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Boyce JM, Pittet D. Rinse, gel, and foam - is there any evidence for a difference in their effectiveness in preventing infections? Antimicrob Resist Infect Control 2024; 13:49. [PMID: 38730473 PMCID: PMC11084031 DOI: 10.1186/s13756-024-01405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Following publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs). METHODS Data regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted. RESULTS The amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs. CONCLUSIONS Current evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.
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Affiliation(s)
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Reinoso Schiller N, Bludau A, Mathes T, König A, von Landesberger T, Scheithauer S. Unpacking nudge sensu lato: insights from a scoping review. J Hosp Infect 2024; 143:168-177. [PMID: 37949370 DOI: 10.1016/j.jhin.2023.11.001] [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: 09/13/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Nudges may play an important role in improving infection prevention and control (IPC) in hospitals. However, despite the novelty of the framework, their objectives, strategies and implementation approaches are not new. This review aims to provide an overview of the methods typically used by nudge interventions in IPC in hospitals targeting healthcare workers (HCWs). The initial search in PubMed yielded nine hits. Consequently, the search criteria were broadened and a second search was conducted, introducing 'nudge sensu lato' which incorporates insights from sources beyond the traditional nudge framework while maintaining the same objectives, strategies and approaches. During the second search, PubMed, Epistemonikos, Web of Science and PsycInfo were searched in accordance with the PRISMA guidelines. Abstracts were screened, and reviewers from an interdisciplinary team read the full text of selected papers. In total, 5706 unique primary studies were identified. Of these, 67 were included in the review, and only four were listed as nudge sensu stricto, focusing on changing HCWs' hand hygiene. All articles reported positive intervention outcomes. Of the 56 articles focused on improving hand hygiene compliance, 71.4% had positive outcomes. For healthcare equipment disinfection, 50% of studies showed significant results. Guideline adherence interventions had a 66.7% significant outcome rate. The concept of nudge sensu lato was introduced, encompassing interventions that employ strategies, methods and implementation approaches found in the nudge framework. The findings demonstrate that this concept can enhance the scientific development of more impactful nudges. This may help clinicians, researchers and policy makers to develop and implement effective nudging interventions.
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Affiliation(s)
- N Reinoso Schiller
- Department for Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany.
| | - A Bludau
- Department for Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - T Mathes
- Department of Medical Statistics, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - A König
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - T von Landesberger
- Chair for Visualization and Visual Analytics, University of Cologne, Cologne, Germany
| | - S Scheithauer
- Department for Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
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Scaria E, Safdar N, Alagoz O. Validating agent-based simulation model of hospital-associated Clostridioides difficile infection using primary hospital data. PLoS One 2023; 18:e0284611. [PMID: 37083629 PMCID: PMC10120937 DOI: 10.1371/journal.pone.0284611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
As agent-based models (ABMs) are increasingly used for modeling infectious diseases, model validation is becoming more crucial. In this study, we present an alternate approach to validating hospital ABMs that focuses on replicating hospital-specific conditions and proposes a new metric for validating the social-environmental network structure of ABMs. We adapted an established ABM representing Clostridioides difficile infection (CDI) spread in a generic hospital to a 426-bed Midwestern academic hospital. We incorporated hospital-specific layout, agent behaviors, and input parameters estimated from primary hospital data into the model, referred to as H-ABM. We compared the predicted CDI rate against the observed rate from 2013-2018. We used colonization pressure, a measure of nearby infectious agents, to validate the socio-environmental agent networks in the ABM. Finally, we conducted additional experiments to compare the performance of individual infection control interventions in the H-ABM and the generic model. We find that the H-ABM is able to replicate CDI trends during 2013-2018, including a roughly 46% drop during a period of greater infection control investment. High CDI burden in socio-environmental networks was associated with a significantly increased risk of C. difficile colonization or infection (Risk ratio: 1.37; 95% CI: [1.17, 1.59]). Finally, we found that several high-impact infection control interventions have diminished impact in the H-ABM. This study presents an alternate approach to validation of ABMs when large-scale calibration is not appropriate for specific settings and proposes a new metric for validating socio-environmental network structure of ABMs. Our findings also demonstrate the utility of hospital-specific modeling.
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Affiliation(s)
- Elizabeth Scaria
- Department of Industrial and Systems Engineering, University of Wisconsin- Madison, Madison, WI, United States of America
| | - Nasia Safdar
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin- Madison, Madison, WI, United States of America
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, United States of America
- William S. Middleton Memorial Veterans Hospital, Madison, WI, United States of Ameirca
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin- Madison, Madison, WI, United States of America
- Population Health Sciences, School of Medicine and Public Health, University of Wisconsin- Madison, Madison, WI, United States of America
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SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit. Trop Med Infect Dis 2022; 8:tropicalmed8010027. [PMID: 36668933 PMCID: PMC9867086 DOI: 10.3390/tropicalmed8010027] [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: 08/10/2022] [Revised: 10/28/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. METHODS We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). RESULTS A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was 'basic' (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to 'intermediate' level (262). There was no change in the neonatal unit HA-BSI rate. CONCLUSION Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.
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Simmons CG, Hennigan AW, Loyd JM, Loftus RW, Sharma A. Patient Safety in Anesthesia: Hand Hygiene and Perioperative Infection Control. CURRENT ANESTHESIOLOGY REPORTS 2022; 12:493-500. [PMID: 36345323 PMCID: PMC9631600 DOI: 10.1007/s40140-022-00545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review This review highlights the importance of the anesthesia team in minimizing perioperative infection risks and prevention of surgical site infection. Due to the immense financial and patient care burden that results from perioperative infection, a foundational knowledge in preventive measures is essential. Recent Findings Perioperative infection control, the role of the anesthesia team in reducing infection risk, and more specifically the outsized importance of hand hygiene in this space have become increasingly apparent. Maintenance of workspace cleanliness along with hand hygiene forms the cornerstone of preventing microbial transmission. Unfortunately, improvements around perioperative infection control are lacking. Summary The importance of the anesthesia team in maintaining proper hand hygiene, a clean work environment, and appropriate patient conditions to minimize risk of perioperative infection cannot be overstated. Poor clinical outcomes, economic burden, and external pressure from payers highlight the need for anesthesia providers to have an up-to-date knowledge of best practices in this area. In this article, we will review the current recommendations for hand hygiene practices and perioperative infection prevention.
