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Baddal B, Taner F, Uzun Ozsahin D. Harnessing of Artificial Intelligence for the Diagnosis and Prevention of Hospital-Acquired Infections: A Systematic Review. Diagnostics (Basel) 2024; 14:484. [PMID: 38472956 DOI: 10.3390/diagnostics14050484] [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: 12/16/2023] [Revised: 01/23/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Healthcare-associated infections (HAIs) are the most common adverse events in healthcare and constitute a major global public health concern. Surveillance represents the foundation for the effective prevention and control of HAIs, yet conventional surveillance is costly and labor intensive. Artificial intelligence (AI) and machine learning (ML) have the potential to support the development of HAI surveillance algorithms for the understanding of HAI risk factors, the improvement of patient risk stratification as well as the prediction and timely detection and prevention of infections. AI-supported systems have so far been explored for clinical laboratory testing and imaging diagnosis, antimicrobial resistance profiling, antibiotic discovery and prediction-based clinical decision support tools in terms of HAIs. This review aims to provide a comprehensive summary of the current literature on AI applications in the field of HAIs and discuss the future potentials of this emerging technology in infection practice. Following the PRISMA guidelines, this study examined the articles in databases including PubMed and Scopus until November 2023, which were screened based on the inclusion and exclusion criteria, resulting in 162 included articles. By elucidating the advancements in the field, we aim to highlight the potential applications of AI in the field, report related issues and shortcomings and discuss the future directions.
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Affiliation(s)
- Buket Baddal
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
- DESAM Research Institute, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
| | - Ferdiye Taner
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
- DESAM Research Institute, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
| | - Dilber Uzun Ozsahin
- Department of Medical Diagnostic Imaging, College of Health Science, University of Sharjah, Sharjah 27272, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Operational Research Centre in Healthcare, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
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Garnier A, Dubs C, Haerder C, Bonnabry P, Bouchoud L. Game-based training to improve the compliance of hospital pharmacy operators with handwashing guidelines. J Hosp Infect 2024; 144:137-143. [PMID: 38081455 DOI: 10.1016/j.jhin.2023.11.015] [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: 08/31/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Good hand hygiene techniques (HHTs), like those of the World Health Organization (WHO), prevent microbial contamination of aseptic preparations. The objective of this study was to assess the efficacy of a game-based training (GBT) tool (the Handtastic Box) to improve the compliance of hospital pharmacy operators (HPOs) with handwashing guidelines. METHODS A camera recorded handwashing by HPOs for 1 month before the training day, for 1 month after the training day (M1), and between month 1 and month 3 (M2&3). Movements were scored as fully executed, partially executed or not executed. Compliance rates of each HPO with HHTs were compared between observation periods. During 1-h training sessions, pairs of HPO trainees watched handwashing videos and noted which of five guideline steps was missing. They examined wooden hands with areas stained with fluorescein under ultraviolet light to find the hand showing the matching contamination. RESULTS The mean compliance score for nine HPOs increased from 44.6% (before training, N=32 videos) to 86.7% (M1, N=40) to 82.5% (M2&3, N=45). Compliance with every step improved from before training to M1 and generally stabilized in M2&3, except for the fingertip washing step which dropped significantly in M2&3. DISCUSSION To the authors' knowledge, this is the first study to assess the efficacy of a GBT tool to improve HPO compliance with the WHO HHTs. The tool improved handwashing scores significantly, and maintained them at the same level for 3 months after training. The separate results for each step highlight the need to train every movement. CONCLUSION This GBT tool successfully improved compliance with the WHO HHTs for 3 months. This training could be used for other healthcare professionals.
