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Ledo J, Hettinga KA, Bijman J, Kussaga J, Luning PA. A tailored food safety and hygiene training approach for dairy farmers in an emerging dairy chain. Food Control 2021. [DOI: 10.1016/j.foodcont.2021.107918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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2
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Gesser-Edelsburg A, Cohen R, Halavi AM, Zemach M. Motivating healthcare professionals (nurses, nurse assistants, physicians) to integrate new practices for preventing healthcare-associated infections into the care continuum: turning Positive Deviance into positive norms. BMC Infect Dis 2021; 21:495. [PMID: 34049512 PMCID: PMC8161960 DOI: 10.1186/s12879-021-06215-3] [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: 08/16/2020] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background The literature examining healthcare-associated infections (HAI) points to two main problems in conforming to infection prevention and control (IPC) guidelines among healthcare professionals (HP). One is the discrepancy between HPs’ behavioral intentions and their implementation in practice. The other refers to how HPs maintain these practices after the intervention stage ends. The method proposed in this study seeks to address both these issues by using the Positive Peviance (PD) approach to focus on the dissemination stage of interventions. The study seeks to offer a method for disseminating 27 PD practices to 135 HPs, among them nurses, nurse assistants and physicians, so as to help them maintain IPC guidelines, offer feedback on the dissemination process and examine the impact of the dissemination stage on changes in their behavior. Methods The theoretical model underlying this qualitative research was the Recognition-Primed dDecision (RPD) model, which we implemented in the field of healthcare-associated infections (HAIs). Moreover, we used the Discovery & Action Dialogue (DAD) and Think Aloud (TA) techniques to describe the methodological development of simulations for HPs. Feedback from the HP demonstrators underwent content analysis, while descriptive statistics were used to characterize behavioral changes. Results HPs’ information processing regarding infection prevention shifts from peripheral/automatic processing to intuition and analytical/central processing, turning PD practices into positive norms. The HPs personally experienced finding a solution and made repeated corrections until they overcame the barriers. Most of the HPs (69.4%) reported that the practices were fully implemented, together with additional practices. Conclusions Implementation of the dissemination stage indicates that in order for HPs to integrate and assimilate practices that are not in the official guidelines, merely observing simulations is not sufficient. Rather, each staff member must personally carry out the procedures.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel. .,The Health and Risk Communication Research Center, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel.
| | - Ricky Cohen
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel.,The Health and Risk Communication Research Center, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel
| | - Adva Mir Halavi
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel.,The Health and Risk Communication Research Center, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, 3498838, Haifa, Israel
| | - Mina Zemach
- Midgam Consulting & Research Ltd. Derech Ben Gurion 13, 68181, Bnei Brak, Israel
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3
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Chang NCN, Reisinger HS, Schweizer ML, Jones I, Chrischilles E, Chorazy M, Huskins C, Herwaldt L. Hand Hygiene Compliance at Critical Points of Care. Clin Infect Dis 2021; 72:814-820. [PMID: 32034404 DOI: 10.1093/cid/ciaa130] [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: 10/11/2019] [Accepted: 02/06/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Most articles on hand hygiene report either overall compliance or compliance with specific hand hygiene moments. These moments vary in the level of risk to patients if healthcare workers (HCWs) are noncompliant. We assessed how task type affected HCWs' hand hygiene compliance. METHODS We linked consecutive tasks individual HCWs performed during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study into care sequences and identified task pairs-2 consecutive tasks and the intervening hand hygiene opportunity. We defined tasks as critical and/or contaminating. We determined the odds of critical and contaminating tasks occurring, and the odds of hand hygiene compliance using logistic regression for transition with a random effect adjusting for isolation precautions, glove use, HCW type, and compliance at prior opportunities. RESULTS Healthcare workers were less likely to do hand hygiene before critical tasks than before other tasks (adjusted odds ratio [aOR], 0.97 [95% confidence interval {CI}, .95-.98]) and more likely to do hand hygiene after contaminating tasks than after other tasks (aOR, 1.12 [95% CI, 1.10-1.13]). Nurses were more likely to perform both critical and contaminating tasks, but nurses' hand hygiene compliance was better than physicians' (aOR, 0.94 [95% CI, .91-.97]) and other HCWs' compliance (aOR, 0.87 [95% CI, .87-.94]). CONCLUSIONS Healthcare workers were more likely to do hand hygiene after contaminating tasks than before critical tasks, suggesting that habits and a feeling of disgust may influence hand hygiene compliance. This information could be incorporated into interventions to improve hand hygiene practices, particularly before critical tasks and after contaminating tasks.
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Affiliation(s)
- Nai-Chung Nelson Chang
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.,Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,Veterans Affair Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Heather Schacht Reisinger
- Iowa City Veterans Affair Health Care System, Iowa City, Iowa, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marin L Schweizer
- Iowa City Veterans Affair Health Care System, Iowa City, Iowa, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ichael Jones
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Elizabeth Chrischilles
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Margaret Chorazy
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Charles Huskins
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Loreen Herwaldt
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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4
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Borg MA, Camilleri L. What Is Driving the Epidemiology of Methicillin-Resistant Staphylococcus aureus Infections in Europe? Microb Drug Resist 2020; 27:889-894. [PMID: 33337277 DOI: 10.1089/mdr.2020.0259] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The burden from infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the European Union/European Economic Area (EU/EEA) has increased in recent years, especially in the higher prevalence southern and eastern countries. Addressing this challenge requires a clear knowledge of the factors driving this epidemiology to inform effective national interventions and campaigns. Methods: We identified national quality metrics for antibiotic use and hand hygiene from the 2016/2017 European Centre for Disease Control (ECDC) Point Prevalence study as well as structural, cultural, and governance indicators from other sources. We then utilized general linear modeling to identify parsimonious correlations with national MRSA proportions reported by the European Antimicrobial Resistance Surveillance Network (EARS-Net). Results: The main process predictor of MRSA prevalence in EU/EEA countries was the use of more than one concurrent antibiotic per patient. The impact of hand hygiene was less clear, possibly because consumption of alcohol hand-rub was suboptimal throughout Europe. Hospital and infection control structural factors did not appear relevant at overall national level. Culture and governance were collectively key predictor groups; uncertainty avoidance, masculinity, and corruption indices strongly correlated with MRSA prevalence. Discussion: Our results suggest that the critical antibiotic stewardship factor associated with MRSA in EU/EEA countries is the quality of antibiotic prescribing, especially spectrum of activity, rather than overall consumption levels in hospitals or proportion of patients treated. Above all, MRSA hyperendemicity is correlated with a set of sociocultural behavioral constructs that typically manifest themselves in lack of urgency to address risk and normalization of deviance in relation to noncompliant practices.
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Affiliation(s)
- Michael A Borg
- Department of Infection Control, Mater Dei Hospital, Msida, Malta.,Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
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5
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What distinguishes positive deviance (PD) health professionals from their peers and what impact does a PD intervention have on behaviour change: a cross-sectional study of infection control and prevention in three Israeli hospitals. Epidemiol Infect 2020; 148:e259. [PMID: 33050958 PMCID: PMC7689599 DOI: 10.1017/s0950268820002484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Past studies using the positive deviance (PD) approach in the field of infection prevention and control (IPC) have primarily focused on impacts on healthcare-associated infection rates. This research aimed to determine if health professionals who exhibit PD behaviours have distinctive socio-cognitive profiles compared to non-PD professionals, and to examine the impact of a PD intervention on healthcare professionals’ (HPs) behavioural changes in maintaining IPC guidelines. In a cross-sectional study among 135 HPs, respondents first filled out a socio-cognitive characteristics questionnaire, and after 5 months were requested to complete a self-reported behavioural change questionnaire. The main findings indicate that socio-cognitive variables such as external locus of control, perceived threat and social learning were significant predictors of a person exhibiting PD behaviours. Almost 70% of HPs reported behavioural change and creating social networks as a result of the PD intervention in maintaining IPC guidelines, 16.9% of them are a ‘PD boosters’ (a new group of HPs who have adopted the positive practices of PDs that were originally identified, and also added additional practices of their own). Social networks can contribute to internalizing and raising personal accountability even among non-PD professionals, by creating a mind map that makes each person believe they are an important node in the network, regardless of their status and role. Health intervention programmes should purposely make visible and prominent social network connections in the hospital system.
