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Livshiz-Riven I, Hurvitz N, Nativ R, Borer A, Gushansky A, Eilig D, Kopitman A, Ziv-Baran T. Nursing students led simulations to improve healthcare workers' hand hygiene compliance. Contemp Nurse 2024:1-14. [PMID: 38470983 DOI: 10.1080/10376178.2024.2322994] [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: 02/09/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Hand hygiene compliance (HHC) is recognised as a major factor in the prevention of healthcare-associated infections. Healthcare workers (HCWs) compliance is still suboptimal. Simulation as an educational strategy may contribute to improved performance. OBJECTIVE This study aimed to assess the effect of simulation interventions led by nursing students on HCWs' HHC. METHOD A prospective quasi-experimental design with before and after intervention measurements was implemented in an 1150-bed tertiary hospital. Four consecutive periods, measuring before and after HHC, were examined in four hospital divisions. For each division, unique simulation activities were developed and led by nursing students, educators, and hospital leaders. Sixty seven students and 286 healthcare workers, along with two nurse educators, participated in the simulation sessions. HHC of all HCWs in the divisions was assessed by hospital infection control personnel. RESULTS Hospital HHC rose across the four periods in all four divisions during this study. In three out of four periods and divisions, HHC increased significantly more in the simulation intervention groups compared to the overall hospital improvement. CONCLUSION Student-led simulation for HCWs is an additional effective method to improve HHC. Nursing managers should consider joining forces with nursing educators to enable students to become agents of change in healthcare settings and encourage further collaboration.
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Affiliation(s)
- Ilana Livshiz-Riven
- Department of Nursing, Recanati School for Community Health ProfessionsBen-Gurion University of the Negev, Beer-Sheva, Israel
- Quality Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Nancy Hurvitz
- Department of Nursing, Recanati School for Community Health ProfessionsBen-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ronit Nativ
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Abraham Borer
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alex Gushansky
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Dynai Eilig
- Orthopaedic Department, Assuta-Ashdod Medical Center, Ashdod, Israel
| | - Alina Kopitman
- Obstetrics and Gynaecology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv, Israel
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Gobte NJ, Gozdzielewska L, Kc D, Sithole BL, Vorndran A, McAloney-Kocaman K, Mehtar S, Price L. Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon. Am J Infect Control 2024; 52:274-279. [PMID: 37741291 DOI: 10.1016/j.ajic.2023.09.011] [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: 06/29/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital. METHODS It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance. RESULTS 5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml). CONCLUSIONS Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.
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Affiliation(s)
- Nkwan J Gobte
- Baptist Training School for Health Personnel, Cameroon Baptist Convention Health Services, Banso, Cameroon
| | - Lucyna Gozdzielewska
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - Deepti Kc
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | | | - Anna Vorndran
- Infection Control Africa Network (ICAN), Cape Town, South Africa
| | | | - Shaheen Mehtar
- Infection Control Africa Network (ICAN), Cape Town, South Africa
| | - Lesley Price
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK
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Chitamanni P, Allana A, Hand I. Quality Improvement Project to Improve Hand Hygiene Compliance in a Level III Neonatal Intensive Care Unit. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1484. [PMID: 37761445 PMCID: PMC10528076 DOI: 10.3390/children10091484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
This quality improvement project aimed to improve hand hygiene (HH) compliance in a Level III Neonatal Intensive Care Unit. The project was conducted over three Plan-Do-Study-Act (PDSA) cycles, with each cycle lasting two months. The interventions included healthcare worker (HCW) education on HH, repetition of education, and immediate feedback to HCWs. Compliance data were collected through covert observations of HCWs in the NICU. The overall compliance rate increased from 31.56% at baseline to 46.64% after the third PDSA cycle. The HH compliance was noted to be relatively low after touching patient care surroundings, at entry and exit from the NICU main unit, before wearing gloves and after removing gloves, at baseline and throughout the three PDSA cycles. HCW education alone did not result in significant improvements, highlighting the need for additional interventions. The study underscores the importance of involving NICU leadership and providing immediate feedback to promote HH compliance. Further efforts should focus on addressing the false sense of security associated with glove usage among HCWs, individual rewards and involving the healthcare staff in the shared goal of increasing HH compliance. Consideration of workload metrics and their impact on compliance could steer future interventions.
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Affiliation(s)
- Pavani Chitamanni
- Department of Pediatrics, NYC Health & Hospitals/Kings County, Brooklyn, NY 11203, USA; (P.C.); (A.A.)
- Department of Pediatrics, SUNY-Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Ahreen Allana
- Department of Pediatrics, NYC Health & Hospitals/Kings County, Brooklyn, NY 11203, USA; (P.C.); (A.A.)
- Department of Pediatrics, SUNY-Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Ivan Hand
- Department of Pediatrics, NYC Health & Hospitals/Kings County, Brooklyn, NY 11203, USA; (P.C.); (A.A.)