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Affiliation(s)
- A Garnier
- Pharmacy Department, Geneva University Hospitals, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
| | - C Dubs
- In The Box Consulting GmbH, Schaffhausen, Switzerland
| | - C Haerder
- In The Box Consulting GmbH, Schaffhausen, Switzerland
| | - P Bonnabry
- Pharmacy Department, Geneva University Hospitals, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - L Bouchoud
- Pharmacy Department, Geneva University Hospitals, Geneva, Switzerland
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Boyce JM. Current issues in hand hygiene. Am J Infect Control 2023; 51:A35-A43. [PMID: 37890952 DOI: 10.1016/j.ajic.2023.02.003] [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: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Multiple aspects of hand hygiene have changed in recent years. METHODS A PubMed search was conducted to identify recent articles about hand hygiene. RESULTS The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. CONCLUSIONS Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, CT, USA.
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Karahan Okuroğlu G, Kaynar Şimşek A, Pazar N, Ecevit Alpar Ş. The Effect of Video-Assisted Training and Visual Feedback With UV Germ Technology on Nursing Students' Hand Hygiene Beliefs, Practices, and Compliance: A Randomized Controlled Study. J Nurs Care Qual 2023; 38:335-340. [PMID: 36947854 DOI: 10.1097/ncq.0000000000000710] [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: 03/24/2023]
Abstract
BACKGROUND Hand hygiene (HH) is the most effective way to prevent health care-associated infections; however, HH compliance rates continue to be suboptimal. PURPOSE To determine the effectiveness of video-assisted training and visual feedback with ultraviolet (UV) germ technology on nursing students' HH beliefs, practices, and compliance. METHODS This study used a double-blind, posttest randomized controlled design. The experimental group received training, visual feedback with UV germ technology, and instructional videos. RESULTS A total of 46 students were included in the study (experimental 21 and control 25). The mean score of the HH skills checklist of the experimental group was significantly higher than that of the control group ( P = .0001). The HH compliance rate was also higher in the experimental group (52.62%) compared with the control group (39.1%). CONCLUSIONS The training, visual feedback with UV germ technology, and instructional videos increased HH compliance rates in nursing students.
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Affiliation(s)
- Gülten Karahan Okuroğlu
- Department of Nursing, Faculty of Health Sciences, Marmara University, Istanbul, Turkey (Drs Karahan Okuroğlu, Kaynar Şimşek and Ecevit Alpar); and Marmara University Pendik Education and Research Hospital, Istanbul, Turkey (Ms Pazar)
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Robinson J, Price L, Otter J, Burnett E. Designing an optimal infection prevention service: Part 2. J Infect Prev 2023; 24:11-22. [PMID: 36644523 PMCID: PMC9834426 DOI: 10.1177/17571774221127573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/04/2022] [Indexed: 01/18/2023] Open
Abstract
Background The importance of infection prevention and control (IPC) services to prevent threats from healthcare-associated infections and improve the quality of healthcare delivery is undeniable. However, IPC services across the UK and Ireland have substantial variability in terms of team structures and delivery models. Aim The aim of this study was to define an optimal IPC service in different contexts and settings within the United Kingdom and Ireland. Methods This mixed methods study adopted discussion huddles with IPC teams to explore various components of IPC programmes and services. A Nominal Group technique was then undertaken to achieve a group consensus of what an optimal infection prevention service should look like. Results Five discussion huddles were conducted which included 53 participants in total. Key themes arising were IPC Service Priorities, IPC Service Enablers for Success, and Necessary Skills and Expertise Required for Delivering an Effective IPC Service. For the nominal technique, 45 responses were identified which were determining the key priorities for an effective IPC service and 69 responses for establishing key enablers for success. Discussion These findings supported the development of a conceptual model for designing an optimal infection prevention service, which can be used to develop IPC services at an international, national, regional and local level. A focus is required around implementation of these highlighted enablers, so are effectively embedded into infection prevention and control services, and wider healthcare settings.