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Taylor K, Thomas S, Mendez D, Chicken C, Carrick J, Heller J, Durrheim D. "Prevention is the biggest success": Barriers and enablers to personal biosecurity in the thoroughbred breeding industry. Prev Vet Med 2020; 183:105135. [PMID: 32961422 DOI: 10.1016/j.prevetmed.2020.105135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 11/25/2022]
Abstract
Employees in the equine industry are at occupational risk of zoonoses such as Hendra virus and equine chlamydiosis through exposure to infected materials. This study aimed to gain a deeper understanding of the views and experiences of employees, and the key drivers of infection control and personal biosecurity (PB) practices in the Thoroughbred breeding industry. Methods: An exploratory qualitative study was conducted in 2018 in New South Wales, Australia using interviews (9) and small group discussions (7). The 29 participants included veterinarians, veterinary nurses, foaling staff, stud managers and laboratory personnel working in a range of equine medicine settings. Interviews and focus groups were recorded, transcribed and analysed manually by at least two members of the research team. An iterative approach was used to derive themes. Results: Five main themes emerged: (i) greater awareness of current and emerging infectious risks promotes use of Personal Protective Equipment (PPE); (ii) currently available PPE is not comfortable, practical or well-suited to equine reproductive work in Australia's hot climate; (iii) creating supportive environments for PB reduces risk of exposure to infectious materials; (iv) strong leadership is required to implement sustainable change in workplace culture and practices; and (v) policy and economic factors play an important role in adopting biosecurity (BS) and PB measures in the workplace. Personnel working in the Australian Thoroughbred breeding industry face unique zoonotic risks in a challenging physical environment. A qualitative approach provided rich insights into social and physical factors motivating BS and PB in this occupational group. There is an opportunity for collaboration between Public Health services and industry partners to develop and implement strategies most likely to be effective in ensuring consistent uptake of PB measures in the workplace.
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Affiliation(s)
- Kathryn Taylor
- University of Newcastle, Australia; Hunter New England Local Health District, Australia.
| | - Susan Thomas
- University of Newcastle, Australia; Hunter New England Local Health District, Australia
| | | | | | | | | | - David Durrheim
- University of Newcastle, Australia; Hunter New England Local Health District, Australia
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7
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Nguyen HV, Tran HT, Khuong LQ, Nguyen TV, Ho NTN, Dao ATM, Hoang MV. Healthcare Workers' Knowledge and Attitudes Regarding the World Health Organization's "My 5 Moments for Hand Hygiene": Evidence From a Vietnamese Central General Hospital. J Prev Med Public Health 2020; 53:236-244. [PMID: 32752593 PMCID: PMC7411246 DOI: 10.3961/jpmph.19.319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/09/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives: Although the World Health Organization (WHO) initiative “My 5 Moments for Hand Hygiene” has been lauded as effective in preventing hospital-associated infections, little is known about healthcare workers (HCWs)’ hand hygiene behavior. In this study, we sought to assess knowledge and attitudes towards the concepts in this initiative, as well as associated factors, among Vietnamese HCWs at a general hospital. Methods: A structured questionnaire was administered to HCWs at a central Vietnamese general hospital in 2015. Multiple logistic regression analysis was used to identify factors associated with HCWs’ knowledge and attitudes towards hand hygiene. Results: Of 120 respondents, 65.8% and 67.5% demonstrated appropriate knowledge and a positive attitude, respectively, regarding all 5 hand hygiene moments. Logistic regression indicated better knowledge of hand hygiene in workers who were over 30 years old, who were direct HCWs (rather than managers), who had frequent access to clinical information, and who received their clinical information from training. Those who worked in infectious and tropical disease wards, who had frequent access to clinical information, and who received information from training were more likely to have a positive attitude towards hand hygiene than their counterparts. Conclusions: Although many Vietnamese HCWs displayed moderate knowledge and positive attitudes towards the WHO hand hygiene guidelines, a key gap remained. Regular education and training programs are needed to increase knowledge and to improve attitudes and practices towards hand hygiene. Furthermore, a combination of multimodal strategies and locally-adapted interventions is needed for sustainable hand hygiene adherence.
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Affiliation(s)
- Huy Van Nguyen
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan.,Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Population and Quantitative Health Sciences at the University of Massachusetts Medical School, Worcester, MA, USA
| | - Hieu Trung Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Long Quynh Khuong
- Center for Population Health Science, Hanoi University of Public Health, Vietnam
| | - Thanh Van Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Na Thi Nhi Ho
- School of Nursing, Duy Tan University, Da Nang, Vietnam
| | - An Thi Minh Dao
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Population and Quantitative Health Sciences at the University of Massachusetts Medical School, Worcester, MA, USA
| | - Minh Van Hoang
- Department of Health Economics, Hanoi University of Public Health, Hanoi, Vietnam
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8
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Gon G, Virgo S, de Barra M, Ali SM, Campbell OM, Graham WJ, Nash S, Woodd SL, de Bruin M. Behavioural Determinants of Hand Washing and Glove Recontamination before Aseptic Procedures at Birth: A Time-and-Motion Study and Survey in Zanzibar Labour Wards. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041438. [PMID: 32102276 PMCID: PMC7068290 DOI: 10.3390/ijerph17041438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/16/2022]
Abstract
Recent research calls for distinguishing whether the failure to comply with World Health Organisation hand hygiene guidelines is driven by omitting to rub/wash hands, or subsequently recontamination of clean hands or gloves prior to a procedure. This study examined the determinants of these two behaviours. Across the 10 highest-volume labour wards in Zanzibar, we observed 103 birth attendants across 779 hand hygiene opportunities before aseptic procedures (time-and-motion methods). They were then interviewed using a structured cross-sectional survey. We used mixed-effect multivariable logistic regressions to investigate the independent association of candidate determinants with hand rubbing/washing and avoiding glove recontamination. After controlling for confounders, we found that availability of single-use material to dry hands (OR:2.9; CI:1.58–5.14), a higher workload (OR:29.4; CI:12.9–67.0), more knowledge about hand hygiene (OR:1.89; CI:1.02–3.49), and an environment with more reminders from colleagues (OR:1.20; CI:0.98–1.46) were associated with more hand rubbing/washing. Only the length of time elapsed since donning gloves (OR:4.5; CI:2.5–8.0) was associated with avoiding glove recontamination. We identified multiple determinants of hand washing/rubbing. Only time elapsed since washing/rubbing was reliably associated with avoiding glove recontamination. In this setting, these two behaviours require different interventions. Future studies should measure them separately.
