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Ruiz-Castro C, Querencias-García P, Ruiz-Huerta-García de Viedma C. Hand Hygiene strategy in a hospital in Madrid. A decade of evolution. Enferm Clin (Engl Ed) 2024; 34:142-143. [PMID: 38484936 DOI: 10.1016/j.enfcle.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Affiliation(s)
- Carmen Ruiz-Castro
- Departamento de Medicina Preventiva, Hospital Universitario Cruz Roja San José y Santa Adela, Madrid, Spain.
| | - Pilar Querencias-García
- Unidad de Geriatría, Hospitalización Agudos, Hospital Universitario Cruz Roja San José y Santa Adela, Madrid, Spain
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MacLeod C, Braun L, Caruso BA, Chase C, Chidziwisano K, Chipungu J, Dreibelbis R, Ejemot-Nwadiaro R, Gordon B, Esteves Mills J, Cumming O. Recommendations for hand hygiene in community settings: a scoping review of current international guidelines. BMJ Open 2023; 13:e068887. [PMID: 37344109 PMCID: PMC10314431 DOI: 10.1136/bmjopen-2022-068887] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/17/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Hand hygiene is an important measure to prevent disease transmission. OBJECTIVE To summarise current international guideline recommendations for hand hygiene in community settings and to assess to what extent they are consistent and evidence based. ELIGIBILITY CRITERIA We included international guidelines with one or more recommendations on hand hygiene in community settings-categorised as domestic, public or institutional-published by international organisations, in English or French, between 1 January 1990 and 15 November 2021. DATA SOURCES To identify relevant guidelines, we searched the WHO Institutional Repository for Information Sharing Database, Google, websites of international organisations, and contacted expert organisations and individuals. CHARTING METHODS Recommendations were mapped to four areas related to hand hygiene: (1) effective hand hygiene; (2) minimum requirements; (3) behaviour change and (4) government measures. Recommendations were assessed for consistency, concordance and whether supported by evidence. RESULTS We identified 51 guidelines containing 923 recommendations published between 1999 and 2021 by multilateral agencies and international non-governmental organisations. Handwashing with soap is consistently recommended as the preferred method for hand hygiene across all community settings. Most guidelines specifically recommend handwashing with plain soap and running water for at least 20 s; single-use paper towels for hand drying; and alcohol-based hand rub (ABHR) as a complement or alternative to handwashing. There are inconsistent and discordant recommendations for water quality for handwashing, affordable and effective alternatives to soap and ABHR, and the design of handwashing stations. There are gaps in recommendations on soap and water quantity, behaviour change approaches and government measures required for effective hand hygiene. Less than 10% of recommendations are supported by any cited evidence. CONCLUSION While current international guidelines consistently recommend handwashing with soap across community settings, there remain gaps in recommendations where clear evidence-based guidance might support more effective policy and investment.
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Affiliation(s)
- Clara MacLeod
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Laura Braun
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Claire Chase
- Water and Sanitation Program, World Bank Group, Washington, District of Columbia, USA
| | - Kondwani Chidziwisano
- Department of Environmental Health and WASHTED, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Jenala Chipungu
- Social and Behavioural Science Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Regina Ejemot-Nwadiaro
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Bruce Gordon
- Water, Sanitation, Hygiene and Health Unit, WHO, Geneva, Switzerland
| | | | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
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Liu HL, Liu YL, Sun FY, Li ZC, Tan HY, Xu YC. Hand Hygiene among Anesthesiologists and Microorganisms Contamination in Anesthesia Environments: A Single-Center Observational Study. Biomed Environ Sci 2022; 35:992-1000. [PMID: 36443252 DOI: 10.3967/bes2022.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the baseline levels of microorganisms' growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital. METHODS This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital. Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination. RESULTS Microorganisms' growth results showed that 20% (5/25) of anesthesiologists' hands carried microorganisms (> 10 CFU/cm 2) before patient contact began. Female anesthesiologists performed hand hygiene better than did their male counterparts, with fewer CFUs ( P = 0.0069) and fewer species ( P = 0.0202). Our study also found that 55.6% (5/9) of ready-to-use operating rooms carried microorganisms (> 5 CFU/cm 2). Microorganisms regrowth began quickly (1 hour) after disinfection, and increased gradually over time, reaching the threshold at 4 hours after disinfection. Staphylococcus aureus was isolated from the hands of 20% (5/25) of anesthesiologists and 33.3% (3/9) of operating rooms. CONCLUSION Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene, daily cleaning rate of the operating room may be insufficient, and we would suggest that there should be a repeat cleaning every four hours.
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Affiliation(s)
- Hong Lei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China;Graduate School, Capital Medical University, Beijing 100069, China
| | - Ya Li Liu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China;Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing 100730, China
| | - Fang Yan Sun
- Infection Control Department, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
| | - Zong Chao Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hong Yu Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ying Chun Xu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China;Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing 100730, China
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Müller SA, Diallo AOK, Rocha C, Wood R, Landsmann L, Camara BS, Schlindwein L, Tounkara O, Arvand M, Diallo M, Borchert M. Mixed methods study evaluating the implementation of the WHO hand hygiene strategy focusing on alcohol based handrub and training among health care workers in Faranah, Guinea. PLoS One 2021; 16:e0256760. [PMID: 34437634 PMCID: PMC8389517 DOI: 10.1371/journal.pone.0256760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The most frequent adverse health events in healthcare worldwide are healthcare-associated infection. Despite ongoing implementation of the WHO multimodal Hand Hygiene (HH) Improvement Strategy, healthcare-associated infection rate continues to be twofold higher in low- than in high-income countries. This study focused on continued evaluation of HH compliance and knowledge. The mixed method approach, with inclusion of patients and care-givers, provided insight into challenges and facilitators of the WHO HH Improvement Strategy, and highlighted improvement points. Methods An uncontrolled, before-and–after intervention, mixed methods study in Faranah Regional Hospital was conducted from December 2017 to August 2019. The intervention implemented the WHO HH Strategy including HH training for healthcare workers (HCWs), and the relaunch of the local production of alcohol-based handrub (ABHR). A baseline assessment of HH knowledge, perception and compliance of HCWs was done prior to the intervention and compared to two follow-up assessments. The second follow-up assessment was complemented by a qualitative component. Results Overall compliance six months post-intervention was 45.1% and significantly higher than baseline but significantly lower than in first follow-up. Knowledge showed similar patterns of improvement and waning. The perception survey demonstrated high appreciation of the intervention, such as local production of ABHR. HCW’s were concerned about overconsuming of ABHR, however simultaneous quantitative measurements showed that consumption in fact was 36% of the estimated amount needed for sufficient HH compliance. Potential fields for improvement identified by HCWs to enhance sustainability were permanent ABHR availability, having a dedicated person with ownership over continuous simulation HH trainings including simulations to improve technique. Conclusion The study shows that the WHO multimodal HH strategy has a positive effect on HCW compliance and knowledge. Improvement points identified by local staff like sensitization on appropriate ABHR amount per HH action should be considered for sustainable HH improvement.
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Affiliation(s)
- Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | | | - Carlos Rocha
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Rebekah Wood
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Lena Landsmann
- Unit for Hospital Hygiene, Infection Prevention and Control, Robert Koch Institute, Berlin, Germany
| | - Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Maférinya, Guinea
| | | | | | - Mardjan Arvand
- Unit for Hospital Hygiene, Infection Prevention and Control, Robert Koch Institute, Berlin, Germany
| | | | - Matthias Borchert
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
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Dawodu OG, Akanbi RB. Isolation and identification of microorganisms associated with automated teller machines on Federal Polytechnic Ede campus. PLoS One 2021; 16:e0254658. [PMID: 34351934 PMCID: PMC8341644 DOI: 10.1371/journal.pone.0254658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
Automated Teller Machines (ATM) are visited everyday by millions of people. This machine is accessible to the general public irrespective of class, age or race. The contact point of all ATM machines is the hand which on their own are ‘vaults’ of microorganisms. An elaborate survey was taken for complete assessment of possible microbial contamination in the Federal Polytechnic Ede campus. Selected ATM machines on campus were used as case study to characterize, identify and determine the degree of bacterial contamination of microorganisms and their potential as reservoir of microbes. Swabs were collected from each ATM screen, buttons, floor, user’s hand, and exposure of plates. After collection of the samples, they were plated in nutrient agar. The results showed the presence of increased bacterial count subsequently, most pathogens on characterization revealed the genus of the particular organisms E. coli, Pseudomonas, Staphylococcus aureus, Klebsiella, Micrococcus, Salmonella and Serratia. The study showed the potential hazard inherent in ATM machine usage and draws attention to our level of hand hygiene compliance.
