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Kashyap B, Jhamb R, Saha R, Prasad P, Singh NP. Feasibility of direct observation and consumption method for hand hygiene compliance in an intensive care unit of a Tertiary Care Hospital. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2021. [DOI: 10.4103/injms.injms_165_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Suzuki Y, Morino M, Morita I, Yamamoto S. The effect of a 5-year hand hygiene initiative based on the WHO multimodal hand hygiene improvement strategy: an interrupted time-series study. Antimicrob Resist Infect Control 2020; 9:75. [PMID: 32460892 PMCID: PMC7251720 DOI: 10.1186/s13756-020-00732-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/08/2020] [Indexed: 01/09/2023] Open
Abstract
Background A World Health Organization (WHO) guideline-based multimodal hand hygiene (HH) initiative was introduced hospital-wide to a nonteaching Japanese hospital for 5 years. The objective of this study was to assess the effect of this initiative in terms of changes in alcohol-based hand rub (ABHR) consumption and the Hand Hygiene Self-Assessment Framework (HHSAF) score. Methods The consumption of monthly hospital-wide ABHR was calculated in L per 1000 patient days (PDs). The change in ABHR consumption was analysed by an interrupted time series analysis with a pre-implementation period of 36 months and an implementation period of 60 months. The correlation between annual ABHR consumption and the HHSAF score was estimated using Pearson’s correlation coefficients. Results The annual ABHR consumption was 4.0 (L/1000 PDs) to 4.4 in the pre-implementation period and 10.4 to 34.4 in the implementation period. The HHSAF score was 117.5 (out of 500) in the pre-implementation period and 267.5 to 445 in the implementation period. A statistically significant increase in the monthly ABHR consumption (change in slope: + 0.479 L/1000 PDs, p < 0.01) was observed with the implementation of the initiative. Annual ABHR consumption was strongly correlated with the annual HHSAF score (r = 0.971, p < 0.01). Conclusions A 5-year WHO-based HH initiative significantly increased ABHR consumption. Our study suggested that the HHSAF assessment can be a good process measure to improve HH in a single facility, as ABHR consumption increased with the HHSAF score.
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Affiliation(s)
- Yumi Suzuki
- Department of Pediatrics, National Hospital Organization (NHO) Shimoshizu National Hospital, 934-5 Shikawatashi, Yotsukaido, 284-0003, Chiba, Japan. .,Division of Infection Control, NHO Shimoshizu National Hospital, Yotsukaidou, Japan.
| | - Motoko Morino
- Division of Infection Control, NHO Shimoshizu National Hospital, Yotsukaidou, Japan.,Department of Nursing, NHO Shimoshizu National Hospital, Yotsukaidou, Japan
| | - Ichizo Morita
- Japanese Red Cross Toyota College of Nursing, 12-33 Nanamagari Hakusancho, Toyota, 471-8565, Aichi, Japan
| | - Shigenori Yamamoto
- Department of Pediatrics, National Hospital Organization (NHO) Shimoshizu National Hospital, 934-5 Shikawatashi, Yotsukaido, 284-0003, Chiba, Japan
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Masroor N, Doll M, Stevens M, Bearman G. Approaches to hand hygiene monitoring: From low to high technology approaches. Int J Infect Dis 2017; 65:101-104. [PMID: 29054442 DOI: 10.1016/j.ijid.2017.09.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/25/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
Hand hygiene is a global and critical infection prevention practice across all healthcare settings. Approaches to monitoring hand hygiene compliance vary from simple methods such as direct observation and product usage to more advanced methods such as automated electronic monitoring systems. Current literature supports a multimodal approach, supplemented by education, to enhance hand hygiene performance.
