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Moore LD, Arbogast JW, Robbins G, DiGiorgio M, Parker AE. Drastic hourly changes in hand hygiene workload and performance rates: A multicenter time series analysis. Am J Infect Control 2024:S0196-6553(24)00691-6. [PMID: 39241916 DOI: 10.1016/j.ajic.2024.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/28/2024] [Accepted: 08/31/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND High hand hygiene (HH) workload is a commonly cited barrier to optimal HH performance. The objective of this study was to assess trends of HH workload as defined by HH opportunities (HHO) and performance rates over different timescales using automated HH monitoring system data. METHODS This multiyear retrospective observational study was conducted in 58 inpatient units located in 10 North American hospitals. HHO and HH rates were analyzed by time series mixed effects general additive model. RESULTS Median HH rates peaked at 50.0 between 6 and 7 AM with a trough of 38.2 at 5 PM. HHO over hours in a day were the highest at 184 per hospital unit per hour at 10 AM with a trough of 49.0 between 2 and 3 AM. Median rates for day and night shifts were 40.8 and 45.5, respectively (P = .078). Weekend day shift had the lowest median rate (39.4) compared with any other 12-hour shift (P < .1018). The median rates and HHO varied little across days in a week and months. CONCLUSIONS HH workload and performance rates were negatively correlated and changed drastically over hours in a day. Hospitals should consider HH workload in the development and timely delivery of improvement interventions.
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Affiliation(s)
| | - James W Arbogast
- GOJO Industries, Akron, OH; JW Arbogast Advanced Science Consulting, LLC, Akron, OH
| | | | | | - Albert E Parker
- Center for Biofilm Engineering, Montana State University, Bozeman, MT; Department of Mathematical Sciences, Montana State University, Bozeman, MT
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Bredin D, O'Doherty D, Hannigan A, Kingston L. Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis. J Hosp Infect 2022; 130:20-33. [PMID: 36089071 DOI: 10.1016/j.jhin.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct observation of hand hygiene compliance is the "gold standard" despite limitations and potential for bias. Previous literature highlights poorer hand hygiene compliance amongst physicians than nurses and suggests that covert monitoring may give better compliance estimates than overt monitoring. AIM This review aimed to explore differences in compliance between physicians and nurses further, and to analyse if compliance estimates differed when observations were covert rather than overt. METHODS A systematic search of databases PubMed, EMBASE, CENTRAL and CINAHL was performed. Experimental or observational studies in hospital settings in high-income countries published in English from 2010 onwards were included if estimates for both physicians and nurses using direct observation were reported. The search yielded 4814 studies, of which 105 were included. FINDINGS The weighted pooled compliance rate for nurses was 52% (95% CI 47% to 57%) and for doctors was 45% (95% CI 40% to 49%). Heterogeneity was considerable (I2=99%). The majority of studies were at moderate or high risk of bias. Random-effects meta-analysis of low risk of bias studies suggests higher compliance for nurses than physicians for both overt (difference of 7%, 95% CI for the difference 0.8% to 13.5%, p=0.027) and covert (difference of 7%, 95% CI 3% to 11%, p=0.0002) observation. Considerable heterogeneity was found in all analyses. CONCLUSION Wide variability in compliance estimates and differences in the methodological quality of hand hygiene studies were identified. Further research with meta-regression should explore sources of heterogeneity and improve the conduct and reporting of hand hygiene studies.
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Affiliation(s)
- D Bredin
- School of Medicine, University of Limerick, Ireland
| | - D O'Doherty
- School of Medicine, University of Limerick, Ireland
| | - A Hannigan
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - L Kingston
- Department of Nursing and Midwifery, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
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Abstract
OBJECTIVE To determine whether the order in which healthcare workers perform patient care tasks affects hand hygiene compliance. DESIGN For this retrospective analysis of data collected during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, we linked consecutive tasks healthcare workers performed into care sequences and identified task transitions: 2 consecutive task sequences and the intervening hand hygiene opportunity. We compared hand hygiene compliance rates and used multiple logistic regression to determine the adjusted odds for healthcare workers (HCWs) transitioning in a direction that increased or decreased the risk to patients if healthcare workers did not perform hand hygiene before the task and for HCWs contaminating their hands. SETTING The study was conducted in 17 adult surgical, medical, and medical-surgical intensive care units. PARTICIPANTS HCWs in the STAR*ICU study units. RESULTS HCWs moved from cleaner to dirtier tasks during 5,303 transitions (34.7%) and from dirtier to cleaner tasks during 10,000 transitions (65.4%). Physicians (odds ratio [OR]: 1.50; P < .0001) and other HCWs (OR, 2.15; P < .0001) were more likely than nurses to move from dirtier to cleaner tasks. Glove use was associated with moving from dirtier to cleaner tasks (OR, 1.22; P < .0001). Hand hygiene compliance was lower when HCWs transitioned from dirtier to cleaner tasks than when they transitioned in the opposite direction (adjusted OR, 0.93; P < .0001). CONCLUSIONS HCWs did not organize patient care tasks in a manner that decreased risk to patients, and they were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks than the reverse. These practices could increase the risk of transmission or infection.