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Affiliation(s)
- Giorgia Gon
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
- Correspondence:
| | - Sandra Virgo
- University of Kent, Higher Education Access Tracker, Catenrbury CT2 7NZ, UK;
| | - Mícheál de Barra
- Department of Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK;
| | - Said M. Ali
- Public Health Laboratory-Ivo de Carneri, Chake Chake, Pemba, Zanzibar 9820, Tanzania;
| | - Oona M. Campbell
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
| | - Wendy J. Graham
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
| | - Susannah L. Woodd
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London WC1E 7HT, UK; (O.M.C.); (W.J.G.); (S.N.); (S.L.W.)
| | - Marijn de Bruin
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK;
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, 6525 GA Nijmegen, The Netherlands
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9
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Gesser-Edelsburg A, Cohen R, Zemach M, Halavi AM. Discourse on hygiene between hospitalized patients and health care workers as an accepted norm: Making it legitimate to remind health care workers about hand hygiene. Am J Infect Control 2020; 48:61-67. [PMID: 31358416 DOI: 10.1016/j.ajic.2019.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite World Health Organization recommendations that patients should play a role in encouraging hand hygiene (HH) as a means of preventing infection, patient engagement remains an underused method. From the perspectives of hospitalized patients (HPs) and health care workers (HCWs) at 2 major public hospitals in Haifa, Israel, this research investigated (1) HP barriers to reminding HCWs to maintain HH, (2) HCW barriers to giving HPs instruction on proper hygiene, (3) what could help HPs and HCWs overcome these barriers, and (4) how video clips can be used to devise tailored strategies governing discourse on HH between HCWs and HPs. METHODS Intervention type 2 design and examination of 2 population groups-HPs and HCWs-before and after intervention by means of mixed methods research. RESULTS Both HPs and HCWs reported partial knowledge, embarrassment, and fears regarding commenting to staff, as well as a lack of cultural adaptation. The interviewees indicated that the video clips granted legitimacy to reminding HCWs about hygiene through strategies designed to identify and solve barriers, authenticity, and cultural adaptation. CONCLUSIONS To overcome HP and HCW barriers to maintaining HH, tailored video clips on HH should specify barriers and solutions with which they can both identify, thus turning discourse on HH into an accepted norm.
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10
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Ng WK, Shaban RZ, van de Mortel T. Hand hygiene beliefs and behaviours about alcohol-based hand rub use: Questionnaire development, piloting and validation. Infect Dis Health 2019; 25:43-49. [PMID: 31727595 DOI: 10.1016/j.idh.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Behavioural theories are crucial to the development and success of effective hand hygiene interventions. Research demonstrates that hand hygiene behaviours can also be influenced by religious and cultural beliefs. In this paper we detail the processes undertaken to develop a valid and reliable questionnaire to examine healthcare workers' beliefs and behaviours related to the use of alcoholbased hand rub (ABHR), with particular emphasis on associated religious and cultural factors. METHODS Using the Theory of Planned Behaviour, an existing questionnaire was modified and pilot-tested on 35 staff in the Quality Department. Cronbach's alpha values and mean inter-item correlations of the scale items were the main outcome measures. A Pearson correlation was conducted to assess for social desirability response bias. RESULTS The questionnaire demonstrated high content and face validity and satisfactory internal consistency in most scales, except for the religious beliefs, cultural beliefs and perceived behavioural control scales, where the inter-item correlations were 0.10, 0.13, and 0.14, respectively. There was a significant correlation between scores on the social desirability scale and the attitude scale. Partial correlation should be used to control the effect of social desirability responding when analysing data from the attitudes scale. CONCLUSIONS A validation process allowed the introduction and subsequent modification of religious and cultural belief scales to an existing questionnaire examining behavioural and attitudinal influences on hand hygiene using ABHR. Such processes should be considered for questionnaire development and modification when considering religious and cultural factors as drivers of behaviour.
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Affiliation(s)
- Wai Khuan Ng
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia.
| | - Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead, NSW, Australia.
| | - Thea van de Mortel
- School of Nursing and Midwifery, Griffith University, Clinical Sciences 2 Building (G16), Parklands Drive, Southport, Qld, 4215, Australia.
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11
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Gartmeier M, Baumgartner M, Burgkart R, Heiniger S, Berberat PO. Why hand hygiene is not sufficient: modeling hygiene competence of clinical staff as a basis for its development and assessment. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc39. [PMID: 31544139 PMCID: PMC6737265 DOI: 10.3205/zma001247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/06/2019] [Accepted: 05/28/2019] [Indexed: 06/10/2023]
Abstract
Adhering to hygiene standards in daily clinical work is an important characteristic of qualitatively high-value medical care. In this regards, hand hygiene is often focused on in the literature. From the viewpoint of medical education research, we argue that this focus is too narrow to explain how staff who are working clinically with patients implement and adhere to standards of hygiene across a wide variety of tasks of their daily clinical routine. We present basic features of a differentiated concept of hygiene competence, which includes specialized knowledge, corresponding inner attitudes, and action routines that are customized to the needs of specific situations. Building on that, we present a current simulation-based course concept aimed at developing hygiene competence in medical education. Furthermore, we describe a test instrument that is designed according to the principle of a situational judgment test and that appears promising for the assessment of hygiene competence. The course and the measurement instrument are discussed in regards to their fit to the competence model and the related perspectives for research and teaching.
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Affiliation(s)
- Martin Gartmeier
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Maria Baumgartner
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Rainer Burgkart
- Technical University of Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany
| | - Susanne Heiniger
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Pascal O. Berberat
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
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12
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Hammerschmidt J, Manser T. Nurses' knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC Health Serv Res 2019; 19:547. [PMID: 31382968 PMCID: PMC6683349 DOI: 10.1186/s12913-019-4347-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Infections with multi-resistant bacteria’s, associated with healthcare, is a known problem. The nursing home setting differs from other healthcare environments in individual and organisational factors such as knowledge, behaviour, and attitude to improve hand hygiene and it is therefore difficult to research the influential factors to improve hand hygiene. Studies have shown that increasing knowledge, behaviour and attitudes could enhance hand hygiene compliance in nursing homes. Therefore, it may be important to examine individual and organisational factors that foster improvement of these factors in hand hygiene. We aim to explore these influences of individual and organisational factors of hand hygiene in nursing home staff, with a particular focus on the function of role modelling by nursing managers. Methods We conducted a mixed-methods study surveying 165 nurses and interviewing 27 nursing managers from nursing homes in Germany. Results Most nurses and nursing managers held the knowledge of effective hand hygiene procedures. Hygiene standards and equipment were all generally available but compliance to standards also depended upon availability in the immediate work area and role modelling. Despite a general awareness of the impact of leadership on staff behaviour, not all nursing managers fully appreciated the impact of their own consistent role modelling regarding hand hygiene behaviours. Conclusion These results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.