- Department of Pediatrics, SUNY-Downstate Health Sciences University, Brooklyn, NY 11203, USA
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Hussenoeder FS. Social network sites as learning environments and their implications for mental health. Front Digit Health 2022; 4:939740. [PMID: 36300130 PMCID: PMC9589159 DOI: 10.3389/fdgth.2022.939740] [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: 06/15/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Social network sites (SNSs) have become ubiquitous around the globe and interwoven with all aspects of life. In this article, I will argue that the communicative infrastructure of SNSs, i.e., all SNS-elements that allow users to communicate, is a key element for understanding their impact as it creates environments in which users, their behaviors, and social interactions are embedded. These digital environments facilitate and encourage fundamental mechanisms of implicit learning from feedback as well as observation in an unprecedented way. I will discuss how these technology-based learning environments impact the mental health of their users, e.g., by linking negative online feedback to depression and following influencers to disturbed eating. The article ends with a conclusion that emphasizes the advantages of understanding SNSs as environments in order to reflect the complexity, relevance, and ubiquitousness of the phenomenon.
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Casaroto E, Generoso JR, Serpa Neto A, Prado M, Gagliardi GM, de Menezes FG, Gonçalves P, Hohmann FB, Olivato GB, Gonçalves GP, Xavier N, Fernandes Miguel M, Edmond MB, Marra AR. Comparing human to electronic observers to monitor hand hygiene compliance in an intensive care unit. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e161. [PMID: 36483392 PMCID: PMC9726540 DOI: 10.1017/ash.2022.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/17/2023]
Abstract
Objective We sought to determine whether an electronic hand hygiene (HH) system could monitor HH compliance at similar rates to direct human observation. Methods This 4-year proof-of-concept study was conducted in an intensive care unit (ICU) of a private tertiary-care hospital in São Paulo, Brazil, where electronic HH systems were installed in 2 rooms. HH compliance was reported respectively using direct observation and electronic counter devices with an infrared system for detecting HH opportunities. Results In phase 1, HH compliance by human observers was 56.3% (564 of 1,001 opportunities), while HH compliance detected by the electronic observer was 51.0% (515 of 1,010 opportunities). In phase 2, human observers registered 484 HH opportunities with a HH compliance rate of 64.7% (313 of 484) versus 70.6% (346 of 490) simultaneously detected by the electronic system. In addition, an enhanced HH electronic system monitored activity 24 hours per day and HH compliance without the presence of a human observer was 40.3% (10,642 of 26,421 opportunities), providing evidence for the Hawthorne effect. Conclusions The electronic HH monitoring system had good correlation with human HH observation, but compliance was remarkably lower when human observers were not present due to the Hawthorne effect (25%-30% absolute difference). Electronic monitoring systems can replace direct observation and can markedly reduce the Hawthorne effect.
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Affiliation(s)
- Eduardo Casaroto
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Jose R. Generoso
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Ary Serpa Neto
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, ANZIC-RC, Melbourne, Victoria, Australia
| | - Marcelo Prado
- Universidade de São Paulo, São Carlos, São Paulo, Brazil
| | | | | | | | | | | | | | - Nathalia Xavier
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - Michael B. Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Alexandre R. Marra
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
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Hand Hygiene Compliance at a Canadian provincial cancer centre - the complementary roles of nurse auditor-driven and patient auditor-driven audit processes and impact upon practice in ambulatory cancer care. Am J Infect Control 2021; 49:571-575. [PMID: 33096127 DOI: 10.1016/j.ajic.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND We examined the patterns of hand hygiene compliance (HHC) among health care providers (HCP) as observed by trained nurse and patient auditors over time in an ambulatory care Canadian provincial cancer agency. METHODS Nurse and volunteer patient auditors completed separate standardized forms documenting hand-cleansing opportunities during clinic visits. HHC rates were compared over time by HCP group and by specialty teams. Observations from 10 calendar quarters were analyzed from April 2015 to September 2019. RESULTS Nurse audit HHC rates ranged from 84% to 96%, encompassing 7,213 opportunities with no significant time-dependent trends by linear regression (R2 = 2.3E-005, P = .9895). The patient audit HHC rates ranged from 57% to 82%, encompassing 23,402 opportunities, were lower overall compared to the nurse audit (73.6% vs 89.2%, respectively, P < .0001), but displayed an increasing trend (R2 = 0.5374, P = .0159) over the same 10 time periods. The relative risk ratio for the differences decreased over time (R2 = .5101, P = .0203). Patients acknowledged the importance of HHC and the audit process, but were reticent to remind HCP to comply. CONCLUSIONS The nurse audit measuring HCP HHC before entering and after exiting patient examination rooms showed persistently high compliance over time whereas the patient-driven audit measuring HHC within the examination room increased over time suggesting a training effect upon practice. These measures appeared complementary.