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Affiliation(s)
- Colby G. Simmons
- Department of Anesthesiology, University of Colorado– Anschutz Medical Campus, Mail Stop B113, Leprino Building, 12401 E 17th Ave. Leprino Bldg #734, Aurora, CO 80045 USA
| | - Andrew W. Hennigan
- Department of Anesthesiology, University of Colorado– Anschutz Medical Campus, Mail Stop B113, Leprino Building, 12401 E 17th Ave. Leprino Bldg #734, Aurora, CO 80045 USA
| | - Jacob M. Loyd
- Department of Anesthesiology, University of Colorado– Anschutz Medical Campus, Mail Stop B113, Leprino Building, 12401 E 17th Ave. Leprino Bldg #734, Aurora, CO 80045 USA
| | - Randy W. Loftus
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, 6618 John Colloton Pavillion, Iowa City, IA 52242 USA
| | - Archit Sharma
- Department of Anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, 6618 John Colloton Pavillion, Iowa City, IA 52242 USA
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Bredin D, O'Doherty D, Hannigan A, Kingston L. Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis. J Hosp Infect 2022; 130:20-33. [PMID: 36089071 DOI: 10.1016/j.jhin.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct observation of hand hygiene compliance is the "gold standard" despite limitations and potential for bias. Previous literature highlights poorer hand hygiene compliance amongst physicians than nurses and suggests that covert monitoring may give better compliance estimates than overt monitoring. AIM This review aimed to explore differences in compliance between physicians and nurses further, and to analyse if compliance estimates differed when observations were covert rather than overt. METHODS A systematic search of databases PubMed, EMBASE, CENTRAL and CINAHL was performed. Experimental or observational studies in hospital settings in high-income countries published in English from 2010 onwards were included if estimates for both physicians and nurses using direct observation were reported. The search yielded 4814 studies, of which 105 were included. FINDINGS The weighted pooled compliance rate for nurses was 52% (95% CI 47% to 57%) and for doctors was 45% (95% CI 40% to 49%). Heterogeneity was considerable (I2=99%). The majority of studies were at moderate or high risk of bias. Random-effects meta-analysis of low risk of bias studies suggests higher compliance for nurses than physicians for both overt (difference of 7%, 95% CI for the difference 0.8% to 13.5%, p=0.027) and covert (difference of 7%, 95% CI 3% to 11%, p=0.0002) observation. Considerable heterogeneity was found in all analyses. CONCLUSION Wide variability in compliance estimates and differences in the methodological quality of hand hygiene studies were identified. Further research with meta-regression should explore sources of heterogeneity and improve the conduct and reporting of hand hygiene studies.
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Affiliation(s)
- D Bredin
- School of Medicine, University of Limerick, Ireland
| | - D O'Doherty
- School of Medicine, University of Limerick, Ireland
| | - A Hannigan
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - L Kingston
- Department of Nursing and Midwifery, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
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Saleh AM, Alrawaili SM, Abdelbasset WK. Hand hygiene practices among Jordanian nurses in Amman. Afr Health Sci 2022; 22:710-717. [PMID: 36910398 PMCID: PMC9993278 DOI: 10.4314/ahs.v22i3.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Hand hygiene is a simple and effective practice that helps to reduce the spread of hospital-acquired infections. However, health care professionals' adherence to hand hygiene guidelines is low. The purpose of this study is to evaluate hand hygiene practices among Jordanian nurses working in hospitals. Methodology The standardized version of the World Health Organization (WHO) questionnaire was given to Jordanian nurses from two hospitals in Amman. Result The response rate was 76 percent, with 173 nurses contacted to enroll 226 participants. According to the study, 65.5 percent (113) of the participants have a good practice hand hygiene, while 11 percent (19) practiced poor hand hygiene. The percentage of female participants who practiced good hand hygiene was found to be significantly higher (70 percent) than the percentage of male participants (30 percent). Conclusion To improve compliance with hand hygiene practices, male nurses and nurses working in the department of internal medicine and pediatrics need in-service educational intervention. Posters and other visual aids emphasizing the importance of hand hygiene should be displayed in all departments to raise awareness of the importance of hand hygiene among nurses.
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Affiliation(s)
- Ahmad M Saleh
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Saud M Alrawaili
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
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Kibira J, Kihungi L, Ndinda M, Wesangula E, Mwangi C, Muthoni F, Augusto O, Owiso G, Ndegwa L, Luvsansharav UO, Bancroft E, Rabinowitz P, Lynch J, Njoroge A. Improving hand hygiene practices in two regional hospitals in Kenya using a continuous quality improvement (CQI) approach. Antimicrob Resist Infect Control 2022; 11:56. [PMID: 35379327 PMCID: PMC8981833 DOI: 10.1186/s13756-022-01093-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hand hygiene (HH) is central in prevention of health care-associated infections. In low resource settings, models to improve HH compliance are needed. We implemented a continuous quality improvement (CQI) program targeting HH in two hospitals in Kenya.
Objective To determine the impact of the HH CQI program and identify factors associated with HH compliance between 2018 and 2019. Methods A CQI project targeting the improvement of hand hygiene was implemented, including training and mentorship. Data were collected monthly between April 2018 and December 2019 in Thika and Kitale Hospitals. Healthcare workers trained on Infection Prevention and Control (IPC) observed and recorded HH opportunities and subsequent compliance among staff, including nurses, clinicians, and auxiliary staff, using the World Health Organization’s “My Five Moments for Hand Hygiene” tool. Covariates were explored using mixed-effects logistic regression with random department-level intercepts. Results Hand hygiene compliance improved from 27% at baseline to 44% after 21 months. Indication/moment for HH was significantly associated with compliance. Adjusting for site, professional category and department, compliance was higher after a moment of body fluid exposure (aOR 1.43, 95% CI 1.17–1.74, p value < 0.001) and lower before an aseptic procedure (aOR 0.12, 95% CI 0.08–0.17, p value < 0.001) compared to after patient contact. Wearing of gloves often replaced proper HH in surgical departments, which although not significant, had lower compliance compared to departments for internal medicine (aOR 0.93, 95% CI 0.85–1.02). Adjusted HH compliance from all quarters improved from baseline, but comparing each quarter to the previous quarter, the improvement fluctuated over time. Conclusion Training and mentorship on the importance of HH for all moments is needed to improve overall HH compliance. CQI with regular monitoring and feedback of HH performance can be an effective approach in improving HH compliance in public hospitals in Kenya.
