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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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Schwappach D, Sendlhofer G, Häsler L, Gombotz V, Leitgeb K, Hoffmann M, Jantscher L, Brunner G. Speaking up behaviors and safety climate in an Austrian university hospital. Int J Qual Health Care 2019; 30:701-707. [PMID: 29701770 DOI: 10.1093/intqhc/mzy089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/09/2018] [Indexed: 12/22/2022] Open
Abstract
Objective To analyze speaking up behavior and safety climate with a validated questionnaire for the first time in an Austrian university hospital. Design Survey amongst healthcare workers (HCW). Data were analyzed using descriptive statistics, Cronbach's alpha was calculated as a measure of internal consistencies of scales. Analysis of variance and t-tests were used. Setting The survey was conducted in 2017. Participants About 2.149 HCW from three departments were asked to participate. Intervention To measure speaking up behavior and safety climate. Main Outcome Measure To explore psychological safety, encouraging environment and resignation towards speaking up. Results About 859 evaluable questionnaires were returned (response rate: 40%). More than 50% of responders perceived specific concerns about patient safety within the last 4 weeks and observed a potential error or noticed rule violations. For the different items, between 16% and 42% of HCW reported that they remained silent though concerns for safety. In contrast, between 96% and 98% answered that they did speak up in certain situations. The psychological safety for speaking up was lower for HCW with a managerial function (P < 0.001). HCW with managerial functions perceived the environment as less encouraging to speak up (P < 0.05) than HCW without managerial function. Conclusions We identified speaking up behaviors for the first time in an Austrian university hospital. Only moderately frequent concerns were in conflict with frequent speaking up behaviors. These results clearly show that a paradigm shift is needed to increase speaking up culture.
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Affiliation(s)
- David Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Lynn Häsler
- Swiss Patient Safety Foundation, Zurich, Switzerland
| | - Veronika Gombotz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Karina Leitgeb
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Magdalena Hoffmann
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lydia Jantscher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Hoffmann M, Sendlhofer G, Pregartner G, Gombotz V, Tax C, Zierler R, Brunner G. Interventions to increase hand hygiene compliance in a tertiary university hospital over a period of 5 years: An iterative process of information, training and feedback. J Clin Nurs 2018; 28:912-919. [PMID: 30357973 DOI: 10.1111/jocn.14703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVE To explore whether an iterative process of information and training paired with a feedback system to observed healthcare professionals and the respective management improves hand hygiene (HH) compliance. BACKGROUND Healthcare-associated infections are a major risk for patient safety, and adherence to the "My five moments" (M5M) for HH varies significantly within organisations as well as within healthcare professional groups. Identified barriers in a baseline survey revealed the need of more information, training, repetitive compliance measurements and feedback to all healthcare professionals. DESIGN A quality improvement project using the method of direct observation of healthcare professionals in nonsurgical and surgical wards. METHODS Between 2013 and 2017, 6,009 healthcare professionals were informed and trained, and HH compliance measurements were performed by hygiene experts. Compliance measurement results were documented in an online tool to give an immediate feedback to observed healthcare professionals. Additionally, a report was forwarded to the management of the respective department to raise awareness. Compliance rates per year were descriptively summarised. The research and reporting methodology followed SQUIRE 2.0. RESULTS In total, 84 compliance measurements with 19,295 "M5M for HH" were observed in 49 wards. Overall, mean HH compliance increased from 81.9 ± 5.2% in 2013 to 94.0 ± 3.6% in 2017. Physicians' HH compliance rate improved from 69.0 ± 16.6% to 89.3 ± 6.6%, that of nurses from 86.0 ± 6.9% to 96.4 ± 3.1%, and that of others from 60.5 ± 27.9% to 83.8 ± 20.2%. All M5M for HH (#1-#5) increased over the study period (#1: +16.9%; #2: +20.5%; #3: +7.6%; #4: +5.9%; #5: +12.7%). CONCLUSIONS Results demonstrated that an iterative process of information, training, observation and feedback over a period of 5 years can be successful in increasing HH compliance. Positive trends were observed for HH compliance rates across all healthcare professional groups as well as for all M5M for HH.
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Affiliation(s)
- Magdalena Hoffmann
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Veronika Gombotz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | | | - Renate Zierler
- Executive Department for Hygiene Aspects, University Hospital Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,University Hospital Graz, Graz, Austria
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Kwok YLA, Harris P, McLaws ML. Social cohesion: The missing factor required for a successful hand hygiene program. Am J Infect Control 2017; 45:222-227. [PMID: 27938987 DOI: 10.1016/j.ajic.2016.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are limited explorations into hospital staff reactions to automated hand hygiene surveillance or hand hygiene interventions. METHODS An automated surveillance system with daily feedback and a behavioral intervention component was trialed in 2 wards in an Australian tertiary teaching hospital. After 9 months, 12 clinicians from each ward were interviewed prior to the completion of the trial to explore satisfaction with the system and behavioral component of nudging each other with a reminder to comply. Only on completion of the trial were transcripts analyzed for themes. RESULTS Staff from the ward with improved compliance described a socially cohesive team with a well-liked nurse unit manager who accessed daily compliance rates and worked with staff to set goals. This contrasted with the ward without improvement in compliance, whose staff described their great reluctance and discomfort to nudge each other to comply and distrust of the authenticity of the rates established from the automated system. CONCLUSIONS Interventions for improving compliance are more likely to be successful in a ward with a social cohesive team. Patient safety interventions, in the first instance, may benefit from purposeful selection of wards with cohesive teams and skilled leaders who can transform clinicians into early adopters of the program.