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Affiliation(s)
- Jude Robinson
- Infection Prevention and control, NHS England and Improvement, Midlands, UK
| | - Lesley Price
- School of Health and life sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jon Otter
- Infection Prevention and control, Guy’s and St Thomas NHS, London, UK
| | - Emma Burnett
- Fatima College of Health Sciences, Al Ain, United Arab Emirates
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Zhang Y, Chen X, Lao Y, Qiu X, Liu K, Zhuang Y, Gong X, Wang P. Effects of the Implementation of Intelligent Technology for Hand Hygiene in Hospitals: A Systematic Review and Meta-analysis (Preprint). J Med Internet Res 2022; 25:e37249. [DOI: 10.2196/37249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 12/12/2022] [Accepted: 03/19/2023] [Indexed: 03/20/2023] Open
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Lin TY, Lin CT, Chen KM, Hsu HF. Information technology on hand hygiene compliance among health care professionals: A systematic review and meta-analysis. J Nurs Manag 2021; 29:1857-1868. [PMID: 33772923 DOI: 10.1111/jonm.13316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/25/2022]
Abstract
AIM To determine the effectiveness of information technology interventions on hand hygiene compliance among health care professionals. BACKGROUND Performing hand hygiene is the optimal approach to prevent the transmission of health care-associated infections. However, results regarding the effectiveness of information technology interventions on hand hygiene compliance were inconsistent to date. EVALUATION A search for studies published up to May 2020 was undertaken. A meta-analysis was conducted using RevMan 5.3 software. KEY ISSUES The most commonly used information technology systems were as follows: automated training, electronic counting devices and remote monitoring, real-time hand hygiene reminders and feedback, and automated monitoring. These four types of technology systems can significantly improve hand hygiene compliance among health care professionals (odds ratio = 3.06, p < .001). CONCLUSION The four types of information technology can be effectively used to change the hand hygiene behaviour. Because the information systems can monitor personnel and conduct statistical analyses automatically, they save labour costs of human monitors, are more time efficient and eliminate accompanying human error. IMPLICATIONS FOR NURSING MANAGEMENT The use of the four types of information technology is convenient and could reduce health care-associated infections; thus, they could be widely used in the future as the key to increase hand hygiene compliance rate.
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Affiliation(s)
- Tang-Yu Lin
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Ting Lin
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Long-term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Fen Hsu
- Center for Long-term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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Huang F, Brouqui P, Boudjema S. How does innovative technology impact nursing in infectious diseases and infection control? A scoping review. Nurs Open 2021; 8:2369-2384. [PMID: 33765353 PMCID: PMC8363394 DOI: 10.1002/nop2.863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/28/2021] [Accepted: 03/04/2021] [Indexed: 12/22/2022] Open
Abstract
Aim Considering the increasing number of emerging infectious diseases, innovative approaches are strongly in demand. Additionally, research in this field has expanded exponentially. Thus, faced with this diverse information, we aim to clarify key concepts and knowledge gaps of technology in nursing and the field of infectious diseases. Design This scoping review followed the methodology of scoping review guidance from Arksey and O’Malley. Methods Six databases were searched systematically (PubMed, Web of Science, IEEE Explore, EBSCOhost, Cochrane Library and Summon). After the removal of duplicates, 532 citations were retrieved and 77 were included in the analysis. Results We identified five major trends in technology for nursing and infectious diseases: artificial intelligence, the Internet of things, information and communications technology, simulation technology and e‐learning. Our findings indicate that the most promising trend is the IoT because of the many positive effects validated in most of the reviewed studies.
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Affiliation(s)
- Fanyu Huang
- IRD, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France
| | - Philippe Brouqui
- IRD, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France.,AP-HM, IHU-Méditerranée Infection, Marseille, France
| | - Sophia Boudjema
- IRD, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France
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Feng G, Jun H, Elaine G, Haitao S. Powdered Activated Charcoal Tracing in Hand Hygiene Training and Compliance Assessment During the COVID-19 Pandemic. Risk Manag Healthc Policy 2021; 14:675-683. [PMID: 33623457 PMCID: PMC7896769 DOI: 10.2147/rmhp.s295551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Because of the COVID-19 pandemic there has been a significant increase in the prevalence of nosocomial infections. As a result, we sought to find an effective, efficient and safe way to train healthcare workers on proper hand washing techniques. We used powdered activated carbon (PAC) as a tracer to visually display hand washing defects after the hand washing process. The real-time visual assessment of the efficacy of the hand washing technique aided in the immediate correction of errors, and this definitively improved hand hygiene techniques of the interns. Methods Clinical interns at the emergency department of Shengjing Hospital were included in this study and received training in relation to the six-step hand-washing technique developed by the World Health Organization (WHO). The subjects’ hand-washing defects or faults were traced using PAC and corrected accordingly. Acceptance of the PAC tracing method by the interns, and its safety, were both assessed using a questionnaire survey. Results The results indicated that the back of the hands, fingers, and the wrists were prone to hand-washing defects. The hand-washing defects were significantly reduced after targeted corrections by the trainers. Subjects reported satisfactory acceptance toward the PAC tracing method and the method was relatively safe for subjects. Conclusion The PAC tracing method can visually display hand-washing defects and significantly improve the effectiveness of hand-washing training.