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Affiliation(s)
- Jemima Kibira
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Loyce Kihungi
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Mary Ndinda
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Evelyn Wesangula
- Department of Patient and Healthcare Worker Safety, Ministry of Health, Nairobi, Kenya
| | - Catherine Mwangi
- Infection Prevention and Control Department, Thika Level 5 Hospital, Kiambu, Kenya
| | - Faith Muthoni
- Infection Prevention and Control Department, Kitale County Referral Hospital, Trans-Nzoia, Kenya
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, USA
| | - George Owiso
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Linus Ndegwa
- Division of Global Health Protection (DGHP), Center for Global Health (CGH), US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Ulzii-Orshikh Luvsansharav
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Elizabeth Bancroft
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - John Lynch
- Department of Medicine, University of Washington, Seattle, USA
| | - Anne Njoroge
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya. .,Department of Global Health, University of Washington, Seattle, USA.
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Casas I, Castellà L, Gimenez M, Pulido A, Sopena N, Ciércoles A, Mena G, Reina D, López R, Garcia-Quesada MJ. Impact of a multimodal intervention on compliance with hand hygiene among health care workers of a tertiary hospital. Med Clin (Barc) 2022; 159:426-431. [PMID: 35210097 DOI: 10.1016/j.medcli.2021.12.018] [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: 09/24/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Hand hygiene (HH) is the simplest and most effective measure for the prevention of infection related to healthcare. Despite this, compliance in healthcare professionals continues to be suboptimal. The aim of this study is to assess the impact of an expanded World Health Organization (WHO) multimodal strategy on HH compliance in healthcare personnel. MATERIAL AND METHODS A quasi-experimental before-after study was designed, carrying out the expanded WHO multimodal strategy in 2018, aimed at professionals in a tertiary hospital. In this strategy, apart from applying the 5 pillars of the WHO, a video was made, the administration of the WHO perceptions questionnaire and an incentive to the service/unit with better compliance, adding to the training a modality of practical workshops. The compliance percentages for 2017 and 2018 were compared. RESULTS In 2017, 1056 opportunities were observed, registering 631 HH actions, with global compliance of 60% (95% CI 56.7-62.7). In 2018, with 1481 opportunities observed and 1111 HH actions, compliance was 75% (95% CI 72.7-77.2) (P<.001). This compliance increased in all professional categories and in all indications. CONCLUSIONS The application of an expanded multimodal strategy has a positive impact on HH compliance. Strategies should be directed to the categories with the worst compliance and continuously over time.
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Affiliation(s)
- Irma Casas
- Servicio de Medicina Preventiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España; Institut de Recerca Germans Trias i Pujol (IGTP), Badalona, Barcelona, España
| | - Laia Castellà
- Enfermería de Control de Infección, Dirección Enfermera, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Montse Gimenez
- Servicio de Microbiología, Laboratorio Clínico Metropolitana Norte, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - Ana Pulido
- Enfermería de Control de Infección, Dirección Enfermera, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - Nieves Sopena
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España; Institut de Recerca Germans Trias i Pujol (IGTP), Badalona, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - Anna Ciércoles
- Enfermería de Control de Infección, Dirección Enfermera, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - Guillermo Mena
- Servicio de Medicina Preventiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España; Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, España; Institut de Recerca Germans Trias i Pujol (IGTP), Badalona, Barcelona, España
| | - Dina Reina
- Enfermería de Control de Infección, Dirección Enfermera, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - Raúl López
- Enfermería de Control de Infección, Dirección Enfermera, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - Maria-José Garcia-Quesada
- Enfermería de Control de Infección, Dirección Enfermera, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
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Nuckchady DC. Impact of a Multimodal Improvement Strategy to Promote Hand Hygiene at a Hospital in Mauritius. Cureus 2021; 13:e15812. [PMID: 34306879 PMCID: PMC8294769 DOI: 10.7759/cureus.15812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Limited data is available on which interventions are likely to improve compliance to hand hygiene, especially in underdeveloped countries. The objective of this study is to explore whether the introduction of a particular bundle of strategies to improve hand hygiene is effective. Material and methods In this pre-post study, a multimodal strategy comprised of educating healthcare staff, using reminders, providing feedback and increasing the availability of soap and alcohol, was implemented over a period of one year from 2019 to 2020. Trained observers assessed compliance to hand hygiene before and after the intervention. Results A total of 143 hand hygiene opportunities were observed. Hand hygiene compliance rate did not improve despite the introduction of multiple measures. Conclusions Other approaches should be considered to promote hand hygiene. The choice of which strategies to use should be adapted to the local setting. For instance, in some healthcare facilities, emphasis should be placed on leadership support and on the training of hand hygiene champions.
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de Arriba-Fernández A, Molina-Cabrillana MJ, Serra Majem L. [Evolution of adherence to hand hygiene in health care professionals in a third level hospital in relation to the SARS-CoV-2 pandemic]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2021; 34:214-219. [PMID: 33829723 PMCID: PMC8179943 DOI: 10.37201/req/150.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/20/2021] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Proper hand hygiene is the main measure in the prevention and control of infection associated with healthcare. It describes how the pandemic period of 2020 has influenced the evolution of the degree of compliance with hand hygiene practices in health professionals at the Hospital Universitario Insular de Gran Canaria with respect to previous years. METHODS Descriptive cross-sectional study of direct observation on compliance with the five moments of hand hygiene in the 2018-2020 period. Adherence is described with the frequency distribution of the different moments in which it was indicated. RESULTS Total adherence has increased from 42.5% in 2018, to 47.6% in 2019, and 59.2% in 2020 (p <0.05). Total adherence was greater in the moments after contact with the patient (67%) than in the moments before contact (48%). The area with the highest adherence was dialysis (83%). There is a greater adherence in open areas than in hospitalization areas (65% vs 56%). Higher adherence was determined in physicians (73%) and nurses (74%), than in nursing assistants (50%) (p<0.05). CONCLUSIONS In 2020 there was an increase in adherence to hand hygiene compared to previous years. A higher percentage of adherence was determined in physicians and nurses than in nursing assistants. We consider that the current SARS-CoV-2 pandemic has played a relevant role in this increase in adherence.
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Affiliation(s)
- A de Arriba-Fernández
- Alejandro de Arriba-Fernández, Universidad de Las Palmas de Gran Canaria. Paseo Blas Cabrera Felipe "Físico", 310, Las Palmas Gran Canaria. Spain.