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Sendlhofer G, Pregartner G, Leitgeb K, Hoffmann M, Berghold A, Smolle C, Brunner G, Kamolz LP. Results of a population-based-assessment: we need better communication and more profound patient involvement. Wien Klin Wochenschr 2017; 129:269-277. [PMID: 28101668 PMCID: PMC5399065 DOI: 10.1007/s00508-016-1165-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/19/2016] [Indexed: 12/05/2022]
Abstract
Background In Austria several regulations were published in order to support initiatives to increase patient safety. Since then, many patient safety projects were implemented in Austrian hospitals; therefore, it was the aim of the current survey to examine the perceptions of Austrian citizens with respect to topics relevant to patient safety. Methods Between 8 and 22 October 2015 a qualitative cross-sectional telephone interview study was performed. A sample of citizens above 14 years of age was randomly drawn. The survey contained 6 questions. In each of the nine states of Austria, a representative number of citizens were interviewed. Results In total 1021(female: 52.3%) telephone interviews were performed and 249 (24.7%) citizens stated that trust/confidence in patient safety is very high, 571 (55.9%) assessed the reputation of a hospital as very important and 739 (72.4%) stated that a detailed explanation of the treatment as well as information on associated risk factors and possibilities of further treatments is very important. Of the respondents 722 (70.7%) stated that patient safety measures in a given hospital are very important, 807 (79.0%) stated that it is important to be informed about patient safety measures and 547 (53.6%) stated that if something did not satisfactorily function they would complain to the hospital. Significant differences occurred for states with and without university hospitals. Conclusion The results of the survey give cause for concern as the majority of interviewed citizens have medium or low trust/confidence in patient safety. Furthermore, more than two-thirds of Austrian citizens revealed that detailed explanation of treatment, information on associated risk factors, information about patient safety measures to predict medical errors and information about patient safety measures which are in place in a hospital are very important. The study showed that patient safety is an important topic for Austrian citizens and they want to be informed and involved. The study also indicated the need to promote patient safety aspects and to decrease the number of people who are not confident concerning patient safety in Austrian hospitals.
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Affiliation(s)
- Gerald Sendlhofer
- Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036, Graz, Austria. .,Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria. .,Austrian Society for Quality and Safety in Healthcare (ASQS), Graz, Austria.
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Karina Leitgeb
- Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036, Graz, Austria.,Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Austrian Society for Quality and Safety in Healthcare (ASQS), Graz, Austria
| | - Magdalena Hoffmann
- Executive Department for Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036, Graz, Austria.,Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Austrian Society for Quality and Safety in Healthcare (ASQS), Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Christian Smolle
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Austrian Society for Quality and Safety in Healthcare (ASQS), Graz, Austria.,University Hospital Graz, Graz, Austria
| | - Lars Peter Kamolz
- Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Austrian Society for Quality and Safety in Healthcare (ASQS), Graz, Austria
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Kwok YLA, Juergens CP, McLaws ML. Automated hand hygiene auditing with and without an intervention. Am J Infect Control 2016; 44:1475-1480. [PMID: 27776819 DOI: 10.1016/j.ajic.2016.08.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Daily feedback from continuous automated auditing with a peer reminder intervention was used to improve compliance. Compliance rates from covert and overt automated auditing phases with and without intervention were compared with human mandatory audits. METHODS An automated system was installed to covertly detect hand hygiene events with each depression of the alcohol-based handrub dispenser for 5 months. The overt phase included key clinicians trained to share daily rates with clinicians, set compliance goals, and nudge each other to comply for 6 months. During a further 6 months, the intervention continued without being refreshed. Hand Hygiene Australia (HHA) human audits were performed quarterly during the intervention in accordance with the World Health Organization guidelines. Percentage point (PP) differences between compliance rates were used to determine change. RESULTS HHA rates for June 2014 were 85% and 87% on the medical and surgical wards, respectively. These rates were 55 PPs and 38 PPs higher than covert automation rates for June 2014 on the medical and surgical ward at 30% and 49%, respectively. During the intervention phase, average compliance did not change on the medical ward from their covert rate, whereas the surgical ward improved compared with the covert phase by 11 PPs to 60%. On average, compliance during the intervention without being refreshed did not change on the medical ward, whereas the average rate on the surgical ward declined by 9 PPs. CONCLUSIONS Automation provided a unique opportunity to respond to daily rates, but compliance will return to preintervention levels once active intervention ceases or human auditors leave the ward, unless clinicians are committed to change.
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Affiliation(s)
- Yen Lee Angela Kwok
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Craig P Juergens
- Southwestern Sydney Clinical School, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia.
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