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Zhong X, Wang DL, Xiao LH, Mo LF, Wu QF, Chen YW, Luo XF. Comparison of two electronic hand hygiene monitoring systems in promoting hand hygiene of healthcare workers in the intensive care unit. BMC Infect Dis 2021; 21:50. [PMID: 33430792 PMCID: PMC7802277 DOI: 10.1186/s12879-020-05748-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 12/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background Hand hygiene (HH) is the cornerstone of infection control, and the promotion of HH is the focus of the world. The study aims to compare the role of two different types of electronic hand hygiene monitoring systems (EHHMSs) in promoting HH of healthcare workers (HCWs) in the intensive care unit (ICU). Methods In a 16-bed ICU of a general tertiary hospital in Shenzhen, the research was divided into three stages with interrupted time series (ITS) design. In the first stage, the direct observation method was used to monitor and feed back the HH compliance rate of HCWs monthly. In the second stage, the type1 EHHMS was applied to monitor and feed back the individual number of HH events monthly. In the third stage, the type2 EHHMS with a function of instant reminder and feedback was employed, and the personal HH compliance rates were fed back monthly. Meanwhile, direct observation continued in the last two stages. Results In the second stage, The HH compliance rate increased. However, there was no significant difference in the trajectory of the rate compared with the first stage. In the first month of the third stage, the HH compliance rate increased by 12.324% immediately and then ascended by 1.242% over time. The number of HH events per bed day and HH products’ consumption per bed day were consistent with the change of HH compliance rate observed. Conclusion Monitoring and feedback can improve the HH of HCWs. The EHHMS, with the function of real-time reminders and feedback, has a more noticeable effect on promoting HH. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05748-3.
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Affiliation(s)
- Xiao Zhong
- Department of Nosocomial Infection Control, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China.
| | - Dong-Li Wang
- Inspection center, Guangming District Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Li-Hua Xiao
- Department of Nosocomial Infection Control, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
| | - Lan-Fang Mo
- Department of Nosocomial Infection Control, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
| | - Qing-Fei Wu
- Department of Nosocomial Infection Control, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
| | - Yan-Wei Chen
- Department of Nosocomial Infection Control, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
| | - Xiao-Feng Luo
- Department of Nosocomial Infection Control, Shenzhen Hospital, University of Chinese Academy of Sciences, Shenzhen, 518106, Guangdong, China
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5
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Lai X, Wang X, Yang Q, Xu X, Tang Y, Liu C, Tan L, Lai R, Wang H, Zhang X, Zhou Q, Chen H. Will healthcare workers improve infection prevention and control behaviors as COVID-19 risk emerges and increases, in China? Antimicrob Resist Infect Control 2020; 9:83. [PMID: 32527300 PMCID: PMC7289224 DOI: 10.1186/s13756-020-00746-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background COVID-19 arise global attention since their first public reporting. Infection prevention and control (IPC) is critical to combat COVID-19, especially at the early stage of pandemic outbreak. This study aimed to measure level of healthcare workers’ (HCW’) self-reported IPC behaviors with the risk of COVID-19 emerges and increases. Methods A cross-sectional study was conducted in two tertiary hospitals. A structured self-administered questionnaire was delivered to HCWs in selected hospitals. The dependent variables were self-reported IPC behavior compliance; and independent variables were outbreak risk and three intent of infection risk (risk of contact with suspected patients, high-risk department, risk of affected area). Chi-square tests and multivariable negative binomial regression models were employed. Results A total of 1386 participants were surveyed. The risk of outbreak increased self-reported IPC behavior on each item (coefficient varied from 0.029 to 0.151). Considering different extent of risk, HCWs from high-risk department had better self-reported practice in most IPC behavior (coefficient ranged from 0.027 to 0.149). HCWs in risk-affected area had higher self-reported compliance in several IPC behavior (coefficient ranged from 0.028 to 0.113). However, HCWs contacting with suspected patients had lower self-reported compliance in several IPC behavior (coefficient varied from − 0.159 to − 0.087). Conclusions With the risk of COVID-19 emerges, HCWs improve IPC behaviors comprehensively, which benefits for better combat COVID-19. With the risk (high-risk department and affected area) further increases, majority of IPC behaviors achieved improvement. Nevertheless, under the risk of contact with suspected patients, HCWs show worse IPC behaviors. Which may result from higher work load and insufficient supplies and resources among these HCWs. The preparedness system should be improved and medical assistance is urgently needed.
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Affiliation(s)
- Xiaoquan Lai
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuemei Wang
- Present address: School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province, China
| | - Qiuxia Yang
- Present address: School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province, China
| | - Xiaojun Xu
- First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yuqing Tang
- Present address: School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province, China
| | - Chenxi Liu
- Present address: School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province, China
| | - Li Tan
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruying Lai
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - He Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- Present address: School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province, China.
| | - Qian Zhou
- Present address: School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province, China.
| | - Hao Chen
- Present address: School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, No.13 Hangkong Rd, Wuhan, Hubei Province, China.