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Affiliation(s)
- Judith Hammerschmidt
- Institute for Patient Safety, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Tanja Manser
- University of Applied Sciences and Arts Northwestern Switzerland, FHNW School of Applied Psychology, Olten, Switzerland
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13
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Breckwoldt J, Knecht M, Massée R, Flach B, Hofmann-Huber C, Kaap-Fröhlich S, Witt CM, Aeberhard R, Sax H. Operating room technician trainees teach medical students - an inter-professional peer teaching approach for infection prevention strategies in the operation room. Antimicrob Resist Infect Control 2019; 8:75. [PMID: 31114677 PMCID: PMC6518629 DOI: 10.1186/s13756-019-0526-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Education is a cornerstone strategy to prevent health-associated infections. Trainings benefit from being interactive, simulation-based, team-orientated, and early in professional socialization. We conceived an innovative inter-professional peer-teaching module with operating room technician trainees (ORTT) teaching infection prevention behavior in the operating room (OR) to medical students (MDS). Methods ORTT delivered a 2-h teaching module to small groups of MDS in a simulated OR setting with 4 posts: ‘entering OR’; ‘surgical hand disinfection’; ‘dressing up for surgery and preparing a surgical field’, ‘debriefing’. MDS and ORTT evaluated module features and teaching quality through 2 specific questionnaires. Structured field notes by education specialist observers were analyzed thematically. Results On Likert scales from − 2 to + 2, mean overall satisfaction was + 1.91 (±0.3) for MDS and + 1.66 (±0.6 SD) for ORTT while teaching quality was rated + 1.89 (±0.3) by MDS and self-rated with + 1.34 (±0.5) by ORTT. Students and observers highlighted that the training fostered mutual understanding and provided insight into the corresponding profession. Conclusions Undergraduate inter-professional teaching among ORTT and MDS in infection prevention and control proved feasible with high educational quality. Inducing early mutual understanding between professional groups might improve professional collaboration and patient safety. Electronic supplementary material The online version of this article (10.1186/s13756-019-0526-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Breckwoldt
- 1Faculty of Medicine, Office of the Dean, University of Zurich, Pestalozzistr. 3-5, CH-8091 Zurich, Switzerland
| | - Monika Knecht
- Careum Training Centre, Gloriastrasse 16, CH-8006 Zurich, Switzerland
| | - Ralph Massée
- Careum Training Centre, Gloriastrasse 16, CH-8006 Zurich, Switzerland
| | - Barbara Flach
- Careum Training Centre, Gloriastrasse 16, CH-8006 Zurich, Switzerland
| | | | - Sylvia Kaap-Fröhlich
- 1Faculty of Medicine, Office of the Dean, University of Zurich, Pestalozzistr. 3-5, CH-8091 Zurich, Switzerland.,Department for Education Development, Careum, Pestalozzistr. 3, CH-8006 Zurich, Switzerland
| | - Claudia M Witt
- 1Faculty of Medicine, Office of the Dean, University of Zurich, Pestalozzistr. 3-5, CH-8091 Zurich, Switzerland.,4Institute for Complementary and Integrative Medicine, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Ruth Aeberhard
- Careum Training Centre, Gloriastrasse 16, CH-8006 Zurich, Switzerland
| | - Hugo Sax
- 5Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med 2018; 44:742-759. [PMID: 29754308 DOI: 10.1007/s00134-018-5212-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022]
Abstract
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU. It discusses the optimal therapy of catheter-related infections and thrombosis. Prevention of complications is a multidisciplinary task that combines both improvement of the process of care and introduction of new technologies. We emphasize the main component of the prevention strategies that should be used in critical care and propose areas of future investigation in this field.
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15
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Cresswell P, Monrouxe LV. 'And you'll suddenly realise 'I've not washed my hands': medical students', junior doctors' and medical educators' narratives of hygiene behaviours. BMJ Open 2018; 8:e018156. [PMID: 29572392 PMCID: PMC5875678 DOI: 10.1136/bmjopen-2017-018156] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Compliance to hygiene behaviours has long been recognised as important in the prevention and control of healthcare associated infections, but medical doctors still display some of the lowest rates of compliance of all healthcare workers. We aim to understand compliance to hygiene behaviours by analysing medical students', junior doctors' and medical educators' narratives of these behaviours to identify their respective attitudes and beliefs around compliance and how these are learnt during training. Such an understanding can inform future interventions to improve compliance targeted to areas of greatest need. DESIGN A qualitative study, using narrative interviews (nine focus groups and one individual interview). Data were analysed thematically using inductive framework analysis. SETTING Teaching hospitals in the UK. PARTICIPANTS Convenience sample of 25 participants: third-year medical students in their first clinical year (n=13), junior doctors (n=6) and medical educators (n=6). RESULTS We identified four main themes: (1) knowledge, (2) constraints, (3) role models/culture and (4) hygiene as an added extra. Knowledge varied across participant groups and appeared to influence behaviours; medical students relied on what they have been told by seniors, while medical educators relied on their own knowledge and experience. There was a strong belief that evidence for the effectiveness of good hygiene behaviours is lacking. Furthermore, medical educators' behaviour appears to strongly influence others. Finally, hygiene was predominately viewed as an added extra rather than an integral part of the process. CONCLUSIONS Awareness of the evidence around good hygiene needs to be improved at all levels. Medical students and junior doctors should be encouraged to consider why they are asked to perform certain hygiene behaviours in order to improve ownership of those behaviours. Medical educators need to recognise their responsibilities as role models for their junior counterparts, thereby understanding their role in developing the culture of hygiene practices within their clinical domains.
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Affiliation(s)
- Penelope Cresswell
- NHS East and North Hertfordshire Clinical Commissioning Group, Welwyn Garden City, UK
| | - Lynn V Monrouxe
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (R.O.C.)
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Dawson C, Wells F, Mackrill J, Prevc K. Using inherent and elective behavior to improve hand hygiene monitoring in health care. Am J Infect Control 2017. [PMID: 28629755 DOI: 10.1016/j.ajic.2017.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study established a method for collecting hand hygiene (HH) performance data based on behavioral drivers (inherent or elective) that can be used by infection preventionists (IPs) to improve practice. Further, we explored the influence that task and setting has on HH behavior. A significant effect was found between task and setting that has implications for improving the usefulness of HH measurement, with positive feedback reported regarding the new measurement method.
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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: 239] [Impact Index Per Article: 34.1] [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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Chatfield SL, DeBois K, Nolan R, Crawford H, Hallam JS. Hand hygiene among healthcare workers: A qualitative meta summary using the GRADE-CERQual process. J Infect Prev 2016; 18:104-120. [PMID: 28989515 DOI: 10.1177/1757177416680443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 10/27/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hand hygiene is considered an effective and potentially modifiable infection control behaviour among healthcare workers (HCW). Several meta-studies have been published that compare quantitatively expressed findings, but limited efforts have been made to synthesise qualitative research. OBJECTIVES This paper provides the first report of integrated findings from qualitative research reports on hand hygiene compliance among HCW worldwide that employs the GRADE-CERQual process of quality assessment. METHODS We conducted database searches and identified 36 reports in which authors conducted qualitative or mixed methods research on hand hygiene compliance among HCW. We used Dedoose analysis software to facilitate extraction of relevant excerpts. We applied the GRADE-CERQual process to describe relative confidence as high, moderate or low for nine aggregate findings. FINDINGS Highest confidence findings included that HCW believe they have access to adequate training, and that management and resource support are sometimes lacking. Individual, subjective criteria also influence hand hygiene. DISCUSSION These results suggest the need for further investigation into healthcare cultures that are perceived as supportive for infection control. Surveillance processes have potential, especially if information is perceived by HCW as timely and relevant.
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Affiliation(s)
- Sheryl L Chatfield
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Kristen DeBois
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Rachael Nolan
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Hannah Crawford
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
| | - Jeffrey S Hallam
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, USA
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19
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Robin C, Bettridge J, McMaster F. Zoonotic disease risk perceptions in the British veterinary profession. Prev Vet Med 2016; 136:39-48. [PMID: 28010906 PMCID: PMC7126003 DOI: 10.1016/j.prevetmed.2016.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/27/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
Abstract
In human and veterinary medicine, reducing the risk of occupationally-acquired infections relies on effective infection prevention and control practices (IPCs). In veterinary medicine, zoonoses present a risk to practitioners, yet little is known about how these risks are understood and how this translates into health protective behaviour. This study aimed to explore risk perceptions within the British veterinary profession and identify motivators and barriers to compliance with IPCs. A cross-sectional study was conducted using veterinary practices registered with the Royal College of Veterinary Surgeons. Here we demonstrate that compliance with IPCs is influenced by more than just knowledge and experience, and understanding of risk is complex and multifactorial. Out of 252 respondents, the majority were not concerned about the risk of zoonoses (57.5%); however, a considerable proportion (34.9%) was. Overall, 44.0% of respondents reported contracting a confirmed or suspected zoonoses, most frequently dermatophytosis (58.6%). In veterinary professionals who had previous experience of managing zoonotic cases, time or financial constraints and a concern for adverse animal reactions were not perceived as barriers to use of personal protective equipment (PPE). For those working in large animal practice, the most significant motivator for using PPE was concerns over liability. When assessing responses to a range of different “infection control attitudes”, veterinary nurses tended to have a more positive perspective, compared with veterinary surgeons. Our results demonstrate that IPCs are not always adhered to, and factors influencing motivators and barriers to compliance are not simply based on knowledge and experience. Educating veterinary professionals may help improve compliance to a certain extent, however increased knowledge does not necessarily equate to an increase in risk-mitigating behaviour. This highlights that the construction of risk is complex and circumstance-specific and to get a real grasp on compliance with IPCs, this construction needs to be explored in more depth.