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Affiliation(s)
- Nadia Masroor
- VCU Health Infection Prevention Program, P.O. Box 980019, Richmond, Virginia 23298, United States.
| | - Michelle Doll
- VCU Health Infection Prevention Program, P.O. Box 980019, Richmond, Virginia 23298, United States
| | - Michael Stevens
- VCU Health Infection Prevention Program, P.O. Box 980019, Richmond, Virginia 23298, United States
| | - Gonzalo Bearman
- VCU Health Infection Prevention Program, P.O. Box 980019, Richmond, Virginia 23298, United States
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Gould DJ, Moralejo D, Drey N, Chudleigh JH, Taljaard M. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2017; 9:CD005186. [PMID: 28862335 PMCID: PMC6483670 DOI: 10.1002/14651858.cd005186.pub4] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. OBJECTIVES To assess the short- and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection. SEARCH METHODS We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. SELECTION CRITERIA We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol-based hand rub (ABHR), or both. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta-analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. MAIN RESULTS This review includes 26 studies: 14 randomised trials, two non-randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long-term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention.Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes.Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low.Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence).Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence.Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence.Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence.Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. AUTHORS' CONCLUSIONS With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context.
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Affiliation(s)
- Dinah J Gould
- Cardiff UniversitySchool of Healthcare SciencesEastgate HouseCardiffWalesUK
| | - Donna Moralejo
- Memorial UniversitySchool of NursingH2916, Health Sciences Centre300 Prince Philip DriveSt. John'sNLCanadaA1B 3V6
| | - Nicholas Drey
- City, University of LondonCentre for Health Services ResearchNorthampton SquareLondonUKEC1V 0HB
| | - Jane H Chudleigh
- City, University of LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
| | - Monica Taljaard
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramThe Ottawa Hospital ‐ Civic Campus1053 Carling Ave, Box 693OttawaONCanadaK1Y 4E9
- University of OttawaSchool of Epidemiology, Public Health and Preventive MedicineOttawaONCanada
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Baghaei R, Sharifian E, Kamran A. Can theoretical intervention improve hand hygiene behavior among nurses? Psychol Res Behav Manag 2016; 9:133-8. [PMID: 27366106 PMCID: PMC4913994 DOI: 10.2147/prbm.s91433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hand washing is the best strategy to prevent known nosocomial infections but the nurses’ hand hygiene is estimated to be poor in Iran. Objective This study aimed to determine the effectiveness of BASNEF (Behavior, Attitude, Subjective Norms, and Enabling Factors) model on hand hygiene adherence education. Methods This controlled quasi-experimental study was conducted on 70 hemodialysis unit nurses (35 case and 35 control) in the health and educational centers of the University of Medical Sciences of Urmia, Iran. To collect the data, a six-part validated and reliable questionnaire was used. The data were analyzed using SPSS version18, using Wilcoxon, Mann–Whitney, chi-square, and Fisher’s exact tests. The significance level was considered P<0.05. Results The mean age was 38.4±8.1 years for the intervention group and 40.2±8.0 years for the control group. There was no significant difference between the two groups for any demographic variables. Also, before the intervention, there was no significant difference between the two groups for any components of the BASNEF model. Post-intervention, the attitude, subjective norms, enabling factors, and intention improved significantly in the intervention group (P<0.001), but hand hygiene behavior did not show any significant change in the intervention group (P=0.16). Conclusion Despite the improving attitudes and intention, the intervention had no significant effect on hand hygiene behavior among the studied nurses.
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Affiliation(s)
- Rahim Baghaei
- Inpatient Safety Research Center, Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia, Iran
| | - Elham Sharifian
- Inpatient Safety Research Center, Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia, Iran
| | - Aziz Kamran
- Public Health Department, Khalkhal Faculty of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
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Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review. Infect Control Hosp Epidemiol 2016; 37:567-75. [PMID: 26861117 DOI: 10.1017/ice.2015.341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3) quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation. DESIGN Systematic review METHODS A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and assessment of study quality was conducted for each study reviewed. RESULTS A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100 (20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most frequently reported measure. CONCLUSIONS Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To facilitate replication and effective implementation, reporting fidelity should be standard practice when describing results of complex behavioral interventions such as hand hygiene.