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Affiliation(s)
- Guo Feng
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Han Jun
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Gitonga Elaine
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
| | - Shen Haitao
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, People's Republic of China
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Dray S, Lehingue S, Valera S, Nouguier P, Boussen MS, Daviet F, Bastian D, Pilarczik E, Jousset I, Le Floch S, Grech G, Leonetti G, Papazian L, Cassir N, Forel JM. Using an ultraviolet cabinet improves compliance with the World Health Organization's hand hygiene recommendations by undergraduate medical students: a randomized controlled trial. Antimicrob Resist Infect Control 2020; 9:147. [PMID: 32883351 PMCID: PMC7469265 DOI: 10.1186/s13756-020-00808-4] [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: 05/28/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Appropriate hand hygiene (HH) is key to reducing healthcare-acquired infections. The World Health Organization (WHO) recommends education and training to improve HH knowledge and compliance. Physicians are ranked among the worst of all healthcare workers for compliant handrubbing with its origin probably being the failure to learn this essential behavior during undergraduate medical studies. This study evaluated if the use of Ultraviolet-cabinets (UVc) for fluorescent-alcohol-based handrubs (AHR) during an undergraduate medical student training improved the compliance rate to the WHO hand hygiene recommendations (completeness of AHR application and HH opportunities). METHODS This randomized trial compared a HH training with personal feedback (using UVc) to a control group. The first year, the students (2nd degree) were convened by groups (clusters) of 6-9 for a demonstration of the correct execution of WHO procedure. Randomization by cluster was done prior HH training. In the control group, the students hand rubbed under visual supervision of a tutor. In the intervention group after the same visual supervision, completeness of fluorescent-AHR hand application was recorded under UVc and was shown to the student. The intervention group had free access to the UVc until complete application. HH practices were included in simulation sessions for the both groups. One year after (3rd degree), all the students were asked to hand rub with fluorescent-AHR. A tutor (blinded to the study group) assessed the completeness of hand application under UVc and the compliance with the WHO opportunities. Complete application of AHR was defined as fluorescence for all the surfaces of hands and wrists. RESULTS 242 students participated (140 in the intervention group and 102 in the control group). One year after the initial training, the rate of complete application of AHR was doubled in the intervention group (60.0% vs. 30.4%, p < 0.001). In a multivariate analysis which included gender, additional HH or UVc training, surgical traineeship and regular use of AHR, the hazard ratio for the intervention was 3.84 (95%CI: 2.09-7.06). The compliance with the HH WHO's opportunities was increased in the intervention group (58.1% vs. 42.4%, p < 0.018). CONCLUSION Using UVc for undergraduate medical students education to hand hygiene improves their technique and compliance with WHO recommendations.