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Phan HT, Zingg W, Tran HTT, Dinh APP, Pittet D. Sustained effects of a multimodal campaign aiming at hand hygiene improvement on compliance and healthcare-associated infections in a large gynaecology/obstetrics tertiary-care centre in Vietnam. Antimicrob Resist Infect Control 2020; 9:51. [PMID: 32276646 PMCID: PMC7146877 DOI: 10.1186/s13756-020-00712-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background Hung Vuong Hospital (HVH) is a 900-bed maternity hospital in Ho-Chi-Minh-City, Vietnam. Due to low compliance, a quasi-experimental, observational study was conducted with the aim to improve hand hygiene. Methods A multimodal promotion strategy was established in 2010 and further developed towards ongoing, repetitive and inventive campaigns including patient participation. Hand hygiene compliance was monitored by direct observation and healthcare-associated infections (HAIs) by applying standard definitions. Results Between 2010 and 2018, a total of 43,711 hand hygiene opportunities were observed. Compliance improved from 21.5% (95%CI: 20.2–22.8%) in 2010 to 75.1% (73.9–76.2%) in 2018 (incidence rate ratio, IRR , 1.10; 95%CI, 1.10–1.11). This was achieved through increasing recourse to alcohol-based hand rubbing. A total of 554,720 women were admitted to HVH during the study period for 353,919 deliveries (198,679 vaginal; 155,240 by C-section) and 257,127 surgical procedures. The HAI-incidence decreased significantly from 1.10 episodes per 1000 patient-days in 2010 to 0.45 per 1000 patient-days in 2018 (IRR 0.85; 95%CI, 0.79–0.90). Significant improvement was observed also for surgical site infections after gynaecological surgery (IRR 0.95; 95%CI, 0.92–0.99) and endometritis after abortion (IRR 0.80; 95%CI, 0.68–0.93). Conclusions A multimodal strategy aiming at behaviour change significantly improved and sustained hand hygiene, which contributed to the reduction of healthcare-associated infections.
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Affiliation(s)
- Hang Thi Phan
- Infection control programme, Hung Vuong hospital, Ho Chi Minh City, Vietnam
| | - 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, 1205, Geneva, Switzerland.
| | - Hang Thi Thuy Tran
- Infection control programme, Hung Vuong hospital, Ho Chi Minh City, Vietnam
| | | | - Didier Pittet
- Infection control programme and WHO collaborating centre on patient safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
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7
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Mckay KJ, Shaban RZ, Ferguson P. Hand hygiene compliance monitoring: Do video-based technologies offer opportunities for the future? Infect Dis Health 2020; 25:92-100. [PMID: 31932242 DOI: 10.1016/j.idh.2019.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022]
Abstract
Hand hygiene is universally recognised as the primary measure to reduce healthcare-associated infections. Studies have convincingly demonstrated a link between increased hand hygiene compliance and reductions in rates of healthcare-associated infections. Direct observation is considered the gold standard method for monitoring hand hygiene compliance. Despite the acknowledged benefits of this approach, recent literature has highlighted a range of issues impacting on the reliability and validity of this data collection technique. The rise of technology in healthcare provides opportunity for alternative methods that promise advantages over direct human observation. There have been no published examples of systems that are able to capture data consistent with all the WHO '5 Moments for Hand Hygiene'. In this paper we explore current human-based auditing practises for monitoring hand hygiene compliance and raise for discussion and debate video-based technologies to monitor hand hygiene compliance. We raise questions regarding hybrid approaches that incorporate both direct human observation and indirect video-based surveillance, and the possible advantages and disadvantages therein for monitoring hand hygiene compliance. We suggest that such methods have the potential to ameliorate, or minimise, the inherent biases associated with direct observation, notably the Hawthorne Effect. Future research into the utility of a hybrid approach to auditing, including the technical specifications, efficacy, cost effectiveness and acceptability of such a model is warranted.
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Affiliation(s)
- Katherine J Mckay
- Infection Prevention and Control, Eastern Health, Box Hill, Victoria, Australia; Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia.
| | - Patricia Ferguson
- School of Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia.
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Jain S, Clezy K, McLaws ML. Modified glove use for contact precautions: Health care workers' perceptions and acceptance. Am J Infect Control 2019; 47:938-944. [PMID: 30850247 DOI: 10.1016/j.ajic.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients colonized or infected with methicillin-resistant Staphylococcus aureus and or vancomycin-resistant Enterococcus are placed under contact precautions. Contact precautions require patients to be placed in single rooms and their health care workers (HCWs) to wear gowns, aprons and gloves on entry and doffing on exit. Glove use is widely accepted to be associated with poor hand hygiene compliance. We trailed the removal of gloves for contact precautions for contacts not expected to involve body fluids to improve hand hygiene between multiple contacts of the patient and patient zone. METHODS We have conducted a 5 phase study of the removal of gloves for contacts without body fluids in 250 HCWs using pretrial focus groups (N = 12), hand microbiology (N = 40) (reported elsewhere), development of a modified contact precautions poster, trial of modified poster (n = 100), posttrial focus group discussion (n = 22), and a survey of HCWs postrollout in additional locations (n = 76). RESULTS Pretrial focus groups identified 4 themes, and the leading theme identified as the facilitator for glove use as self-protection. HCWs viewed current contact precaution guidelines as preventing them from making their own judgement regarding the need for gloving for patient contacts, leading continuous glove use without changing gloves between multiple contacts. Participants believed that the trial empowered them to make their own clinical judgment for gloves and to consciously use hand hygiene between dry (no body fluid) contacts. Four themes were discussed during the posttrial focus groups and although self-protection remained the central theme, hand hygiene replaced glove use. Participants spoke of an appreciation of and increased trust in hand hygiene during nonglove use for dry contacts. The survey responses from additional sites were mostly positive for the safety of nonglove use for dry contacts, it improved hand hygiene and that the adoption of the modified guidelines was empowering. CONCLUSIONS The trial of nonglove use for expected dry contact, while caring for patients under contact precautions for methicillin-resistant S aureus and or vancomycin-resistant Enterococcus, was successful in refocusing HCWs reliance on hand hygiene for self-protection. Mandatory glove use for contact precautions was believed to contribute to their failure to change gloves between procedures on the same patient and patient zone, with HCWs now recognizing multiple contacts with the same gloves as a risk for contamination.