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de Lima ED, Fleck CS, Borges JJV, Condessa RL, Vieira SRR. Effects of educational intervention on adherence to the technical recommendations for tracheobronchial aspiration in patients admitted to an intensive care unit. Rev Bras Ter Intensiva 2015; 25:115-22. [PMID: 23917976 PMCID: PMC4031840 DOI: 10.5935/0103-507x.20130022] [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: 11/22/2012] [Accepted: 05/29/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of an educational intervention on healthcare professionals' adherence to the technical recommendations for tracheobronchial aspiration in intensive care unit patients. METHODS A quasi-experimental study was performed to evaluate intensive care unit professionals' adherence to the tracheobronchial aspiration technical recommendations in intensive care unit patients both before and after a theoretical and practical educational intervention. Comparisons were performed using the chi-square test, and the significance level was set to p<0.05. RESULTS A total of 124 procedures, pre- and post-intervention, were observed. Increased adherence was observed in the following actions: the use of personal protective equipment (p=0.01); precaution when opening the catheter package (p<0.001); the use of a sterile glove on the dominant hand to remove the catheter (p=0.003); the contact of the sterile glove with the catheter only (p<0.001); the execution of circular movements during the catheter removal (p<0.001); wrapping the catheter in the sterile glove at the end of the procedure (p=0.003); the use of distilled water, opened at the start of the procedure, to wash the connection latex (p=0.002); the disposal of the leftover distilled water at the end of the procedure (p<0.001); and the performance of the aspiration technique procedures (p<0.001). CONCLUSION There was a low adherence by health professionals to the preventive measures against hospital infection, indicating the need to implement educational strategies. The educational intervention used was shown to be effective in increasing adherence to the technical recommendations for tracheobronchial aspiration.
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Tavolacci MP, Ladner J, Bailly L, Merle V, Pitrou I, Czernichow P. Prevention of Nosocomial Infection and Standard Precautions: Knowledge and Source of Information Among Healthcare Students. Infect Control Hosp Epidemiol 2015; 29:642-7. [DOI: 10.1086/588683] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To evaluate the knowledge of healthcare students after four curricula on infection control and to identify sources of information.Design.Cross-sectional study.Setting.Four healthcare schools at Rouen University (Rouen, France).Participants.Medical students, nursing students, assistant radiologist students, and physiotherapist students taking public health courses.Methods.To measure students' knowledge of infection control and their sources of information, 6 multiple-choice questions were asked about 3 specific areas: standard precautions, hand hygiene, and nosocomial infection. Each questionnaire section had 10 possible points, for an overall perfect score of 30. The sources of information for these 3 areas were also recorded: self-learning, practice training in wards, formal training in wards, and teaching during the curriculum. A logistic regression analysis was performed to identify factors associated with acceptable level of knowledge.Results.Three hundred fifty students (107 medical students, 78 nursing students, 71 physiotherapist students, and 94 assistant radiologist students) were included in the study. The mean overall score (±SD) was 21.5 ± 2.84. Nursing students had a better mean overall score (23.2 ± 2.35) than did physiotherapist students (21.9 ± 2.36), medical students (21.1 ± 2.35), and assistant radiologist students (20.5 ± 3.04; P < .001). The mean scores (±SD) for the component sections of the questionnaire were 8.5 ±1.4 for standard precautions, 7.4 ± 1.26 for hand hygiene, and 5.7 ± 1.55 for nosocomial infections (P < .001). The main source of information was material taught during the curriculum. Results of multivariate analysis indicate that the probability of attaining acceptable knowledge in each area was smaller for medical students and assistant radiologist students than for nursing students.Conclusion.The overall score for infection control indicated that instruction was effective; however, knowledge levels were different by area (the best scores were results of tests of standard precautions) and curriculum (nursing students achieved the best overall score). Ward training for daily infection control practice (ie, bedside instructions training and course work) could be improved for healthcare students.
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Mah MW, Tam YC, Deshpande S. Social Marketing Analysis of 2 Years of Hand Hygiene Promotion. Infect Control Hosp Epidemiol 2015; 29:262-70. [DOI: 10.1086/526442] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective.To assess published hand hygiene behavioral interventions that employed a social marketing framework and to recommend improvements to future interventions.Methods.We performed a systematic literature review by searching the PubMed database and the Cumulative Index to Nursing and Allied Health Literature for published articles about hand hygiene behavioral interventions in healthcare facilities, schools, and community settings. Our analysis included articles that describe multifaceted interventions and evaluated them with predefined social marketing benchmark criteria.Results.Of 53 interventions analyzed in this review, 16 (30.2%) employed primary formative audience research, 5 (9.4%) incorporated social or behavioral theories, 27 (50.9%) employed segmentation and targeting of the audience, 44 (83.0%) used components of the “marketing mix,” 3 (5.7%) considered the influence of competing behaviors, 7 (13.2%) cultivated relationships with the target audience, and 15 (28.3%) provided simple behavioral messages. Thirty-five (66.0%) of the interventions demonstrated a significant improvement in performance, but only 21 (39.6%) were considered to have a strong evaluative design. The median duration of the interventions was 8.0 months.Conclusions.From a social marketing perspective, the promotion of hand hygiene could be improved in several ways. The effectiveness of social marketing in hand hygiene promotion should be tested in future interventions.