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Sustaining compliance with hand hygiene when resources are low: A quality improvement report. PLoS One 2020; 15:e0241706. [PMID: 33141855 PMCID: PMC7608919 DOI: 10.1371/journal.pone.0241706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background Sustainability of hand hygiene is challenging in low resource settings. Adding ownership and goal setting to the WHO-5 multimodal intervention may help sustain high compliance. Aim To increase and sustain compliance of nursing and medical staff with hand hygiene in a tertiary referral center with limited resources. Methods A quality improvement initiative was conducted over two years (2016–2018). After determining baseline compliance rates, the WHO-5 multimodal intervention was implemented with staff education and training, system change, hospital reminders, direct observation and feedback, and hospital safety climate. Additionally, the medical staff was responsible for continuous surveillance of compliance (ownership) until rates above 90% were achieved and sustained (goal setting). Results Of 2987 observations collected between August 2016 and April 2018, 1630 (54.5%) were before, and 1357 (45.5%) were after patient encounters. The average overall compliance with hand hygiene was sustained at 94% for nursing and medical staff. Two instances of drops below 90% were associated with incidence of nosocomial Rotavirus infections. There were no similar infections during intervention periods with compliance rates above the set goal. Analysis using p-charts revealed significant improvement in compliance rates from baseline (χ2 (1) = 7.94, p = 0.005). Conclusion Adding ownership and goal setting to the WHO-5 multimodal intervention may help achieve, and sustain high rates of compliance with hand hygiene. Involving health care workers in quality improvement initiatives is feasible, durable, reliable, and cheap, especially in settings with limited financial resources.
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Barker AK, Scaria E, Safdar N, Alagoz O. Evaluation of the Cost-effectiveness of Infection Control Strategies to Reduce Hospital-Onset Clostridioides difficile Infection. JAMA Netw Open 2020; 3:e2012522. [PMID: 32789514 PMCID: PMC7426752 DOI: 10.1001/jamanetworkopen.2020.12522] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/25/2020] [Indexed: 12/14/2022] Open
Abstract
Importance Clostridioides difficile infection is the most common hospital-acquired infection in the United States, yet few studies have evaluated the cost-effectiveness of infection control initiatives targeting C difficile. Objective To compare the cost-effectiveness of 9 C difficile single intervention strategies and 8 multi-intervention bundles. Design, Setting, and Participants This economic evaluation was conducted in a simulated 200-bed tertiary, acute care, adult hospital. The study relied on clinical outcomes from a published agent-based simulation model of C difficile transmission. The model included 4 agent types (ie, patients, nurses, physicians, and visitors). Cost and utility estimates were derived from the literature. Interventions Daily sporicidal cleaning, terminal sporicidal cleaning, health care worker hand hygiene, patient hand hygiene, visitor hand hygiene, health care worker contact precautions, visitor contact precautions, C difficile screening at admission, and reduced intrahospital patient transfers. Main Outcomes and Measures Cost-effectiveness was evaluated from the hospital perspective and defined by 2 measures: cost per hospital-onset C difficile infection averted and cost per quality-adjusted life-year (QALY). Results In this agent-based model of a simulated 200-bed tertiary, acute care, adult hospital, 5 of 9 single intervention strategies were dominant, reducing cost, increasing QALYs, and averting hospital-onset C difficile infection compared with baseline standard hospital practices. They were daily cleaning (most cost-effective, saving $358 268 and 36.8 QALYs annually), health care worker hand hygiene, patient hand hygiene, terminal cleaning, and reducing intrahospital patient transfers. Screening at admission cost $1283/QALY, while health care worker contact precautions and visitor hand hygiene interventions cost $123 264/QALY and $5 730 987/QALY, respectively. Visitor contact precautions was dominated, with increased cost and decreased QALYs. Adding screening, health care worker hand hygiene, and patient hand hygiene sequentially to the daily cleaning intervention formed 2-pronged, 3-pronged, and 4-pronged multi-intervention bundles that cost an additional $29 616/QALY, $50 196/QALY, and $146 792/QALY, respectively. Conclusions and Relevance The findings of this study suggest that institutions should seek to streamline their infection control initiatives and prioritize a smaller number of highly cost-effective interventions. Daily sporicidal cleaning was among several cost-saving strategies that could be prioritized over minimally effective, costly strategies, such as visitor contact precautions.
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Affiliation(s)
- Anna K. Barker
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Elizabeth Scaria
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin–Madison
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Oguzhan Alagoz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin–Madison
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Ben Fredj S, Ben Cheikh A, Bhiri S, Ghali H, Khefacha S, Dhidah L, Merzougui L, Ben Rejeb M, Said Latiri H. Multimodal intervention program to improve hand hygiene compliance: effectiveness and challenges. J Egypt Public Health Assoc 2020; 95:11. [PMID: 32813132 PMCID: PMC7364722 DOI: 10.1186/s42506-020-00039-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hand hygiene (HH) is considered the most important measure to tackle the transmission of healthcare-associated pathogens. However, compliance with recommendations is usually low and effective improvement strategies are needed. We aimed to assess the effectiveness of an intervention targeting hand hygiene promotion among healthcare workers (HCWs). METHODS We conducted a pre-post interventional study design in the university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The intervention program consisted of training sessions and distribution of posters of hand hygiene guidelines. To assess the evolution of HH observance at pre- and post-intervention, the same observation form was distributed and collected at healthcare workers' workplace. RESULTS Of the 1201 and 1057 opportunities for hand hygiene observed among all categories of HCWs, overall compliance enhanced significantly from 32.1 to 39.4% (p < 0.001) respectively at pre- and post-intervention. Nurses were the most compliant with a significant improvement from 34.1 to 45.7% (p < 0.001) respectively at pre- and post-intervention. Furthermore, analysis by department showed significant improvement of compliance in orthopedic department (p < 0.001), maxillofacial-surgery department (p < 0.001), pediatrics department (p = 0.013), and emergencies (p = 0.038). CONCLUSION This study showed the feasibility and effectiveness of a health-setting-based intervention to enhance hand hygiene observance in the context of a developing country.
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Affiliation(s)
- Sihem Ben Fredj
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
| | - Asma Ben Cheikh
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Sana Bhiri
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Hela Ghali
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
| | - Salwa Khefacha
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
| | - Lamine Dhidah
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Latifa Merzougui
- Department of Epidemiology, University Hospital Ibn El Jazzar, 3100 Kairouan, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Houyem Said Latiri
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
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Hand hygiene compliance surveillance with time series anomaly detection. Am J Infect Control 2019; 47:1449-1452. [PMID: 31326263 DOI: 10.1016/j.ajic.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hand hygiene is the most important intervention to reduce the risk of transmission of pathogens in health care. Assurance of effective hand hygiene improvement campaigns includes adequate data analytics for reporting compliance. Traditional analytical approaches for monitoring hand hygiene compliance suffer from several limitations, including autocorrelation. The objective of this study was to use a novel time series anomaly detection algorithm to analyze routine hand hygiene compliance data. METHODS Hand hygiene compliance data were collected daily by trained observers in a large academic medical center. Statistical process control p-charts were used as a comparison method of analysis per facility protocol. Time series anomaly detection was carried out using the seasonal and trend decomposition using LOESS (STL) algorithm. RESULTS A total of 34 months of hand hygiene compliance data were analyzed. Traditional statistical process control p-charts identified over 76% of rates as special-cause variation, whereas STL identified 18% of rates as anomalous. CONCLUSIONS This study supports the use of time series anomaly detection for the routine surveillance of hand hygiene compliance data. This method will facilitate specific and accurate feedback, helping to improve this critical approach for improving patient safety.
