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Garlasco J, Vicentini C, Emelurumonye IN, D'Alessandro G, Quattrocolo F, Zotti CM. Alcohol-Based Hand Rub Consumption and World Health Organization Hand Hygiene Self-Assessment Framework: A Comparison Between the 2 Surveillances in a 4-Year Region-Wide Experience. J Patient Saf 2022; 18:e658-e665. [PMID: 34520440 DOI: 10.1097/pts.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Hand hygiene is essential for infection prevention. In Piedmont (Northwest Italy), hand hygiene is routinely monitored through 2 surveillance systems, the World Health Organization Hand Hygiene Self-Assessment Framework (HHSAF) and alcohol-based hand rub (ABHR) consumption. This study was aimed at (1) comparing the results of these surveillances, investigating the consistence of the 2 systems and (2) inquiring whether organizational differences among healthcare facilities significantly affected hand hygiene performances. METHODS A retrospective analysis was performed on data collected annually from 2015 to 2018 for both surveillances from 40 hospitals of the region: HHSAF score (500 points maximum) and ABHR consumption in milliliters per patient-day (mL/PD) were considered. Logistic regression models were built to evaluate possible correlations between these variables, and observations were clustered considering both variables to identify whether groups with significant differences could be discerned. A tree-structured partitioning model was used to confirm the obtained results. RESULTS A positive correlation was observed between HHSAF score and odds of belonging to the high ABHR consumption group, particularly for cutoffs set to 19 to 23 mL/PD (P = 0.033 for 23 mL/PD). Two ABHR consumption peaks were identified at approximately 10 and 22 mL/PD, corresponding to median HHSAF scores of 353.75 and 375 points, respectively. The group with better performances was mainly composed of hub hospitals (with single-hospital management). CONCLUSIONS The 2 surveillance systems are consistent, and the HHSAF score could work as a reasonable predictor of hand hygiene compliance in healthcare settings. Different management characteristics are crucial in creating a more/less favorable environment for hand hygiene compliance and infection prevention.
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Affiliation(s)
- Jacopo Garlasco
- From the Department of Public Health Sciences and Paediatrics
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2
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Silva MT, Galvao TF, Chapman E, da Silva EN, Barreto JOM. Dissemination interventions to improve healthcare workers' adherence with infection prevention and control guidelines: a systematic review and meta-analysis. Implement Sci 2021; 16:92. [PMID: 34689810 PMCID: PMC8542414 DOI: 10.1186/s13012-021-01164-6] [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: 05/28/2021] [Accepted: 10/09/2021] [Indexed: 01/04/2023] Open
Abstract
Background The COVID-19 pandemic has challenged health systems worldwide since 2020. At the frontline of the pandemic, healthcare workers are at high risk of exposure. Compliance with infection prevention and control (IPC) should be encouraged at the frontline. This systematic review aimed to assess the effects of dissemination interventions to improve healthcare workers’ adherence with IPC guidelines for respiratory infectious diseases in the workplace. Methods We searched CENTRAL, MEDLINE, Embase, and the Cochrane COVID-19 Study Register. We included randomized controlled trials (RCTs) and cluster RCTs that assessed the effect of any dissemination strategy in any healthcare settings. Certainty of evidence was assessed using the GRADE approach. We synthesized data using random-effects model meta-analysis in Stata 14.2. Results We identified 14 RCTs conducted from 2004 to 2020 with over 65,370 healthcare workers. Adherence to IPC guidelines was assessed by influenza vaccination uptake, hand hygiene compliance, and knowledge on IPC. The most assessed intervention was educational material in combined strategies (plus educational meetings, local opinion leaders, audit and feedback, reminders, tailored interventions, monitoring the performance of the delivery of health care, educational games, and/or patient-mediated interventions). Combined dissemination strategies compared to usual routine improve vaccination uptake (risk ratio [RR] 1.59, 95% confidence interval [CI] 1.54 to 1.81, moderate-certainty evidence), and may improve hand hygiene compliance (RR 1.70; 95% CI 1.03 to 2.83, moderate-certainty). When compared to single strategies, combined dissemination strategies probably had no effect on vaccination uptake (RR 1.01, 95% CI 0.95 to 1.07, low-certainty), and hand hygiene compliance (RR 1.16, 95% CI 0.99 to 1.36, low-certainty). Knowledge of healthcare workers on IPC improved when combined dissemination strategies were compared with usual activities, and the effect was uncertain in comparison to single strategy (very low-certainty evidence). Conclusions Combined dissemination strategies increased workers’ vaccination uptake, hand hygiene compliance, and knowledge on IPC in comparison to usual activities. The effect was negligible when compared to single dissemination strategies. The adoption of dissemination strategies in a planned and targeted way for healthcare workers may increase adherence to IPC guidelines and thus prevent dissemination of infectious disease in the workplace. Trial registration Protocol available at http://osf.io/aqxnp.
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Affiliation(s)
| | - Tais Freire Galvao
- Faculty of Pharmaceutical Sciences, University of Campinas, Campinas, Brazil
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3
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The Effectiveness of Interventions in Improving Hand Hygiene Compliance: A Meta-Analysis and Logic Model. ACTA ACUST UNITED AC 2021; 2021:8860705. [PMID: 34336066 PMCID: PMC8313351 DOI: 10.1155/2021/8860705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/12/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Background Despite the availability of various guidelines, rules, and strategies, hand hygiene adherence rates among healthcare workers are reported significantly lower than expected. The aim of this meta-analysis is to determine the most effective interventions to improve hand hygiene and to develop a logic model based on the characteristics of the most effective interventions. Methods A literature search was conducted on PubMed, ProQuest, Web of Knowledge, Scopus, Cochrane Library, and ScienceDirect databases up to December 21, 2019, with no time limit. Randomized clinical trials which had designed interventions to improve hand hygiene were reviewed. Data were extracted independently by two authors. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software (version 2.0). A random-effects model was used to estimate odds ratios. Results Although 14 studies were initially reviewed, only 12 studies entered the meta-analysis, since they had identified percentage rates of hand hygiene compliance. The most effective intervention (odds ratio 18.4, 95% CI (13.6–24.8)) was a multilevel strategy that influenced the determinants of hand hygiene behavior at individual, interpersonal, and organizational levels. Following this, a theory-driven logic model was mapped out to promote hand hygiene, based on situational analysis. Conclusion This study suggests that designing integrated interventions based on a multilevel socioecological approach has the greatest potential to improve hand hygiene compliance in healthcare workers. The logical model proposed in this study can thus provide a useful guide for designing and conducting future experimental research.