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Evaluating the impact of pluridisciplinary training on proper glove use in hospital. Med Mal Infect 2014; 44:268-74. [DOI: 10.1016/j.medmal.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/10/2014] [Accepted: 04/01/2014] [Indexed: 11/23/2022]
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Amin TT, Al Noaim KI, Bu Saad MA, Al Malhm TA, Al Mulhim AA, Al Awas MA. Standard precautions and infection control, medical students' knowledge and behavior at a Saudi university: the need for change. Glob J Health Sci 2013; 5:114-25. [PMID: 23777728 PMCID: PMC4776810 DOI: 10.5539/gjhs.v5n4p114] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/15/2013] [Indexed: 11/12/2022] Open
Abstract
Background: No previous studies have reported the knowledge of Saudi medical students about Standard Precautions (SPs) and infection control. Objectives: The objectives of this study were to assess medical students’ knowledge in clinical years at King Faisal University, Saudi Arabia about SPs’ and to explore their attitudes toward the current curricular/training in providing them with effective knowledge and necessary skills with regard to SPs. Subjects and Methods: This cross sectional study targeted students in clinical stage at College of Medicine, King Faisal University, Saudi Arabia. A pre-tested anonymous self administered data collection form was used. Inquires about students’ characteristics, general concepts of infection control/SPs, hand hygiene, personal protective equipment, sharp injuries and disposal, and care of health providers were included. The main source of information for each domain was also inquired. The second part dedicated to explore the attitudes toward the curricular and teaching relevant to SPs. Results: A total of 251 students were included. Knowledge scores in all domains were considerably low, 67 (26.7%) students scored ≥ 24 (out of 41points) which was considered as an acceptable level of knowledge, 22.2% in 4th year, 20.5% in 5th year and 36.8% in 6th year. Sharp injuries, personal protective equipment and health care of the providers showed the least knowledge scores. The main sources of knowledge were self learning, and informal bed side practices The majority of students’ believed that the current teaching and training are insufficient in providing them with the necessary knowledge and skills regarding SPs. Conclusion: The overall knowledge scores for SPs were low especially in the domains of hand hygiene, sharp management, and personal protective equipment reflecting insufficient and ineffective instructions received by medical students through the current curriculum posing them vulnerable to health facilities related infections. Proper curricular reform and training are required to protect students and their patients.
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An investigation of nurses' knowledge, attitudes, and practices regarding disinfection procedures in Italy. BMC Infect Dis 2011; 11:148. [PMID: 21612613 PMCID: PMC3123570 DOI: 10.1186/1471-2334-11-148] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 05/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study assessed the level of knowledge, attitudes, and practice regarding disinfection procedures among nurses in Italian hospitals. METHODS A face-to-face interview gathered the following information: demographic and practice characteristics; knowledge about the healthcare-associated infections (HAIs) and the disinfection practices; attitudes towards the utility of guidelines/protocols and perception of the risks of acquiring/transmitting HAIs; compliance with antisepsis/disinfection procedures; and sources of information. RESULTS Only 29% acknowledged that urinary and respiratory tract infections were the two most common HAIs and this knowledge was significantly higher in those with a higher level of education. Attitudes towards the utility of guidelines/protocols for disinfection procedures showed a mean score of 9.1. The results of the linear regression model indicated a more positive attitude in female nurses, in those with a lower number of years of activity, and in those needing additional information about disinfection procedures. Nurses with higher educational level and with a higher perception of risk of transmitting an infectious disease while working were more likely to perform appropriate antisepsis of the surgical wound and handwashing before and after medication. CONCLUSIONS Plan of successful prevention activities about HAIs and provide pointers to help optimize disinfection procedures and infection prophylaxis and management are needed.