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Valim MD, Rocha ILDS, Souza TPM, Cruz YAD, Bezerra TB, Baggio É, Morais RBD, Ribeiro AC. Efficacy of the multimodal strategy for Hand Hygiene compliance: an integrative review. Rev Bras Enferm 2019; 72:552-565. [PMID: 31017221 DOI: 10.1590/0034-7167-2018-0584] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/01/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Evaluate, from the literature, the effectiveness of the implementation of the multimodal strategy for health professionals compliance with Hand Hygiene and its sustainability over time. METHOD Integrative review, with a view to answering the following question: "Is the implementation of the multimodal strategy effective in health professionals compliance with Hand Hygiene and can it be sustained over time?". The MEDLINE, SCOPUS, LILACS and CINAHL databases were used to retrieve the primary articles. RESULTS Twenty-five studies were analyzed. Among the components of the multimodal strategy, three need to be better worked: health education, feedback from practices and management involvement. Although it needs to focus more on its five elements, interventions based on the multimodal strategy have favored HH compliance and its long-term sustainability. CONCLUSION The strategy proved to be effective for HH compliance, especially when all integrating components are adequately addressed.
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Affiliation(s)
| | | | | | | | | | - Érica Baggio
- Universidade Federal de Mato Grosso,Faculdade de Enfermagem. Cuiabá-MT, Brasil
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Kallam B, Pettitt-Schieber C, Owen M, Agyare Asante R, Darko E, Ramaswamy R. Implementation science in low-resource settings: using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana. Int J Qual Health Care 2019; 30:724-730. [PMID: 29788245 PMCID: PMC6307329 DOI: 10.1093/intqhc/mzy111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 05/11/2018] [Indexed: 12/30/2022] Open
Abstract
Quality issue Low-resource clinical settings often face obstacles that challenge the implementation of recommended evidence-based practices (EBPs). Implementation science approaches are useful in identifying barriers and developing strategies to address them. Initial assessment Ridge Regional Hospital (RRH), a tertiary referral hospital in Accra, Ghana experienced a spike in rates of neonatal sepsis and launched a quality improvement (QI) initiative that identified poor adherence to hand hygiene in the neonatal intensive care unit as a potential source of infections. Choice of solution A multi-modal change package of World Health Organization-recommended solutions was created to address this issue. Implementation To ensure that the outputs of the QI effort were adopted within the organization, leaders at RRH and Kybele, Inc. used an implementation science framework called the ‘Interactive Systems Framework for Dissemination and Implementation’ (ISF) to create a package of locally acceptable implementation strategies. The ISF has never been used before to guide implementation in low-resource settings. Evaluation Hand hygiene compliance rose from 67% to 92% overall, including a 36% increase during the night shifts—a group of healthcare workers with typically very low levels of compliance. Lessons learned The drastic improvement in adherence to hand hygiene suggests the potential value of the joint use of QI and implementation science to promote the creation and application of contextually appropriate EBPs in low-resource settings. Our results also suggest that using an implementation framework such as the ISF could rapidly increase the uptake of other evidence-based interventions in low-resource settings.
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Affiliation(s)
| | - Christie Pettitt-Schieber
- Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Medge Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | | | - Elizabeth Darko
- Department of Child Health, Ridge Regional Hospital, Accra, Ghana
| | - Rohit Ramaswamy
- Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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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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Barker AK, Alagoz O, Safdar N. Interventions to Reduce the Incidence of Hospital-Onset Clostridium difficile Infection: An Agent-Based Modeling Approach to Evaluate Clinical Effectiveness in Adult Acute Care Hospitals. Clin Infect Dis 2018; 66:1192-1203. [PMID: 29112710 PMCID: PMC5888988 DOI: 10.1093/cid/cix962] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022] Open
Abstract
Background Despite intensified efforts to reduce hospital-onset Clostridium difficile infection (HO-CDI), its clinical and economic impacts continue to worsen. Many institutions have adopted bundled interventions that vary considerably in composition, strength of evidence, and effectiveness. Considerable gaps remain in our knowledge of intervention effectiveness and disease transmission, which hinders HO-CDI prevention. Methods We developed an agent-based model of C. difficile transmission in a 200-bed adult hospital using studies from the literature, supplemented with primary data collection. The model includes an environmental component and 4 distinct agent types: patients, visitors, nurses, and physicians. We used the model to evaluate the comparative clinical effectiveness of 9 single interventions and 8 multiple-intervention bundles at reducing HO-CDI and asymptomatic C. difficile colonization. Results Daily cleaning with sporicidal disinfectant and C. difficile screening at admission were the most effective single-intervention strategies, reducing HO-CDI by 68.9% and 35.7%, respectively (both P < .001). Combining these interventions into a 2-intervention bundle reduced HO-CDI by 82.3% and asymptomatic hospital-onset colonization by 90.6% (both, P < .001). Adding patient hand hygiene to healthcare worker hand hygiene reduced HO-CDI rates an additional 7.9%. Visitor hand hygiene and contact precaution interventions did not reduce HO-CDI, compared with baseline. Excluding those strategies, healthcare worker contact precautions were the least effective intervention at reducing hospital-onset colonization and infection. Conclusions Identifying and managing the vast hospital reservoir of asymptomatic C. difficile by screening and daily cleaning with sporicidal disinfectant are high-yield strategies. These findings provide much-needed data regarding which interventions to prioritize for optimal C. difficile control.