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Affiliation(s)
- Susan Jain
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia; Infection Prevention and Control, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Kate Clezy
- Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
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Fehling P, Hasenkamp J, Unkel S, Thalmann I, Hornig S, Trümper L, Scheithauer S. Effect of gloved hand disinfection on hand hygiene before infection-prone procedures on a stem cell ward. J Hosp Infect 2019; 103:321-327. [PMID: 31226271 DOI: 10.1016/j.jhin.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hand hygiene compliance even before infection-prone procedures (indication 2, 'before aseptic tasks', according to the World Health Organization (WHO)) remains disappointing. AIM To improve hand hygiene compliance by implementing gloved hand disinfection as a resource-neutral process optimization strategy. METHODS We performed a three-phase intervention study on a stem cell transplant ward. After baseline evaluation of hand hygiene compliance (phase 1) gloved hand disinfection was allowed (phase 2) and restricted (phase 3) to evaluate and differentiate intervention derived from learning and time effects. The incidence of severe infections as well as of hospital-acquired multidrug-resistant bacteria was recorded by active surveillance. FINDINGS Hand hygiene compliance improved significantly from 50% to 76% (P < 0.001) when gloved hand disinfection was allowed. The biggest increase was for infection-prone procedures (WHO 2) from 31% to 65%; P < 0.001. Severe infections decreased by trend (from 6.0 to 2.5 per 1000 patient-days) whereas transmission of multidrug-resistant organisms was not affected. CONCLUSION Gloved hand disinfection significantly improved compliance with the hand hygiene, especially in activities relevant to infections and infection prevention. Thus, this process optimization may be an additional, easy implementable, resource-neutral tool for a highly vulnerable patient cohort.
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Affiliation(s)
- P Fehling
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany.
| | - J Hasenkamp
- Department of Hematology and Oncology, University Medical Center, Georg August University Goettingen, Germany
| | - S Unkel
- Department of Medical Statistics, University Medical Center, Georg August University Goettingen, Germany
| | - I Thalmann
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany
| | - S Hornig
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany
| | - L Trümper
- Department of Hematology and Oncology, University Medical Center, Georg August University Goettingen, Germany
| | - S Scheithauer
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany
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10
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Baloh J, Thom KA, Perencevich E, Rock C, Robinson G, Ward M, Herwaldt L, Reisinger HS. Hand hygiene before donning nonsterile gloves: Healthcareworkers' beliefs and practices. Am J Infect Control 2019; 47:492-497. [PMID: 30616932 DOI: 10.1016/j.ajic.2018.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Understanding the perceptions and beliefs of health care workers (HCWs) regarding glove use and associated hand hygiene (HH) may be informative and ultimately improve practice. Research in this area is limited. This study examined the practices and beliefs of HCWs surrounding the use of nonsterile gloves and HH before gloving. METHODS The study was conducted at 3 large academic US hospitals using a parallel convergent mixed-method design. To estimate compliance rates, the gloving and HH practices of HCWs were observed at entry to patient rooms for 6 months. Interviews were conducted with 25 providers, nurses, and nursing assistants to investigate their beliefs and perceptions of these practices. RESULTS Observed HH compliance rates before gloving were 42%, yet in the interviews most HCWs reported 100% compliance. Observed compliance with gloving before entering contact precaution rooms was 78%, although all HCWs reported always gloving for standard and contact precautions. Most HCWs described using gloves more often than necessary. HCWs generally use gloves for their own safety and sanitize hands before gloving for patient safety. Numerous barriers to compliance with HH before gloving were discussed, including beliefs that gloves provide enough protection. CONCLUSIONS HH and glove use are highly intertwined in clinical practice and should be considered jointly in infection prevention improvement efforts.
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11
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Zhang S, Kong X, Lamb KV, Wu Y. High nursing workload is a main associated factor of poor hand hygiene adherence in Beijing, China: An observational study. Int J Nurs Pract 2019; 25:e12720. [PMID: 30609173 DOI: 10.1111/ijn.12720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/20/2018] [Accepted: 11/24/2018] [Indexed: 11/27/2022]
Abstract
AIM The aim of the study was to explore the impact of nurse workloads on adherence to hand hygiene. BACKGROUND Adherence to hand hygiene and nursing workloads have been linked to quality of patient care. Therefore, it was important to understand the relationship to safe patient care. DESIGN This cross-sectional study was performed from January 2016 to June 2016. METHODS Workloads and adherence to hand hygiene for nurses on 3-day shifts in a tertiary hospital were investigated in 2016. Actual hours worked per shift were timed using a stopwatch to assess nursing workloads. Descriptive and inferential statistics and multiple variable regression analysis were used to analyse the data. RESULTS Sixty-four nurses from four wards were observed. The average adherence rate of hand hygiene was 26.6% and the average nursing workload per shift was 6.7 hours. Multiple regression revealed that nursing workload was negatively related to adherence rate of hand hygiene. CONCLUSION Nurses in this study that had a low rate of adherence with hand hygiene frequently had high workloads. Adherence to hand hygiene was independently associated with actual hours worked per shift.