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Ward DJ. The role of education in the prevention and control of infection: a review of the literature. NURSE EDUCATION TODAY 2011; 31:9-17. [PMID: 20409621 DOI: 10.1016/j.nedt.2010.03.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 02/06/2010] [Accepted: 03/03/2010] [Indexed: 05/29/2023]
Abstract
This paper discusses a literature review which was undertaken prior to a research study about student nurses' and midwives' experiences of learning infection control in clinical practice. Its aim is to identify the role of education in the prevention and control of infection, with a specific focus on compliance with infection control precautions and reduction in infection rates. It also identifies the methods used for teaching infection control. The review concludes that there is no rigorous and convincing evidence that education improves compliance with infection control precautions or reduces rates of infection, particularly in the long-term. Areas for future research are identified.
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Affiliation(s)
- Deborah J Ward
- School of Nursing, Midwifery & School Work, University of Manchester, United Kingdom.
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Gould DJ, Moralejo D, Drey N, Chudleigh JH. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2010:CD005186. [PMID: 20824842 DOI: 10.1002/14651858.cd005186.pub3] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. OBJECTIVES To update the review done in 2007, to assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection. SEARCH STRATEGY We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. Originally searched to July 2006, for the update databases were searched from August 2006 until November 2009. SELECTION CRITERIA Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group were eligible for inclusion. Studies reporting indicators of hand hygiene compliance and proxy indicators such as product use were considered. Self-reported data were not considered a valid measure of compliance. Studies to promote hand hygiene compliance as part of a care bundle approach were included, providing data relating specifically to hand hygiene were presented separately. Studies were excluded if hand hygiene was assessed in simulations, non-clinical settings or the operating theatre setting. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed data quality. MAIN RESULTS Four studies met the criteria for the review: two from the original review and two from the update. Two studies evaluated simple education initiatives, one using a randomized clinical trial design and the other a controlled before and after design. Both measured hand hygiene compliance by direct observation. The other two studies were both interrupted times series studies. One study presented three separate interventions within the same paper: simple substitutions of product and two multifaceted campaigns, one of which included involving practitioners in making decisions about choice of hand hygiene products and the components of the hand hygiene program. The other study also presented two separate multifaceted campaigns, one of which involved application of social marketing theory. In these two studies follow-up data collection continued beyond twelve months, and a proxy measure of hand hygiene compliance (product use) was recorded. Microbiological data were recorded in one study. Hand hygiene compliance increased for one of the studies where it was measured by direct observation, but the results from the other study were not conclusive. Product use increased in the two studies in which it was reported, with inconsistent results reported for one initiative. MRSA incidence decreased in the one study reporting microbiological data. AUTHORS' CONCLUSIONS The quality of intervention studies intended to increase hand hygiene compliance remains disappointing. Although multifaceted campaigns with social marketing or staff involvement appear to have an effect, there is insufficient evidence to draw a firm conclusion. There remains an urgent need to undertake methodologically robust research to explore the effectiveness of soundly designed and implemented interventions to increase hand hygiene compliance.
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Affiliation(s)
- Dinah J Gould
- Adult Nursing Department, School of Community and Health Sciences, City University, 24 Chiswell Street, London, UK, EC1 4TY
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Tenías JM, Mayordomo C, Benavent ML, Micó MSF, García Esparza MA, Oriola RA. [Impact of an educational intervention for promoting handwashing and the rational use of gloves in a hospital]. ACTA ACUST UNITED AC 2009; 24:36-41. [PMID: 19369141 DOI: 10.1016/s1134-282x(09)70074-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To estimate the impact of educational intervention on hand washing and gloves use. MATERIAL AND METHODS The educational intervention consisted of a one-hour weekly workshop aimed at doctors and nurses, with a previous questionnaire on hand-washing, a presentation talk on three key points (hand washing, use of gloves, alcohol-based solutions). Adherence to hand washing and use of gloves was re-evaluated 6-9 months after the intervention. RESULTS We conducted 34 workshops for 296 health care workers, 239 (80.4%) women and 57 (19.6%) men, with an average age of 40.1 years (range, 18-62 years). Most were nurses (41.2%), nursing assistants (37.8%) and physicians (8.2%). Compliance to hand washing ranged between 29% and 87%. The gloves were used in maneuvers not indicated (19% before giving meals and a 27.7% when performing an ECG). Compliance with hand washing 6-9 months after the workshop improved significantly (p < 0.05) in three of the 5 items. The use of gloves was not significantly different. The intensity of the intervention was inversely related to the incidence of nosocomial infections (RR for every 100 workers intervened in the previous month = 0.89; 95% CI, 0.789-1.003; p = 0.057). CONCLUSIONS The training workshops had a positive impact on hand washing compliance, but there was no significant change in the use of gloves. The introduction of education has an inverse relationship to the incidence of nosocomial infections.