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Affiliation(s)
- Charlotte Robin
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, United Kingdom; NIHR Health Protection Research Unit, University of Liverpool, Ronald Ross Building, Liverpool, L69 7BE, United Kingdom.
| | - Judy Bettridge
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, School of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, CH64 7TE, United Kingdom; International Livestock Research Institute, Old Naivasha Road, PO Box 30709-00100, Nairobi, Kenya
| | - Fiona McMaster
- Department of Public Health, Anglia Ruskin University, East Road, Cambridge, CB1 1PT, United Kingdom
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20
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Chatfield SL, Nolan R, Crawford H, Hallam JS. Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis. SAGE Open Med 2016; 4:2050312116675098. [PMID: 27803809 PMCID: PMC5077071 DOI: 10.1177/2050312116675098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/13/2016] [Indexed: 02/05/2023] Open
Abstract
Objective: Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals’ perceptions of hygiene might drive practices. Methods: We conducted qualitative interview research with eight nurses in the United States who were employed in various patient-care roles. We analyzed the data using an interpretative phenomenological analysis methodology to explore how nurses described their perceptions of, and experiences with, hygiene. We developed themes that explored individual, workplace, and management influences on perception of hygiene. Results: Developed themes include practical hygiene, risky business, and hygiene on trial; the latter theme described the conflict between how nurses perceived their own hygiene practices and how they felt hospital management perceived these practices. Other findings included that participants distinguished between policy-mandated use of sanitizer and a personal sense of cleanliness; the latter was more likely to be associated with scrubbing or removal of contaminants than with use of protectants. Conclusion: While participants asserted support for facility hand hygiene policies, their behavior in certain instances might be mediated by broadly defined emergent situations and a belief that it is not currently possible to establish a causal link between an healthcare-associated infections and a specific individual or occurrence. Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions, to encourage ownership, and emphasizing detailed cases as training content to take advantage of individuals’ sensory responses to hygiene.
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Affiliation(s)
- Sheryl L Chatfield
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA
| | - Rachael Nolan
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA
| | - Hannah Crawford
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA
| | - Jeffrey S Hallam
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH, USA
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21
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Konicki T, Miller E. Use of a simulation intervention to examine differences in nursing students' hand hygiene knowledge, beliefs, and behaviors. NURSE EDUCATION TODAY 2016; 45:96-101. [PMID: 27429413 DOI: 10.1016/j.nedt.2016.06.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/19/2016] [Accepted: 06/29/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND Although hand hygiene remains an essential aspect of quality care, adherence to best patient safety practices continues to pose major challenges. OBJECTIVES The objectives of this study are to examine hand hygiene knowledge, beliefs, practices, perceived importance and behaviors using Social Cognitive Theory and simulation-based intervention. DESIGN Participants were taken from a convenience sample of 131 undergraduate nursing students enrolled in a nursing fundamentals course at an urban university in the midwestern United States, and then randomly assigned to their respective groups. Using an experimental pretest-posttest design, control and intervention groups received the same lecture pertaining to hand hygiene and 3 data collection points where van de Mortel's Hand Hygiene Questionnaire (HHQ) was administered. In addition, the intervention group viewed a 6.5min video related to healthcare acquired infection and participated in 4 simulated situations requiring hand hygiene, based on World Health Organization guidelines. For all students, the hand hygiene technique was assessed through the use of Glo Germ, followed by handwashing and photography under ultraviolet light (posttest only). Image illumination was analyzed using image processing software. Microbiological sampling plates (pretest-posttest) were assessed quantitatively by colony counting. RESULTS Study findings did not support differences in the intervention group for the 5 hypothesized relationships. Social desirability responding and negative item confusion were found to occur with the HHQ in the student population. There was a significant difference in the UV hand photographs, with students in the afternoon having lower values than students in the morning. CONCLUSIONS Given the study results, there were no definitive educational recommendations to teach hand hygiene to nursing students. Future research should continue to further examine multi-focal modalities to enhance adherence to hand hygiene practices, as well as control for extraneous mediating or moderating variables found in educational settings.
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Affiliation(s)
- Tara Konicki
- Wright State University, College of Nursing and Health, 3640 Colonel Glenn Hwy, Dayton, Ohio 45435, United States.
| | - Elaine Miller
- University of Cincinnati, College of Nursing, Cincinnati, Ohio, United States
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22
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A survey of acute care clinicians' views on factors influencing hand hygiene practice and actions to improve hand hygiene compliance. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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File K, McLaws ML. Ni-Vanuatu health-seeking practices for general health and childhood diarrheal illness: results from a qualitative methods study. BMC Res Notes 2015; 8:189. [PMID: 25947195 PMCID: PMC4435643 DOI: 10.1186/s13104-015-1151-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND A local perspective on diarrheal illness has been shown to enhance control strategies for diarrheal disease in traditional rural settings. We aimed to assess caregivers' understandings of childhood general and diarrheal illness, in one rural community in Vanuatu, to help formulate control strategies for preventing diarrheal disease. FINDINGS This was a descriptive study using qualitative analysis of responses to open-ended questions to provide a fuller understanding of illness. Thematic analysis with categories derived from medical anthropology was used to analyse responses and draw conclusions. Twenty-nine participants were interviewed; 22 were maternal responses, three were traditional practitioners, two were rural health care workers, one was a spiritual healer and one had a caregiver role. Respondents categorised illness as biomedical or traditional. Explanations of illness were enmeshed in and derived from both the traditional and biomedical system as the illness experience in the child under their care unfolded. Diarrheal severity influenced treatment selection and respondents expressed a preference for biomedical assistance. Respondents articulated a preference for biomedicine as the primary help-seeking resort for small children. Exclusive reliance on either traditional or biomedical options was uncommon. Local herbal remedies were the preferred home treatment when illness was known or mild, while oral rehydration therapy was used when accessing biomedical practitioners. CONCLUSIONS Belief about diarrheal illness was influenced by traditional medicine and biomedicine. New evidence points to a growing preference for biomedicine as the first choice for severe childhood diarrheal illness. Diarrheal illness could be countered by maternal hand hygiene education at the medical dispensary and rural aid post.
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Affiliation(s)
- Karen File
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, 3rd Floor Samuels Building, Sydney, NSW, 2052, Australia.
| | - Mary-Louise McLaws
- Epidemiology in Healthcare Infection and Infectious Diseases Control, School of Public Health and Community Medicine, UNSW Medicine, UNSW, Australia, Sydney, Australia.