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Affiliation(s)
- O. G. Dawodu
- Department of Science Laboratory Technology, Federal Polytechnic Ede, Ede, Osun State, Nigeria
- * E-mail: ,
| | - R. B. Akanbi
- Department of Science Laboratory Technology, Federal Polytechnic Ede, Ede, Osun State, Nigeria
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Huang F, Armando M, Dufau S, Florea O, Brouqui P, Boudjema S. COVID-19 outbreak and healthcare worker behavioural change toward hand hygiene practices. J Hosp Infect 2021; 111:27-34. [PMID: 33716086 PMCID: PMC7948529 DOI: 10.1016/j.jhin.2021.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has affected healthcare workers (HCWs) in their clinical practice. HCWs were challenged with new guidelines and practices to protect themselves from occupational risks. AIM To determine whether hand hygiene behaviour by real-time measurement was related to the dynamic of the epidemic, and the type of patient being cared for in France. METHODS This study used an automated hand hygiene recording system to measure HCW hand hygiene on entry to and exit from patient rooms throughout the COVID-19 pandemic. The correlation between hand hygiene compliance and COVID-19 epidemiological data was analysed. Analysis of variance was performed to compare compliance rate during the different periods of the epidemic. FINDINGS HCW hand hygiene rate on room entry decreased over time; on room exit, it increased by 13.73% during the first wave of COVID-19, decreased by 9.87% during the post-lockdown period, then rebounded by 2.82% during the second wave of the epidemic. Hand hygiene during patient care and hand hygiene on room exit had a positive relationship with the local COVID-19 epidemic; conversely, hand hygiene on room entry did not depend on the trend of the epidemic, nor on nursing of COVID-19 patients, and it decreased over time. CONCLUSION HCWs modified their behaviours to face the risk propensity of the pandemic. However, to improve the poor compliance at room entry, reducing confusion between the hand hygiene recommendation and glove recommendation may be necessary; disinfection of gloving hands might solve this issue.
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Affiliation(s)
- F Huang
- Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France.
| | - M Armando
- Aix Marseille Université, CNRS, Laboratory of Cognitive Psychology (UMR 7290), Marseille, France
| | - S Dufau
- Aix Marseille Université, CNRS, Laboratory of Cognitive Psychology (UMR 7290), Marseille, France
| | - O Florea
- AP-HM, IHU Méditerranée Infection, Marseille, France
| | - P Brouqui
- Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France; AP-HM, IHU Méditerranée Infection, Marseille, France
| | - S Boudjema
- Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
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KUMAR ARVIND, KERI VISHAKHC, KHAN MAROOFAHMAD, RANJAN PIYUSH, RASTOGI NEHA, SAHU MONALISA, WIG NAVEET. Assessment of healthcare worker's hand hygiene and infection prevention practices of their personal belongings in a healthcare setting: a survey in pre COVID-19 era and literature review on standard disinfection practices. J Prev Med Hyg 2021; 62:E104-E109. [PMID: 34322624 PMCID: PMC8283623 DOI: 10.15167/2421-4248/jpmh2021.62.1.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
Background Healthcare workers’ (HCW) hands and personnel belongings are vehicles of transmission of nosocomial infections. Knowledge, attitude, and practice of hand hygiene have been extensively studied suggesting adequate knowledge but poor compliance. Similar data on aprons, mobile phone and stethoscope disinfection practices are lacking. This becomes an extensively important topic of discussion in current COVID-19 pandemic where inadequacy in hygiene practices is devastating. Aim To study the knowledge, attitude, and infection prevention practices of HCWs aprons, electronic devices, stethoscopes, and hands. Methods A cross sectional questionnaire-based survey was conducted among HCWs of Medicine ward and ICU. Results Sixty-six HCWs responded to the survey. Awareness that hands, aprons, mobile phones, stethoscopes could cause cross transmission and knowledge of correct practices was present in majority of the respondents. Hand hygiene was performed by 65.2% of the respondents before touching a patient and 54.5% after touching the patient surroundings while 13.6% performed only when it was visibly soiled. Mobile phones and stethoscopes were disinfected by 13.6 and 30.3% of the respondents after each patient encounter, respectively. Aprons were washed after using them at a stretch for a median duration of 5 days (1-30 days). Forgetfulness, lack of reinforcement, lack of time, inadequate awareness on standard disinfection practices and fear of damaging electronic devices from disinfectants use were reasons for poor compliance. Conclusions There is an urgent need to spread awareness and formulate standard guidelines on disinfection practices especially for mobile phones, stethoscopes, and aprons in addition to reinforcing hand hygiene practices.
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Affiliation(s)
| | - VISHAKH C. KERI
- Department of Medicine and Microbiology, AIIMS, New Delhi
- Correspondence: Vishakh C. Keri, Senior Resident, Infectious Diseases, Department of Medicine and Microbiology, AIIMS, New Delhi - Tel.: 8073067525 - E-mail:
| | | | | | - NEHA RASTOGI
- Department of Medicine and Microbiology, AIIMS, New Delhi
| | - MONALISA SAHU
- Department of Medicine and Microbiology, AIIMS, New Delhi
| | - NAVEET WIG
- Department of Medicine, AIIMS, New Delhi
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KIELAR MACIEJ, DEPURBAIX RENATA, AGNYZIAK MARZENA, WIJASZKA BOGUMIŐA, POBOŻY TOMASZ. The COVID-19 pandemic as a factor of hospital staff compliance with the rules of hand hygiene: assessment of the usefulness of the "Clean Care is a Safer Care" program as a tool to enhance compliance with hand hygiene principles in hospitals. J Prev Med Hyg 2021; 62:E25-E32. [PMID: 34322613 PMCID: PMC8283626 DOI: 10.15167/2421-4248/jpmh2021.62.1.1603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
Introduction Hand cleansing and disinfection is the most efficient method for reducing the rates of hospital-acquired infections which are a serious medical and economic problem. Striving to ensure the maximum safety of the therapeutic process, we decided to promote hand hygiene by implementing the educational program titled "Clean Care is a Safer Care". The occurrence of the COVID-19 pandemic affected the compliance with procedures related to the sanitary regime, including the frequency and accuracy of hand decontamination by medical personnel. Objective The objective of the study was to assess the usefulness of the educational program titled "Clean Care is a Safer Care" as a tool for increasing compliance with hand hygiene principles. Methods We monitored the compliance with the hygiene procedure before implementation of the program as well as during the hand hygiene campaign by means of direct observation as well as the disinfectant consumption rates. Results In the initial self-assessment survey, the hospital had scored 270/500 points (54%). Preliminary audit revealed the hygiene compliance rate at the level of 49%. After broad-scaled educational efforts, the semi-annual audit revealed an increase in hand hygiene compliance rate up to 81% (hospital average) while the final audit carried out after one year of campaigning revealed a compliance rate of 77%. The final score for the hospital increased to 435/500 points. Conclusions COVID-19 pandemic dramatically increased accuracy of proper hand hygiene procedures and consumption of disinfectant agents. The educational program has succeeded to reach its goal; however, long-term educational efforts are required to maintain and improve the quality of provided services.