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Leis JA, Powis JE, McGeer A, Ricciuto DR, Agnihotri T, Coyle N, Williams V, Moore C, Salt N, Wong L, McCreight L, Sivaramakrishna S, Junaid S, Cao X, Muller M. Introduction of Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study. Clin Infect Dis 2021; 71:e680-e685. [PMID: 32270865 DOI: 10.1093/cid/ciaa412] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/08/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Group electronic monitoring is a validated method of measuring HH adherence, but data demonstrating the clinical impact of this technology are lacking. METHODS A stepped-wedge cluster randomized quality improvement study was performed on 26 inpatient medical and surgical units across 5 acute care hospitals in Ontario, Canada. The intervention involved daily HH reporting as measured by group electronic monitoring to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (percentage) between baseline and intervention. Secondary outcomes included transmission of antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections. RESULTS After adjusting for the correlation within inpatient units and hospitals, there was a significant overall improvement in HH adherence associated with the intervention (incidence rate ratio [IRR], 1.73 [95% confidence interval {CI}, 1.47-1.99]; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1 395 450/4 544 144) to 37% (598 035/1 536 643) within 1 month, followed by consecutive incremental increases up to 53% (804 108/1 515 537) by 10 months (P < .0001). There was a trend toward reduced healthcare-associated transmission of MRSA (IRR, 0.74 [95% CI, .53-1.04]; P = .08). CONCLUSIONS The introduction of a system for group electronic monitoring led to rapid, significant improvements in HH performance within a 2-year period. This method offers significant advantages over direct observation for measurement and improvement of HH.
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Affiliation(s)
- Jerome A Leis
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada
| | - Jeff E Powis
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada.,Michael Garron Hospital, Toronto, Canada
| | - Allison McGeer
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Sinai Health Systems, Toronto, Canada
| | | | | | | | | | | | - Natasha Salt
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | | | | - Xinghan Cao
- Sunnybrook Research Institute, Toronto, Canada
| | - Matthew Muller
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
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Sasahara T, Kosami K, Yoshimura A, Ae R, Akine D, Ogawa M, Morisawa Y. Improvement of hand hygiene adherence among staff in long-term care facilities for elderly in Japan. J Infect Chemother 2020; 27:329-335. [PMID: 33341372 DOI: 10.1016/j.jiac.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hand hygiene is crucial for infection control in long-term care facilities for elderly (LTCFEs), because it can be easily implemented in the low-resource settings of LTCFEs. This study investigated the actual status of hand hygiene adherence in LTCFEs, identified the factors inhibiting its appropriate implementation, and evaluated the effectiveness of a hand hygiene promotion program. METHODS In this before-and-after study, participants were staff members (n = 142) at two LTCFEs in Gunma Prefecture, Japan. We modified the World Health Organization's "five moments for hand hygiene" and assessed participants' hand hygiene adherence rates in four situations: (1) Before touching around a resident's mucous membrane area; (2) Before medical practice or clean/aseptic procedures; (3) After body fluid exposure/risk or after touching around a resident's mucous membrane area; and (4) After touching a resident's contaminated environments. The study was divided into four phases. In Phase 1, participants self-assessed their hand hygiene adherence using a questionnaire. In Phase 2, we objectively assessed participants' pre-intervention adherence rates. In Phase 3, an intervention comprising various hand hygiene promotion measures, such as education and hands-on training on hand hygiene practices and timings, was implemented. In Phase 4, participants' post-intervention adherence rates were objectively measured. RESULTS Although most participants reported high hand hygiene adherence rate in the self-assessment (93.1%), the pre-intervention evaluation revealed otherwise (16.8%). Participants' post-intervention adherence rates increased for all four situations (77.3%). CONCLUSION The intervention program helped increase participants' hand hygiene adherence rates, indicating its effectiveness. Similar interventions in other LTCFEs may also improve adherence rates.
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Affiliation(s)
- Teppei Sasahara
- Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan; Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Akio Yoshimura
- Medical Corporation Sanikukai Nissin Hospital, Kiryu, Gunma, 376-0001, Japan.
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Dai Akine
- Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan; Health Service Center, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Masanori Ogawa
- Health Service Center, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Yuji Morisawa
- Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
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Mason MR, Morawski BM, Bayliss RL, Noor FM, Jama SH, Clabots CL, Johnson JR. Prevalence, Characteristics, and Epidemiology of Microbial Hand Contamination Among Minnesota State Fair Attendees (2014). Front Public Health 2020; 8:574444. [PMID: 33392128 PMCID: PMC7772179 DOI: 10.3389/fpubh.2020.574444] [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: 06/19/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Many antimicrobial-resistant infections are community-acquired, yet community carriage of microorganisms by healthy individuals is poorly characterized. We assessed microorganism carriage on the hands of Minnesota State Fair attendees and explored associated factors. Methods: Minnesota State Fair attendees (in 2014) from households with ≥2 members (≥1 member being <19 years old [a child]) were eligible to participate. Participants provided biological samples via a hand plating technique and completed a questionnaire on factors potentially related to microorganism carriage. Using presumptive taxonomic identifications and disk-diffusion-determined resistance phenotypes, hand-culture isolates were classified by microbial type; types were grouped into four broad categories based on inferred pathogenicity and consistency with the skin microbiota. Descriptive statistics, X2 tests, and generalized linear mixed-effects models were used to explore associations between survey and culture data. Results: We enrolled 206 participants from 82 households during 2 days; 50% of subjects were children. Overall, 99.5% (205/206) of hand samples yielded microorganisms. Most were non-pathogenic, whether skin microbiota (98.5% of participants) or non-skin microbiota (93.2% of participants). Only 2.4% (5/206) of samples yielded antibiotic-resistant bacteria. Children were more likely than adults to carry potentially pathogenic (OR = 3.63, 95% CI: 1.66–7.93) and presumably non-pathogenic (OR = 6.61, 95% CI: 1.67–26.15) non-skin microorganisms. Conclusions: Large community gatherings can serve as efficient sites for estimating the prevalence of microorganism carriage. A small proportion of participants carried antimicrobial-resistant pathogens on their hands; most carried non-pathogenic microorganisms, and no exposures specific to the state fair were associated with microorganism carriage.
