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Senges C, Herzer C, Norkus E, Krewing M, Mattner C, Rose L, Gebhardt T, Mattner F, Niesalla H. Workflows and locations matter - insights from electronic hand hygiene monitoring into the use of hand rub dispensers across diverse hospital wards. Infect Prev Pract 2024; 6:100364. [PMID: 38601127 PMCID: PMC11004075 DOI: 10.1016/j.infpip.2024.100364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/28/2024] [Indexed: 04/12/2024] Open
Abstract
Background While healthcare-associated infections (HAIs) affect approximately 3.2-6.5% of hospitalised patients in the US and Europe, improving hand hygiene (HH) could reduce HAI rates. Investigating HH is time-consuming and not always objective, and comprehensive, unbiased data is needed to develop effective strategies. Using electronic tools can provide new and detailed insights on the determinants of HH. Aim To evaluate location-dependent usage of wall-mounted dispensers (WMDs) and point-of-care dispensers (POCs) using an electronic HH recording system. Methods In this retrospective study, hand rub volumes were anonymously recorded for 931,446 disinfections from 17 wards in nine German hospitals using the electronic monitoring system NosoEx®. Number of disinfections and rub volumes of WMDs/POCs by ward and room type were analysed. Findings Generally, WMDs were most prevalent. With >3 dispensers per bed and >20 disinfections per patient day, availability and use were highest in intensive care (ICU) and intermediate care (IMC), but here rub volumes from WMDs were lowest (∼2.0 mL). Although most dispensers are located in patient rooms (∼42%), they are more frequently used in hallways. In surgical ICUs, dispensers are often used in patient rooms, where contact with open wounds is common. About 3.6 mL of hand rub is used per disinfection in treatment rooms, the highest volume of all room types. Conclusion Dispenser use was dependent on location, room type, ward specialisation and workflow. Optimising the location of hand rub dispensers (HRDs)s is not the only solution to improve HH, but can help reduce inconvenience, achieve more ergonomic workflows and better meet user needs.
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Affiliation(s)
- Christoph Senges
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
| | | | | | - Marco Krewing
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
| | - Clara Mattner
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
- Institute of Rural Studies, Johann Heinrich von Thünen Institute, Braunschweig, Germany
| | - Leonard Rose
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
| | | | - Frauke Mattner
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
| | - Heide Niesalla
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
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Gobte NJ, Gozdzielewska L, Kc D, Sithole BL, Vorndran A, McAloney-Kocaman K, Mehtar S, Price L. Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon. Am J Infect Control 2024; 52:274-279. [PMID: 37741291 DOI: 10.1016/j.ajic.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital. METHODS It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance. RESULTS 5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml). CONCLUSIONS Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.
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Affiliation(s)
- Nkwan J Gobte
- Baptist Training School for Health Personnel, Cameroon Baptist Convention Health Services, Banso, Cameroon
| | - Lucyna Gozdzielewska
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - Deepti Kc
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | | | - Anna Vorndran
- Infection Control Africa Network (ICAN), Cape Town, South Africa
| | | | - Shaheen Mehtar
- Infection Control Africa Network (ICAN), Cape Town, South Africa
| | - Lesley Price
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK
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Smith-Millman M, Daniels L, Gallagher K, Aspinwall S, Brightman H, Ubertini G, Borrero GU, Palmo L, Weinstock P, Allan C. Hazard Assessment and Remediation Tool for Simulation-Based Healthcare Facility Design Testing. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:287-305. [PMID: 37545401 DOI: 10.1177/19375867231188151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To develop an objective, structured observational tool to enable identification and measurement of hazards in the built environment when applied to audiovisual recordings of simulations by trained raters. BACKGROUND Simulation-based facility design testing is increasingly used to optimize safety of healthcare environments, often relying on participant debriefing or direct observation by human factors experts. METHODS Hazard categories were defined through participant debriefing and detailed review of pediatric intensive care unit in situ simulation videos. Categories were refined and operational definitions developed through iterative coding and review. Hazard detection was optimized through the use of structured coding protocols and optimized camera angles. RESULTS Six hazard categories were defined: (1) slip/trip/fall/injury risk, impaired access to (2) patient or (3) equipment, (4) obstructed path, (5) poor visibility, and (6) infection risk. Analysis of paired and individual coding demonstrated strong overall reliability (0.89 and 0.85, Gwet's AC1). Reliability coefficients for each hazard category were >0.8 for all except obstructed path (0.76) for paired raters. Among individual raters, reliability coefficients were >0.8, except for slip/trip/fall/injury risk (0.68) and impaired access to equipment (0.77). CONCLUSIONS Hazard Assessment and Remediation Tool (HART) provides a framework to identify and quantify hazards in the built environment. The tool is highly reliable when applied to direct video review of simulations by either paired raters or trained single clinical raters. Subsequent work will (1) assess the tool's ability to discriminate between rooms with different physical attributes, (2) develop strategies to apply HART to improve facility design, and (3) assess transferability to non-ICU acute care environments.