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Affiliation(s)
- Shan Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiangping Kong
- Teaching Administration, Beijing Chaoyang Hospital, Beijing, China
| | - Karen V Lamb
- College of Nursing, Rush University, Chicago, Illinois, USA
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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12
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Belela-Anacleto ASC, Kusahara DM, Peterlini MAS, Pedreira MLG. Hand hygiene compliance and behavioural determinants in a paediatric intensive care unit: An observational study. Aust Crit Care 2018; 32:21-27. [PMID: 29580966 DOI: 10.1016/j.aucc.2018.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hand hygiene is considered the single most effective means of reducing healthcare-associated infections, but improving and sustaining hand hygiene compliance remains a great challenge. OBJECTIVES To compare hand hygiene compliance before and after interventions to promote adherence in a paediatric intensive care unit (PICU) and to identify predictors of intention to perform the behaviour "hand hygiene during patient care in the PICU". METHODS A before and after study was conducted in three phases. Based on the World Health Organization guideline for hand hygiene compliance monitoring, 1261 hand hygiene opportunities were directly observed during routine patient care by two observers simultaneously, in a nine-bed PICU in Brazil, before and after infrastructure and educational interventions. To identify predictors of healthcare professionals' intention to perform the behaviour hand hygiene during patient care, a data collection instrument was designed based on the Theory of Planned Behaviour. Statistical analyses were undertaken using Chi-square test or the Fisher's exact test and regression analysis. A significance level of 5% (p < 0.05) was applied to all analyses. RESULTS The hand hygiene compliance rate increased significantly from 27.3% in the "pre-intervention phase" to 33.1% in "phase 1-post-intervention," to 37.0% in "phase 2-post-intervention" (p = .010). Perceived social pressure (p = .026) was a determinant factor of intention to perform the behaviour. CONCLUSIONS Hand hygiene compliance raised significantly after infrastructure, educational, and performance feedback interventions. However, despite the significant effect of the implemented interventions, the overall hand hygiene compliance rate was low. Perceived social pressure characterised a determinant factor of intention to perform the behaviour "hand hygiene during patient care in the PICU", reinforcing the need for behaviour determinants analysis when designing promotional interventions.
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Affiliation(s)
- Aline S C Belela-Anacleto
- Pediatric Nursing Department, Paulista Nursing School, Federal University of São Paulo, Napoleão de Barros Street, 754. Vila Clementino, São Paulo, 04024-002, Office 113, Brazil.
| | - Denise M Kusahara
- Pediatric Nursing Department, Paulista Nursing School, Federal University of São Paulo, Napoleão de Barros Street, 754. Vila Clementino, São Paulo, 04024-002, Office 113, Brazil.
| | - Maria Angélica S Peterlini
- Pediatric Nursing Department, Paulista Nursing School, Federal University of São Paulo, Napoleão de Barros Street, 754. Vila Clementino, São Paulo, 04024-002, Office 113, Brazil.
| | - Mavilde L G Pedreira
- Pediatric Nursing Department, Paulista Nursing School, Federal University of São Paulo, Napoleão de Barros Street, 754. Vila Clementino, São Paulo, 04024-002, Office 113, Brazil.
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Dalziel C, McIntyre J, Chand AG, McWilliam S, Ritchie L. Validation of a national hand hygiene proxy measure in NHS Scotland. J Hosp Infect 2017; 98:375-377. [PMID: 29017934 DOI: 10.1016/j.jhin.2017.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/02/2017] [Indexed: 12/16/2022]
Abstract
The Scottish national hand hygiene proxy measure uses the volume of alcohol-based hand rub (ABHR) purchased by NHS Scotland boards as an indicator of the number of hand hygiene moments being performed per patient-bed-day. The proxy measure calculation is based on the assumption that 3 mL of ABHR is used per hand hygiene moment. This study aimed to validate the volume of ABHR being used per hand hygiene moment. It found that the median volume of ABHR being used in practice is approximately 1 mL per hand hygiene moment, and that using this validated volume in the calculation substantially increases the proxy measure of hand hygiene compliance.
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Affiliation(s)
- C Dalziel
- NHS National Services Scotland, Health Protection Scotland, Glasgow, UK.
| | - J McIntyre
- NHS National Services Scotland, Health Protection Scotland, Glasgow, UK
| | - A G Chand
- NHS National Services Scotland, Procurement Commissioning and Facilities, Glasgow, UK
| | - S McWilliam
- NHS National Services Scotland, Procurement Commissioning and Facilities, Glasgow, UK
| | - L Ritchie
- NHS National Services Scotland, Health Protection Scotland, Glasgow, UK
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Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance. Am J Infect Control 2017; 45:528-535. [PMID: 28456322 DOI: 10.1016/j.ajic.2016.11.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 01/16/2023]
Abstract
Monitoring hand hygiene compliance among health care personnel (HCP) is an essential element of hand hygiene promotion programs. Observation by trained auditors is considered the gold standard method for establishing hand hygiene compliance rates. Advantages of observational surveys include the unique ability to establish compliance with all of the World Health Organization "My 5 Moments for Hand Hygiene" initiative Moments and to provide just-in-time coaching. Disadvantages include the resources required for observational surveys, insufficient sample sizes, and nonstandardized methods of conducting observations. Electronic and camera-based systems can monitor hand hygiene performance on all work shifts without a Hawthorne effect and provide significantly more data regarding hand hygiene performance. Disadvantages include the cost of installation, variable accuracy in estimating compliance rates, issues related to acceptance by HCP, insufficient data regarding their cost-effectiveness and influence on health care-related infection rates, and the ability of most systems to monitor only surrogates for Moments 1, 4, and 5. Increasing evidence suggests that monitoring only Moments 1, 4, and 5 provides reasonable estimates of compliance with all 5 Moments. With continued improvement of electronic monitoring systems, combining electronic monitoring with observational methods may provide the best information as part of a multimodal strategy to improve and sustain hand hygiene compliance rates among HCP.
