 390 Darlinghurst Road, Darlinghurst, 2010 NSW Australia
| | - Sandy Middleton
- />Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5, de Lacy Building, 390 Darlinghurst Road, Darlinghurst, 2010 NSW Australia
- />School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 33 Berry Street, North Sydney, 2060 NSW Australia
| | - Dinah Gould
- />School of Healthcare Sciences, Cardiff University, Eastgate House, Newport Road, Cardiff, CF24 OAB UK
| |
Collapse
|
46
|
Johnson L, Grueber S, Schlotzhauer C, Phillips E, Bullock P, Basnett J, Hahn-Cover K. A multifactorial action plan improves hand hygiene adherence and significantly reduces central line-associated bloodstream infections. Am J Infect Control 2014; 42:1146-51. [PMID: 25444260 DOI: 10.1016/j.ajic.2014.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/01/2014] [Accepted: 07/02/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although hand hygiene (HH) is key to reducing health care-associated infections, it is well documented that health care worker (HCW) adherence to appropriate HH protocols is relatively low. METHODS This was a collaborative quality improvement project with multiple interventions conducted in a 570-bed academic hospital in Columbia, MO between April 2006 and September 2012. A multimodal action plan to improve HH adherence among all HCWs was developed, addressing 4 key areas: staff education, staff accountability, hand sanitizer product selection and accessibility, and organizational culture. HH adherence and central line-associated bloodstream infection (CLABSI) rates were monitored as outcome measures. RESULTS The overall HH adherence rate increased from 58% in April 2006 to 98% in September 2012. The adherence rates increased among all hospital units and among all HCW categories; in September 2012, HH adherence was 96% for physicians, 99% for nursing staff, and 99% for food services staff. CLABSI rates decreased over the same period, from 4.08 per 1000 device-days to 0.42 per 1000 device-days. CONCLUSIONS This multifactorial quality improvement project resulted in an institution-wide increase in HH adherence and a significant decrease in CLABSIs.
Collapse
|
47
|
Barker A, Sethi A, Shulkin E, Caniza R, Zerbel S, Safdar N. Patients' hand hygiene at home predicts their hand hygiene practices in the hospital. Infect Control Hosp Epidemiol 2014; 35:585-8. [PMID: 24709731 DOI: 10.1086/675826] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We examine factors associated with hand hygiene practices of hospital patients. Hygiene in the hospital decreased compared to that at home, and home practices were strongly associated with hospital practices. Understanding and leveraging the intrinsic value some patients associate with hand hygiene may be important for improving overall hospital hygiene and decreasing healthcare-associated infections.
Collapse
Affiliation(s)
- Anna Barker
- Department of Population Health Sciences, University of Wisconsin Medical School, Madison, Wisconsin
| | | | | | | | | | | |
Collapse
|
48
|
Sharp D, Palmore T, Grady C. The ethics of empowering patients as partners in healthcare-associated infection prevention. Infect Control Hosp Epidemiol 2014; 35:307-9. [PMID: 24521598 DOI: 10.1086/675288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Daniel Sharp
- Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland
| | | | | |
Collapse
|
49
|
Wyer M, Iedema R, Hor SY. Editorial: Patients: passive subjects or active participants in reducing the spread of infection? J Clin Nurs 2014; 23:2385-6. [DOI: 10.1111/jocn.12464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mary Wyer
- Centre for Health Communication; University of Technology; Sydney NSW Australia
| | - Rick Iedema
- Centre for Health Communication; University of Technology; Sydney NSW Australia
| | - Su-Yin Hor
- Centre for Health Communication; University of Technology; Sydney NSW Australia
| |
Collapse
|
50
|
Control of Foodborne Viruses at Retail. RETAIL FOOD SAFETY 2014. [PMCID: PMC7122658 DOI: 10.1007/978-1-4939-1550-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|