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Foster M, Egerton-Warburton D, Cullen L, Fatovich DM, Keijzers G. Is a nudge all we need to promote deliberate clinical inertia and thoughtful clinical decision making? Emerg Med Australas 2021; 33:748-752. [PMID: 33880874 DOI: 10.1111/1742-6723.13782] [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: 09/08/2020] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
Deliberate clinical inertia is the art of doing nothing as a positive response. Individual clinicians can promote deliberate clinical inertia through teaching, re-framing the act of 'doing nothing' as 'doing something' and engaging in shared decision making. Behaviour change on a larger scale requires a systematic approach. Nudging is a subtle change to the decision-making context to prompt specific choices. A nudge unit is a team of relevant professionals who engage with various multidisciplinary teams within a health service who help test and implement nudge interventions in a clinical environment. A nudge unit could be used to design environments to prompt clinicians to re-think before ordering unnecessary tests or treatments. Nudge units could improve knowledge translation, support continuous quality improvement and help build a learning health system. They could also boost collaboration and empower staff to evaluate their workplace decision-making frameworks.
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Affiliation(s)
- Mieke Foster
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Diana Egerton-Warburton
- Monash Medical Centre, Melbourne, Victoria, Australia.,School of Clinical Science at Monash Health, Monash University Faculty of Medicine, Nursing and Health Sciences, Melbourne, Victoria, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel M Fatovich
- Royal Perth Hospital, Perth, Western Australia, Australia.,Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,School of Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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5
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Aghdassi SJS, Schröder C, Lemke E, Behnke M, Fliss PM, Plotzki C, Wenk J, Gastmeier P, Kramer TS. A multimodal intervention to improve hand hygiene compliance in peripheral wards of a tertiary care university centre: a cluster randomised controlled trial. Antimicrob Resist Infect Control 2020; 9:113. [PMID: 32682429 PMCID: PMC7368705 DOI: 10.1186/s13756-020-00776-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background Interventions to improve hand hygiene (HH) compliance are a key element in the practice infection prevention and control. It was our objective to assess the effect of a multimodal intervention on HH compliance at a tertiary care university hospital. As a secondary objective, we investigated the effect of the intervention on the occurrence of device-associated bloodstream infections. Methods We performed a single centre cluster randomised controlled trial at a university hospital in Germany. Twenty peripheral wards were invited to participate and randomly assigned to either the intervention (n = 10) or control group (n = 10). Quarterly, specifically trained student employees conducted direct compliance observations in all twenty wards. The intervention entailed dissemination of teaching materials on aseptic procedures, equipment with flexibly mountable alcoholic hand rub dispensers, and quarterly feedback on HH compliance. Results In total, 21,424 HH opportunities were observed. Overall, compliance did not change significantly in either group (intervention group: 59% vs. 61% (1482 HH actions for 2494 HH opportunities vs. 5033 HH actions for 8215 HH opportunities), odds ratio (OR) 1.08 (95% confidence interval (CI95) 0.88, 1.33)); control group: 59% vs. 60% (1457 HH actions for 2484 HH opportunities vs. 4948 HH actions for 8231 HH opportunities), OR 1.06 (CI95 0.84, 1.35)). Compliance prior to aseptic procedures improved significantly in the intervention group from 44% (168 HH actions for 380 HH opportunities) to 53% (764 HH actions for 1452 HH opportunities) (OR 1.40 (CI95 1.04, 1.89), p = 0.03), while no significant increase was noted in the control group. In the intervention group, significantly fewer device-associated bloodstream infections per 1000 patient-days occurred than in the control group (84 vs. 123, incidence rate ratio 0.61 (CI95 0.46, 0.81), p < 0.01). Conclusions The lack of a significant overall improvement of HH compliance demonstrated that comprehensive implementation of HH interventions in multiple wards simultaneously is difficult. However, through targeted intervention measures, we were able to significantly increase HH compliance before aseptic procedures.
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Affiliation(s)
- Seven Johannes Sam Aghdassi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany. .,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.
| | - Christin Schröder
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Elke Lemke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Michael Behnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | | | | | - Janina Wenk
- BODE SCIENCE CENTER, BODE Chemie GmbH, Hamburg, Germany
| | - Petra Gastmeier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Tobias Siegfried Kramer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.,Aktion Saubere Hände, Berlin, Germany
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Yoong SL, Hall A, Stacey F, Grady A, Sutherland R, Wyse R, Anderson A, Nathan N, Wolfenden L. Nudge strategies to improve healthcare providers' implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews. Implement Sci 2020; 15:50. [PMID: 32611354 PMCID: PMC7329401 DOI: 10.1186/s13012-020-01011-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Nudge interventions are those that seek to modify the social and physical environment to enhance capacity for subconscious behaviours that align with the intrinsic values of an individual, without actively restricting options. This study sought to describe the application and effects of nudge strategies on clinician implementation of health-related guidelines, policies and practices within studies included in relevant Cochrane systematic reviews. METHODS As there is varied terminology used to describe nudge, this study examined studies within relevant systematic reviews. A two-stage screening process was undertaken where, firstly, all systematic reviews published in the Cochrane Library between 2016 and 2018 were screened to identify reviews that included quantitative studies to improve implementation of guidelines among healthcare providers. Secondly, individual studies within relevant systematic reviews were included if they were (i) randomised controlled trials (RCTs), (ii) included a nudge strategy in at least one intervention arm, and (iii) explicitly aimed to improve clinician implementation behaviour. We categorised nudge strategies into priming, salience and affect, default, incentives, commitment and ego, and norms and messenger based on the Mindspace framework. SYNTHESIS The number and percentage of trials using each nudge strategy was calculated. Due to substantial heterogeneity, we did not undertake a meta-analysis. Instead, we calculated within-study point estimates and 95% confidence intervals, and used a vote-counting approach to explore effects. RESULTS Seven reviews including 42 trials reporting on 57 outcomes were included. The most common nudge strategy was priming (69%), then norms and messenger (40%). Of the 57 outcomes, 86% had an effect on clinician behaviour in the hypothesised direction, and 53% of those were statistically significant. For continuous outcomes, the median effect size was 0.39 (0.22, 0.45), while for dichotomous outcomes the median Odds Ratio was 1.62 (1.13, 2.76). CONCLUSIONS This review of 42 RCTs included in Cochrane systematic reviews found that the impact of nudge strategies on clinician behaviour was at least comparable to other interventions targeting implementation of evidence-based guidelines. While uncertainty remains, the review provides justification for ongoing investigation of the evaluation and application of nudge interventions to support provider behaviour change. TRIAL REGISTRATION This review was not prospectively registered.