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Affiliation(s)
- Sandrine Dray
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Samuel Lehingue
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Sabine Valera
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Philippe Nouguier
- Service d'Aide Médicale Urgente (SAMU), Assistance Publique Hôpitaux de Marseille, CHU Timone, Marseille, France
| | - Michel Salah Boussen
- Département d'Anesthésie Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Timone, Marseille, France
| | - Florence Daviet
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Delphine Bastian
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France.,Service d'Accueil des Urgences, Assistance Publique Hôpitaux de Marseille, CHU Nord, Marseille, France
| | - Estelle Pilarczik
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France.,Service d'Accueil des Urgences, Assistance Publique Hôpitaux de Marseille, CHU Nord, Marseille, France
| | - Isabelle Jousset
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Sébastien Le Floch
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Georgette Grech
- Comité de Lutte Contre les Infections Nosocomiales (CLIN), Assistance Publique Hôpitaux de Marseille, CHU Nord, Marseille, France
| | - Georges Leonetti
- Faculté de Médecine de Marseille, Aix Marseille University, Marseille, France
| | - Laurent Papazian
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France.,Faculté de Médecine de Marseille, EA 3279, CEReSS - Health Service Research and Quality of life Center, Aix Marseille University, Marseille, France
| | - Nadim Cassir
- Comité de Lutte Contre les Infections Nosocomiales (CLIN), Assistance Publique Hôpitaux de Marseille, CHU Nord, Marseille, France
| | - Jean-Marie Forel
- Médecine Intensive Réanimation, Assistance Publique Hôpitaux de Marseille, CHU Nord, Chemin des Bourrely, 13015, Marseille, France. .,Faculté de Médecine de Marseille, EA 3279, CEReSS - Health Service Research and Quality of life Center, Aix Marseille University, Marseille, France.
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Awwad S, Tarvade S, Piccardi M, Gattas DJ. The use of privacy-protected computer vision to measure the quality of healthcare worker hand hygiene. Int J Qual Health Care 2019; 31:36-42. [PMID: 29767747 DOI: 10.1093/intqhc/mzy099] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 03/23/2018] [Accepted: 04/20/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES (i) To demonstrate the feasibility of automated, direct observation and collection of hand hygiene data, (ii) to develop computer visual methods capable of reporting compliance with moment 1 (the performance of hand hygiene before touching a patient) and (iii) to report the diagnostic accuracy of automated, direct observation of moment 1. DESIGN Observation of simulated hand hygiene encounters between a healthcare worker and a patient. SETTING Computer laboratory in a university. PARTICIPANTS Healthy volunteers. MAIN OUTCOME MEASURES Sensitivity and specificity of automatic detection of the first moment of hand hygiene. METHODS We captured video and depth images using a Kinect camera and developed computer visual methods to automatically detect the use of alcohol-based hand rub (ABHR), rubbing together of hands and subsequent contact of the patient by the healthcare worker using depth imagery. RESULTS We acquired images from 18 different simulated hand hygiene encounters where the healthcare worker complied with the first moment of hand hygiene, and 8 encounters where they did not. The diagnostic accuracy of determining that ABHR was dispensed and that the patient was touched was excellent (sensitivity 100%, specificity 100%). The diagnostic accuracy of determining that the hands were rubbed together after dispensing ABHR was good (sensitivity 83%, specificity 88%). CONCLUSIONS We have demonstrated that it is possible to automate the direct observation of hand hygiene performance in a simulated clinical setting. We used cheap, widely available consumer technology and depth imagery which potentially increases clinical application and decreases privacy concerns.
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Affiliation(s)
- Sari Awwad
- Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Sanjay Tarvade
- Intensive Care Unit, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Massimo Piccardi
- Faculty of Engineering and IT, University of Technology Sydney, Ultimo, NSW, Australia
| | - David J Gattas
- Intensive Care Unit, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
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Abstract
Although substantial improvements in hand hygiene practices have occurred in recent years, many health care facilities continue to encounter challenges in achieving and maintaining high levels of hand hygiene compliance. Issues of current interest include the optimum dose of alcohol-based handrub (ABHR) that should be applied, the impact of hand size and alcohol-based handrub dry times have on efficacy, and ideal hand hygiene technique. There is a need to determine which additional promotional activities can augment improvements in hand hygiene that are achieved by implementing the multimodal improvement strategy recommended by the World Health Organization. Monitoring hand hygiene performance and providing personnel with feedback on their performance are essential elements of successful improvement programs. Further research is needed to establish the most effective methods of providing feedback. Additional studies are needed to optimize strategies for performing direct observation of hand hygiene compliance, and to determine the role of supplementing direct observations using automated monitoring systems.