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Affiliation(s)
- Meghan R Mason
- Public Health Department, Henrietta Schmoll School of Health, Saint Catherine University, Saint Paul, MN, United States.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Bozena M Morawski
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Ruby L Bayliss
- Public Health Department, Henrietta Schmoll School of Health, Saint Catherine University, Saint Paul, MN, United States
| | - Fatuma M Noor
- Public Health Department, Henrietta Schmoll School of Health, Saint Catherine University, Saint Paul, MN, United States
| | - Sagal H Jama
- Public Health Department, Henrietta Schmoll School of Health, Saint Catherine University, Saint Paul, MN, United States
| | - Connie L Clabots
- Minneapolis VA Health Care System, Minneapolis, MN, United States
| | - James R Johnson
- Minneapolis VA Health Care System, Minneapolis, MN, United States.,Division of Infectious Disease and International Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, United States
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Abuosi AA, Akoriyea SK, Ntow-Kummi G, Akanuwe J, Abor PA, Daniels AA, Alhassan RK. Hand hygiene compliance among healthcare workers in Ghana’s health care institutions: An observational study. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2020. [DOI: 10.1177/2516043520958579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To assess hand hygiene compliance in selected primary hospitals in Ghana. Design A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients.
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Affiliation(s)
- Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | | | | | - Joseph Akanuwe
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Patience Aseweh Abor
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Anita Anima Daniels
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Robert Kaba Alhassan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections. Infect Control Hosp Epidemiol 2020; 41:931-937. [PMID: 32460928 DOI: 10.1017/ice.2020.182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Hand hygiene adherence has been associated with reductions in nosocomial infection. We assessed the effect of improvements in electronically measured hand hygiene adherence on the incidence of hospital-acquired infections. METHODS This quasi-experimental study was conducted in a 555-bed urban safety-net level I trauma center. The preintervention period was January 2015 through June 2016. Baseline electronic hand hygiene data collection took place from April through June 2016. The intervention period was July 2016 through December 2017. An electronic hand hygiene system was installed in 4 locations in our hospital. Performance improvement strategies were implemented that included education, troubleshooting, data dissemination, and feedback. Adherence rates were tracked over time. Rates of hospital-acquired infections were evaluated in the intervention units and in control units selected for comparison. The intervention period was subdivided into the initial and subsequent 9-month periods and were compared to the baseline period. RESULTS Electronically measured hand hygiene rates improved significantly from baseline to intervention, from 47% 77% adherence. Rates >70% continued to be measured 18 months after the intervention. Interrupted time series analysis indicated a significant effect of hand hygiene on healthcare facility-onset Clostridioides difficile infection rates during the first 9 months of the intervention. This trend continued during the final 9 months of the intervention but was nonsignificant. No effects were observed for other hospital-acquired infection rates. CONCLUSIONS Implementation of electronic hand hygiene monitoring and performance improvement interventions resulted in reductions in hospital-onset Clostridioides difficile infection rates.
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Pada SMSK, Chee PL, Rathenam S, Ng KS, Alenton LS, Poh L, Tambyah PA. Effectiveness of a Ward level target accountability strategy for hand hygiene. Antimicrob Resist Infect Control 2019; 8:177. [PMID: 31788234 PMCID: PMC6858769 DOI: 10.1186/s13756-019-0641-0] [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] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background Hand hygiene is a simple and effective solution in prevention of Multi Drug Resistant Organisms. Hand Hygiene campaigns have mostly taken the form of a generalised hospital approach with visual reminders and rewards for improvement in compliance. We describe a hand hygiene programme that sets an individualised ward target to increase accountability and drive improvement. Methods We undertook to develop a "Hand Hygiene Accountability" model, where the mean compliance rate, using the WHO hand hygiene assessment tool, for each ward over the past 6 months plus 10% was used as a target for that particular ward.Rewards were given to wards with the most percentage improvement over the year. A graded escalation was used for wards that did not meet targets based on 1,2 or 3 months of non-compliance. The most extreme action, setting up a task force directed by the Chairman of our Medical Board, would be required if 3 continuous months of non-compliance was observed. Hand Hygiene audits were performed by staff trained using the WHO audit tools. The same strategy was repeated at our community hospital.Active surveillance testing for Methicillin Resistant Staphylococcus aureus (MRSA) using nasal, groin and axilla swabs established before the project continued to be in operation, as did surveillance for hospital acquired MRSA bacteraemia (using NHSN criteria), hospital-onset Clostridioides difficile (HO-CD), and multi-resistant gram-negative bacilli. Results Data from July 2015 to December 2017 was analysed. In the acute and community hospitals, 21,582 and 5770 hand hygiene (HH) observations were undertaken respectively.In the acute care hospital, HH compliance rates went from 65 to 78% (p-value < 0.00001). There was a reduction in MRSA bacteraemia from 5 episodes at the start of the study to 0 in 2017.In the community hospital, HH compliance improved from a mean of 64 to 75% (p-value 0.00005). MRSA transmission rate decreased from 5.72 per 1000 patient days, to 2.79 per 1000 patient days (p-value 0.00035) with an admission prevalence of 13.1% for 2016 and 20.6% in 2017. Conclusions Using a ward level accountability for hand hygiene is possible and can be successful in improving hand hygiene rates, possibly reducing transmission of MDROs. Realistic targets need to be set and adequate rewards and incentives provided to ensure continuous improvement.