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Affiliation(s)
- Sze Lin Yoong
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia.
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia.
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.
| | - Alix Hall
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
| | - Fiona Stacey
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
| | - Alice Grady
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Rebecca Wyse
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Amy Anderson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
| | - Nicole Nathan
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia
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Drey N, Gould D, Purssell E, Chudleigh J, Moralejo D, Gallagher R, Jeanes A, Wigglesworth N, Pittet D. Applying thematic synthesis to interpretation and commentary in epidemiological studies: identifying what contributes to successful interventions to promote hand hygiene in patient care. BMJ Qual Saf 2020; 29:756-763. [PMID: 32019823 DOI: 10.1136/bmjqs-2019-009833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Hand hygiene is considered the most important preventive measure for healthcare-associated infections, but adherence is suboptimal. We previously undertook a Cochrane Review that demonstrated that interventions to improve adherence are moderately effective. Impact varied between organisations and sites with the same intervention and implementation approaches. This study seeks to explore these differences. METHODS A thematic synthesis was applied to the original authors' interpretation and commentary that offered explanations of how hand hygiene interventions exerted their effects and suggested reasons why success varied. The synthesis used a published Cochrane Review followed by three-stage synthesis. RESULTS Twenty-one papers were reviewed: 11 randomised, 1 non-randomised and 9 interrupted time series studies. Thirteen descriptive themes were identified. They reflected a range of factors perceived to influence effectiveness. Descriptive themes were synthesised into three analytical themes: methodological explanations for failure or success (eg, Hawthorne effect) and two related themes that address issues with implementing hand hygiene interventions: successful implementation needs leadership and cooperation throughout the organisation (eg, visible managerial support) and understanding the context and aligning the intervention with it drives implementation (eg, embedding the intervention into wider patient safety initiatives). CONCLUSIONS The analytical themes help to explain the original authors' perceptions of the degree to which interventions were effective and suggested new directions for research: exploring ways to avoid the Hawthorne effect; exploring the impact of components of multimodal interventions; the use of theoretical frameworks for behaviour change; potential to embed interventions into wider patient safety initiatives; adaptations to demonstrate sustainability; and the development of systematic approaches to implementation. Our findings corroborate studies exploring the success or failure of other clinical interventions: context and leadership are important.
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Affiliation(s)
- Nicholas Drey
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Dinah Gould
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Edward Purssell
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Jane Chudleigh
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Donna Moralejo
- Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | | | | | | | - Didier Pittet
- Infection Prevention and Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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8
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Romero DMP, Reboredo MM, Gomes EP, Coelho CM, Paula MASD, Souza LCD, Colugnati FAB, Pinheiro BV. Effects of the implementation of a hand hygiene education program among ICU professionals: an interrupted time-series analysis. J Bras Pneumol 2019; 45:e20180152. [PMID: 31188977 PMCID: PMC6715164 DOI: 10.1590/1806-3713/e20180152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/23/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the effects that a hand hygiene education program has on the compliance of health professionals in an ICU. Methods: This was a quasi-experimental study with an interrupted time-series design, conducted over a 12-month period: the 5 months preceding the implementation of a hand hygiene education program (baseline period); the 2 months of the intensive (intervention) phase of the program; and the first 5 months thereafter (post-intervention phase). Hand hygiene compliance was monitored by one of the researchers, unbeknownst to the ICU team. The primary outcome measure was the variation in the rate of hand hygiene compliance. We also evaluated the duration of mechanical ventilation (MV), as well as the incidence of ventilator-associated pneumonia (VAP) at 28 days and 60 days, together with mortality at 28 days and 60 days. Results: On the basis of 959 observations, we found a significant increase in hand hygiene compliance rates-from 31.5% at baseline to 65.8% during the intervention phase and 83.8% during the post-intervention phase, corresponding to prevalence ratios of 2.09 and 2.66, respectively, in comparison with the baseline rate (p < 0.001). Despite that improvement, there were no significant changes in duration of MV, VAP incidence (at 28 or 60 days), or mortality (at 28 or 60 days). Conclusions: Our findings indicate that a hand hygiene education program can increase hand hygiene compliance among ICU professionals, although it appears to have no impact on VAP incidence, duration of MV, or mortality.
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Affiliation(s)
- Diana Marcela Prieto Romero
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Maycon Moura Reboredo
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil.,. Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Edimar Pedrosa Gomes
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil.,. Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Cristina Martins Coelho
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | | | - Luciene Carnevale de Souza
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | | | - Bruno Valle Pinheiro
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil.,. Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
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9
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Jeanes A, Coen PG, Gould DJ, Drey NS. Validity of hand hygiene compliance measurement by observation: A systematic review. Am J Infect Control 2019; 47:313-322. [PMID: 30322815 DOI: 10.1016/j.ajic.2018.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hand hygiene is monitored by direct observation to improve practice, but this approach can potentially cause information, selection, and confounding bias, threatening the validity of findings. The aim of this study was to identify and describe the potential biases in hand hygiene compliance monitoring by direct observation; develop a typology of biases and propose improvements to reduce bias; and increase the validity of compliance measurements. METHODS This systematic review of hospital-based intervention studies used direct observation to monitor health care workers' hand hygiene compliance. RESULTS Seventy-one publications were eligible for review. None was free of bias. Selection bias was present in all studies through lack of data collection on the weekends (n = 61, 86%) and at night (n = 46, 65%) and observations undertaken in single-specialty settings (n = 35, 49%). We observed inconsistency of terminology, definitions of hand hygiene opportunity, criteria, tools, and descriptions of the data collection. Frequency of observation, duration, or both were not described or were unclear in 58 (82%) publications. Observers were trained in 56 (79%) studies. Inter-rater reliability was measured in 26 (37%) studies. CONCLUSIONS Published research of hand hygiene compliance measured by direct observation lacks validity. Hand hygiene should be measured using methods that produce a valid indication of performance and quality. Standardization of methodology would expedite comparison of hand hygiene compliance between clinical settings and organizations.