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Pennathur PR, Herwaldt LA. Role of Human Factors Engineering in Infection Prevention: Gaps and Opportunities. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017; 9:230-249. [PMID: 32226329 PMCID: PMC7100866 DOI: 10.1007/s40506-017-0123-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Human factors engineering (HFE), with its focus on studying how humans interact with systems, including their physical and organizational environment, the tools and technologies they use, and the tasks they perform, provides principles, tools, and techniques for systematically identifying important factors, for analyzing and evaluating how these factors interact to increase or decrease the risk of Healthcare-associated infections (HAI), and for identifying and implementing effective preventive measures. We reviewed the literature on HFE and infection prevention and control and identified major themes to document how researchers and infection prevention staff have used HFE methods to prevent HAIs and to identify gaps in our knowledge about the role of HFE in HAI prevention and control. Our literature review found that most studies in the healthcare domain explicitly applying (HFE) principles and methods addressed patient safety issues not infection prevention and control issues. In addition, most investigators who applied human factors principles and methods to infection prevention issues assessed only one human factors element such as training, technology evaluations, or physical environment design. The most significant gap pertains to the limited use and application of formal HFE tools and methods. Every infection prevention study need not assess all components in a system, but investigators must assess the interaction of critical system components if they want to address latent and deep-rooted human factors problems.
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Affiliation(s)
- Priyadarshini R. Pennathur
- Department of Mechanical and Industrial Engineering, 2132 Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, IA USA
| | - Loreen A. Herwaldt
- Department of Medicine, University of Iowa School of Medicine, Iowa City, IA USA
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Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, Price L, Egger M, Grayson ML, Kelley E, Allegranzi B. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resist Infect Control 2017; 6:6. [PMID: 28078082 PMCID: PMC5223492 DOI: 10.1186/s13756-016-0149-9] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.
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Affiliation(s)
- Julie Storr
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Anthony Twyman
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Walter Zingg
- Infection Control Programme, and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Nizam Damani
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Claire Kilpatrick
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Jacqui Reilly
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Lesley Price
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - M Lindsay Grayson
- Austin Health and University of Melbourne, 145 Studley Road, PO Box 5555, Heidelberg, VIC Australia
| | - Edward Kelley
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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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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Rashidi B, Li A, Patel R, Harmsen IE, Sabri E, Kyeremanteng K, D'Egidio G. Effectiveness of an extended period of flashing lights and strategic signage to increase the salience of alcohol-gel dispensers for improving hand hygiene compliance. Am J Infect Control 2016; 44:782-5. [PMID: 26922102 DOI: 10.1016/j.ajic.2016.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/19/2015] [Accepted: 01/04/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple factors affect compliance with hand hygiene, including conspicuity of alcohol-gel dispensers. Previous studies have shown that flashing lights increase hand hygiene compliance; however, the durability of this effect has not been studied. METHODS We affixed flashing lights to hand sanitizer dispensers for a total of 6 weeks. Regression analysis was used to compare compliance rates between the beginning and end of the intervention. Our secondary objective was to determine whether compliance rates in cold weather could be improved by adding a sign separated in time and space from the dispensers. RESULTS Flashing lights improved hand hygiene compliance from 11.8% to 20.7%, and this effect was unchanged over the 6-week study period. Fully charged lights resulted in a greater compliance increase. A preemptive sign did not have a significant effect on hand hygiene rates nor did absolute temperatures. CONCLUSIONS Flashing lights are a simple, inexpensive way of improving hand hygiene. Brighter lights appear to have a greater effect; however, this must be balanced with annoyance in specific settings. Temperature did not have a significant effect; however, this may be because the relationship does not fit a linear model. Other interventions, such as signs, may need to be tailored specifically to individual hospital environments.
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Affiliation(s)
- Babak Rashidi
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Aimee Li
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rakesh Patel
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Irene E Harmsen
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elham Sabri
- Ottawa Research Health Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Gianni D'Egidio
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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