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Affiliation(s)
- Anna K Barker
- Department of Population Health Sciences, School of Medicine and Public Health, Madison, Wisconsin
| | - Oguzhan Alagoz
- Department of Population Health Sciences, School of Medicine and Public Health, Madison, Wisconsin
- Department of Industrial and Systems Engineering, College of Engineering, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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Al Kuwaiti A. Impact of a multicomponent hand hygiene intervention strategy in reducing infection rates at a university hospital in Saudi Arabia. Interv Med Appl Sci 2017; 9:137-143. [PMID: 29201437 PMCID: PMC5700699 DOI: 10.1556/1646.9.2017.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Few studies have reported the correlation between hand hygiene (HH) practices and infection rates in Saudi Arabia. This work was aimed to study the effect of a multicomponent HH intervention strategy in improving HH compliance and reducing infection rates at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia between January 2014 and December 2016. METHODS A yearlong multicomponent HH intervention, which included various strategies recommended by the World Health Organization, was introduced. HH compliance among staff and infection rates observed in the inpatient wards were assessed and compared at pre- and post-interventional phases. RESULTS There was a significant increase in mean HH compliance from 50.17% to 71.75% after the intervention (P < 0.05). Hospital-acquired infection (HAI) and catheter-associated urinary tract infection (CAUTI) rates decreased from 3.37 to 2.59 and from 3.73 to 1.75, respectively (P < 0.05). HH compliance was found to be negatively correlated with HAI (r = -0.278) and CAUTI (r = -0.523) rates. CONCLUSIONS Results show that multicomponent intervention is effective in improving HH compliance, and that an increase in HH compliance among hospital staff decreases infection rates. Further studies on cost-effectiveness of such a model could augment to these findings.
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Affiliation(s)
- Ahmed Al Kuwaiti
- Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University (Formerly University of Dammam), Al-Khobar, Kingdom of Saudi Arabia
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Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance. Am J Infect Control 2017; 45:528-535. [PMID: 28456322 DOI: 10.1016/j.ajic.2016.11.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 01/16/2023]
Abstract
Monitoring hand hygiene compliance among health care personnel (HCP) is an essential element of hand hygiene promotion programs. Observation by trained auditors is considered the gold standard method for establishing hand hygiene compliance rates. Advantages of observational surveys include the unique ability to establish compliance with all of the World Health Organization "My 5 Moments for Hand Hygiene" initiative Moments and to provide just-in-time coaching. Disadvantages include the resources required for observational surveys, insufficient sample sizes, and nonstandardized methods of conducting observations. Electronic and camera-based systems can monitor hand hygiene performance on all work shifts without a Hawthorne effect and provide significantly more data regarding hand hygiene performance. Disadvantages include the cost of installation, variable accuracy in estimating compliance rates, issues related to acceptance by HCP, insufficient data regarding their cost-effectiveness and influence on health care-related infection rates, and the ability of most systems to monitor only surrogates for Moments 1, 4, and 5. Increasing evidence suggests that monitoring only Moments 1, 4, and 5 provides reasonable estimates of compliance with all 5 Moments. With continued improvement of electronic monitoring systems, combining electronic monitoring with observational methods may provide the best information as part of a multimodal strategy to improve and sustain hand hygiene compliance rates among HCP.
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Risk behaviours for organism transmission in health care delivery-A two month unstructured observational study. Int J Nurs Stud 2017; 70:38-45. [PMID: 28231441 DOI: 10.1016/j.ijnurstu.2017.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/30/2016] [Accepted: 02/12/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Errors in infection control practices risk patient safety. The probability for errors can increase when care practices become more multifaceted. It is therefore fundamental to track risk behaviours and potential errors in various care situations. OBJECTIVE The aim of this study was to describe care situations involving risk behaviours for organism transmission that could lead to subsequent healthcare-associated infections. DESIGN & SETTING Unstructured nonparticipant observations were performed at three medical wards. PARTICIPANTS & METHODS Healthcare personnel (n=27) were shadowed, in total 39h, on randomly selected weekdays between 7:30 am and 12 noon. Content analysis was used to inductively categorize activities into tasks and based on the character into groups. Risk behaviours for organism transmission were deductively classified into types of errors. Multiple response crosstabs procedure was used to visualize the number and proportion of errors in tasks. One-Way ANOVA with Bonferroni post Hoc test was used to determine differences among the three groups of activities. RESULTS The qualitative findings gives an understanding of that risk behaviours for organism transmission goes beyond the five moments of hand hygiene and also includes the handling and placement of materials and equipment. The tasks with the highest percentage of errors were; 'personal hygiene', 'elimination' and 'dressing/wound care'. The most common types of errors in all identified tasks were; 'hand disinfection', 'glove usage', and 'placement of materials'. Significantly more errors (p<0.0001) were observed the more multifaceted (single, combined or interrupted) the activity was. CONCLUSION The numbers and types of errors as well as the character of activities performed in care situations described in this study confirm the need to improve current infection control practices. It is fundamental that healthcare personnel practice good hand hygiene however effective preventive hygiene is complex in healthcare activities due to the multifaceted care situations, especially when activities are interrupted. A deeper understanding of infection control practices that goes beyond the sense of security by means of hand disinfection and use of gloves is needed as materials and surfaces in the care environment might be contaminated and thus pose a risk for organism transmission.
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Sopjani I, Jahn P, Behrens J. Training as an Effective Tool to Increase the Knowledge About Hand Hygiene Actions. An Evaluation Study of Training Effectiveness in Kosovo. Med Arch 2017; 71:16-19. [PMID: 28428667 PMCID: PMC5364797 DOI: 10.5455/medarh.2017.71.16-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Hand hygiene (HH) compliance with World Health Organization (WHO) guidelines is essential to prevent bacterial transmission and infections acquired from hospital settings. Aim: The aim of this study was to evaluate the impact of training tool of World Health Organization’s (WHOs) Hand Hygiene multi modal campaign at all public hospitals and at the University Clinical Center in Kosovo (UCCK). Method: During February 2016, 691 questionnaires were distributed to health care workers. The data collection was conducted through a questionnaire distributed before and after training. Measurement of questions was realized through a 5 point Likert scale. Results: The gender structure of participants turned out to be greater for women (n=571, 85%). The knowledge of health care workers differed significantly before and after the training (p<0.001), emphasizing that the impact of the training was important to improve the knowledge of participants. Thus, the average value of improvement of HCW’ knowledge was about 41.66 %. Conclusion: The findings emphasized the role of the training to improve the knowledge of participants about hand hygiene as well as prevention from infection.