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Affiliation(s)
- Surinder M. S. Kaur Pada
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Poh Ling Chee
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Sarathemani Rathenam
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Kim Sim Ng
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Lilibeth Silagan Alenton
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Lishi Poh
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Paul Anatharajah Tambyah
- National University Hospital, National University Health Services, 5 Lower Kent Ridge Rd, Singapore, 119074 Singapore
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Castro AFD, Rodrigues MCS. Audit of standardized precautionary and contact practices in the Intensive Care Unit. Rev Esc Enferm USP 2019; 53:e03508. [PMID: 31433023 DOI: 10.1590/s1980-220x2018018603508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 04/09/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the structure and adherence to the standardized and specific precautionary measures of health professionals in the Intensive Care Unit of a teaching hospital in the Federal District of Brazil. METHOD A descriptive, cross-sectional and prospective study. A structured questionnaire was used via observations which recorded the practices of professionals with Individual Protection Equipment and indications of precautions. The chi-square test was applied, and the p-value was calculated. RESULTS A total of 52 professionals participated in the study, and 445 care procedures were observed in 36 audit sessions. The average adhesion rate for equipment use was 72.72%, with 94.91% for gloves, 91.43% for aprons, 80% for masks and 24.56% for safety glasses. When there was no indication and no personal protective equipment was used, the average rate was 68.01%, with 30.77% for gloves, 87.58% for aprons, 57.58% for masks, and 96.13% for safety glasses. Contact precautions were unnecessarily indicated for 35% of patients. CONCLUSION Good adherence to using gloves, aprons and masks were observed, but there was poor adherence to using safety glasses and unnecessary use of masks and admission contact precautions.
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Affiliation(s)
- Alaíde Francisca de Castro
- Universidade de Brasília, Programa de Pós-Graduação em Enfermagem, Brasília, DF, Brasil.,Hospital Universitário de Brasília, Divisão de Enfermagem, Brasília, DF, Brasil
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Testing a novel audit and feedback method for hand hygiene compliance: A multicenter quality improvement study. Infect Control Hosp Epidemiol 2018; 40:89-94. [PMID: 30430974 DOI: 10.1017/ice.2018.277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Although most hospitals report very high levels of hand hygiene compliance (HHC), the accuracy of these overtly observed rates is questionable due to the Hawthorne effect and other sources of bias. In the study, we aimed (1) to compare HHC rates estimated using the standard audit method of overt observation by a known observer and a new audit method that employed a rapid (<15 minutes) "secret shopper" method and (2) to pilot test a novel feedback tool. DESIGN Quality improvement project using a quasi-experimental stepped-wedge design. SETTING This study was conducted in 5 acute-care hospitals (17 wards, 5 intensive care units) in the Midwestern United States. METHODS Sites recruited a hand hygiene observer from outside the acute-care units to rapidly and covertly observe entry and exit HHC during the study period, October 2016-September 2017. After 3 months of observations, sites received a monthly feedback tool that communicated HHC information from the new audit method. RESULTS The absolute difference in HHC estimates between the standard and new audit methods was ~30%. No significant differences in HHC were detected between the baseline and feedback phases (OR, 0.92; 95% CI, 0.84-1.01), but the standard audit method had significantly higher estimates than the new audit method (OR, 9.83; 95% CI, 8.82-10.95). CONCLUSIONS HHC estimates obtained using the new audit method were substantially lower than estimates obtained using the standard audit method, suggesting that the rapid, secret-shopper method is less subject to bias. Providing feedback using HHC from the new audit method did not seem to impact HHC behaviors.
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Thirkell G, Chambers J, Gilbart W, Thornhill K, Arbogast J, Lacey G. Pilot study of digital tools to support multimodal hand hygiene in a clinical setting. Am J Infect Control 2018; 46:261-265. [PMID: 29079136 DOI: 10.1016/j.ajic.2017.08.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Digital tools for hand hygiene do not share data, limiting their potential to support multimodal programs. The Christie NHS Foundation Trust, United Kingdom, worked with GOJO (in the United States), MEG (in Ireland), and SureWash (in Ireland) to integrate their systems and pilot their combined use in a clinical setting. METHODS A 28-bed medical oncology unit piloted the system for 5 weeks. Live data from the tools were combined to create a novel combined risk status metric that was displayed publicly and via a management Web site. RESULTS The combined risk status reduced over the pilot period. However, larger and longer duration studies are required to reach statistical significance. Staff and especially patient reaction was positive in that 70% of the hand hygiene training events were by patients. The digital tools did not negatively impact clinical workflow and received positive engagement from staff and patients. The combined risk status did not change significantly over the short pilot period because there was also no specific hand hygiene improvement campaign underway at the time of the pilot study. CONCLUSIONS The results indicate that integrated digital tools can provide both rich data and novel tools that both measure impact and provide feedback to support the implementation of multimodal hand hygiene campaigns, reducing the need for significant additional personnel resources.