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Affiliation(s)
- MACIEJ KIELAR
- Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Poland
- Department of Surgery, Surgery Clinic, Medicover Hospital, Warsaw, Poland
| | - RENATA DEPURBAIX
- Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Poland
| | - MARZENA AGNYZIAK
- Department of Surgery, Surgery Clinic, Medicover Hospital, Warsaw, Poland
| | - BOGUMIŐA WIJASZKA
- Department of Orthopaedic Surgery, Ciechanów Hospital, Ciechanów, Poland
- Correspondence: Bogumiła Wijaszka, Department of Orthopedic Surgery, Voivodal Specialistic Hospital in Ciechanów, Ul, Powstańców Wielkopolskich 2, 06-400 Ciechanów, Poland - Tel. +486730420 - E-mail:
| | - TOMASZ POBOŻY
- Department of Orthopaedic Surgery, Ciechanów Hospital, Ciechanów, Poland
- Department of Orthopedic Surgery, Surgery Clinic, Medicover Hospital, Warsaw, Poland
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Shin JH, Mizuno S, Okuno T, Itoshima H, Sasaki N, Kunisawa S, Kaku M, Yoshida M, Gu Y, Morii D, Shibayama K, Ohmagari N, Imanaka Y. Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals. BMC Infect Dis 2021; 21:234. [PMID: 33639873 PMCID: PMC7912490 DOI: 10.1186/s12879-021-05921-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include "implementing appropriate infection prevention and control" and "appropriate use of antimicrobials," which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship. METHODS We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses. RESULTS The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses. CONCLUSIONS Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Anti-Infective Agents/therapeutic use
- Antimicrobial Stewardship/methods
- Antimicrobial Stewardship/standards
- Catheter-Related Infections/drug therapy
- Catheter-Related Infections/epidemiology
- Catheter-Related Infections/prevention & control
- Cross Infection/drug therapy
- Cross Infection/epidemiology
- Cross Infection/prevention & control
- Drug Resistance, Bacterial
- Hand Hygiene/standards
- Hand Hygiene/statistics & numerical data
- Health Knowledge, Attitudes, Practice
- Hospitals, Teaching/standards
- Hospitals, Teaching/statistics & numerical data
- Humans
- Infection Control/methods
- Infection Control/standards
- Japan/epidemiology
- Personnel, Hospital/statistics & numerical data
- Pneumonia, Ventilator-Associated/drug therapy
- Pneumonia, Ventilator-Associated/epidemiology
- Pneumonia, Ventilator-Associated/prevention & control
- Practice Patterns, Physicians'/standards
- Surveys and Questionnaires
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Affiliation(s)
- Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Seiko Mizuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takuya Okuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Hisashi Itoshima
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Mitsuo Kaku
- Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Makiko Yoshida
- Department of Infectious Diseases, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Daiichi Morii
- Department of Infection Control and Prevention, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norio Ohmagari
- Department of Infectious Diseases, AMR Clinical Reference Center, and Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Lescure D, Haenen A, de Greeff S, Voss A, Huis A, Hulscher M. Exploring determinants of hand hygiene compliance in LTCFs: a qualitative study using Flottorps' integrated checklist of determinants of practice. Antimicrob Resist Infect Control 2021; 10:14. [PMID: 33446248 PMCID: PMC7809817 DOI: 10.1186/s13756-021-00882-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly residents in long-term care facilities (LTCFs) are vulnerable to healthcare-associated infections. Although hand hygiene is a leading measure for preventing infection, the compliance of healthcare workers is low. The aim of this study is to identify determinants that influence hand hygiene compliance of nursing staff in LTCFs. This information on determinants can eventually be used to develop a tailored implementation strategy for LTCFs. METHODS This is an explorative, descriptive study using qualitative methods. We performed semi-structured focus group discussions with 31 nurses and nurse assistants from five Dutch LTCFs. Our focus group discussions continued until no new information could be identified from the data. We used Flottorps' comprehensive checklist for identifying determinants of practice (the TICD checklist) to guide data collection and analysis. The audiotapes were transcribed verbatim and two authors independently analysed the transcripts with Atlas.ti software. RESULTS LTCFs for the elderly have setting specific determinants that are decisive in explaining hand hygiene compliance. Most of these determinants are related to the residents with whom nurses build close relationships and for whom they want to create a homelike atmosphere. Residents can complicate the provision of care with unpredictable behaviour, being unwilling to receive care or use shared facilities. Our study also discovered setting-transcending determinants related to knowledge, professional interactions, guidelines, and incentives/resources. CONCLUSIONS Nurses in LTCFs are constantly pursuing a balance between working hygienically, responding adequately to acute care needs, and maintaining a homelike environment for their residents. As a result, setting-specific determinants affect hand hygiene compliance, as do the known determinants that are important in other care settings. To improve compliance in LTCFs, interventions should be selected on a theoretical base while linking these determinants to change interventions. TRIAL REGISTRATION Registration number 50-53000-98-113, Compliance With Hand Hygiene in Nursing Homes: Go for a Sustainable Effect (CHANGE) on ClinicalTrials.gov. Date of registration 28-6-2016.
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Affiliation(s)
- Dominique Lescure
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Present Address: Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Anja Haenen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Centre for Infectious Disease Control/Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment (RIVM), P.O. Box 9101, 6500 HB Nijmegen, Bilthoven, The Netherlands
| | - Sabine de Greeff
- Department Antimicrobial Resistance and Healthcare Associated Infections, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Canisius-Wilhelmina Hospital, P.O. Box 9015, 6500 GS Nijmegen, The Netherlands
| | - Anita Huis
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Gharpure R, Miller GF, Hunter CM, Schnall AH, Kunz J, Garcia-Williams AG. Safe Use and Storage of Cleaners, Disinfectants, and Hand Sanitizers: Knowledge, Attitudes, and Practices among U.S. Adults during the COVID-19 Pandemic, May 2020. Am J Trop Med Hyg 2020; 104:496-501. [PMID: 33377450 PMCID: PMC7866329 DOI: 10.4269/ajtmh.20-1119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
Cleaning and disinfection of frequently touched surfaces and frequent hand hygiene are recommended measures to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. Since the onset of the COVID-19 pandemic, poison center calls regarding exposures to cleaners, disinfectants, and hand sanitizers have increased as compared with prior years, indicating a need to evaluate household safety precautions. An opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020. Survey items evaluated knowledge regarding use and storage of cleaners, disinfectants, and hand sanitizers; attitudes about household cleaning and disinfection; and safety precautions practiced during the prior month. We assigned a knowledge score to each respondent to quantify knowledge of safety precautions and calculated median scores by demographic characteristics and attitudes. We identified gaps in knowledge regarding safe use and storage of cleaners, disinfectants, and hand sanitizers; the overall median knowledge score was 5.17 (95% CI: 4.85-5.50; maximum 9.00). Knowledge scores were lower among younger than older age-groups and among black non-Hispanic and Hispanic respondents compared with white non-Hispanic respondents. A greater proportion of respondents expressed knowledge of safety precautions than the proportion who engaged in these precautions. Tailored communication strategies should be used to reach populations with lower knowledge of cleaning and disinfection safety. In addition, as knowledge alone did not shape individual engagement in safety precautions, health promotion campaigns may specifically emphasize the health risks of unsafe use and storage of cleaners, disinfectants, and hand sanitizers to address risk perception.