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Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, Allegranzi B, Magiorakos AP, Pittet D. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. THE LANCET. INFECTIOUS DISEASES 2015; 15:212-24. [DOI: 10.1016/s1473-3099(14)70854-0] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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McLaws ML, Farahangiz S, Palenik CJ, Askarian M. Iranian healthcare workers' perspective on hand hygiene: a qualitative study. J Infect Public Health 2014; 8:72-9. [PMID: 24997855 DOI: 10.1016/j.jiph.2014.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/15/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Hand hygiene (HH) has been identified as one of the simplest, but most important, methods to prevent cross-infection in healthcare facilities. In spite of this fact, the HH compliance rate remains low among healthcare workers (HCWs). Several factors may affect HH behavior. In this study, we aimed to assess various aspects of HH from the perspective of HCWs. METHOD This qualitative study was conducted in two hospital settings in Shiraz, Iran. Eight focus group discussions (FGDs) and six in-depth interview sessions were held with ICU and surgical ward nurses, attending physicians, medical and nursing students and supporting staff. Each FGD and interview was transcribed verbatim, open codes were extracted, and thematic analysis was conducted. RESULTS Three themes emerged from the thematic analysis including: "the relationship between personal factors and HH compliance," "the relationship between environmental factors and HH compliance" and "the impact of the health system on HH adherence, including the role of adequate health systems, administrative obligations and the effect of surveillance systems." CONCLUSION Several factors played a significant role in improving HCWs HH compliance, such as the regular adherence to health system tenets. HH compliance may be improved through application of realistic policies and better supervision. In addition, appropriate education may positively affect HH behavior and attitudes.
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Affiliation(s)
- Mary-Louise McLaws
- School of Public Health & Community Medicine, UNSW Medicine, UNSW Australia, Sydney, Australia.
| | - Saman Farahangiz
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Charles J Palenik
- Department of Oral Biology, Infection Control Research and Services, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Mehrdad Askarian
- Department of Community Medicine, Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Exploring physician hand hygiene practices and perceptions in 2 community-based Canadian hospitals. J Patient Saf 2014; 9:140-4. [PMID: 23965836 DOI: 10.1097/pts.0b013e318283f56d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to explore the self-reported hand hygiene practices and the predictors of hand hygiene among physicians in a midsize Canadian city. METHODS A descriptive cross-sectional survey using self-report questionnaire administered to a complete list of 354 local physicians. Perception of proper compliance was defined in a participant if he/she indicated performance of hand hygiene before and after every patient contact at least 80% of the time. RESULTS One hundred fifty-four physicians completed the questionnaire, yielding a 44.9% response rate. Only 45.3% of our sample reported performing preprocedure and postprocedure hand hygiene at least 80% of the time. Stepwise logistic regression results suggested that the variables "presence of hand hygiene auditing" (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.47-6.91), "being too busy" (OR, 0.43; 95% CI, 0.20-0.90), "forgetfulness" (OR, 0.27; 95%, CI, 0.13-0.56), and "the perception that hand hygiene products are damaging to the skin" (OR, 0.31;95% CI, 0.11-0.88) were the only independent predictors of physician hand hygiene compliance. CONCLUSIONS Hand hygiene compliance among physicians remains an issue. The findings emphasize the need of health-care institutions to prioritize hand hygiene by ensuring proper promotion and enforcement of current policies to all practicing HCPs.
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Borg MA. Lowbury Lecture 2013. Cultural determinants of infection control behaviour: understanding drivers and implementing effective change. J Hosp Infect 2014; 86:161-8. [PMID: 24534705 DOI: 10.1016/j.jhin.2013.12.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 12/28/2013] [Indexed: 11/18/2022]
Abstract
Despite dealing with biomedical practices, infection prevention and control (IPC) is essentially a behavioural science. Human behaviour is influenced by various factors, including culture. Hofstede's model of cultural dimensions proposes that national cultures vary along consistent dimensions which can be grouped and scored as specific constructs. Studies have reported that three Hofstede constructs--power distance, uncertainty avoidance, and masculinity--show significant association with several key performance indicators relevant to IPC and antibiotic stewardship. In addition, national meticillin-resistant Staphylococcus aureus (MRSA) levels within Europe correlate well with general quality-of-care indices, including preventive strategies and patient rights. This suggests that IPC may be simply a microcosm of overall quality and safety standards within hospitals and countries. Effective improvement would therefore need to address underlying and embedded core cultural values relevant to patient safety and quality of care. Successful IPC strategies are likely to be those that are compatible with the cultural background where they are implemented. To this end, content analysis of many current IPC improvement tools identifies elements of strong compatibility with cultures that are low in uncertainty avoidance and power distance, and high in individualism and masculinity. However, this cultural combination is largely restricted to Anglo-Saxon countries, where most of the recent improvements in healthcare-associated infection (HCAI) incidence have taken place. There is a paucity of research on IPC behaviour change in different cultural backgrounds, especially countries that score high for power distance and/or uncertainty avoidance. This information is vital to inform IPC campaigns in these countries, which often show high HCAI prevalence.
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Affiliation(s)
- M A Borg
- Mater Dei Hospital and University of Malta, Msida, Malta.
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Wyeth J. Hand hygiene and the use of personal protective equipment. ACTA ACUST UNITED AC 2013; 22:920, 922, 924-5. [DOI: 10.12968/bjon.2013.22.16.920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jenny Wyeth
- The Royal Berkshire NHS Foundation Trust, Reading
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Mitchell BG, Gardner A. Addressing the need for an infection prevention and control framework that incorporates the role of surveillance: a discussion paper. J Adv Nurs 2013; 70:533-42. [PMID: 23789617 DOI: 10.1111/jan.12193] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2013] [Indexed: 11/29/2022]
Abstract
AIM To present a discussion on theoretical frameworks in infection prevention and control. BACKGROUND Infection prevention and control programmes have been in place for several years in response to the incidence of healthcare-associated infections and their associated morbidity and mortality. Theoretical frameworks play an important role in formalizing the understanding of infection prevention activities. DESIGN Discussion paper. DATA SOURCES A literature search using electronic databases was conducted for published articles in English addressing theoretical frameworks in infection prevention and control between 1980-2012. RESULTS Nineteen papers that included a reference to frameworks were identified in the review. A narrative analysis of these papers was completed. Two models were identified and neither included the role of surveillance. DISCUSSION To reduce the risk of acquiring a healthcare-associated infection, a multifaceted approach to infection prevention is required. One key component in this approach is surveillance. The review identified two infection prevention and control frameworks, yet these are rarely applied in infection prevention and control programmes. Only one framework considered the multifaceted approach required for infection prevention. It did not, however, incorporate the role of surveillance. We present a framework that incorporates the role of surveillance into a biopsychosocial approach to infection prevention and control. CONCLUSION Infection prevention and control programmes and associated research are led primarily by nurses. There is a need for an explicit infection prevention and control framework incorporating the important role that surveillance has in infection prevention activities. This study presents one framework for further critique and discussion.
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Affiliation(s)
- Brett G Mitchell
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Canberra, Australian Capital Territory, Australia; Faculty of Nursing and Health, Avondale College, Wahroonga, New South Wales, Australia
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Lee K. Student and infection prevention and control nurses’ hand hygiene decision making in simulated clinical scenarios: a qualitative research study of hand washing, gel and glove use choices. J Infect Prev 2013. [DOI: 10.1177/1757177413484784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Final year nursing students and infection prevention and control nurses were recorded verbalising their hand hygiene decision-making while working through clinical scenarios on a computer, to understand what factors they were taking into account in choosing a decontamination method (hand washing or alcohol based hand rub/gel) or to wear gloves. Results demonstrated an overuse of gloves, and underuse of gel. Three main themes emerged: ‘Experience or expectation’; this was what they had seen on placement, or it was what ‘we’ do. ‘Just in case,’ was characterised by an awareness that what they would do wasn’t actually necessary but they tended to do it anyway. Thirdly, ‘gel doesn’t feel clean,’ was characterised by a feeling that using gel didn’t make the nurses feel clean after ‘dirty’ tasks, even though gel is actually more effective. There was little evidence that participants were making risk assessments based on the individual patient characteristics given, or the tasks, as they had been taught to do. Choice of hand decontamination agent and whether to use gloves appeared to be based on an habitual characterisation of whether the task was ‘clean’ or ‘dirty,’ with a very low threshold for ‘dirty’ based on an excessive perception of risk to the student.