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Affiliation(s)
| | - Lorraine Daniels
- Enterprise Project Management Office, Boston Children's Hospital, MA, USA
| | - Katie Gallagher
- Enterprise Project Management Office, Boston Children's Hospital, MA, USA
| | - Sarah Aspinwall
- Cardiovascular Program, Nursing Patient Services, Boston Children's Hospital, MA, USA
| | - Howard Brightman
- Enterprise Project Management Office, Boston Children's Hospital, MA, USA
| | - Gina Ubertini
- Cardiovascular Program, Nursing Patient Services, Boston Children's Hospital, MA, USA
| | | | - Lobsang Palmo
- Immerisve Design Systems, Boston Children's Hospital, MA, USA
| | - Peter Weinstock
- Immerisve Design Systems, Boston Children's Hospital, MA, USA
- Department of Anesthesia, Pain, and Critical Care Medicine, Boston Children's Hospital, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, MA, USA
| | - Catherine Allan
- Immerisve Design Systems, Boston Children's Hospital, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, MA, USA
- Division of Cardiac Intensive Care, Department of Cardiology, Boston Children's Hospital, MA, USA
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Kuster S, Roth JA, Frei R, Meier CA, Dangel M, Widmer AF. Handrub dispensers per acute care hospital bed: a study to develop a new minimum standard. Antimicrob Resist Infect Control 2021; 10:93. [PMID: 34134772 PMCID: PMC8206889 DOI: 10.1186/s13756-021-00949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background Accessibility to alcohol-based handrub (ABHR) dispenser is crucial to improve compliance to hand hygiene (HH), being offered as wall-mounted dispensers (ABHR-Ds), and/or pocket bottles. Nevertheless, information on the distribution and density of ABHR-Ds and their impact on HH have hardly been studied. Institutions such as the World Health Organisation or the Centers for Disease Control and Prevention do not provide guidance. The Robert-Koch-Institute (RKI) from Germany recommends an overall density of > 0.5 dispensers per patient bed. We aimed to investigate current conditions in hospitals to develop a standard on the minimal number of ABHR-D. Methods Between 07 and 09/2019, we applied a questionnaire to 178 hospitals participating in the Swissnoso National Surveillance Network to evaluate number and location of ABHR-Ds per bed in acute care hospitals, and compared the data with consumption and compliance with HH. Results 110 of the 178 (62%) hospitals provided data representing approximately 20,000 hospital beds. 83% hospitals provided information on both the total number of ABHR-Ds and patient beds, with a mean of 2.4 ABHR-Ds per bed (range, 0.4–22.1). While most hospitals (84%) had dispensers located at the room entrance, 47% reported also locations near or at the bed. Additionally, pocket-sized dispensers (100 mL) are available in 97% of hospitals. Conclusions Swiss hospitals provide 2.4 dispensers per bed, much more than governmental recommendation. The first study on the number of ABHR-Ds in hospitals may help to define a minimal standard for national and international recommendations Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00949-0.
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Affiliation(s)
- Sabine Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Jan A Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Reno Frei
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Christoph A Meier
- Medical Director, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Internal Medicine, Clinic and Amublance of Internal Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Marc Dangel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Swissnoso, Swiss National Center for Infenction Prevention, Sulgenecstrasse 35, 3007, Bern, Switzerland.