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Use of ventilator utilization ratio for stratifying alcohol-based hand-rub consumption data to improve surveillance on intensive care units. J Hosp Infect 2016; 95:185-188. [PMID: 27887755 DOI: 10.1016/j.jhin.2016.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/26/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Germany has established a nationwide surveillance system of alcohol-based hand-rub consumption (AHC) per patient-day in hospital settings as a surrogate parameter for hand hygiene (HH) compliance. Analysis of AHC data in intensive care units (ICUs) shows not only a wide range of consumption between units of different specialties, but also within units of one specialty. This seems to reflect variation in the number of HH opportunities per patient-day between ICUs due to variation in complexity of care. AIM To investigate whether ventilator utilization ratio (VUR) might be a good surrogate for describing complexity and intensity of care on ICUs and whether stratification by VUR works as a new method of setting benchmarks for AHC data. METHODS Data from 365 ICUs participating in the German national nosocomial infection surveillance system (KISS) were used. VUR was calculated by dividing the number of ventilator-days per unit by the number of patient-days per unit. AHC was stratified according to VUR in quartiles. FINDINGS The median AHC was 107mL/patient-day [interquartile range (IQR): 86-134] and the median VUR was 33% (IQR: 22-45%). The Spearman rank correlation coefficient was 0.28 (P<0.0001). After stratifying AHC according to VUR, the AHC in quartile I was significantly lower compared to quartile IV. There was also significant difference between quartile I and quartiles II and III. CONCLUSION Stratification of AHC data according to VUR is suggested to improve the quality of benchmark parameters based on AHC data as surrogate parameter for HH compliance in ICUs.
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[A multimodal strategy to improve adherence to hand hygiene in a university hospital]. ACTA ACUST UNITED AC 2016; 32:50-56. [PMID: 27614929 DOI: 10.1016/j.cali.2016.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Within the framework of the PaSQ (Patient Safety and Quality care) Project, this hospital decided to implement a multifaceted hospital-wide Hand Hygiene (HH) intervention based on a multimodal WHO approach over one year, focusing on achieving a sustained change in HH cultural change in this hospital. MATERIAL AND METHODS Setting: University Hospital Marqués de Valdecilla, Santander (Spain), a tertiary hospital with 900 beds. Intervention period: 2014. An action plan was developed that included the implementation of activities in each component of the 5-step multimodal intervention. An observation/feedback methodology was used that included the provision of performance and results feedback to the staff. A 3/3 strategy (non-blinded direct observation audits performed during 3 randomised days every 3 weeks with pro-active corrective actions at the end of each observation period). HH compliance, alcohol-based hand-rub (ABHR) consumption, and rate of MRSA infection, were monitored during the intervention. RESULTS Hospital ABHR consumption increased during the study period: from 17.5 to 19.7mL/patient-days. In the intervention units, this consumption was 24.8mL pre-intervention, 42.5mL during the intervention, and 30.4mL two months post-intervention. There were 137 evaluation periods in 30 different days, in which a total of 737 health-care workers were observed and 1,870 HH opportunities. HH compliance was 54.5%, ranging between 44.8% and 69.9%. The incidence of MRSA infection decreased during the intervention in the selected units, from 13.2 infections per 10,000 patient-days pre-intervention to 5.7 three months post-intervention. CONCLUSIONS Our HH strategy, supported by a 3/3 strategy increased alcohol-based hand-rub consumption and compliance. A reduction in MRSA infections was observed.
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Fayed A, Elkouny A, Zoughaibi N, Wahabi HA. Elective surgery cancelation on day of surgery: An endless dilemma. Saudi J Anaesth 2016; 10:68-73. [PMID: 26955314 PMCID: PMC4760047 DOI: 10.4103/1658-354x.169479] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Cancelation of surgery is a constant agonizing dilemma for nearly all healthcare services that has been intensively investigated to find out its roots, consequences, and possible solutions. The rates of cancelation of surgery vary between centers and more so among surgical specialties with numerous reasons standing behind this phenomenon. Patients and Methods: In the current study, analysis of monthly cancelation rates from January 2009 to December 2012, and assessment of establishing new operating rooms (ORs) using statistical process control charts was conducted. A detailed review of a total of 1813 cases canceled on the day of surgery from January to December 2012, to examine the various reasons of cancelation among surgical specialties. Results: The average cancelation rate was 11.1%, which dropped to 9.0% after launching of new theaters. Four reasons explained about 80% of cancelations; Patients “no show” was the leading cause of cancelation (27%). One-fourth of cancelations (24.3%) were due to the need for further optimization, and the third most prominent cause of cancelation was a lack of OR time (19.5%). Unavailability of staff/equipment/implants accounted for only 0.7% of cancelations. The no show was the most common cause of cancelation among all surgical specialties ranging from 21% for plastic surgery to 32% in ophthalmic surgeries. Conclusion: It was confirmed that there is a unique profile of cancelation of surgery problem for every institute, an extension of infrastructure may not be the only solution. Control charts helped to enhance the general picture and are functional in monitoring and evaluating changes in the cancelation of surgery.
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Affiliation(s)
- A Fayed
- Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt; College of Medicine, Princess Norah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - A Elkouny
- Department of Anaesthesia, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - N Zoughaibi
- Department of Anaesthesia, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; Sheikh Bahamdan Research Chair of Evidence-based Healthcare and Knowledge Translation, College of Medicine, Riyadh, Kingdom of Saudi Arabia
| | - H A Wahabi
- Chair of Evidence Based Healthcare and Knowledge Translation, King Saud University, Riyadh, Kingdom of Saudi Arabia
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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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Cruz JP, Bashtawi MA. Predictors of hand hygiene practice among Saudi nursing students: A cross-sectional self-reported study. J Infect Public Health 2015; 9:485-93. [PMID: 26707706 PMCID: PMC7102782 DOI: 10.1016/j.jiph.2015.11.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/04/2015] [Accepted: 11/10/2015] [Indexed: 11/29/2022] Open
Abstract
Hand hygiene is an important component of infection control, which is critical to ensuring patients’ safety in hospitals. Nursing students are regarded as healthcare workers in training and can also be vehicles of cross-contamination within the hospital. Thus, this study aimed to identify the predictors of hand hygiene practice among Saudi nursing students. A descriptive, cross-sectional, self-reported study was conducted among 198 Saudi nursing students. Knowledge, attitude, and practice of hand hygiene were assessed using the WHO Hand Hygiene Knowledge Questionnaire for Health-Care Workers and its adopted scales. A regression analysis was performed to identify the predictors of hand hygiene practice. The respondents demonstrated moderate knowledge of hand hygiene (mean 13.20 ± 2.80). The majority displayed a moderate attitude toward hand hygiene (52.1%), while only a few reported a poor attitude (13.1%). Approximately 68.7%, 29.8%, and 1.5% of the respondents reported moderate, good, and poor practice of hand hygiene, respectively. Having a good attitude toward hand hygiene, being male, being aware that hand hygiene is an effective intervention in preventing healthcare-associated infections (HAIs), attendance at hand hygiene trainings and seminars, and being in the lower academic level of nursing education were identified as predictors of better hand hygiene practice. The importance of ensuring a positive attitude toward hand hygiene and improving awareness of hand hygiene is emphasized, as are educational interventions. Educational interventions should be implemented to reinforce knowledge and instill a positive attitude toward hand hygiene.