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Affiliation(s)
- Annette Jeanes
- Infection Control Department, University College London Hospitals, London, United Kingdom.
| | - Pietro G Coen
- Infection Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Nicolas S Drey
- School of Health Sciences, Cardiff, University of London, London, United Kingdom
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10
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Gould D, Moralejo D, Chudleigh J, Drey N. The Australian National Hand Hygiene Initiative: framework for future research. THE LANCET. INFECTIOUS DISEASES 2018; 18:1171-1172. [PMID: 30274722 DOI: 10.1016/s1473-3099(18)30598-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/13/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Dinah Gould
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - Donna Moralejo
- School of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jane Chudleigh
- School of Health Sciences, CitXersity of London, London, UK
| | - Nicholas Drey
- School of Health Sciences, CitXersity of London, London, UK
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11
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Fouad H, Halim MMA, Algebaly HF, Elmallakh NA. Influence of Handprint Culture Training on Compliance of Healthcare Workers with Hand Hygiene. Interdiscip Perspect Infect Dis 2018; 2018:3727521. [PMID: 29706997 PMCID: PMC5863290 DOI: 10.1155/2018/3727521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 01/22/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We aimed to study the effect of visual observation of bacterial growth from handprints on healthcare workers' (HCWs) compliance with hand hygiene (HH). SETTINGS Medical and postoperative cardiac surgery units. DESIGN Prospective cohort study. SUBJECT The study included 40 HCWs. INTERVENTION Each HCW was interviewed on 3 separate occasions. The 1st interview was held to obtain a handprint culture before and after a session demonstrating the 7 steps of HH using alcohol-based hand rub, allowing comparison of results before and after HH. A 2nd interview was held 6 weeks later to obtain handprint culture after HH. A 3rd interview was held to obtain a handprint culture before HH. One month before implementation of handprint cultures and during the 12-week study period, monitoring of HCWs for compliance with HH was observed by 2 independent observers. MAIN RESULTS There was a significant improvement in HH compliance following handprint culture interview (p < 0.001). The frequency of positive cultures, obtained from patients with suspected healthcare-associated infections, significantly declined (blood cultures: p = 0.001; wound cultures: p = 0,003; sputum cultures: p = 0.005). CONCLUSION The visual message of handprint bacterial growth before and after HH seems an effective method to improve HH compliance.
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Affiliation(s)
- Hala Fouad
- Department of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mona M. A. Halim
- Department of Clinical and Chemical Pathology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - HebatAllah F. Algebaly
- Department of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Nardeen A. Elmallakh
- Department of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
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12
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Gould D, Moralejo D, Drey N, Chudleigh J, Taljaard M. Interventions to improve hand hygiene compliance in patient care: Reflections on three systematic reviews for the Cochrane Collaboration 2007-2017. J Infect Prev 2018; 19:108-113. [PMID: 29796092 DOI: 10.1177/1757177417751285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/10/2017] [Indexed: 11/15/2022] Open
Abstract
This article presents highlights from a recently updated systematic Cochrane review evaluating the effectiveness of interventions to improve hand hygiene compliance in patient care. It is an advance on the two earlier reviews we undertook on the same topic as it has, for the first time, provided very rigorous synthesis of evidence that such interventions can improve practice. In this article, we provide highlights from a recently updated Cochrane systematic review. We identify omissions in the information reported and point out important aspects of hand hygiene intervention studies that were beyond the scope of the review. A full report of the review is available free of charge on the Cochrane website.
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Affiliation(s)
- Dinah Gould
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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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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Gould DJ, Navaie D, Purssell E, Drey NS, Creedon S. Changing the paradigm: messages for hand hygiene education and audit from cluster analysis. J Hosp Infect 2017; 98:345-351. [PMID: 28760636 DOI: 10.1016/j.jhin.2017.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hand hygiene is considered to be the foremost infection prevention measure. How healthcare workers accept and make sense of the hand hygiene message is likely to contribute to the success and sustainability of initiatives to improve performance, which is often poor. METHODS A survey of nurses in critical care units in three National Health Service trusts in England was undertaken to explore opinions about hand hygiene, use of alcohol hand rubs, audit with performance feedback, and other key hand-hygiene-related issues. Data were analysed descriptively and subjected to cluster analysis. RESULTS Three main clusters of opinion were visualized, each forming a significant group: positive attitudes, pragmatism and scepticism. A smaller cluster suggested possible guilt about ability to perform hand hygiene. CONCLUSION Cluster analysis identified previously unsuspected constellations of beliefs about hand hygiene that offer a plausible explanation for behaviour. Healthcare workers might respond to education and audit differently according to these beliefs. Those holding predominantly positive opinions might comply with hand hygiene policy and perform well as infection prevention link nurses and champions. Those holding pragmatic attitudes are likely to respond favourably to the need for professional behaviour and need to protect themselves from infection. Greater persuasion may be needed to encourage those who are sceptical about the importance of hand hygiene to comply with guidelines. Interventions to increase compliance should be sufficiently broad in scope to tackle different beliefs. Alternatively, cluster analysis of hand hygiene beliefs could be used to identify the most effective educational and monitoring strategies for a particular clinical setting.