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Scheithauer S, Batzer B, Dangel M, Passweg J, Widmer A. Workload even affects hand hygiene in a highly trained and well-staffed setting: a prospective 365/7/24 observational study. J Hosp Infect 2017; 97:11-16. [PMID: 28389091 DOI: 10.1016/j.jhin.2017.02.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Compliance with hand hygiene (HH) has often not proved satisfactory; high workload is a commonly self-reported reason. Previous studies comparing workload and compliance have not measured workload precisely and have focused on certain times of day. This study aimed to investigate the association between HH compliance and workload, both electronically defined 365/7/24 (primary endpoint). In addition, the quality of commonly used compliance defining methods (hand disinfectant usage, direct observation) was investigated (secondary endpoint). MATERIALS AND METHODS Correlation of electronically measured HH compliance (hand-rub activities (HRA)/HH opportunities) with electronically determined workload (nursing time output/nursing time input) was undertaken over one year at a stem cell transplant unit at University Hospital Basel, Switzerland. HRA and procedures requiring HRA according to the five World Health Organization indications were recorded continuously (365/7/24) using electronic dispensers and electronic documentation, and compliance was calculated accordingly. Hand disinfectant usage was calculated using spending records for one year; direct observation was performed for approximately 1800 HH opportunities. RESULTS During the investigation, 208,184 HRA, translating into 57 [standard deviation (SD) 10] HRA/patient-day (PD), were performed. Electronically determined compliance ranged from 24% to 66% [mean 42.39% (SD 8%)]. The higher the workload, the lower the compliance (R=-0.411; P<0.001). HRA/PD (r=-0.037), hand disinfectant usage (mean 160mL/PD) and observed compliance (95%; 1734 HRA/1813 HH opportunities) were not found to be associated with workload. CONCLUSION Calculated compliance was inversely associated with nurses' workload. HRA/PD, observer-determined compliance and amount of disinfectant dispensed were used as surrogates for compliance, but did not correlate with actual compliance and thus should be used with caution.
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Affiliation(s)
- S Scheithauer
- Infection Control and Infectious Diseases, University Medicine Goettingen, University Goettingen, Germany; Infectious Diseases, Basel University Hospital, Basel, Switzerland.
| | - B Batzer
- Infectious Diseases, Basel University Hospital, Basel, Switzerland
| | - M Dangel
- Infectious Diseases, Basel University Hospital, Basel, Switzerland
| | - J Passweg
- Clinic for Haematology, Basel University Hospital, Basel, Switzerland
| | - A Widmer
- Infectious Diseases, Basel University Hospital, Basel, Switzerland
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Measuring hand hygiene when it matters. THE LANCET. INFECTIOUS DISEASES 2016; 16:1306-1307. [PMID: 27599873 DOI: 10.1016/s1473-3099(16)30335-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 12/22/2022]
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Salge TO, Vera A, Antons D, Cimiotti JP. Fighting MRSA Infections in Hospital Care: How Organizational Factors Matter. Health Serv Res 2016; 52:959-983. [PMID: 27329446 DOI: 10.1111/1475-6773.12521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections at the level of the hospital organization. DATA SOURCES Data from all 173 acute trusts in the English National Health Service (NHS). STUDY DESIGN A longitudinal study based on trust-level panel data for the 5-year period from April 2004 to March 2009. Fixed effects negative binominal and system generalized method of moment models were used to examine the effect of (i) patient mix characteristics, (ii) resource endowments, and (iii) infection control practices on yearly MRSA counts. DATA COLLECTION Archival and staff survey data from multiple sources, including Public Health England, the English Department of Health, and the Healthcare Commission, were merged to form a balanced panel dataset. PRINCIPAL FINDINGS MRSA infections decrease with increases in general cleaning (-3.52 MRSA incidents per 1 standard deviation increase; 95 percent confidence interval: -6.61 to -0.44), infection control training (-3.29; -5.22 to -1.36), hand hygiene (-2.72; -4.76 to -0.68), and error reporting climate (-2.06; -4.09 to -0.04). CONCLUSIONS Intensified general cleaning, improved hand hygiene, additional infection control training, and a climate conducive to error reporting emerged as the factors most closely associated with trust-level reductions in MRSA infections over time.
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Affiliation(s)
- Torsten Oliver Salge
- Innovation, Strategy and Organization Group (ISO) and TIME Research Area, RWTH Aachen University School of Business and Economics, Aachen, Germany
| | - Antonio Vera
- Department of Organization and Human Resource Management, German Police University, Münster, Germany
| | - David Antons
- Innovation, Strategy and Organization Group (ISO) and TIME Research Area, RWTH Aachen University School of Business and Economics, Aachen, Germany
| | - Jeannie P Cimiotti
- Florida Blue Center forHealth Care Quality, University of Florida College of Nursing, Gainesville, FL
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Muller MP, Levchenko AI, Ing S, Pong SM, Fernie GR. Electronic Monitoring of Individual Healthcare Workers’ Hand Hygiene Event Rate. Infect Control Hosp Epidemiol 2016; 35:1189-92. [DOI: 10.1086/677631] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Løyland B, Wilmont S, Hessels AJ, Larson E. Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities. Nurs Res 2016; 65:132-41. [PMID: 26938362 PMCID: PMC4822544 DOI: 10.1097/nnr.0000000000000136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The burden of healthcare-associated infection worldwide is considerable, and there is a need to improve surveillance and infection control practices such as hand hygiene. OBJECTIVES The aims of this study were to explore direct care providers' knowledge about infection prevention and hand hygiene, their attitudes regarding their own and others' hand hygiene practices, and their ideas and advice for improving infection prevention efforts. METHODS This exploratory study included interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers conducted semistructured interviews using an interview guide with open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted a thematic analysis using a strategy adapted from the systematic text condensation approach. RESULTS From 31 interviews, four major thematic categories with subthemes emerged from the analysis: (a) hand hygiene products; (b) knowledge, awareness, perceptions, and beliefs; (c) barriers to infection prevention practices; and (d) suggested improvements. There was confusion regarding hand hygiene recommendations, use of soap or sanitizer, and isolation precaution policies. There was a robust "us" and "them" mentality between professionals. DISCUSSION One essential driver of staff behavior change is having expectations that are meaningful to staff, and many staff members stated that they wanted more in-person staff meetings with education and hands-on, practical advice. Workflow patterns and/or the physical environment need to be carefully evaluated to identify systems and methods to minimize cross-contamination. Further studies need to evaluate if personal sized containers of hand sanitizer (e.g., for the pocket, attached to a belt or lanyard) would facilitate improvement of hand hygiene in these facilities.