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Affiliation(s)
- Radhika Gharpure
- COVID-19 Response, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gabrielle F. Miller
- COVID-19 Response, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Candis M. Hunter
- COVID-19 Response, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy H. Schnall
- National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jasen Kunz
- COVID-19 Response, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Jindal R, Pandhi D. Addition of a sixth step in hand hygiene protocol: Moisturization. J Am Acad Dermatol 2020; 84:e171-e172. [PMID: 33160980 PMCID: PMC7833417 DOI: 10.1016/j.jaad.2020.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Rashmi Jindal
- Department of Dermatology, Venereology, and Leprosy, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India.
| | - Deepika Pandhi
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, New Delhi, India
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Moreno-Casbas MT. Factors related to SARS-CoV-2 infection in healthcare professionals in Spain. The SANICOVI project. Enferm Clin (Engl Ed) 2020; 30:360-370. [PMID: 32571661 PMCID: PMC7247504 DOI: 10.1016/j.enfcli.2020.05.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the factors related to the situation of SARS-CoV-2 transmission identified by health professionals in Spain and to propose prevention strategies. METHOD Cross-sectional descriptive study. The population were healthcare professionals working in institutions caring for COVID-19 patients and also confirmed cases of SARS-CoV-2 infection. A questionnaire with sociodemographic, occupational and epidemiological variables was used. Descriptive and bivariate analysis was performed according to the nature of the variables. RESULTS A total of 2.230 questionnaires were analysed on a potential population of 41,239 (5.47%). The diagnosis was made based on a suspicious case (63.4%) and a probable case (12.3%). A study of contacts was carried out at 50.3%. The perception about the availability of protective measures as «always/frequently» were: FPP1 mask 57.3%, gloves 89.5%, soap 95% and hydroalcoholic solution 91.5%. In PPE, FPP2, FPP3 mask, goggles and disposable gowns at around 50%. The availability of protective measures, by field of work, presented significant differences. The average number of patients attended related to the performance of hand hygiene at moment4 and the perception of performing it correctly at moments4 and5. CONCLUSIONS Preliminary data are presented, with variability in the response rate by Autonomous Region. Healthcare professionals infected by SARS-CoV-2 identified the management of the chain of infection transmission, the use and adequacy of protective equipment, as well as the effectiveness of handwashing as factors related to the transmission of the virus among professionals.
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Affiliation(s)
- María Teresa Moreno-Casbas
- Unidad de Investigación en Cuidados y Servicios de Salud del Instituto de Salud Carlos III (Investén-isciii), Madrid, España; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, España.
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Kanagasabai U, Singh A, Shiraishi RW, Ly V, Hy C, Sanith S, Srun S, Sansam S, SopHeap ST, Liu Y, Jones G, Ijeoma UC, Bock N, Benech I, Selenic D, Drammah B, Gadde R, Mili FD. Improving injection safety practices of Cambodian healthcare workers through training. PLoS One 2020; 15:e0241176. [PMID: 33126238 PMCID: PMC7599083 DOI: 10.1371/journal.pone.0241176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study evaluated the impact of a safe injection safety training on healthcare worker (HCW) practice and knowledge following an HIV outbreak in Roka commune, Cambodia. METHODS Surveys were conducted at baseline (September 2016) and seven months after a training intervention (March 2018) using the World Health Organization standardized injection practices assessment tool. HCWs were sampled at 15 purposively government health facilities in two provinces. HCWs were observed during injection practices and interviewed by trained experts from Becton-Dickinson and the Ministry of Health Cambodia. The Rao-Scott chi square test was used test for differences between baseline and follow-up. RESULTS We completed 115 observations of practice at baseline and 206 at post-training follow-up. The proportion of patients whose identification was confirmed by HCWs prior to procedure being performed increased from 40.4% to 98% (p <0.0001). The proportion of HCWs who practiced correct hand hygiene increased from 22.0% to 80.6% (p = 0.056) [therapeutic observations] and 17.2% to 63.4% (p = 0.0012) [diagnostic observations]. Immediate disposal of sharps by HCWs decreased from 96.5% to 92.5% (p = 0.0030). CONCLUSIONS We found significant improvements in the practice of patient identity confirmation and hand hygiene but not in the immediate disposal of sharps in the post-training intervention. However, findings are not representative of all HCWs in the country. Further pre-service and in-service training and monitoring are necessary to ensure sustained behavior change.
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Affiliation(s)
| | - Adarshpal Singh
- Becton, Dickinson and Company, Franklifn Lakes, NJ, United States of America
| | - Ray W. Shiraishi
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Vanthy Ly
- U.S. Centers for Disease Control and Prevention, Cambodia
| | - Chhaily Hy
- U.S. Centers for Disease Control and Prevention, Cambodia
| | - Sou Sanith
- Ministry of Health, Phnom Pehn, Cambodia
| | - Sok Srun
- Ministry of Health, Phnom Pehn, Cambodia
| | - Sim Sansam
- Ministry of Health, Phnom Pehn, Cambodia
| | | | - Yuliang Liu
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Gerald Jones
- Division of Health Informatics and Surveillance, Epidemiology and Laboratory Services, CDC, Atlanta, GA, United States of America
| | - Ugonna C. Ijeoma
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Naomi Bock
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Irene Benech
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Dejana Selenic
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Bakary Drammah
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
| | - Renuka Gadde
- Becton, Dickinson and Company, Franklifn Lakes, NJ, United States of America
| | - Fatima D. Mili
- Division of Global HIV/AIDS and Tuberculosis, CDC, Atlanta, GA, United States of America
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Duszynska W, Rosenthal VD, Szczesny A, Zajaczkowska K, Fulek M, Tomaszewski J. Device associated -health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015-2017). BMC Infect Dis 2020; 20:761. [PMID: 33066740 PMCID: PMC7562760 DOI: 10.1186/s12879-020-05482-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Device-associated health care-associated infections (DA-HAIs) in intensive care unit (ICU) patients constitute a major therapeutic issue complicating the regular hospitalisation process and having influence on patients' condition, length of hospitalisation, mortality and therapy cost. METHODS The study involved all patients treated > 48 h at ICU of the Medical University Teaching Hospital (Poland) from 1.01.2015 to 31.12.2017. The study showed the surveillance and prevention of DA-HAIs on International Nosocomial Infection Control Consortium (INICC) Surveillance Online System (ISOS) 3 online platform according to methodology of the INICC multidimensional approach (IMA). RESULTS During study period 252 HAIs were found in 1353 (549F/804M) patients and 14,700 patient-days of hospitalisation. The crude infections rate and incidence density of DA-HAIs was 18.69% and 17.49 ± 2.56 /1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI) and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 12.63 ± 1.49, 1.83 ± 0.65 and 6.5 ± 1.2, respectively. VAP(137) constituted 54.4% of HAIs, whereas CA-UTI(91) 36%, CLA-BSI(24) 9.6%.The most common pathogens in VAP and CA-UTI was multidrug-resistant (MDR) Acinetobacter baumannii (57 and 31%), and methicillin-resistant Staphylococcus epidermidis (MRSE) in CLA-BSI (45%). MDR Gram negative bacteria (GNB) 159 were responsible for 63.09% of HAIs. The length of hospitalisation of patients with a single DA-HAI at ICU was 21(14-33) days, while without infections it was 6.0 (3-11) days; p = 0.0001. The mortality rates in the hospital-acquired infection group and no infection group were 26.1% vs 26.9%; p = 0.838; OR 0.9633;95% CI (0.6733-1.3782). Extra cost of therapy caused by one ICU acquired HAI was US$ 11,475/Euro 10,035. Hand hygiene standards compliance rate was 64.7%, while VAP, CLA-BSI bundles compliance ranges were 96.2-76.8 and 29-100, respectively. CONCLUSIONS DA-HAIs was diagnosed at nearly 1/5 of patients. They were more frequent than in European Centre Disease Control report (except for CLA-BSI), more frequent than the USA CDC report, yet less frequent than in limited-resource countries (except for CA-UTI). They prolonged the hospitalisation period at ICU and generated substantial additional costs of treatment with no influence on mortality. The Acinetobacter baumannii MDR infections were the most problematic therapeutic issue. DA-HAIs preventive methods compliance rate needs improvement.