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Affiliation(s)
- D J Gould
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - D Navaie
- University Hospital Lewisham, London, UK
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Gould D, Creedon S, Jeanes A, Drey N, Chudleigh J, Moralejo D. Impact of observing hand hygiene in practice and research: a methodological reconsideration. J Hosp Infect 2017; 95:169-174. [DOI: 10.1016/j.jhin.2016.08.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/03/2016] [Indexed: 11/25/2022]
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Harris A, Pineles L, Perencevich E. Recognising the value of infection prevention and its role in addressing the antimicrobial resistance crisis. BMJ Qual Saf 2016; 26:683-686. [DOI: 10.1136/bmjqs-2016-005982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/18/2016] [Accepted: 11/29/2016] [Indexed: 11/04/2022]
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Arise K, Nishizaki S, Morita T, Yagi Y, Takeuchi S. Continued direct observation and feedback of hand hygiene adherence can result in long-term improvement. Am J Infect Control 2016; 44:e211-e214. [PMID: 27810069 DOI: 10.1016/j.ajic.2016.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital-wide multifaceted approaches can improve hand hygiene compliance in health care workers. However, the true effects of monitoring and feedback interventions are not clear. METHODS Hand hygiene compliance was evaluated by applying direct observation techniques over 5 years (2005-2009) in a tertiary care general hospital in Japan. The observed results were periodically reported as feedback to the health care workers. RESULTS The overall hand hygiene compliance rate increased from 50.8% in 2005 to 61.0% in 2006 (P = .004) and was sustained at approximately 60% through the completion of the study. The compliance rate for the indication before entering the room increased from 2005 to 2009 (P = .005). The compliance rates for 4 before patient contact indications increased from 2005 to 2009 (P = .002). The combined compliance rate for the 6 indications with the lowest compliance rates in 2005 increased from 2005 to 2009 (P = .001). CONCLUSIONS Direct observation and feedback methods are effective strategies that resulted in a long-lasting improvement in hand hygiene compliance that was sustained over 5 years through the completion of the study. Focusing on the procedures with high baseline noncompliance rates can be an effective way to improve the overall compliance.
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Affiliation(s)
- Kazumi Arise
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan
| | - Sayaka Nishizaki
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan
| | - Tamae Morita
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan; Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Japan
| | - Yusuke Yagi
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan; Department of Pharmacy, Kochi Medical School Hospital, Nankoku, Japan
| | - Seisho Takeuchi
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan; Department of General Medicine, Kochi Medical School Hospital, Nankoku, Japan.
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Stewardson AJ, Sax H, Gayet-Ageron A, Touveneau S, Longtin Y, Zingg W, Pittet D. Enhanced performance feedback and patient participation to improve hand hygiene compliance of health-care workers in the setting of established multimodal promotion: a single-centre, cluster randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2016; 16:1345-1355. [PMID: 27599874 DOI: 10.1016/s1473-3099(16)30256-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/28/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hand hygiene compliance of health-care workers remains suboptimal despite standard multimodal promotion, and evidence for the effectiveness of novel interventions is urgently needed. We aimed to assess the effect of enhanced performance feedback and patient participation on hand hygiene compliance in the setting of multimodal promotion. METHODS We did a single-centre, cluster randomised controlled trial at University of Geneva Hospitals (Geneva, Switzerland). All wards hosting adult, lucid patients, and all health-care workers and patients in these wards, were eligible. After a 15-month baseline period, eligible wards were assigned by computer-generated block randomisation (1:1:1), stratified by the type of ward, to one of three groups: control, enhanced performance feedback, or enhanced performance feedback plus patient participation. Standard multimodal hand hygiene promotion was done hospital-wide throughout the study. The primary outcome was hand hygiene compliance of health-care workers (according to the WHO Five Moments of Hand Hygiene) at the opportunity level, measured by direct observation (20-min sessions) by 12 validated infection control nurses, with each ward audited at least once every 3 months. This trial is registered with ISRCTN, number ISRCTN43599478. FINDINGS We randomly assigned 67 wards to the control group (n=21), enhanced performance feedback (n=24), or enhanced performance feedback plus patient participation (n=22) on May 19, 2010. One ward in the control group became a high-dependency unit and was excluded from analysis. During 1367 observation sessions, 12 579 hand hygiene opportunities were recorded. Between the baseline period (April 1, 2009, to June 30, 2010) and the intervention period (July 1, 2010, to June 30, 2012), mean hand hygiene compliance increased from 66% (95% CI 62-70) to 73% (70-77) in the control group (odds ratio [OR] 1·41, 95% CI 1·21-1·63), from 65% (62-69) to 75% (72-77) in the enhanced performance feedback group (1·61, 1·41-1·84), and from 66% (62-70) to 77% (74-80) in the enhanced performance feedback plus patient participation group (1·73, 1·51-1·98). The absolute difference in compliance attributable to interventions was 3 percentage points (95% CI 0-7; p=0·19) for the enhanced performance feedback group and 4 percentage points (1-8; p=0·048) for the enhanced performance feedback plus patient participation group. Hand hygiene compliance remained significantly higher than baseline in all three groups (OR 1·21 [1·00-1·47] vs 1·38 [1·19-1·60] vs 1·36 [1·18-1·57]) during the post-intervention follow-up (Jan 1, 2013, to Dec 31, 2014). INTERPRETATION Hand hygiene compliance improved in all study groups, and neither intervention had a clinically significant effect compared with control. Improvement in control wards might reflect cross-contamination, highlighting challenges with randomised trials of behaviour change. FUNDING Swiss National Science Foundation.
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Affiliation(s)
- Andrew James Stewardson
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Medicine (Austin), University of Melbourne, Melbourne, VIC, Australia
| | - Hugo Sax
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Angèle Gayet-Ageron
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sylvie Touveneau
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Yves Longtin
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Infection Prevention and Control Unit, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Walter Zingg
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Gould DJ, Gallagher R, Allen D. Leadership and management for infection prevention and control: what do we have and what do we need? J Hosp Infect 2016; 94:165-8. [PMID: 27520488 DOI: 10.1016/j.jhin.2016.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - D Allen
- Cardiff University, Cardiff, UK
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Neo JRJ, Sagha-Zadeh R, Vielemeyer O, Franklin E. Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review. Am J Infect Control 2016; 44:691-704. [PMID: 27240800 DOI: 10.1016/j.ajic.2015.11.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/28/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission and nosocomial infections. However, most HH interventions (HHI) have not been sustainable. AIMS This review aims to provide a comprehensive summary of recently published evidence-based HHI designed to improve HH compliance (HHC) that will enable health care providers to make informed choices when allocating limited resources to improve HHC and patient safety. METHODS The Medline electronic database (using PubMed) was used to identify relevant studies. English language articles that included hand hygiene interventions and related terms combined with health care environments or related terms were included. RESULTS Seventy-three studies that met the inclusion criteria were summarized. Interventions were categorized as improving awareness with education, facility design, and planning, unit-level protocols and procedures, hospital-wide programs, and multimodal interventions. Past successful HHIs may not be as effective when applied to other health care environments. HH education should be interactive and engaging. Electronic monitoring and reminders should be implemented in phases to ensure cost-effectiveness. To create hospitalwide programs that engage end users, policy makers should draw expertise from interdisciplinary fields. Before implementing the various components of multimodal interventions, health care practitioners should identify and examine HH difficulties unique to their organizations. CONCLUSIONS Future research should seek to achieve the following: replicate successful HHI in other health care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions, examine ways (eg, hospital leadership, financial support, and strategies from public health and infection prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs.