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Brotfain E, Livshiz-Riven I, Gushansky A, Erblat A, Koyfman L, Ziv T, Saidel-Odes L, Klein M, Borer A. Monitoring the hand hygiene compliance of health care workers in a general intensive care unit: Use of continuous closed circle television versus overt observation. Am J Infect Control 2017; 45:849-854. [PMID: 28479008 DOI: 10.1016/j.ajic.2017.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A variety of hand hygiene monitoring programs (HHMPs) have come into use in hospitals throughout the world. In the present study, we compare continuous closed circle television (CCTV) with overt observation for monitoring the hand hygiene compliance of health care workers (HCWs) in a general intensive care unit (GICU). METHODS This is a cross-sectional and comparative study. In this study, we use a novel hand hygiene CCTV monitoring system for hand hygiene performance monitoring. The study population incorporated all the GICU HCWs, including registered nurses, staff physicians, and auxiliary workers. RESULTS All HCWs of our GICU were observed, including ICU registered nurses, ICU staff physicians, and auxiliary workers participated in the present study. Overall, each observer team did 50 sessions in each arm of the study. Total number of hand hygiene opportunities was approaching 500 opportunities. The compliance rates when only overt observations were performed was higher than when only covert observations were performed with a delta of approximately 10% (209 out of 590 [35.43%] vs 130 out of 533 [24.39%]; P < .001). Both methods of observations (overt and covert [CCTV]) demonstrated excellent reliability (intraclass correlation coefficient [ICC], 0.96 [0.93-0.98] of overt and ICC, 0.81 [0.69-0.89] for covert, respectively). However, the correlation between both methods was found weak in simultaneous sessions (ICC, 0.40 [0.62-0.107]). CONCLUSION We demonstrated that CCTV is an appropriate, reliable, and neutral method for observation of hand hygiene. However, there is no clear basis for incorporating a CCTV observation modality into a health care system that already operates an overt observation program. We have shown that CCTV methodology records a different distribution of opportunities for performing hand hygiene and of actual performances of hand hygiene compared with overt observation.
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Arai A, Tanabe M, Nakamura A, Yamasaki D, Muraki Y, Kaneko T, Kadowaki A, Ito M. Utility of electronic hand hygiene counting devices for measuring physicians' hand hygiene adherence applied to outpatient settings. Am J Infect Control 2016; 44:1481-1485. [PMID: 27665030 DOI: 10.1016/j.ajic.2016.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Our objectives were to evaluate the utility of electronic hand hygiene counting devices in outpatient settings and the impact of results feedback on physicians' hand hygiene behaviors. METHODS We installed 130 electronic hand hygiene counting devices in our redesigned outpatient department. We remotely monitored physicians' hand hygiene practices during outpatient examinations and calculated the adherence rate as follows: number of hand hygiene counts divided by the number of outpatients examined multiplied by 100. Physician individual adherence rates were also classified into 4 categories. RESULTS Two hundred and eighty physicians from 28 clinical departments were monitored for 3 months. The overall hand hygiene adherence rate was 10.7% at baseline, which improved significantly after feedback to 18.2% in the third month. Of the clinical departments, 78.6% demonstrated significant improvement in hand hygiene compliance. The change in the percentage of physicians in each category before and after feedback were as follows: very low (84.3% to 72.1%), low (8.6% to 14.3%), moderate (2.9% to 8.9%), and high (4.3% to 4.6%), from the first to third month, respectively. Based on category assessment, 17.1% of physicians were classified as responders. CONCLUSIONS Physicians' adherence to hand hygiene practices during outpatient examinations was successfully monitored remotely using electronic counting devices. Audit and feedback of adherence data may have a positive impact on physicians' hand hygiene compliance.
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Affiliation(s)
- Akie Arai
- Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan; Department of Nursing, Mie University Hospital, Tsu, Japan
| | - Masaki Tanabe
- Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan.
| | - Akiko Nakamura
- Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan
| | - Daisuke Yamasaki
- Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan; Department of Pharmacy, Mie University Hospital, Tsu, Japan
| | - Yuichi Muraki
- Department of Pharmacy, Mie University Hospital, Tsu, Japan
| | - Toshihiro Kaneko
- Department of Patient Safety and Infection Control, Mie University Hospital, Tsu, Japan
| | - Ayako Kadowaki
- Department of Nursing, Mie University Hospital, Tsu, Japan
| | - Masaaki Ito
- Department of Cardiology, Mie University Hospital, Tsu, Japan
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Improvement of Hand Hygiene Quality and Compliance Using Bioburden Measurement and Online Feedback in Germany. Infect Control Hosp Epidemiol 2016; 38:119-122. [PMID: 27817762 DOI: 10.1017/ice.2016.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To improve compliance with hand hygiene, a novel method with inclusion of an online reporting system was developed, comprising measurement of total hand bioburden, anonymous online feedback, and onsite training. The intervention significantly improved both compliance and quality of hand hygiene and reduced Staphylococcus aureus incidence. Infect Control Hosp Epidemiol 2016;1-4.