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Affiliation(s)
- José María Tenías
- Servicio de Medicina Preventiva, Hospital Lluís Alcanyís, Xàtiva, Valencia, Spain.
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Picheansathian W, Pearson A, Suchaxaya P. The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit. Int J Nurs Pract 2008; 14:315-21. [DOI: 10.1111/j.1440-172x.2008.00699.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Interventions to improve hand hygiene compliance in patient care. J Hosp Infect 2008; 68:193-202. [DOI: 10.1016/j.jhin.2007.11.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2007] [Accepted: 11/20/2007] [Indexed: 11/20/2022]
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Stout A, Ritchie K, Macpherson K. Clinical effectiveness of alcohol-based products in increasing hand hygiene compliance and reducing infection rates: a systematic review. J Hosp Infect 2007; 66:308-12. [PMID: 17655977 DOI: 10.1016/j.jhin.2007.04.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Accepted: 04/12/2007] [Indexed: 02/04/2023]
Abstract
Reducing the incidence of healthcare-associated infection represents a major challenge. This systematic review of the evidence base considers the clinical effectiveness of incorporating an alcohol-based hand hygiene product into procedures aimed at improving compliance with hand hygiene guidelines, and thereby reducing the incidence of healthcare-associated infections. Multi-component interventions that included alcohol-based products were as effective as those that did not, both in achieving sustained hand hygiene compliance and in reducing infection rates. However, a number of difficulties were encountered in assessing hand hygiene studies: the problem of attributing efficacy to an alcohol-based product when used in a multi-component intervention; the variability inherent in the design of such studies; and how to use data from uncontrolled, unblinded studies in the assessment.
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Affiliation(s)
- A Stout
- NHS Quality Improvement Scotland, Glasgow, UK
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Gould DJ, Chudleigh J, Drey NS, Moralejo D. Measuring handwashing performance in health service audits and research studies. J Hosp Infect 2007; 66:109-15. [PMID: 17433491 DOI: 10.1016/j.jhin.2007.02.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Accepted: 02/02/2007] [Indexed: 11/18/2022]
Abstract
Handwashing is regarded as the most effective way of controlling healthcare-associated infection. A search of the literature identified 42 intervention studies seeking to increase compliance in which the data were collected by directly observing practice. The methods used to undertake observation were so poorly described in most studies that it is difficult to accept the findings as reliable or as valid indicators of health worker behaviour. Most studies were limited in scope, assessing the frequency of handwashing in critical care units. The ethical implications of watching health workers during close patient contact were not considered, especially when observation was covert or health workers were misinformed about the purpose of the study. Future studies should take place in a range of clinical settings to increase the generalizability of findings. Observation should be timed to capture a complete picture of 24h activity and should include all health workers in contact with patients because all have the potential to contribute to cross-infection. Reported details of observation should include: vantage of data collectors; inter-rater reliability when more than one individual is involved; and attempts to overcome the impact of observation on usual health worker behaviour. Ideally an additional data collection method should be used to corroborate or refute the findings of observation, but no well-validated method is presently available.
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Affiliation(s)
- D J Gould
- School of Nursing and Midwifery, City University, 24 Chiswell Street, London, UK.