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Affiliation(s)
- Jun Rong Jeffrey Neo
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY.
| | - Rana Sagha-Zadeh
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY
| | - Ole Vielemeyer
- Division of Infectious Disease, Weill Cornell Medical College, New York, NY
| | - Ella Franklin
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC
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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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Abstract
Purpose of review Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions. Recent findings Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission. Summary Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation.
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Luangasanatip N, Hongsuwan M, Limmathurotsakul D, Lubell Y, Lee AS, Harbarth S, Day NPJ, Graves N, Cooper BS. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ 2015; 351:h3728. [PMID: 26220070 PMCID: PMC4517539 DOI: 10.1136/bmj.h3728] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the relative efficacy of the World Health Organization 2005 campaign (WHO-5) and other interventions to promote hand hygiene among healthcare workers in hospital settings and to summarize associated information on use of resources. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, Embase, CINAHL, NHS Economic Evaluation Database, NHS Centre for Reviews and Dissemination, Cochrane Library, and the EPOC register (December 2009 to February 2014); studies selected by the same search terms in previous systematic reviews (1980-2009). REVIEW METHODS Included studies were randomised controlled trials, non-randomised trials, controlled before-after trials, and interrupted time series studies implementing an intervention to improve compliance with hand hygiene among healthcare workers in hospital settings and measuring compliance or appropriate proxies that met predefined quality inclusion criteria. When studies had not used appropriate analytical methods, primary data were re-analysed. Random effects and network meta-analyses were performed on studies reporting directly observed compliance with hand hygiene when they were considered sufficiently homogeneous with regard to interventions and participants. Information on resources required for interventions was extracted and graded into three levels. RESULTS Of 3639 studies retrieved, 41 met the inclusion criteria (six randomised controlled trials, 32 interrupted time series, one non-randomised trial, and two controlled before-after studies). Meta-analysis of two randomised controlled trials showed the addition of goal setting to WHO-5 was associated with improved compliance (pooled odds ratio 1.35, 95% confidence interval 1.04 to 1.76; I(2)=81%). Of 22 pairwise comparisons from interrupted time series, 18 showed stepwise increases in compliance with hand hygiene, and all but four showed a trend for increasing compliance after the intervention. Network meta-analysis indicated considerable uncertainty in the relative effectiveness of interventions, but nonetheless provided evidence that WHO-5 is effective and that compliance can be further improved by adding interventions including goal setting, reward incentives, and accountability. Nineteen studies reported clinical outcomes; data from these were consistent with clinically important reductions in rates of infection resulting from improved hand hygiene for some but not all important hospital pathogens. Reported costs of interventions ranged from $225 to $4669 (£146-£3035; €204-€4229) per 1000 bed days. CONCLUSION Promotion of hand hygiene with WHO-5 is effective at increasing compliance in healthcare workers. Addition of goal setting, reward incentives, and accountability strategies can lead to further improvements. Reporting of resources required for such interventions remains inadequate.
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Affiliation(s)
- Nantasit Luangasanatip
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand School of Public Health, Queensland University of Technology, Brisbane, Australia
| | - Maliwan Hongsuwan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Andie S Lee
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva 1211, Switzerland Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Stephan Harbarth
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva 1211, Switzerland
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas Graves
- School of Public Health, Queensland University of Technology, Brisbane, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Ben S Cooper
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Patel PA, Robicsek A, Grayes A, Schora DM, Peterson KE, Wright MO, Peterson LR. Evaluation of multiple real-time PCR tests on nasal samples in a large MRSA surveillance program. Am J Clin Pathol 2015; 143:652-8. [PMID: 25873498 DOI: 10.1309/ajcpmdy32ztdxpfc] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES We evaluated the LightCycler MRSA Advanced Test (Roche Molecular Diagnostics, Pleasanton, CA), the BD MAX MRSA assay (Becton Dickinson, Franklin Lakes, NJ), and the Xpert MRSA assay (Cepheid, Sunnyvale, CA) on nasal samples using the same population. METHODS Admission and discharge nasal swabs were collected from inpatients using a double-headed swab. One swab was plated onto CHROMagar MRSA (CMA; Becton Dickinson, Sparks, MD) and then broken off into tryptic soy broth (TSB) for enrichment. TSB was incubated for 24 hours and then plated to CMA. The molecular tests were performed on the second swab. We analyzed the cost benefit of testing to evaluate what parameters affect hospital resources. RESULTS A total of 27,647 specimens were enrolled. The sensitivity/specificity was 98.3%/98.9% for the LightCycler MRSA Advanced Test and 95.7%/98.8% for the Xpert MRSA assay, but the difference was not significant. The positive predictive value was 86.7% for the LightCycler MRSA Advanced Test, 82.7% for the Xpert MRSA assay (P > .1), and 72.2% and for the BD MAX MRSA test (P < .001 compared with the LightCycler MRSA Advanced Test). All three assays were cost-effective, with the LightCycler MRSA Advanced Test having the highest economic return. CONCLUSIONS Our results suggest that the performance of the three commercial assays is similar. When assessing economic cost benefit of methicillin-resistant Staphylococcus aureus screening, the two measures with the most impact are the cost of the test and the specificity of the assay results.