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Affiliation(s)
- Wieslawa Duszynska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L.Pasteura Street 1, 50-367 Wroclaw, Poland
| | | | - Aleksander Szczesny
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L.Pasteura Street 1, 50-367 Wroclaw, Poland
| | - Katarzyna Zajaczkowska
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw, Poland
| | - Michal Fulek
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw, Poland
| | - Jacek Tomaszewski
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw, Poland
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Abstract
Since cases first emerged in December 2019, COVID‐19 (a type of coronavirus) has rapidly become pandemic. This fast‐tracked paper (published quickly) from China on COVID‐19 is written by dermatologists at the epicentre of the outbreak in Wuhan. Dermatology clinic staff may be at risk because protective equipment is not routinely available, and skin lesions might possibly transmit the virus indirectly. These authors suggest preventive measures based on experience in this and previous coronavirus outbreaks. Online consultation for non‐urgent patients reduces the numbers of patients attending clinics. Nurse‐led triage, to identify patients with possible COVID‐19, at the entrances of hospital and skin clinics directs patients with a cough or fever to a specific COVID‐19 area and a dermatologist is consulted if the fever might be related to skin disease. Clinic staff wear N95 masks and observe hand hygiene during consultations. Patients are admitted to a ward only if routine blood tests and chest CT scans exclude COVID‐19. Triage will not detect patients who are showing no symptoms but who are developing the disease, so the hospital should provide an on‐call expert team to discuss inpatients suspected or diagnosed with COVID‐19 and refer them to radiology, respiratory or intensive care colleagues as required. Confirmed cases are managed following local policies. Skin disorders in COVID‐19 inpatients can usually be managed remotely using photographs, email and teleconferencing. If necessary a multidisciplinary team (a team of medical staff from different specialties) can meet in the clean area of the isolation ward. If the dermatologist must see the patient, all records should be provided in advance to minimise exposure time. With these precautions, as of 20th February 2020 no infected patients were detected in the Wuhan Dermatology Department. This is a summary of the study: Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department Linked Article: Tao et al. Br J Dermatol 2020; 182:1477–1478
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Abstract
As a result of the coronavirus disease pandemic, commercial hand hygiene products have become scarce and World Health Organization (WHO) alcohol-based hand rub formulations containing ethanol or isopropanol are being produced for hospitals worldwide. Neither WHO formulation meets European Norm 12791, the basis for approval as a surgical hand preparation, nor satisfies European Norm 1500, the basis for approval as a hygienic hand rub. We evaluated the efficacy of modified formulations with alcohol concentrations in mass instead of volume percentage and glycerol concentrations of 0.5% instead of 1.45%. Both modified formulations met standard requirements for a 3-minute surgical hand preparation, the usual duration of surgical hand treatment in most hospitals in Europe. Contrary to the originally proposed WHO hand rub formulations, both modified formulations are appropriate for surgical hand preparation after 3 minutes when alcohol concentrations of 80% wt/wt ethanol or 75% wt/wt isopropanol along with reduced glycerol concentration (0.5%) are used.
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Diefenbacher S, Sassenrath C, Tatzel J, Keller J. Evaluating healthcare workers' hand hygiene performance using first-person view video observation in a standardized patient-care scenario. Am J Infect Control 2020; 48:496-502. [PMID: 32334725 DOI: 10.1016/j.ajic.2019.11.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Monitoring healthcare workers' (HCWs) hand hygiene (HH) performance is recommended for improving compliance. Observer biases challenge data validity, thus supplemental approaches such as video observation are needed to complement monitoring. METHODS We investigate first-person view (FPV) video observation during simulated standardized patient care handling a catheter in a study with 71 HCWs. HH performance was evaluated for (1) all HH opportunities and (2) a subset of opportunities required in an ideal work sequence, hereafter core opportunities. HCWs' acceptance of FPV video observation and usability judgments were assessed. RESULTS Compliance level for core HH opportunities (M = 43.5%) was significantly higher than compliance considering all opportunities (M = 30.4%, t(70) = 8.493, P < .001). Reducing HH opportunities to core opportunities would significantly increase compliance levels from the observed average of 30.4% to 44.9% (t(70) = 12.822, P < .001). Overall, both usability ratings and acceptance of the body camera were promising. DISCUSSION FPV video observation in simulated standardized patient care provides new instruments to evaluate HH performance beyond mere compliance rates. Our results emphasize the role of optimizing workflow in order to improve HCW's HH compliance. CONCLUSIONS FPV video observation in a standardized patient care simulation is feasible and offers information for HH interventions that target actual deficiencies.
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Affiliation(s)
| | | | - Johannes Tatzel
- Department of Social Psychology, Ulm University, Ulm, Germany
| | - Johannes Keller
- Department of Social Psychology, Ulm University, Ulm, Germany
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Peters A, Vetter P, Guitart C, Lotfinejad N, Pittet D. Understanding the emerging coronavirus: what it means for health security and infection prevention. J Hosp Infect 2020; 104:440-448. [PMID: 32145323 PMCID: PMC7124368 DOI: 10.1016/j.jhin.2020.02.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022]
Affiliation(s)
- A Peters
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P Vetter
- Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C Guitart
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - N Lotfinejad
- Department of Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - D Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Lee MH, Lee GA, Lee SH, Park YH. A systematic review on the causes of the transmission and control measures of outbreaks in long-term care facilities: Back to basics of infection control. PLoS One 2020; 15:e0229911. [PMID: 32155208 PMCID: PMC7064182 DOI: 10.1371/journal.pone.0229911] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The unique characteristics of long-term care facilities (LTCFs) including host factors and living conditions contribute to the spread of contagious pathogens. Control measures are essential to interrupt the transmission and to manage outbreaks effectively. AIM The aim of this systematic review was to verify the causes and problems contributing to transmission and to identify control measures during outbreaks in LTCFs. METHODS Four electronic databases were searched for articles published from 2007 to 2018. Articles written in English reporting outbreaks in LTCFs were included. The quality of the studies was assessed using the risk-of-bias assessment tool for nonrandomized studies. FINDINGS A total of 37 studies were included in the qualitative synthesis. The most commonly reported single pathogen was influenza virus, followed by group A streptococcus (GAS). Of the studies that identified the cause, about half of them noted outbreaks transmitted via person-to-person. Suboptimal infection control practice including inadequate decontamination and poor hand hygiene was the most frequently raised issue propagating transmission. Especially, lapses in specific care procedures were linked with outbreaks of GAS and hepatitis B and C viruses. About 60% of the included studies reported affected cases among staff, but only a few studies implemented work restriction during outbreaks. CONCLUSIONS This review indicates that the violation of basic infection control practice could be a major role in introducing and facilitating the spread of contagious diseases in LTCFs. It shows the need to promote compliance with basic practices of infection control to prevent outbreaks in LTCFs.
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Affiliation(s)
- Min Hye Lee
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, South Korea
| | - Gyeoung Ah Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Seong Hyeon Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Yeon-Hwan Park
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, South Korea
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Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, King's College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
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Longembe EB, Kitronza PL. [Compliance with hand-hygiene practice in the General Reference Hospitals of the city of Kisangani, Democratic Republic of the Congo]. Pan Afr Med J 2020; 35:57. [PMID: 32537061 PMCID: PMC7266366 DOI: 10.11604/pamj.2020.35.57.18500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION the purpose of this study was to assess the compliance with hand-hygiene practice of health-care workers in the General Reference Hospitals (GRH) of the city of Kisangani and to identify factors contributing to it. METHODS we conducted a cross-sectional study in the Maternity, Surgery, Pediatric and Emergency Departments at four GRH of the city of Kisangani over the period 13th-20th June 2018. One hundred and twenty professionals recruited from among doctors, nurses, laboratory technicians and attendants were asked to complete a self-administered questionnaire to assess their level of knowledge and a grid indicating the compliance with hand-hygiene practice in 44 health professionals (1920 opportunities). RESULTS the rate of overall compliance with hand-hygiene practice was 39% [CI95 0.37; 0.41]; friction with hydroalcoholic solution was much less frequent (5%); cleaners and physicians had higher compliance rates (49% and 44% respectively) than nurses (33%). Approximately one third of professionals were aware of the indications for hand-hygiene according to the WHO; 37% of health professionals declared that they had followed a on-the-job training on hand-hygiene and 36% knew the importance of hand-hygiene in the healthcare environment. The gap in knowledge was not significant between the occupational categories studied (p >0.05). CONCLUSION this study and the results obtained from it allowed us to conclude that the level of compliance to precautions standards including hand hygiene by healthcare professionals is insufficient. It is therefore necessary to strengthen the compliance with hand-hygiene practices through training and awareness programs for healthcare professionals, the supply of hygiene products and the awareness of healthcare providers.