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Gould DJ, Chudleigh JH, Moralejo D, Drey N. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2007:CD005186. [PMID: 17443575 DOI: 10.1002/14651858.cd005186.pub2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. OBJECTIVES To assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection. SEARCH STRATEGY We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. All databases were searched to July 2006; MEDLINE was searched from 1980, CINAHL from its inception, and the remainder from 1990 until July 2006. SELECTION CRITERIA Randomised controlled trials; controlled clinical trials; controlled before and after studies; and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group. Studies reporting proxy indicators of hand hygiene compliance were considered. Studies to promote compliance with universal precautions were included providing data relating specifically to hand hygiene were presented separately. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed data quality. MAIN RESULTS Two studies met the criteria for review. One was a randomised controlled trial. The other was a controlled before and after study. Both were poorly controlled. Statistically significant post-intervention increase in hand washing was reported in one study up to four months after the intervention. In the other there was no post-intervention increase in hand hygiene compliance. AUTHORS' CONCLUSIONS There is little robust evidence to inform the choice of interventions to improve hand hygiene. It appears that single interventions based on short, 'one off' teaching sessions are unlikely to be successful, even short-term. There is a need to undertake methodologically robust research to explore the effectiveness of soundly designed interventions to increase hand hygiene compliance.
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Affiliation(s)
- D J Gould
- City University, School of Nursing and Midwifery, 24 Chiswell Street, London, UK EC1 4TY.
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van de Mortel T, Murgo M. An examination of covert observation and solution audit as tools to measure the success of hand hygiene interventions. Am J Infect Control 2006; 34:95-9. [PMID: 16630970 DOI: 10.1016/j.ajic.2005.07.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 07/28/2005] [Accepted: 07/28/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many studies have examined hand hygiene (HH) frequency and adherence in response to various interventions. This study used 2 methods to determine HH frequency and adherence to see how well the outcomes correlated. METHODS HH frequency was measured over 4, 1-month periods (phases 1-4), using 2 methods: an audit of HH solution used during each phase adjusted for patient-days and covert observation of HH adherence. The number of x-ray technician contacts with patients (a known quantity) across the study period was retrospectively compared with the number of observations made of x-ray technicians' HH behavior to see what proportion of contacts were observed. RESULTS HH solution use doubled in phase 2 and was 65% and 55% higher than the baseline level in phases 3 and 4, respectively. Observed HH adherence fell from 51% to 37% in phase 2 and then rose to 58% in phases 3 and 4. Three percent of x-ray technicians' patient contacts were observed across the 4 phases. CONCLUSION Observation of HH may not adequately sample patient contacts to provide an accurate measure of HH adherence. Further studies are needed to confirm this finding.
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Affiliation(s)
- Thea van de Mortel
- School of Nursing and Health Care Practices, Southern Cross University, Lismore, Australia.
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Zingg W, Colombo C, Jucker T, Bossart W, Ruef C. Impact of an outbreak of norovirus infection on hospital resources. Infect Control Hosp Epidemiol 2005; 26:263-7. [PMID: 15796278 DOI: 10.1086/502537] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe a nosocomial norovirus outbreak, its management, and its financial impact on hospital resources. DESIGN A matched case-control study and microbiological investigation. METHODS We compared 16 patients with norovirus infection with control-patients matched by age, gender, disease category, and length of stay. Bed occupancy-days during the peak incidence period of the outbreak were compared with the corresponding periods in 2001 and 2002. Expenses due to increased workload were calculated based on a measuring system that records time spent for nursing care per patient per day. RESULTS The attack rates were 13.9% among patients and 29.5% among healthcare workers. The median number of occupied beds was significantly lower due to bed closure during the peak incidence in 2003 (29) compared with the median number of occupied beds in 2001 and 2002 combined (42.5). Based on this difference and a daily charge of 562.50 dollars per patient, we calculated a revenue loss of 37,968 dollars. Additional expenses totaled 10,300 dollars for increased nursing care. Extra costs for microbiological diagnosis totaled 2707 dollars. Lost productivity costs due to healthcare workers on sick leave totaled 12,807 dollars. The expenses for work by the infection control team totaled 1408 dollars. The financial impact of this outbreak on hospital resources comprising loss of revenue and extra costs for microbiological diagnosis but without lost productivity costs, increased nursing care, and expenses for the infection control team totaled 40,675 dollars. CONCLUSIONS Nosocomial norovirus outbreaks result in significant loss of revenue and increased use of resources. Bed closures had a greater impact on hospital resources than increased need for nursing care