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Affiliation(s)
| | - Ari Robicsek
- NorthShore University HealthSystem, Evanston, IL
- NorthShore University of Chicago Pritzker School of Medicine, Chicago, IL
| | | | | | | | | | - Lance R. Peterson
- NorthShore University HealthSystem, Evanston, IL
- NorthShore University of Chicago Pritzker School of Medicine, Chicago, IL
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Boyce JM. Measuring Healthcare Worker Hand Hygiene Activity: Current Practices and Emerging Technologies. Infect Control Hosp Epidemiol 2015; 32:1016-28. [DOI: 10.1086/662015] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of multidisciplinary hand hygiene improvement programs. Observational surveys conducted by trained personnel are currently considered the “gold standard” method for establishing compliance rates, but they are time-consuming and have a number of shortcomings. Monitoring hand hygiene product consumption is less time-consuming and can provide useful information regarding the frequency of hand hygiene that can be used to give caregivers feedback. Electronic counting devices placed in hand hygiene product dispensers provide detailed information about hand hygiene frequency over time, by unit and during interventions. Electronic hand hygiene monitoring systems that utilize wireless systems to monitor room entry and exit of healthcare workers and their use of hand hygiene product dispensers can provide individual and unit-based data on compliance with the most common hand hygiene indications. Some systems include badges (tags) that can provide healthcare workers with real-time reminders to clean their hands upon entering and exiting patient rooms. Preliminary studies suggest that use of electronic monitoring systems is associated with increased hand hygiene compliance rates and that such systems may be acceptable to care givers. Although there are many questions remaining about the practicality, accuracy, cost, and long-term impact of electronic monitoring systems on compliance rates, they appear to have considerable promise for improving our efforts to monitor and improve hand hygiene practices among healthcare workers.
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Lazo MCJ, Bautista MG, Anicoche ML, Mallari M, Turner E, Asperin R, Garey T, West D. Everyone’s Safety is in Your Hands. J Perianesth Nurs 2014. [DOI: 10.1016/j.jopan.2014.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014. [DOI: 10.1007/s00103-014-1980-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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De Angelis G, Cataldo MA, De Waure C, Venturiello S, La Torre G, Cauda R, Carmeli Y, Tacconelli E. Infection control and prevention measures to reduce the spread of vancomycin-resistant enterococci in hospitalized patients: a systematic review and meta-analysis. J Antimicrob Chemother 2014; 69:1185-92. [DOI: 10.1093/jac/dkt525] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schweizer ML, Reisinger HS, Ohl M, Formanek MB, Blevins A, Ward MA, Perencevich EN. Searching for an Optimal Hand Hygiene Bundle: A Meta-analysis. Clin Infect Dis 2013; 58:248-59. [DOI: 10.1093/cid/cit670] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Monistrol O, Calbo E, Riera M, Nicolás C, Font R, Freixas N, Garau J. Impact of a hand hygiene educational programme on hospital-acquired infections in medical wards. Clin Microbiol Infect 2012; 18:1212-8. [DOI: 10.1111/j.1469-0691.2011.03735.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
Improving the quality and safety of intensive care unit (ICU) care in the United States is a significant challenge for the future. Obtaining improvement in systems of care is difficult given the reactionary mode physicians tend to enter when dealing with moment-to-moment crises. It will be important to implement quality and safety measures that are already supported by evidence. Improvement of device safety will be critical to reducing the large number of device-related complications that occur in US ICUs. Prospective collection of adverse events with rigorous analysis will be important to allow systematic errors to be exposed and corrected.
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Affiliation(s)
- Peter J Rossi
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Hofer C, Abreu T, Silva E, Sepulveda C, Lopes N, Frota AC. The use of comic drama in improving hand hygiene compliance. J Trop Pediatr 2012; 58:417-9. [PMID: 22238135 DOI: 10.1093/tropej/fmr111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012:CD000259. [PMID: 22696318 DOI: 10.1002/14651858.cd000259.pub3] [Citation(s) in RCA: 1351] [Impact Index Per Article: 112.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Audit and feedback is widely used as a strategy to improve professional practice either on its own or as a component of multifaceted quality improvement interventions. This is based on the belief that healthcare professionals are prompted to modify their practice when given performance feedback showing that their clinical practice is inconsistent with a desirable target. Despite its prevalence as a quality improvement strategy, there remains uncertainty regarding both the effectiveness of audit and feedback in improving healthcare practice and the characteristics of audit and feedback that lead to greater impact. OBJECTIVES To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes and to examine factors that may explain variation in the effectiveness of audit and feedback. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2010, Issue 4, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 10 December 2010); MEDLINE, Ovid (1950 to November Week 3 2010) (searched 09 December 2010); EMBASE, Ovid (1980 to 2010 Week 48) (searched 09 December 2010); CINAHL, Ebsco (1981 to present) (searched 10 December 2010); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (1975 to present) (searched 12-15 September 2011). SELECTION CRITERIA Randomised trials of audit and feedback (defined as a summary of clinical performance over a specified period of time) that reported objectively measured health professional practice or patient outcomes. In the case of multifaceted interventions, only trials in which audit and feedback was considered the core, essential aspect of at least one intervention arm were included. DATA COLLECTION AND ANALYSIS All data were abstracted by two independent review authors. For the primary outcome(s) in each study, we calculated the median absolute risk difference (RD) (adjusted for baseline performance) of compliance with desired practice compliance for dichotomous outcomes and the median percent change relative to the control group for continuous outcomes. Across studies the median effect size was weighted by number of health professionals involved in each study. We investigated the following factors as possible explanations for the variation in the effectiveness of interventions across comparisons: format of feedback, source of feedback, frequency of feedback, instructions for improvement, direction of change required, baseline performance, profession of recipient, and risk of bias within the trial itself. We also conducted exploratory analyses to assess the role of context and the targeted clinical behaviour. Quantitative (meta-regression), visual, and qualitative analyses were undertaken to examine variation in effect size related to these factors. MAIN RESULTS We included and analysed 140 studies for this review. In the main analyses, a total of 108 comparisons from 70 studies compared any intervention in which audit and feedback was a core, essential component to usual care and evaluated effects on professional practice. After excluding studies at high risk of bias, there were 82 comparisons from 49 studies featuring dichotomous outcomes, and the weighted median adjusted RD was a 4.3% (interquartile range (IQR) 0.5% to 16%) absolute increase in healthcare professionals' compliance with desired practice. Across 26 comparisons from 21 studies with continuous outcomes, the weighted median adjusted percent change relative to control was 1.3% (IQR = 1.3% to 28.9%). For patient outcomes, the weighted median RD was -0.4% (IQR -1.3% to 1.6%) for 12 comparisons from six studies reporting dichotomous outcomes and the weighted median percentage change was 17% (IQR 1.5% to 17%) for eight comparisons from five studies reporting continuous outcomes. Multivariable meta-regression indicated that feedback may be more effective when baseline performance is low, the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and when it includes both explicit targets and an action plan. In addition, the effect size varied based on the clinical behaviour targeted by the intervention. AUTHORS' CONCLUSIONS Audit and feedback generally leads to small but potentially important improvements in professional practice. The effectiveness of audit and feedback seems to depend on baseline performance and how the feedback is provided. Future studies of audit and feedback should directly compare different ways of providing feedback.