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Affiliation(s)
- Karen Lee
- School of Nursing and Midwifery, University of Dundee, Dundee, UK
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Higgins A, Hannan MM. Improved hand hygiene technique and compliance in healthcare workers using gaming technology. J Hosp Infect 2013; 84:32-7. [PMID: 23498360 DOI: 10.1016/j.jhin.2013.02.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND In 2009, the World Health Organization recommended the use of a 'multi-faceted, multi-modal hand hygiene strategy' (Five Moments for Hand Hygiene) to improve hand hygiene compliance among healthcare workers. As part of this initiative, a training programme was implemented using an automated gaming technology training and audit tool to educate staff on hand hygiene technique in an acute healthcare setting. AIM To determine whether using this automated training programme and audit tool as part of a multi-modal strategy would improve hand hygiene compliance and technique in an acute healthcare setting. METHODS A time-series quasi-experimental design was chosen to measure compliance with the Five Moments for Hand Hygiene and handwashing technique. The study was performed from November 2009 to April 2012. An adenosine triphosphate monitoring system was used to measure handwashing technique, and SureWash (Glanta Ltd, Dublin, Ireland), an automated auditing and training unit, was used to provide assistance with staff training and education. FINDINGS Hand hygiene technique and compliance improved significantly over the study period (P < 0.0001). CONCLUSION Incorporation of new automated teaching technology into a hand hygiene programme can encourage staff participation in learning, and ultimately improve hand hygiene compliance and technique in the acute healthcare setting.
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Affiliation(s)
- A Higgins
- Infection Prevention and Control Department, Mater Private Hospital, Dublin 7, Ireland.
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Impact on hand hygiene compliance following migration to a new hospital with improved resources and the sequential introduction of World Health Organization recommendations. Am J Infect Control 2012; 40:737-41. [PMID: 22285712 DOI: 10.1016/j.ajic.2011.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 09/03/2011] [Accepted: 09/06/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND One commonly cited reason for inadequate hand hygiene (HH) in health care facilities is lack of handwashing sinks and alcohol hand rub (AHR). METHODS Using the World Health Organization (WHO) direct observation method, we studied HH compliance after migration from an old hospital having 1 HH station (sink and AHR) per 6 beds to a new institution with 1 per 0.85 beds. We then introduced the other WHO strategy components in a sequential manner-posters, active education, and performance feedback-and assessed the impact of the various elements over time. RESULTS Migration from the old to the new hospital was actually accompanied by a reduction in HH from 27.3% to 14.5% (P < .01), with a 52% decline in handwashing (P = .01) after patient contact. Small group interactive teaching improved HH compliance but only reached a maximum of 33.1%. No change was seen where only posters and leaflets (without educational sessions) were adopted. Significant improvement was only obtained after a performance feedback campaign coupled with increased staff accountability, reaching an overall average of 63% (P < .001). CONCLUSION Our results suggest that, on their own, better resources do not offer any guarantees of improved HH practices. However, once in place, audit and feedback-coupled with genuine administrative support and fostering of individual accountability-appear to be effective change tools to increase HH compliance.
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Borg MA, Camilleri L, Waisfisz B. Understanding the epidemiology of MRSA in Europe: do we need to think outside the box? J Hosp Infect 2012; 81:251-6. [PMID: 22695171 DOI: 10.1016/j.jhin.2012.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) infections, using bacteraemia as a marker, shows a striking geographical pattern in Europe. The prevalence of MRSA is low in Northern European countries, increases into central Europe and reaches its highest levels in the Mediterranean region. This has been attributed to varying levels of implementation of infection control and antibiotic stewardship (ICAS) programmes, but reasons for this variation have not been clearly established. AIM To investigate the possible impact of national cultural dimensions on the epidemiology of MRSA in Europe. METHODS Median proportions of MRSA bacteraemia were sourced for countries participating in the EARS-Net surveillance network in 2010, and correlated with the national cultural dimension scores of Hofstede et al. FINDINGS Significant associations were identified between MRSA proportions and the cultural constructs of uncertainty avoidance (UAI), masculinity (MAS) and power distance. Multiple regression models found significant associations for UAI, MAS and short-term orientation (R(2) adjusted = 0.475; P < 0.001). The model was found to be predictive of MRSA trends identified in several European countries between 2006 and 2010. CONCLUSION Implementation of ICAS programmes often requires behavioural change. Cultural dimensions appear to be key factors affecting perceptions and values among healthcare workers, which in turn are critical for compliance and uptake. Customizing ICAS initiatives to reflect the local cultural background may improve their chances of success.
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Affiliation(s)
- M A Borg
- Infection Control Unit, Mater Dei Hospital, Msida, Malta.
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Effect of single- versus double-gloving on virus transfer to health care workers' skin and clothing during removal of personal protective equipment. Am J Infect Control 2012; 40:369-74. [PMID: 21831480 PMCID: PMC7115263 DOI: 10.1016/j.ajic.2011.04.324] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 04/19/2011] [Accepted: 04/19/2011] [Indexed: 01/18/2023]
Abstract
Background The removal of personal protective equipment (PPE) after patient care may result in transfer of virus to hands and clothing of health care workers (HCWs). The risk of transfer can be modeled using harmless viruses to obtain quantitative data. To determine whether double-gloving reduces virus transfer to HCWs’ hands and clothing during removal of contaminated PPE, we conducted a human challenge study using bacteriophages to compare the frequency and quantity of virus transfer to hands and clothes during PPE removal with single-gloving and double-gloving technique. Methods Each experiment had a double-gloving phase and a single-gloving phase. Participants donned PPE (ie, contact isolation gown, N95 respirator, eye protection, latex gloves). The gown, respirator, eye protection, and dominant glove were contaminated with bacteriophage. Participants then removed the PPE, and their hands, face, and scrubs were sampled for virus. Results Transfer of virus to hands during PPE removal was significantly more frequent with single-gloving than with double-gloving. Transfer to scrubs was similar during single-gloving and double-gloving. The amount of virus transfer to hands ranged from 0.15 to 2.5 log10 most probable number. Significantly more virus was transferred to participants’ hands after single-gloving than after double-gloving. Conclusions Our comparison of double-gloving and single-gloving using a simulation system with MS2 and a most-probable number method suggests that double gloving can reduce the risk of viral contamination of HCWs’ hands during PPE removal. If incorporated into practice when full PPE is worn, this practice may reduce the risk of viral contamination of HCWs’ hands during PPE removal. The use of double gloves should be explored in larger controlled studies.