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Affiliation(s)
- Jonas P Cruz
- Nursing Department, College of Applied Medical Sciences, Shaqra University, PO Box 1678, Dawadmi 11911, Saudi Arabia.
| | - Meshrif A Bashtawi
- Nursing Department, College of Applied Medical Sciences, Shaqra University, PO Box 1678, Dawadmi 11911, Saudi Arabia
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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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Midturi JK, Narasimhan A, Barnett T, Sodek J, Schreier W, Barnett J, Wheeler C, Barton L, Stock EM, Arroliga AC. A successful multifaceted strategy to improve hand hygiene compliance rates. Am J Infect Control 2015; 43:533-6. [PMID: 25769618 DOI: 10.1016/j.ajic.2015.01.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 10/23/2022]
Abstract
Health care-acquired infections are a major contributor of mortality; therefore, prevention of these infections is a priority. Hand hygiene compliance among health care workers is low. We report the process at our institution to increase the hand hygiene compliance rate (HHCR).We implemented interventions over 6 months. The periods were divided into preintervention, intervention, and postintervention, and the monthly HHCR was calculated. The primary objective was to measure the HHCR after the intervention period and ensure sustainability. There were 25,372 observations, with 22,501 compliant events, for an overall HHCR of 88.7%. The HHCR improved over time (preintervention, 72.7%; invention, 79.7%; postintervention, 93.2%), with significance between pre-and postintervention periods (P < .002). The HHCR stabilized after all interventions and was sustained over 22 months. Our study highlights a multifaceted intervention, including administrative leadership, that led to an increase in the HHCR. Institutions should individualize their multimodal approach to include administrative leadership to achieve a high, sustained HHCR.
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McLaws ML. The relationship between hand hygiene and health care-associated infection: it's complicated. Infect Drug Resist 2015; 8:7-18. [PMID: 25678805 PMCID: PMC4319644 DOI: 10.2147/idr.s62704] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The reasoning that improved hand hygiene compliance contributes to the prevention of health care-associated infections is widely accepted. It is also accepted that high hand hygiene alone cannot impact formidable risk factors, such as older age, immunosuppression, admission to the intensive care unit, longer length of stay, and indwelling devices. When hand hygiene interventions are concurrently undertaken with other routine or special preventive strategies, there is a potential for these concurrent strategies to confound the effect of the hand hygiene program. The result may be an overestimation of the hand hygiene intervention unless the design of the intervention or analysis controls the effect of the potential confounders. Other epidemiologic principles that may also impact the result of a hand hygiene program include failure to consider measurement error of the content of the hand hygiene program and the measurement error of compliance. Some epidemiological errors in hand hygiene programs aimed at reducing health care-associated infections are inherent and not easily controlled. Nevertheless, the inadvertent omission by authors to report these common epidemiological errors, including concurrent infection prevention strategies, suggests to readers that the effect of hand hygiene is greater than the sum of all infection prevention strategies. Worse still, this omission does not assist evidence-based practice.
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Affiliation(s)
- Mary-Louise McLaws
- Healthcare Infection and Infectious Diseases Control, School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia
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Hand Hygiene Practices in Medical Students: A Follow-Up Study. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:591879. [PMID: 27379324 PMCID: PMC4897241 DOI: 10.1155/2014/591879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/20/2014] [Indexed: 11/17/2022]
Abstract
Objective. The study was conducted to study the impact of various measures instituted to improve hand hygiene practices of the medical students after having documented poor hand hygiene awareness and compliance in a study conducted in 2012. Methods. A self-designed questionnaire based on World Health Organization's concept of "Five Moments for Hand Hygiene" was used to evaluate the awareness of the indications of hand hygiene. Compliance was observed during Objective Structured Clinical Examination (OSCE) sessions. Fifty-one students participated voluntarily in the study. Results. The awareness and compliance of hand hygiene among the medical students in 2014 had shown statistically significant improvement (P < 0.005) as compared to figures of the study conducted in 2012. Conclusion. Dedicated multifaceted intervention can improve the hand hygiene practices in medical students.
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Heinrich ERE, KuKanich KS, Davis E, White BJ. Public health campaign to promote hand hygiene before meals in a college of veterinary medicine. JOURNAL OF VETERINARY MEDICAL EDUCATION 2014; 41:301-310. [PMID: 24981423 DOI: 10.3138/jvme.0913-124r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Veterinary students can be exposed to environmental infectious agents in school that may include zoonotic pathogens. Encouraging effective hand hygiene can minimize the spread of zoonoses and promote public health and the One Health concept among veterinary students. The purpose of this study was to determine if a campaign could improve hand hygiene among veterinary students at extracurricular meetings serving meals. Nine Kansas State University College of Veterinary Medicine (KSU-CVM) extracurricular organizations participated in the study, sanitizer was provided at each meeting, and baseline hand-hygiene data were observed. A hand-hygiene opportunity was defined as any student observed to approach the buffet food line. Sanitizer use (yes/no) and gender (male/female) were recorded. Campaign interventions included a 3.5-minute educational video and a novel motivational poster. The video was presented to all first-year, second-year, and third-year veterinary students. Posters encouraging hand sanitization were displayed on doors and tables alongside sanitizers at each meeting. Observational hand-hygiene data were collected immediately after introduction of interventions and again 3 months later. Environmental sampling for presence of bacteria in and around meeting locations was also performed. Observed hand hygiene was lowest during baseline (11.0% ± 1.7), improved significantly post-intervention (48.8% ± 3.2), and remained improved at 3-month follow-up (33.5% ± 4.0). Females had higher probability of hand sanitizing (35.9% ± 2.2) than males (21.4% ± 2.4) (p<.01). Clostridium perfringens was isolated from 2/42 samples, and Salmonella spp. were isolated from 4/42 samples. A short-term public health campaign targeting veterinary students successfully improved hand hygiene before meals.
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Padilla Ortega B. [Methicillin-resistant Staphylococus aureus and health-care workers]. Enferm Infecc Microbiol Clin 2013; 31:497-9. [PMID: 23732045 DOI: 10.1016/j.eimc.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 04/11/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Belén Padilla Ortega
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, España.
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