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Azim S, Juergens C, Hines J, McLaws ML. Introducing automated hand hygiene surveillance to an Australian hospital: Mirroring the HOW2 Benchmark Study. Am J Infect Control 2016; 44:772-6. [PMID: 27040569 DOI: 10.1016/j.ajic.2016.02.012] [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: 11/09/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Human auditing and collating hand hygiene compliance data take hundreds of hours. We report on 24/7 overt observations to establish adjusted average daily hand hygiene opportunities (HHOs) used as the denominator in an automated surveillance that reports daily compliance rates. METHODS Overt 24/7 automated surveillance collected HHOs in medical and surgical wards. Accredited auditors observed health care workers' interaction between patient and patient zones to collect the total number of HHOs, indications, and compliance and noncompliance. Automated surveillance captured compliance (ie, events) via low power radio connected to alcohol-based handrub (ABHR) dispensers. Events were divided by HHOs, adjusted for daily patient-to-nurse ratio, to establish daily rates. RESULTS Human auditors collected 21,450 HHOs during 24/7 with 1,532 average unadjusted HHOs per day. This was 4.4 times larger than the minimum ward sample required for accreditation. The average adjusted HHOs for ABHR alone on the medical ward was 63 HHOs per patient day and 40 HHOs per patient day on the surgical ward. From July 1, 2014-July 31, 2015 the automated surveillance system collected 889,968 events. CONCLUSIONS Automated surveillance collects 4 times the amount of data on each ward per day than a human auditor usually collects for a quarterly compliance report.
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Neo JRJ, Sagha-Zadeh R, Vielemeyer O, Franklin E. Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review. Am J Infect Control 2016; 44:691-704. [PMID: 27240800 DOI: 10.1016/j.ajic.2015.11.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/28/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission and nosocomial infections. However, most HH interventions (HHI) have not been sustainable. AIMS This review aims to provide a comprehensive summary of recently published evidence-based HHI designed to improve HH compliance (HHC) that will enable health care providers to make informed choices when allocating limited resources to improve HHC and patient safety. METHODS The Medline electronic database (using PubMed) was used to identify relevant studies. English language articles that included hand hygiene interventions and related terms combined with health care environments or related terms were included. RESULTS Seventy-three studies that met the inclusion criteria were summarized. Interventions were categorized as improving awareness with education, facility design, and planning, unit-level protocols and procedures, hospital-wide programs, and multimodal interventions. Past successful HHIs may not be as effective when applied to other health care environments. HH education should be interactive and engaging. Electronic monitoring and reminders should be implemented in phases to ensure cost-effectiveness. To create hospitalwide programs that engage end users, policy makers should draw expertise from interdisciplinary fields. Before implementing the various components of multimodal interventions, health care practitioners should identify and examine HH difficulties unique to their organizations. CONCLUSIONS Future research should seek to achieve the following: replicate successful HHI in other health care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions, examine ways (eg, hospital leadership, financial support, and strategies from public health and infection prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs.
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Affiliation(s)
- Jun Rong Jeffrey Neo
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY.
| | - Rana Sagha-Zadeh
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY
| | - Ole Vielemeyer
- Division of Infectious Disease, Weill Cornell Medical College, New York, NY
| | - Ella Franklin
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC
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Thompson D, Bowdey L, Brett M, Cheek J. Using medical student observers of infection prevention, hand hygiene, and injection safety in outpatient settings: A cross-sectional survey. Am J Infect Control 2016; 44:374-80. [PMID: 26804308 DOI: 10.1016/j.ajic.2015.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Health care-associated infection outbreaks have occurred in outpatient settings due to lapses in infection prevention. However, little is known about the overall infection prevention status in outpatient environments. METHODS A cross-sectional design was employed to assess infection prevention policies and practices at 15 outpatient sites across New Mexico in 2014 during a medical student outpatient rotation. A standardized infection prevention checklist was completed via staff interview; observations of injection safety practices and hand hygiene behavior were conducted. Aggregate data were analyzed using Excel (Microsoft, Redmond, WA) and Stata (version 12.1, Stata Corp, College Station, TX) statistical software. RESULTS Medical practice staff interviews reported a mean of 92.8% (median, 96.7%; range, 75.0%-98.9%) presence of recommended policies and practices. One hundred sixty-three injection safety observations were performed that revealed medication vial rubber septums were disinfected with alcohol 78.4% (95% confidence interval [CI], 71.1%-84.7%) of the time before piercing. Three hundred thirty hand hygiene observations revealed 33.9% (95% CI, 28.8%-39.1%) use of alcohol-based handrub, 29.1% (95% CI, 24.2%-34.0%) use of soap and water, and 37.0% (95% CI, 31.8%-42.4%) use of no hand hygiene. DISCUSSION AND CONCLUSION These findings support the need for ongoing infection prevention quality improvement initiatives in outpatient settings and underscore the importance of assessing both self-report and observed behavior of infection prevention compliance.