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Affiliation(s)
- Eugène Basandja Longembe
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo
| | - Panda Lukongo Kitronza
- Faculté de Médecine et de Pharmacie, Université de Kisangani, Kisangani, République Démocratique du Congo
- Ecole de Santé Publique, Faculté de Médecine, Université de Liège, Liège, Belgique
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De Fiore R. [Not Available]. Recenti Prog Med 2020; 111:116-117. [PMID: 32089561 DOI: 10.1701/3309.32802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Ridley N. Effective hand hygiene-wash your hands and reduce the risk. Br J Nurs 2020; 29:10. [PMID: 31917942 DOI: 10.12968/bjon.2020.29.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Neesha Ridley, Senior Lecturer, University of Central Lancashire, discusses the importance of hand hygiene in preventing healthcare-associated infections.
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Abstract
Introduction on January 30, 2020, the World Health Organization declared the novel coronavirus outbreak a Public Health Emergency of International Concern. As of October 5, 2020, there were over 34.8 million reported cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and more than 1 million reported deaths from coronavirus disease 2019 (COVID-19), globally. Non-pharmaceutical interventions, such as social distancing policies, hand hygiene, and mask use, are key public health measures to control COVID-19. In response to, or in some cases even before, the first wave of SARS-CoV-2 infections were reported in their countries, policy makers across Africa issued various social distancing policies. Methods we describe social distancing policies issued from March 1 to April 24, 2020 in 22 Anglophone countries of sub-Saharan Africa. We reviewed policies identified online. Results though all 22 countries closed schools and banned gatherings, they took a variety of approaches to sizes of gatherings banned and to stay-at-home orders, with 13 countries issuing national stay-at-home orders, four issuing subnational stay-at-home orders, and five not issuing stay-at-home orders. Enforcement provisions varied by country, as did funeral and health care exceptions. Conclusion movement restrictions, business restrictions, and school closures can have substantial negative impacts on economies, education, nutrition, and routine health care. Yet easing or lifting of COVID-19 social distancing policies can lead to increased transmission. Our review documents a wide variety of policy alternatives used in Africa and can inform future adjustments as countries ease, lift, and reapply measures in response to their evolving epidemics.
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Affiliation(s)
- Andre Verani
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
- Corresponding author: Andre Verani, U.S. Centers for Disease Control and Prevention, Atlanta, USA.
| | | | | | | | - Kerton Victory
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Avi Hakim
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Mohamed NA, Mohd Rani MD, Tengku Jamaluddin TZM, Ismail Z, Ramli S, Faroque H, Abd Samad FN, Ariffien AR, Che Amir Farid AAR, Isahak I. Effect of hand hygiene intervention on the absenteeism of pre-school children in Klang Valley, Malaysia: a quasi-experimental study. World J Pediatr 2020; 16:416-421. [PMID: 31286426 PMCID: PMC7376078 DOI: 10.1007/s12519-019-00283-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/25/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Absenteeism amongst pre-school children is often due to illnesses such as hand, foot, and mouth disease, acute gastroenteritis, cold and flu, which are easily spread amongst them. This is because of weak immunity and lack of knowledge on proper hand hygiene. This quasi-experimental study assessed the efficacy of an intervention consisting of a hand hygiene education programme, along with digital tools in bringing about a change in behaviour and health conditions amongst pre-school children in Klang Valley, Malaysia. METHODS A total of 377 school children, male and female, aged 5-6 years old, participated and were assigned to either the intervention or a control group. During the 2 months intervention period, children in the test group were trained on proper hand hygiene practices and techniques with the aid of the interactive android-based tablets. The numbers of absent days of all the children were recorded for 2 months before the intervention and during the intervention. RESULTS In the test group, there was a 25% increase in the total number of absent days from the pre-intervention period to the intervention period, a much lesser increment observed as compared to that of control group in which the increase was much higher at 89%. Results showed a significant difference (P < 0·05) between the absenteeism rates for the test and control group during the intervention period. CONCLUSION These results suggest that proper education and intervention increase hand hygiene compliance, which may help decrease school absenteeism due to illness; however, a longer study duration may be necessary to evaluate the benefit further.
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Affiliation(s)
- Nurul Azmawati Mohamed
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia.
| | - Mohd Dzulkhairi Mohd Rani
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | | | - Zarini Ismail
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | - Shalinawati Ramli
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | - Habibah Faroque
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | - Farisha Nur Abd Samad
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | - Abdul Rashid Ariffien
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
| | | | - Ilina Isahak
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Pandan Indah, 55100, Kuala Lumpur, Malaysia
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Jeanes A, Coen PG, Drey NS, Gould DJ. Moving beyond hand hygiene monitoring as a marker of infection prevention performance: Development of a tailored infection control continuous quality improvement tool. Am J Infect Control 2020; 48:68-76. [PMID: 31358420 PMCID: PMC7115327 DOI: 10.1016/j.ajic.2019.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Infection control practice compliance is commonly monitored by measuring hand hygiene compliance. The limitations of this approach were recognized in 1 acute health care organization that led to the development of an Infection Control Continuous Quality Improvement tool. METHODS The Pronovost cycle, Barriers and Mitigation tool, and Hexagon framework were used to review the existing monitoring system and develop a quality improvement data collection tool that considered the context of care delivery. RESULTS Barriers and opportunities for improvement including ambiguity, consistency and feasibility of expectations, the environment, knowledge, and education were combined in a monitoring tool that was piloted and modified in response to feedback. Local adaptations enabled staff to prioritize and monitor issues important in their own workplace. The tool replaced the previous system and was positively evaluated by auditors. Challenges included ensuring staff had time to train in use of the tool, time to collect the audit, and the reporting of low scores that conflicted with a target-based performance system. CONCLUSIONS Hand hygiene compliance monitoring alone misses other important aspects of infection control compliance. A continuous quality improvement tool was developed reflecting specific organizational needs that could be transferred or adapted to other organizations.
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Affiliation(s)
- Annette Jeanes
- Infection Control Department, University College London Hospitals, London, United Kingdom.
| | - Pietro G Coen
- Infection Division, Maples House, London, United Kingdom
| | - Nicolas S Drey
- School of Health Studies, University of London, London, United Kingdom
| | - Dinah J Gould
- School of healthcare Sciences, Cardiff University, Cardiff, United Kingdom
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Abstract
INTRODUCTION Hand hygiene (HH) related illnesses such as diarrhoea and respiratory diseases, contribute to the burden of disease and are included in the top five causes of mortality in children under 5 years in South Africa. Children attending preschools are more susceptible to these infections due to the higher number of children in preschools. HH interventions have shown to reduce HH-related diseases by improving HH practices. In South Africa, there are no documented HH interventions or studies in children under 5 years. The purpose of the study is to determine whether an HH intervention can reduce HH-related diseases among 4-5-year-old preschool children and to improve HH practices in these children, their caregivers and their parents. METHODOLOGY AND ANALYSIS This is a protocol for a controlled intervention study to be conducted at preschools in Kempton Park, City of Ekurhuleni, Gauteng, South Africa. Preschools will be randomly distributed into control and experimental groups (n=70). The intervention includes interactive simulation learning, educational emails and education and poster reminders obtained from the WHO and the Global Handwashing Day website. Data collection, including the intervention, will take place during the calendar year as this coincides with the school year. Data will be analysed both preintervention and postintervention in the experimental group as well as between the experimental and control group. Data collected by means of questionnaires, observations, disease registers, hygiene inspections, semi-structured interviews and hand swabs will be analysed to determine these outcomes. ETHICS AND DISSEMINATION Permission has been obtained from the University of Johannesburg Ethics Committee and Ministerial Consent for Non-Therapeutic Research on Minors from the Department of Health National Ethics Research Council. Permissions for use of copyright protected materials has been obtained. Results of the study will be disseminated through peer-reviewed publications, and feedback within relevant structures through conference proceedings.