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Affiliation(s)
- Borghild Løyland
- Borghild Løyland, PhD, RN, is Associate Professor, Department of Nursing and Health Promotion, Oslo and Akershus University College, Norway. Sibyl Wilmont, BSN, RN, is Research Assistant; and Amanda J. Hessels, PhD, RN, is Postdoctoral Research Fellow, School of Nursing, Columbia University, New York. Elaine Larson, PhD, RN, FAAN, CIC, is Anna C. Maxwell Professor of Nursing Research, Associate Dean for Nursing Research, School of Nursing, and Professor of Epidemiology, the Mailman School of Public Health, Columbia University, New York, and Editor, American Journal of Infection Control
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20
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Smith A, Taggart L, Lebovic G, Zeynalova N, Khan A, Muller M. Clostridium difficile infection incidence: impact of audit and feedback programme to improve room cleaning. J Hosp Infect 2016; 92:161-6. [DOI: 10.1016/j.jhin.2015.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/01/2015] [Indexed: 11/15/2022]
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21
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Smith J. Letter to the Editor. ACTA ACUST UNITED AC 2015; 24:862. [PMID: 26419711 DOI: 10.12968/bjon.2015.24.17.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The editorial in BJN 24(15) written by BJN Editor in Chief, Ian Peate, challenged the Nursing and Midwifery Council's (NMC) Chief Executive and Registrar's assertion that the progress her organisation has achieved over the past 12 months is something to be 'delighted' about. The NMC responded and their letter is below. If you would like to comment on the issue email us: bjn@markallengroup.com.
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Affiliation(s)
- Jackie Smith
- Chief Executive and Chief Registrar, Nursing and Midwifery Council
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22
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Jain S, Edgar D, Bothe J, Newman H, Wilson A, Bint B, Brown M, Alexander S, Harris J. Reflection on observation: A qualitative study using practice development methods to explore the experience of being a hand hygiene auditor in Australia. Am J Infect Control 2015; 43:1310-5. [PMID: 26300099 DOI: 10.1016/j.ajic.2015.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Within the Australian public health care system, an observation model is used to assess hand hygiene practice in health care workers, culminating in a publicly available healthcare service performance indicator. The intent of this study was for the results to inform the development of a strategy to support individual auditors and local sustainability of the hand hygiene auditing program. METHOD This qualitative study used a values clarification tool to gain an understanding of the experiences of hand hygiene auditors. The methodology involved qualitative interpretation of focus group discussions to identify the enablers and barriers to successful performance of the auditors' role. RESULTS Twenty-five participants identified congruous themes of the need for peer and managerial support, improved communication and feedback, and consideration for succession planning. There was consistency in the participants' most frequently identified significant barriers in undertaking the role. CONCLUSION Hand hygiene auditors take pride in their role and work toward the goal of reducing health care-associated infections by having a part to play in improving hand hygiene practices of all staff members. Important themes, barriers, and enablers were identified in this study. This research will be of interest nationally and globally, considering the dearth of published information on the experience of hand hygiene auditors. This study provides evidence of the need to support individual hand hygiene auditors.
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Affiliation(s)
- Susan Jain
- Centre for Healthcare Epidemiology and Staff Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Denise Edgar
- Nursing Practice and Research Development Unit, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Janine Bothe
- St George Hospital and Community Service, Kogarah, NSW, Australia
| | - Helen Newman
- Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Annmaree Wilson
- Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Beth Bint
- Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Megan Brown
- Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Suzanne Alexander
- Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Joanna Harris
- Infection Management and Control Service (IMACS), Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
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Muller MP, Carter E, Siddiqui N, Larson E. Hand Hygiene Compliance in an Emergency Department: The Effect of Crowding. Acad Emerg Med 2015; 22:1218-21. [PMID: 26356832 DOI: 10.1111/acem.12754] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/01/2015] [Accepted: 05/08/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Emergency department (ED) crowding results from the need to see high volumes of patients of variable acuity within a limited physical space. ED crowding has been associated with poor patient outcomes and increased mortality. The authors evaluated whether ED crowding is also associated with reduced hand hygiene compliance among health care workers. METHODS A trained observer measured hand hygiene compliance using standardized definitions for 22 months in the 40-bed ED of a 475-bed academic hospital in Toronto, Ontario, Canada. ED crowding measures, including mean daily patient volumes, time to initial physician assessment, and daily nursing hours, were obtained from hospital administrative and human resource databases. Known predictors of hand hygiene compliance, including the indication for hand hygiene and the health care workers' professions, were also measured. Hand hygiene data, measured during 20-minute observation sessions, were linked to aggregate daily results for each crowding metric. Crowding metrics and known predictors of hand hygiene compliance were then included in a multivariate model if associated with hand hygiene compliance at a p-value of <0.20. RESULTS Hand hygiene compliance was 29% (325 of 1,116 opportunities). Alcohol-based hand rinse was used 66% of the time. Nurses accounted for 68% of hand hygiene opportunities and physicians for 18%, with the remaining 14% attributed to nonphysician, nonnurse health care workers. The most common indications for hand hygiene were hand hygiene prior to (35%) and hand hygiene following (52%) contact with the patient or his or her environment. In multivariate analysis, time to physician assessment > 1.5 hours was associated with lower compliance (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.51 to 0.89). Additionally, compliance was lower for nonnurse, nonphysician health care workers (OR = 0.51, 95% CI = 0.33 to 0.79) and higher for hand hygiene performed after contact with the patients or his/her environment, compared to hand hygiene performed before contact with the patient or his/her environment (OR = 2.0, 95% CI = 1.5 to 2.7). Daily patient volumes and nursing hours were not associated with hand hygiene compliance. CONCLUSIONS ED hand hygiene compliance was low. Increased time to physician assessment was associated with reduced compliance, suggesting an association between crowding and compliance. Strategies that minimize ED crowding may improve ED hand hygiene compliance.