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Affiliation(s)
- Noah Ivers
- Department of Family Medicine, Women’s College Hospital, Toronto, Canada. 2Norwegian Knowledge Centre for the Health Services,Oslo,
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Current world literature. Curr Opin Pediatr 2012; 24:134-44. [PMID: 22245849 DOI: 10.1097/mop.0b013e328350498a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stewardson A, Allegranzi B, Sax H, Kilpatrick C, Pittet D. Back to the future: rising to the Semmelweis challenge in hand hygiene. Future Microbiol 2011; 6:855-76. [PMID: 21861619 DOI: 10.2217/fmb.11.66] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hand hygiene is the single most important intervention for reducing healthcare associated infections and preventing the spread of antimicrobial resistance. This sentence begins most publications regarding hand hygiene in the medical literature. But why - as we mark 150 years since the publication of Ignaz Semmelweis' landmark monograph on the subject - do we continue to repeat it? One might be tempted to regard it as a truism. However, while tremendous progress has certainly been made in this field, a significant amount of work is yet to be done in both strengthening the evidence regarding the impact of hand hygiene and maximizing its implementation. Hand hygiene cannot yet be taken for granted. This article summarizes historical perspectives, dynamics of microbial colonization and efficacy of hand cleansing methods and agents, elements and impacts of successful hand hygiene promotion, as well as scale-up and sustainability. We also explore hand hygiene myths and current challenges such as monitoring, behavior change, patient participation and research priorities.
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Affiliation(s)
- Andrew Stewardson
- Infection Control Program & World Health Organization Collaborating Centre on Patient Safety (Infection Control & Practice Improvement), University of Geneva Hospitals, Switzerland
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Chen YC, Sheng WH, Wang JT, Chang SC, Lin HC, Tien KL, Hsu LY, Tsai KS. Effectiveness and limitations of hand hygiene promotion on decreasing healthcare-associated infections. PLoS One 2011; 6:e27163. [PMID: 22110610 PMCID: PMC3217962 DOI: 10.1371/journal.pone.0027163] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 10/11/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs. METHODS AND FINDINGS A 4-year hospital-wide HHP, with particular emphasis on using an alcohol-based hand rub, was implemented in April 2004 at a 2,200-bed teaching hospital in Taiwan. Compliance was measured by direct observation and the use of hand rub products. Poisson regression analyses were employed to evaluate the densities and trends of HAIs during the preintervention (January 1999 to March 2004) and intervention (April 2004 to December 2007) periods. The economic impact was estimated based on a case-control study in Taiwan. We observed 8,420 opportunities for hand hygiene during the study period. Compliance improved from 43.3% in April 2004 to 95.6% in 2007 (p<.001), and was closely correlated with increased consumption of the alcohol-based hand rub (r = 0.9399). The disease severity score (Charlson comorbidity index) increased (p = .002) during the intervention period. Nevertheless, we observed an 8.9% decrease in HAIs and a decline in the occurrence of bloodstream, methicillin-resistant Staphylococcus aureus, extensively drug-resistant Acinetobacter baumannii, and intensive care unit infections. The intervention had no discernable impact on HAI rates in the hematology/oncology wards. The net benefit of the HHP was US$5,289,364, and the benefit-cost ratio was 23.7 with a 3% discount rate. CONCLUSIONS Implementation of a HHP reduces preventable HAIs and is cost effective.
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Affiliation(s)
- Yee-Chun Chen
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
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Adherence to hand hygiene and risk factors for poor adherence in 13 Ontario acute care hospitals. Am J Infect Control 2011; 39:693-696. [PMID: 21664722 DOI: 10.1016/j.ajic.2010.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 12/02/2010] [Indexed: 11/23/2022]
Abstract
Multicenter studies assessing hand hygiene adherence and risk factors for poor performance are scarce. In an observational study involving 13 hospitals across Ontario, Canada, we found a mean adherence rate of 31.2%, and that adherence was positively associated with nurses, single rooms, contact precautions, and the availability of alcohol hand rub dispensers.
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Peterson LR. Molecular laboratory tests for the diagnosis of respiratory tract infection due to Staphylococcus aureus. Clin Infect Dis 2011; 52 Suppl 4:S361-6. [PMID: 21460297 DOI: 10.1093/cid/cir052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
When Staphylococcus aureus is the cause of ventilator-associated pneumonia or a bacterial infection following influenza, the infections are devastating if not treated promptly. Disease due to methicillin-resistant S. aureus (MRSA) continues to be of concern throughout most of the United States. Currently, the U.S. Food and Drug Administration (FDA) has cleared polymerase chain reaction tests for detection of MRSA in nasal swab specimens; however, there are no FDA-cleared tests for identifying S. aureus in purulent respiratory secretions. The real-time polymerase chain reaction tests for S. aureus (primarily MRSA) in nares provide results in <2 h and have sensitivities ranging from 95% to 100%, with specificities of 96%-99%; these results are comparable to that of standard cultures, which can take up to 3-4 days for final results. The FDA is encouraged to work closely with industry providers to expedite the evaluation and clearance process for molecular diagnostic devices detecting S. aureus (including MRSA) in the diagnosis of respiratory tract infection.
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Affiliation(s)
- Lance R Peterson
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem (NorthShore) and University of Chicago, Evanston, Illinois v, USA.
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Performance of the BD GeneOhm MRSA achromopeptidase assay for real-time PCR detection of methicillin-resistant Staphylococcus aureus in nasal specimens. J Clin Microbiol 2011; 49:2266-8. [PMID: 21508148 DOI: 10.1128/jcm.02431-10] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated the BD GeneOhm MRSA achromopeptidase (ACP) assay, which incorporates a new specimen preparation approach. A total of 1,216 leftover nasal samples were tested; using culture as the gold standard, the sensitivity and specificity were 92% and 94.6%, respectively. The new lysis method provides good sensitivity and simplifies specimen preparation.
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