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Affiliation(s)
- Samantha Louise Lange
- Water and Health Research Centre, Faculty of Health Sciences, University of Johannesburg, Auckland Park, South Africa
| | - Tobias George Barnard
- Water and Health Research Centre, Faculty of Health Sciences, University of Johannesburg, Auckland Park, South Africa
| | - Nisha Naicker
- Environmental Health, Faculty of Health Sciences, University of Johannesburg, Auckland Park, South Africa
- Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
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Maina M, Tosas-Auguet O, McKnight J, Zosi M, Kimemia G, Mwaniki P, Hayter A, Montgomery M, Schultsz C, English M. Extending the use of the World Health Organisations' water sanitation and hygiene assessment tool for surveys in hospitals - from WASH-FIT to WASH-FAST. PLoS One 2019; 14:e0226548. [PMID: 31841540 PMCID: PMC6913973 DOI: 10.1371/journal.pone.0226548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poor water sanitation and hygiene (WASH) in health care facilities increases hospital-associated infections, and the resulting greater use of second-line antibiotics drives antimicrobial resistance. Recognising the existing gaps, the World Health Organisations' Water and Sanitation for Health Facility Improvement Tool (WASH-FIT) was designed for self-assessment. The tool was designed for small primary care facilities mainly providing outpatient and limited inpatient care and was not designed to compare hospital performance. Together with technical experts, we worked to adapt the tool for use in larger facilities with multiple inpatient units (wards), allowing for comparison between facilities and prompt action at different levels of the health system. METHODS We adapted the existing facility improvement tool (WASH-FIT) to create a simple numeric scoring approach. This is to illustrate the variation across hospitals and to facilitate monitoring of progress over time and to group indicators that can be used to identify this variation. Working with stakeholders, we identified those responsible for action to improve WASH at different levels of the health system and used piloting, analysis of interview data to establish the feasibility and potential value of the WASH Facility Survey Tool (WASH-FAST) to demonstrate such variability. RESULTS We present an aggregate percentage score based on 65 indicators at the facility level to summarise hospitals' overall WASH status and how this varies. Thirty-four of the 65 indicators spanning four WASH domains can be assessed at ward level enabling within hospital variations to be highlighted. Three levels of responsibility for WASH service monitoring and improvement were identified with stakeholders: the county/regional level, senior hospital management and hospital infection prevention and control committees. CONCLUSION We propose WASH-FAST can be used as a survey tool to assess, measure and monitor the progress of WASH in hospitals in resource-limited settings, providing useful data for decision making and tracking improvements over time.
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Affiliation(s)
- Michuki Maina
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Olga Tosas-Auguet
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jacob McKnight
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mathias Zosi
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Kimemia
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Paul Mwaniki
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Arabella Hayter
- Water Sanitation and Hygiene Department, World Health Organization, Geneva, Switzerland
| | - Margaret Montgomery
- Water Sanitation and Hygiene Department, World Health Organization, Geneva, Switzerland
| | - Constance Schultsz
- Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Mike English
- Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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Lawson A, Vaganay-Miller M. The Effectiveness of a Poster Intervention on Hand Hygiene Practice and Compliance When Using Public Restrooms in a University Setting. Int J Environ Res Public Health 2019; 16:ijerph16245036. [PMID: 31835651 PMCID: PMC6950365 DOI: 10.3390/ijerph16245036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022]
Abstract
Background: Most research on hand hygiene compliance in community settings indicates that compliance is poor. It is not conclusive as to whether poster interventions are effective at improving compliance. Methods: An independent, self-designed poster intervention was installed in one set of male and female public restrooms in a university campus in the UK. The hand hygiene practice and compliance of the university population was measured via indirect observation over a 60 day period. Results: During the pre-intervention observation period, 51.09% of the university population practiced basic hand hygiene compliance (washed hands with water, soap and dried afterwards), and 7.88% practiced adequate hand hygiene compliance (washed hands with water and soap for 20 s or more and dried afterwards for 20 s or more). During the post-intervention observation period, 55.39% of the university population were observed practicing basic hand hygiene compliance, and 7.97% practicing adequate hand hygiene compliance. Gender differences revealed that more females practiced basic hand hygiene in the post-intervention observation period (62.81%) than during the pre-intervention period (49.23%) and this was statistically significant (χ2 = 13.49, p = < 0.01). Discussion: The poster intervention had a limited effect on improving the basic and adequate hand hygiene compliance of the general population when using public restrooms. The use of independent, self-designed posters to improve hand hygiene practice and compliance is largely ineffective in the short term and should be used with caution in future intervention strategies.
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Abstract
OBJECTIVES In 2009, the World Health Organization (WHO) introduced the "Hand Hygiene Self-Assessment Framework" (HHSAF) to evaluate the level of the application of the Multimodal Hand Hygiene Improvement Strategy (MHHIS), which defines preventive interventions, standards, and tools conceived to improve hand hygiene in healthcare facilities. The aim of our study was to evaluate the implementation of the MHHIS in Piedmont healthcare units in 2014 using the HHSAF document. METHODS Our surveillance was performed through collection and analysis of the data from 50 Piedmont healthcare facilities recorded through the HHSAF in 2014. The HHSAF describes the hand hygiene level evaluating the following 5 parameters: system changes, education/staff training, evaluation and feedback, reminders in the workplace, and promotion of an institutional safety climate. RESULTS We reported that 70.4% of the healthcare facilities involved in the study achieved the intermediate hand hygiene level, 19% the advanced level, and 11% the basic level. No facility exhibited an inadequate level of WHO multimodal implementation. Only 55% of the healthcare units provided information about hand hygiene to patients, and only 15% actively involved patients and their families. CONCLUSIONS The implementation of the MHHIS has achieved important results all over the world in terms of hand hygiene. Piedmont has reached an overall good level, particularly in terms of the supply and availability of hand washing products and staff education. Our results revealed, however, some critical issues related to direct and indirect monitoring of hand hygiene, providing reminders and the active involvement of patients, family members, and caregivers.
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Affiliation(s)
- Fabrizio Bert
- From the Department of Public Health Sciences and Pediatrics, University of Turin, Italy
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Evans EW, Redmond EC. Video observation of hand-hygiene compliance in a manufacturer of ready-to-eat pie and pastry products. Int J Environ Health Res 2019; 29:593-606. [PMID: 30569758 DOI: 10.1080/09603123.2018.1558183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Abstract
Food-handler hand-hygiene can be a contributory factor for food-borne illness. Cognitive data (knowledge/attitudes/self-reported practices), while informative, are not indicative of behaviour, and are subject to biases. Consequently, observation of behaviour is superior to survey data. However, researcher presence in direct observation increases reactivity, whereas video observation gives comprehensive analysis over a longer period, furthermore, familiarity reduces reactivity. Although video observation has been used to assess food safety at retail/foodservice, this valuable method is under-utilized in food-manufacturing environments. For the study, footage (24 h) was reviewed to assess compliance in a food-manufacturing site with company protocol. Video observation of food-handlers entering production (n = 674) was assessed; upon 70 occasions no attempt to implement hand-hygiene was observed. Of attempted hand-hygiene practices (n = 604), only 2% implemented compliant practices. Although 78% of attempts utilized soap, only 42% included sanitizer. Duration ranged from 1 to 69 s (Median 17 s). The study provides hand-hygiene data in an area that observational data is seldom captured.