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Affiliation(s)
- Walter Zingg
- Hospital Epidemiology Unit, Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
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Rosenthal VD, Guzman S, Safdar N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005; 33:392-7. [PMID: 16153485 DOI: 10.1016/j.ajic.2004.08.009] [Citation(s) in RCA: 163] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Accepted: 08/03/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hand hygiene is a fundamental measure for the control of nosocomial infection. However, sustained compliance with hand hygiene in health care workers is poor. We attempted to enhance compliance with hand hygiene by implementing education, training, and performance feedback. We measured nosocomial infections in parallel. METHODS We monitored the overall compliance with hand hygiene during routine patient care in intensive care units (ICUs); 1 medical surgical ICU and 1 coronary ICU, of 1 hospital in Buenos Aires, Argentina, before and during implementation of a hand hygiene education, training, and performance feedback program. Observational surveys were done twice a week from September 2000 to May 2002. Nosocomial infections in the ICUs were identified using the National Nosocomial Infections Surveillance (NNIS) criteria, with prospective surveillance. RESULTS We observed 4347 opportunities for hand hygiene in both ICUs. Compliance improved progressively (handwashing adherence, 23.1% (268/1160) to 64.5% (2056/3187) (RR, 2.79; 95% CI: 2.46-3.17; P < .0001). During the same period, overall nosocomial infection in both ICUs decreased from 47.55 per 1000 patient-days (104/2187) to 27.93 per 1000 patient days (207/7409) RR, 0.59; 95% CI: 0.46-0.74, P < .0001). CONCLUSION A program consisting of focused education and frequent performance feedback produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction in nosocomial infection rates in the ICUs.
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Affiliation(s)
- Victor D Rosenthal
- Section of Infectious Diseases and Hospital Epidemiology, Colegiales Hospital, Buenos Aires, Argentina.
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Abstract
Around 10% of hospital patients acquire a healthcare-associated infection and it has been estimated that around one-third of these could be prevented. This article discusses the causal link between hand hygiene and infection and the reasons why healthcare workers (HCW) fail to comply with hand-hygiene policies. The action of hand hygiene is discussed in terms of the removal of transient micro-organisms and the agents used. Reasons for non-compliance and some measures for achieving compliance, such as education and patient empowerment, are discussed alongside the difficulties that these present. In order to move forward, it is suggested that the problem has to be managed through cultural change, making it easier for HCWs to comply by improving hand-cleansing facilities and materials and providing feedback to personnel on local infection rates so that high-priority areas can be targeted. This may be facilitated by locally based action research.
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Affiliation(s)
- Norman A S Rickard
- University of Central England, Faculty of Health and Community Care, School of Post Registration Studies, Birmingham
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Abstract
PURPOSE OF REVIEW To review the most recently published literature on hand hygiene practices in healthcare settings. RECENT FINDINGS Adherence with recommendations for hand hygiene remains low, but key factors of noncompliance have been identified and corrective actions proposed. Current guidelines recommend the use of alcohol-based handrub formulations as the new standard of care, thus requiring a system change in most hospitals. In addition, healthcare worker education and motivation are obviously important to modify hand hygiene behavior and must be part of multimodal strategies to enhance compliance in hospitals. Compliance improvement is associated with reduced infection rates and resistance spread. Handrub application according to recommended practices is an alternative to conventional surgical handscrubbing with antiseptic soap and water for surgical hand preparation. SUMMARY System change must be addressed in most hospitals where alcohol-based handrubbing has not become a standard of care. Strategies to improve hand hygiene compliance must be multimodal and include staff education and motivation, the use of performance indicators, and hospital management support. Successful campaigns will result in reduced infection rates, antimicrobial resistance spread, and enhance patient safety.
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Affiliation(s)
- Didier Pittet
- Infection Control Program, University of Geneva Hospitals, Switzerland.
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Beyea SC. Nosocomial infections; hand-washing compliance; comparing hand hygiene protocols; sensor-operated faucets. AORN J 2003. [DOI: 10.1016/s0001-2092(06)61262-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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