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McGuire L, Schultz TJ, Kelly J. Developing a Model of Care for a 4- to 6-Bedded Postanesthetic Recovery Unit: A Delphi Study. J Perianesth Nurs 2021; 36:398-405. [PMID: 33714716 DOI: 10.1016/j.jopan.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Recovery units are typically open-plan rooms where all patients can be seen at all times; however, a new hospital has been built with 4- to 6-bed perioperative bays. The purpose of the study was to establish expert consensus regarding problems, benefits, and suggested solutions for the new design across four domains: patient safety, staff satisfaction, organizational efficiency, and maintenance of professional standards. DESIGN We conducted a Delphi study to inform the development of a model of care for this new design. METHODS A two-round Delphi study involved 71 recovery unit nurses from 13 countries. Problems, solutions, and any potential benefits of the new design were collected in round 1 and ranked in round 2. FINDINGS The highest ranked problems were mixing conscious and unconscious patients and need for safe skilled staffing levels. The highest ranked solutions were division of patients, increased safe skilled staffing, and staff education. CONCLUSIONS Participants identified clear risks and mitigation strategies. Implementing these strategies should allow for a safer environment for both patients and staff. A model of care to ensure safety and quality in 4- to 6-bedded bay postanesthetic recovery units should address mixing of patients, staffing levels and staff education.
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Affiliation(s)
- Louise McGuire
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia; Perioperative Bays, Royal Adelaide Hospital, Adelaide, South Australia
| | - Timothy John Schultz
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia.
| | - Janet Kelly
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia
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6
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Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours. J Hosp Infect 2020; 106:107-114. [PMID: 32585171 PMCID: PMC7308774 DOI: 10.1016/j.jhin.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Global pandemic outbreaks are a cause of fear. Healthcare workers (HCWs), especially those fighting the pathogens at the front line, are at higher risk of being infected while they treat patients. In addition, various environmental fomites in hospitals, which may carry infectious agents, can increase the risk of acquiring an infectious disease. AIM In order to deliver the best healthcare practice, it is critical that HCWs feel safe and protected against infectious diseases. The aim of this study was to improve understanding of HCWs' hand hygiene (HH) behaviours and perceptions of infectious diseases from a psychological perspective. METHODS Environmental features were observed in three departments, and questionnaires were used to determine perceived safety against infectious diseases among HCWs and the coping behaviours they used (e.g. avoidance and disinfection). FINDINGS This study found that an increase in the number of HH stations at convenient locations would increase HH compliance and perceived safety against infectious diseases among HCWs. In response to the current research gap in psychological aspects associated with HH, this study found that HCWs' coping behaviours can be predicted by their perceived likelihood of contamination and perceived vulnerability. CONCLUSIONS The study findings should be interpreted with care, and further studies with more academic rigor are needed.
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7
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Cruz JP. Infection prevention climate and its influence on nursing students’ compliance with standard precautions. J Adv Nurs 2019; 75:1042-1052. [DOI: 10.1111/jan.13904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/06/2018] [Accepted: 10/02/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Jonas Preposi Cruz
- Nursing Department College of Applied Medical Sciences at Al Dawadmi Shaqra University Al Dawadmi Saudi Arabia
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8
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Pinter-Wollman N, Jelić A, Wells NM. The impact of the built environment on health behaviours and disease transmission in social systems. Philos Trans R Soc Lond B Biol Sci 2018; 373:20170245. [PMID: 29967306 PMCID: PMC6030577 DOI: 10.1098/rstb.2017.0245] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2018] [Indexed: 01/08/2023] Open
Abstract
The environment plays an important role in disease dynamics and in determining the health of individuals. Specifically, the built environment has a large impact on the prevention and containment of both chronic and infectious disease in humans and in non-human animals. The effects of the built environment on health can be direct, for example, by influencing environmental quality, or indirect by influencing behaviours that impact disease transmission and health. Furthermore, these impacts can happen at many scales, from the individual to the society, and from the design of the plates we eat from to the design of cities. In this paper, we review the ways that the built environment affects both the prevention and the containment of chronic and infectious disease. We bring examples from both human and animal societies and attempt to identify parallels and gaps between the study of humans and animals that can be capitalized on to advance the scope and perspective of research in each respective field. By consolidating this literature, we hope to highlight the importance of built structures in determining the complex dynamics of disease and in impacting the health behaviours of both humans and animals.This article is part of the theme issue 'Interdisciplinary approaches for uncovering the impacts of architecture on collective behaviour'.