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O'Reilly K, Ruokis S, Russell K, Teves T, DiLibero J, Yassa D, Berry H, Howell MD. Standard work for room entry: Linking lean, hand hygiene, and patient-centeredness. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 4:45-51. [PMID: 27001098 DOI: 10.1016/j.hjdsi.2015.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/07/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Healthcare-associated infections are costly and fatal. Substantial front-line, administrative, regulatory, and research efforts have focused on improving hand hygiene. PROBLEM While broad agreement exists that hand hygiene is the most important single approach to infection prevention, compliance with hand hygiene is typically only about 40%(1). GOALS Our aim was to develop a standard process for room entry in the intensive care unit that improved compliance with hand hygiene and allowed for maximum efficiency. STRATEGY We recognized that hand hygiene is a single step in a substantially more complicated process of room entry. We applied Lean engineering techniques to develop a standard process that included both physical steps and also standard communication elements from provider to patients and families and created a physical environment to support this. RESULTS We observed meaningful improvement in the performance of the new standard as well as time savings for clinical providers with each room entry. We also observed an increase in room entries that included verbal communication and an explanation of what the clinician was entering the room to do. IMPLICATIONS The design and implementation of a standardized room entry process and the creation of an environment that supports that new process has resulted in measurable positive outcomes on the medical intensive care unit, including quality, patient experience, efficiency, and staff satisfaction. Designing a process, rather than viewing tasks that need to happen in close proximity in time (either serially or in parallel) as unrelated, simplifies work for staff and results in higher compliance to individual tasks.
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Affiliation(s)
- Kristin O'Reilly
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States.
| | - Samantha Ruokis
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Kristin Russell
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Tim Teves
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Justin DiLibero
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - David Yassa
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Hannah Berry
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Michael D Howell
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
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Prater KJ, Fortuna CA, McGill JL, Brandeberry MS, Stone AR, Lu X. Poor hand hygiene by college students linked to more occurrences of infectious diseases, medical visits, and absence from classes. Am J Infect Control 2016; 44:66-70. [PMID: 26442460 DOI: 10.1016/j.ajic.2015.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Proper hand hygiene has been linked to lower susceptibility to infectious diseases in many types of communities, but it has not been well established on college campuses. This study investigated the hand hygiene statuses of college students and their occurrences in relation to infectious diseases, medical visits, and absence from classes or work. It also examined the effects of education on handwashing technique to improve hand hygiene. METHODS College students enrolled at a university in Northwestern Ohio were recruited as study subjects. Microbial samples were collected 3 times from each of the 220 valid volunteers before washing their hands, after washing with their own procedures, and after washing with a procedure recommended by the Centers for Disease Control and Prevention (CDC). Each volunteer also answered a survey including questions on their health conditions, medical visits, and absence from classes or work. RESULTS Hands of 57.7% volunteers were colonized by an uncountable number of microbial colonies, which were significantly linked to more occurrences to infectious diseases (P < .05), medical visits (P < .05), and arguably more absence from classes or work (P = .09). The handwashing procedure provided by the CDC significantly improved hand hygiene. CONCLUSION It is critical to promote education on proper handwashing in colleges, in grade schools, and at home to improve health and learning outcomes.
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Affiliation(s)
- Kayla J Prater
- College of Sciences, The University of Findlay, Findlay, OH
| | | | - Janis L McGill
- College of Sciences, The University of Findlay, Findlay, OH
| | | | | | - Xu Lu
- College of Sciences, The University of Findlay, Findlay, OH.
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Abstract
Central line-associated bloodstream infections (CLABSI) are one of the leading causes of death in the USA and around the world. As a preventable healthcare-associated infection, they are associated with significant morbidity and excess costs to the healthcare system. Effective and long-term CLABSI prevention requires a multifaceted approach, involving evidence-based best practices coupled with effective implementation strategies. Currently recommended practices are supported by evidence and are simple, such as appropriate hand hygiene, use of full barrier precautions, avoidance of femoral lines, skin antisepsis, and removal of unnecessary lines. The most successful and sustained improvements in CLABSI rates further utilize an adaptive component to align provider behaviors with consistent and reliable use of evidence-based practices. Great success has been achieved in reducing CLABSI rates in the USA and elsewhere over the past decade, but more is needed. This article aims to review the initiatives undertaken to reduce CLABSI and summarizes the sentinel and recent literature regarding CLABSI and its prevention.
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Affiliation(s)
- Asad Latif
- Department of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, 600 North Wolfe Street, Meyer 297-A, Baltimore, MD, 21287, USA,
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Moura ML, Fenley JC, Baraldi MM, Boszczowski Í. Translational Research in Hand Hygiene Compliance. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015. [DOI: 10.1007/s40506-015-0041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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