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Affiliation(s)
- Matthew P. Muller
- St. Michael's Hospital; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
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Cole M. The application of epic3 guidelines: the complexity of practice. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:858-862. [PMID: 26419710 DOI: 10.12968/bjon.2015.24.17.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Healthcare-associated infection (HCAI) is a major patient safety concern and is associated with morbidity, mortality and increased healthcare costs. Prevention and control requires a multi-modal approach, but the individual's accountability and rigorous application of standard infection prevention and control behaviours is at its core. The third instalment of the epic3 guidance ( Loveday et al, 2014a ) provided the evidence and advanced the importance of hand-hygiene behaviour, the use of non-sterile gloves and environmental cleanliness. This discussion considers some of the recommendations made in these areas of practice and some of the underlying complexities. Producing guidelines based on the best available evidence and transforming them into policies can be a useful adjunct to communicating the necessary standards. However, policies often erase the complexity of implementation. To strive for the best possible standard is an understandable and laudable objective, but organisations need to be mindful of the difficulties and obstacles that stand in their way, particularly in an era where the philosophy of 'zero tolerance' is gaining popularity.
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Affiliation(s)
- Mark Cole
- Senior Lecturer, School of Health and Social Care, University of Lincoln
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25
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Hand hygiene monitoring technology: a systematic review of efficacy. J Hosp Infect 2015; 89:51-60. [DOI: 10.1016/j.jhin.2014.10.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/15/2014] [Indexed: 11/18/2022]
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Babiarz LS, Savoie B, McGuire M, McConnell L, Nagy P. Hand sanitizer-dispensing door handles increase hand hygiene compliance: a pilot study. Am J Infect Control 2014; 42:443-5. [PMID: 24679575 DOI: 10.1016/j.ajic.2013.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 11/29/2022]
Abstract
Improving rates of hand hygiene compliance (HHC) has been shown to reduce nosocomial disease. We compared the HHC for a traditional wall-mounted unit and a novel sanitizer-dispensing door handle device in a hospital inpatient ultrasound area. HHC increased 24.5%-77.1% (P < .001) for the exam room with the sanitizer-dispensing door handle, whereas it remained unchanged for the other rooms. Technical improvements like a sanitizer-dispensing door handle can improve hospital HHC.
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Affiliation(s)
- Lukasz S Babiarz
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD.
| | - Brent Savoie
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Mark McGuire
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lauren McConnell
- The Johns Hopkins Hospital, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Paul Nagy
- The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, Baltimore, MD
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Eiamsitrakoon T, Apisarnthanarak A, Nuallaong W, Khawcharoenporn T, Mundy LM. Hand hygiene behavior: translating behavioral research into infection control practice. Infect Control Hosp Epidemiol 2013; 34:1137-45. [PMID: 24113596 DOI: 10.1086/673446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In 2009, the World Health Organization (WHO) recommended "My Five Moments for Hand Hygiene" (5MHH) to optimize hand hygiene (HH). Uptake of these recommendations by healthcare workers (HCWs) remains uncertain. METHODS We prospectively observed HCW compliance to 5 MHH. After observations, eligible HCWs who consented to interviews completed surveys on factors associated with HH compliance based on constructs from the transtheoretical model of behavioral change (TTM) and the theory of planned behavior (TPB). Survey results were compared with observed HCW behaviors. RESULTS There were 968 observations among 123 HCWs, of whom 110 (89.4%) were female and 63 (51.3%) were nurses. The mean HH compliance for all 5 MHH was 23.2% (95% confidence interval [CI], 18.1%-28.3%) by direct observation versus 82.4% (95% CI, 79.9%-84.9%) by self report. The HCW 5 MHH compliance was associated with critical care unit encounters (P < .05), medicine unit encounters (P - 0.08, P < .001]), immunocompromised patient encounters (P < .05), and HCW prioritized patient advocacy (P < .001). Self-reported TTM stages of action or maintenance (P < .08) and the total TPB behavior score correlated with observed 5 MHH (r = 0.21, P < .02) and with self-reported 5 MHH compliance (r = 0.53, P < .001). CONCLUSION Observed HCW compliance to 5 MHH was associated with the type of hospital unit, type of provider-patient encounter, and theory-based behavioral measures of 5 MHH commitment.
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