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Jeong SY, Kim OS. The Structural Model of Hand Hygiene Behavior for the Prevention of Healthcare-associated Infection in Hospital Nurses. ACTA ACUST UNITED AC 2012. [DOI: 10.7475/kjan.2012.24.2.119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Edwards R, Charani E, Sevdalis N, Alexandrou B, Sibley E, Mullett D, Loveday HP, Drumright LN, Holmes A. Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review. THE LANCET. INFECTIOUS DISEASES 2012; 12:318-29. [DOI: 10.1016/s1473-3099(11)70283-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soon J, Baines R. Food safety training and evaluation of handwashing intention among fresh produce farm workers. Food Control 2012. [DOI: 10.1016/j.foodcont.2011.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lindberg M, Lindberg M. HAEMODIALYSIS NURSES KNOWLEDGE ABOUT METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS. J Ren Care 2011; 38:82-5. [DOI: 10.1111/j.1755-6686.2011.00215.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McHugh SM, Corrigan MA, Dimitrov BD, Cowman S, Tierney S, Hill ADK, Humphreys H. Preventing infection in general surgery: improvements through education of surgeons by surgeons. J Hosp Infect 2011; 78:312-6. [PMID: 21640433 DOI: 10.1016/j.jhin.2011.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 03/21/2011] [Indexed: 11/28/2022]
Abstract
Surgical patients are at particular risk of healthcare-associated infection (HCAI) due to the presence of a surgical site leading to surgical site infection (SSI), and because of the need for intravascular access resulting in catheter-related bloodstream infection (CRBSI). A two-year initiative commenced with an initial audit of surgical practice; this was used to inform the development of a targeted educational initiative by surgeons specifically for surgical trainees. Parameters assessed during the initial audit and a further audit after the educational initiative were related to intra- and postoperative aspects of the prevention of SSIs, as well as care of peripheral venous catheters (PVCs) in surgical patients. The proportion of prophylactic antibiotics administered prior to incision across 360 operations increased from 30.0% to 59.1% (P<0.001). Surgical site dressings were observed in 234 patients, and a significant decrease was found in the percentage of dressings that were tampered with during the initial 48h after surgery (16.5% vs 6.2%, P=0.030). In total, 574 PVCs were assessed over the two-year period. Improvements were found in the proportion of unnecessary PVCs in situ (37.9% vs 24.4%, P<0.001), PVCs in situ for >72h (10.6% vs 3.1%, P<0.001) and PVCs covered with clean and intact dressings (87.3% vs 97.6%, P<0.001). Significant improvements in surgical practice were established for the prevention of SSI and CRBSI through a focused educational programme developed by and for surgeons. Potentially, other specific measures may also be warranted to achieve further improvements in infection prevention in surgical practice.
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Affiliation(s)
- S M McHugh
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Kennedy M, Burnett E. Hand hygiene knowledge and attitudes: comparisons between student nurses. J Infect Prev 2011. [DOI: 10.1177/1757177411411124] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is recognised that early intervention in healthcare workers’ education is important in terms of embedding effective infection prevention and control knowledge into practice. One of the most important aspects of this education is hand hygiene compliance and technique expectations. This small study was undertaken in collaboration with the University of Dundee, School of Nursing and Midwifery and NHS Tayside. It explored the differences in knowledge, attitudes and practice towards hand hygiene among second and third year student nurses with the aim of reviewing and informing the development of future educational material at undergraduate level in order to continually enhance knowledge and skills and bridge the theory–practice gap. This study concluded that third year student nurses did have a slightly better knowledge base than the second years and that although knowledge, attitudes and practice were reported to be of a good standard overall, there were still some important issues that must be addressed.
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Affiliation(s)
- M Kennedy
- NHS Tayside, Room C2016, Nurses Residences, Ninewells Hospital, Dundee, UK
| | - E Burnett
- University of Dundee, School of Nursing and Midwifery, Dundee, UK
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Eveillard M, Raymond F, Guilloteau V, Pradelle MT, Kempf M, Zilli-Dewaele M, Joly-Guillou ML, Brunel P. Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units. J Clin Nurs 2011; 20:2744-51. [PMID: 21366742 DOI: 10.1111/j.1365-2702.2011.03704.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To assess the impact of a multi-faceted training program on the compliance with hand hygiene and gloving practices. BACKGROUND Hand hygiene is considered as the cornerstone of the prevention of hospital-acquired infections. Several studies have enhanced the poor effectiveness of training programs in improving hand hygiene compliance. DESIGN A before-after evaluation study. METHODS The study was conducted in four healthcare settings before and after an intervention program which included the performance feedback of the first evaluation phase, three six-h training sessions, the assessment of hand hygiene performance with teaching boxes and the organisation of one full-day session devoted to institutional communication around hand hygiene in each setting. Hand hygiene compliance and quality of hand rubbing were evaluated. Hand hygiene opportunities were differentiated into extra-series opportunities (before or after a single contact and before the first contact or after the last contact of a series of consecutive contacts) and intra-series opportunities (from the opportunity following the first contact to the opportunity preceding the last in the same series). RESULTS Overall, 969 contacts corresponding to 1,470 hand hygiene opportunities (760 during the first phase and 710 during the second) were observed. A significant improvement of observed practices was recorded for the hand hygiene compliance in intra-series opportunities (39·0% vs. 19·0%; p < 10(-5) ), the proportion of gloves worn if indicated (71·4% vs. 52·0%; p < 0·001) and the quality of hand rubbing (85·0% vs. 71·9%; p < 10(-5) ). CONCLUSIONS Some of the performances measured for both hand hygiene and gloving practices were improved. We plan to extend this investigation by performing a qualitative study with experts in behavioural sciences to try improving practices for which adherence was still weak after the training program such as hand hygiene in intra-series opportunities. RELEVANCE TO CLINICAL PRACTICE This study underscored the usefulness of implementing contextualised training programs, while more traditional courses have shown little impact.
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Affiliation(s)
- Matthieu Eveillard
- UFR Médecine, Université d'Angers & Laboratoire de Bactériologie-hygiène, Centre Hospitalier Universitaire, Angers, France.
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Educating healthcare workers to optimal hand hygiene practices: addressing the need. Infection 2010; 38:349-56. [PMID: 20857314 DOI: 10.1007/s15010-010-0047-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
Abstract
The education of healthcare workers is essential to improve practices and is an integral part of hand hygiene promotional strategies. According to the evidence reviewed here, healthcare worker education has a positive impact on improving hand hygiene and reducing healthcare-associated infection. Detailed practical guidance on steps for the organization of education programmes in healthcare facilities and teaching-learning strategies are provided using the World Health Organization (WHO) Guidelines for Hand Hygiene in Health Care as the basis for recommendations. Several key elements for a successful educational programme are also identified. A particular emphasis is placed on concepts included in the tools developed by WHO for education, monitoring and performance feedback.
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Ward DJ. Infection control in clinical placements: experiences of nursing and midwifery students. J Adv Nurs 2010; 66:1533-42. [DOI: 10.1111/j.1365-2648.2010.05332.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McHugh SM, Hill A, Humphreys H. Preventing healthcare-associated infection through education: Have surgeons been overlooked? Surgeon 2010; 8:96-100. [DOI: 10.1016/j.surge.2009.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 11/30/2009] [Indexed: 10/19/2022]
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McHugh SM, Corrigan M, Dimitrov B, Cowman S, Tierney S, Humphreys H, Hill A. A targeted e-learning program for surgical trainees to enhance patient safety in preventing surgical infection. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2010; 30:257-9. [PMID: 21171032 DOI: 10.1002/chp.20091] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. METHODS An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An educational Web site was developed targeting deficiencies highlighted in the audit. Interactive clinical cases were constructed using PHP coding, an HTML-embedded language, and then linked to a MySQL relational database. PowerPoint tutorials were produced as online Flash audiovisual movies. An online repository of streaming videos demonstrating best practice was made available, and weekly podcasts were made available on the iTunes© store for free download. Usage of the e-learning program was assessed quantitatively over 6 weeks in May and June 2010 using the commercial company Hitslink. RESULTS During the 5-month audit, deficiencies in practice were highlighted, including the timing of surgical prophylaxis (33% noncompliance) and intravascular catheter care in surgical patients (38% noncompliance regarding necessity). Over the 6-week assessment of the educational material, the SurgInfection.com Web pages were accessed more than 8000 times; 77.9% of the visitors were from Ireland. The most commonly accessed modality was the repository with interactive clinical cases, accounting for 3463 (43%) of the Web site visits. The average user spent 57 minutes per visit, with 30% of them visiting the Web site multiple times. DISCUSSION Interactive virtual cases mirroring real-life clinical scenarios are likely to be successful as an e-learning modality. User-friendly interfaces and 24-hour accessibility will increases uptake by surgical trainees.
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