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Affiliation(s)
- Noa Pinter-Wollman
- Department of Ecology and Evolutionary Biology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Andrea Jelić
- Department of Architecture, Design and Media Technology, Aalborg University, 9000 Aalborg, Denmark
| | - Nancy M Wells
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY 14853, USA
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Barlow M, Dickie R, Morse C, Bonney D, Simon R. Documentation framework for healthcare simulation quality improvement activities. Adv Simul (Lond) 2017; 2:19. [PMID: 29450020 PMCID: PMC5806278 DOI: 10.1186/s41077-017-0053-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Robyn Dickie
- Mater Education Ltd, Queenslane, Brisbane, Australia
| | - Catherine Morse
- Center for Medical Simulation, Queenslane, Brisbane, Australia
| | - Donna Bonney
- Mater Education Ltd, Queenslane, Brisbane, Australia
| | - Robert Simon
- Center for Medical Simulation, Queenslane, Brisbane, Australia
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Pennathur PR, Herwaldt LA. Role of Human Factors Engineering in Infection Prevention: Gaps and Opportunities. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017; 9:230-249. [PMID: 32226329 PMCID: PMC7100866 DOI: 10.1007/s40506-017-0123-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Human factors engineering (HFE), with its focus on studying how humans interact with systems, including their physical and organizational environment, the tools and technologies they use, and the tasks they perform, provides principles, tools, and techniques for systematically identifying important factors, for analyzing and evaluating how these factors interact to increase or decrease the risk of Healthcare-associated infections (HAI), and for identifying and implementing effective preventive measures. We reviewed the literature on HFE and infection prevention and control and identified major themes to document how researchers and infection prevention staff have used HFE methods to prevent HAIs and to identify gaps in our knowledge about the role of HFE in HAI prevention and control. Our literature review found that most studies in the healthcare domain explicitly applying (HFE) principles and methods addressed patient safety issues not infection prevention and control issues. In addition, most investigators who applied human factors principles and methods to infection prevention issues assessed only one human factors element such as training, technology evaluations, or physical environment design. The most significant gap pertains to the limited use and application of formal HFE tools and methods. Every infection prevention study need not assess all components in a system, but investigators must assess the interaction of critical system components if they want to address latent and deep-rooted human factors problems.
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Affiliation(s)
- Priyadarshini R. Pennathur
- Department of Mechanical and Industrial Engineering, 2132 Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, IA USA
| | - Loreen A. Herwaldt
- Department of Medicine, University of Iowa School of Medicine, Iowa City, IA USA
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Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, Price L, Egger M, Grayson ML, Kelley E, Allegranzi B. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resist Infect Control 2017; 6:6. [PMID: 28078082 PMCID: PMC5223492 DOI: 10.1186/s13756-016-0149-9] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.
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Affiliation(s)
- Julie Storr
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Anthony Twyman
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Walter Zingg
- Infection Control Programme, and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Nizam Damani
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Claire Kilpatrick
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Jacqui Reilly
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Lesley Price
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - M Lindsay Grayson
- Austin Health and University of Melbourne, 145 Studley Road, PO Box 5555, Heidelberg, VIC Australia
| | - Edward Kelley
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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Stiller A, Salm F, Bischoff P, Gastmeier P. Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2016; 5:51. [PMID: 27957323 PMCID: PMC5129243 DOI: 10.1186/s13756-016-0152-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/22/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The influence of the hospital's infrastructure on healthcare-associated colonization and infection rates has thus far infrequently been examined. In this review we examine whether healthcare facility design is a contributing factor to multifaceted infection control strategies. METHODS We searched PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) from 1990 to December 31st, 2015, with language restriction to English, Spanish, German and French. RESULTS We identified three studies investigating accessibility of the location of the antiseptic hand rub dispenser. Each of them showed a significant improvement of hand hygiene compliance or agent consumption with the implementation of accessible dispensers near the patient bed. Nine eligible studies evaluated the impact of single-patient rooms on the acquisition of healthcare-associated colonization and infections in comparison to multi-bedrooms or an open ward design. Six of these studies showed a significant benefit of single-patient bedrooms in reducing the healthcare-associated colonization and infection rate, whereas three studies found that single-patient rooms are neither a protective nor risk factor. In meta-analyses, the overall risk ratio for acquisition of healthcare-associated colonization and infection was 0.55 (95% CI: 0.41 to 0.74), for healthcare-associated colonization 0.52 (95% CI: 0.32 to 0.85) and for bacteremia 0.64 (95% CI: 0.53 to 0.76), all in favor of patient care in single-patient bedrooms. CONCLUSION Implementation of single-patient rooms and easily accessible hand rub dispensers located near the patient's bed are beneficial for infection control and are useful parts of a multifaceted strategy for reducing healthcare-associated colonization and infections.
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Affiliation(s)
- Andrea Stiller
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Florian Salm
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Peter Bischoff
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
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Liang SY, Theodoro DL, Schuur JD, Marschall J. Infection prevention in the emergency department. Ann Emerg Med 2014; 64:299-313. [PMID: 24721718 PMCID: PMC4143473 DOI: 10.1016/j.annemergmed.2014.02.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 01/01/2023]
Abstract
Infection prevention remains a major challenge in emergency care. Acutely ill and injured patients seeking evaluation and treatment in the emergency department (ED) not only have the potential to spread communicable infectious diseases to health care personnel and other patients, but are vulnerable to acquiring new infections associated with the care they receive. This article will evaluate these risks and review the existing literature for infection prevention practices in the ED, ranging from hand hygiene, standard and transmission-based precautions, health care personnel vaccination, and environmental controls to strategies for preventing health care-associated infections. We will conclude by examining what can be done to optimize infection prevention in the ED and identify gaps in knowledge where further research is needed. Successful implementation of evidence-based practices coupled with innovation of novel approaches and technologies tailored specifically to the complex and dynamic environment of the ED are the keys to raising the standard for infection prevention and patient safety in emergency care.
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Affiliation(s)
- Stephen Y Liang
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO; Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
| | - Daniel L Theodoro
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Jeremiah D Schuur
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jonas Marschall
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
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Cure L, Van Enk R, Tiong E. A systematic approach for the location of hand sanitizer dispensers in hospitals. Health Care Manag Sci 2013; 17:245-58. [PMID: 24194381 DOI: 10.1007/s10729-013-9254-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.
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Affiliation(s)
- Laila Cure
- Department of Industrial and Manufacturing Engineering, Western Michigan University, Kalamazoo, MI, 49008, USA,
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15
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Boog MC, Erasmus V, de Graaf JM, van Beeck E(AHE, Melles M, van Beeck EF. Assessing the optimal location for alcohol-based hand rub dispensers in a patient room in an intensive care unit. BMC Infect Dis 2013; 13:510. [PMID: 24171702 PMCID: PMC3826999 DOI: 10.1186/1471-2334-13-510] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 10/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of alcohol-based hand rub dispensers has had a positive influence on compliance of healthcare workers with the recommended guidelines for hand hygiene. However, establishing the best location for alcohol-based hand rub dispensers remains a problem, and no method is currently available to optimize the location of these devices. In this paper we describe a method to determine the optimal location for alcohol-based hand rub dispensers in patient rooms. METHODS We composed a method that consists of a combination of qualitative and quantitative research methods. Firstly, different arrangements of dispensers were determined based on the results of two types of assessment: workflow observations and interviews with nurses and physicians. Each arrangement was then evaluated using two types of assessment: interviews with nurses and physicians and electronic measurements of the user frequency of the dispensers. This procedure was applied in a single-bed patient room on a thoracic surgery intensive care unit. RESULTS The workflow observations revealed that the activities of patient care were most often at the entrance and near the computer at the right side of the test room. Healthcare workers stated that the location of the dispenser should meet several requirements. Measurements of the frequency of use showed that the dispenser located near the computer, at the back of the room, was used less frequently than the dispenser located near the sink and the dispenser located at the entrance to the room. CONCLUSION The applied method has potential for determining the optimal location for alcohol-based hand rub dispensers in a patient room. Workflow observations and the expressed preferences of healthcare workers guide the choice for the location of alcohol-based hand rub dispensers. These choices may be optimized based on measurement of the frequency of use of the dispensers.
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Affiliation(s)
- Matthijs C Boog
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jitske M de Graaf
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Elise (A) HE van Beeck
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628CE Delft, The Netherlands
| | - Ed F van Beeck
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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16
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Point-of-care hand hygiene: preventing infection behind the curtain. Am J Infect Control 2012; 40:S3-10. [PMID: 22546271 DOI: 10.1016/j.ajic.2012.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/28/2012] [Accepted: 02/28/2012] [Indexed: 12/17/2022]
Abstract
Best practices for hand hygiene provide indications for performance of hand hygiene at specific points in time during patient care. For hand hygiene to prevent infections, hand hygiene resources must be readily available to health care workers whenever required. This article reviews practices and recommendations intended to facilitate hand hygiene behavior at the point of care (POC) within the health care setting. Key aspects of POC hand hygiene include the provision of alcohol-based hand rub products, integration of dispensing solutions within the patient zone, consideration of patient care workflow, and dispenser designs that optimize acceptance and usage.
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