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Affiliation(s)
- Ellen W Evans
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University , Cardiff , Wales
| | - Elizabeth C Redmond
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University , Cardiff , Wales
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Appiah-Brempong E, Newton S, Harris MJ, Gulis G. Effect of a theory-based hand hygiene educational intervention for enhancing behavioural outcomes in Ghanaian schools: a cluster-randomised controlled trial. Int J Public Health 2019; 65:99-109. [PMID: 31701186 DOI: 10.1007/s00038-019-01310-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The study sought to determine whether a hand hygiene educational intervention underpinned by educational and psychosocial theories is effective in enhancing behavioural intention and proper handwashing practices among school children. METHODS The study was a cluster-randomised controlled trial, with schools constituting the clusters. At baseline, 717 pupils organised in four clusters were recruited. Techniques for data collection included a structured observation. The Student's t test was used for data analysis. RESULTS At follow-up, a statistically significant difference was observed between the study arms with regard to intention to wash hands with soap [after toilet use (p = 0.032, d = 0.5); before meals (p = 0.020, d = 0.2)]. Similarly, a statistically significant difference was identified between the study arms with regard to the practice of handwashing with soap (HWWS) [after toilet use (p = 0.005); before meals (p = 0.012)]. CONCLUSIONS A theory-driven hand hygiene educational intervention involving school children can have a medium to a very large effect size, with respect to the practice of HWWS, and a low to a medium effect size with respect to behavioural intention.
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Affiliation(s)
- Emmanuel Appiah-Brempong
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana.
| | - Samuel Newton
- Department of Global and International Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Muriel J Harris
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, USA
| | - Gabriel Gulis
- Unit for Health Promotion Research, University of Southern Denmark (SDU), Esbjerg, Denmark
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Lucet JC, Heard I, Roueli A, Lafourcade A, Mandelbrot L, Estellat C, Dommergues M. Transvaginal ultrasound probes are human papillomavirus-free following low-level disinfection: cross-sectional multicenter survey. Ultrasound Obstet Gynecol 2019; 54:688-695. [PMID: 30908769 DOI: 10.1002/uog.20268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/25/2019] [Accepted: 03/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess the frequency of detection of high-risk human papillomavirus (hrHPV) on transvaginal ultrasound (TVS) probes and keyboards and evaluate operator compliance with national recommendations for prevention of cross-infection during TVS. METHODS This was a multicenter observational survey involving 46 public and private centers, in the Paris region of France, in which at least five consecutive TVS examinations were performed per day. We audited 676 TVS procedures. We recorded preventive hygiene actions undertaken by the operator at three stages: (1) during TVS; (2) during probe disinfection; and (3) during preparation of the probe for the next TVS. After probe disinfection, we collected one sample from the bare probe and one from the ultrasound keyboard; following probe preparation for the next examination, an additional sample was obtained from the covered probe. The samples were tested for presence of hrHPV DNA using the Cobas® 4800 System. RESULTS We did not detect hrHPV DNA in samples collected from uncovered or covered probes (0%; 95% CI, 0.00-0.55%). Keyboard samples were positive for hrHPV in two cases (0.3%; 95% CI, 0.04-1.07%). During TVS, the operator avoided touching the keyboard with a hand that had touched the patient's vulva in 86% of cases and held the probe with a gloved hand in 68%. Before probe disinfection, the operator wore new gloves, or performed hand disinfection in 8% of cases. The probe disinfection technique used was adequate in 87% of cases, not performed at all in 12% and insufficient in 1%. Before preparing the probe for the next scan, the operators disinfected their hands or used new gloves in 81% of cases. The probe cover and the coupling gel used complied with recommendations in 98% and 46% of cases, respectively. Of the seven preventive hygiene actions recommended in national guidelines, all were performed in 2%, three to six in 95% and two in 3% of observations. In four (9%) centers, disinfection was not performed in over half the observations. CONCLUSIONS No evidence of hrHPV DNA was found on TVS probes and probe covers following low-level disinfection, despite suboptimal compliance with hygiene guidelines. Routine TVS practice could be made easier and safer with a global approach to probe disinfection and hand hygiene. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J-C Lucet
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, Paris, France
- INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - I Heard
- National HPV Reference Laboratory, Institut Pasteur, Paris, France
| | - A Roueli
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Gynécologie Obstétrique, Paris, France
| | - A Lafourcade
- Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), INSERM, UMR 1123 ECEVE, CIC-1421, Paris, France
| | - L Mandelbrot
- INSERM, IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- AP-HP, Hôpital Louis Mourier, Service de Gynécologie Obstetrique, Colombes, France
- Collège National des Gynécologues Obstétriciens Français, Paris, France
| | - C Estellat
- Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), INSERM, UMR 1123 ECEVE, CIC-1421, Paris, France
| | - M Dommergues
- Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Service de Gynécologie Obstetrique, Paris, France
- Collège Français d'Echographie Fœtale, Montpellier, France
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Nagoshi Y, Cooper LA, Meyer L, Cherabuddi K, Close J, Dow J, Markham MJ, Stalvey C. Application of an objective structured clinical examination to evaluate and monitor intern's proficiency of hand hygiene and personal protective equipment use in the United States. J Educ Eval Health Prof 2019; 16:31. [PMID: 31614408 PMCID: PMC6819956 DOI: 10.3352/jeehp.2019.16.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To determine if an objective structured clinical examination (OSCE) could be used to evaluate and monitor hand hygiene and personal protective equipment (PPE) proficiency for medical interns in the United States. METHODS Interns in July 2015 (N=123, Cohort 1) without OSCE-based contact precaution evaluation and teaching were evaluated early 2016 by OSCE for hand hygiene and PPE proficiency. They performed poorly. Therefore, the new interns entering July 2016 (N=151, Cohort 2) were immediately tested in the same OSCE station as Cohort 1 and provided feedback and teaching. Cohort 2 was then retested in the OSCE station early 2017. The Mann Whitney U test was used to compare Cohort 1 vs. Cohort 2 performances on checklist items. Cohort 2 performance differences at the beginning and end of the intern year were compared using McNemar's X2 test for paired nominal data. RESULTS Checklist items were scored, summed and reported as percent correct. In Cohort 2, the mean percent correct was higher in posttest than pretest, 92% vs. 77% )(P <0 .0001). The passing rate (100% correct) was significantly higher, 55% vs. 16%. Comparing Cohort 1 and Cohort 2 at the end of intern year, the mean percent correct was higher for Cohort 2 compared to Cohort 1, 95% vs 90% (P < 0.0001). 55% of the Cohort 2 passed (a perfect score) compared to 24% in Cohort 1 (P < 0.0001). CONCLUSION An OSCE can be utilized to evaluate and monitor hand hygiene and PPE proficiency for interns in the United States.
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Affiliation(s)
- Ying Nagoshi
- Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Lou Ann Cooper
- College of Medicine Educational Affairs, University of Florida, Gainesville, FL, USA
| | - Lynne Meyer
- Graudate of Medical Education, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kartik Cherabuddi
- Division of Infectious Diseases, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Julia Close
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Jamie Dow
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Merry Jennifer Markham
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Carolyn Stalvey
- Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
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Abstract
OBJECTIVE To assess the potential clinical and economic impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance in a hypothetical general hospital in England, to reduce the incidence of healthcare-associated infections (HCAIs). METHODS Decision analysis estimated the impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance among front-line healthcare practitioners (HCPs). RESULTS The model assumed 4.7% of adult inpatients (ie, ≥18 years of age) and 1.72% of front-line HCPs acquire a HCAI in current practice. The model estimated that if use of the electronic audit and feedback system could lead to a reduction in the incidence of HCAIs of between 5% and 25%, then the annual number of HCAIs avoided could range between 184 and 921 infections per hospital and HCAI-related mortality could range between 6 and 31 deaths per annum per hospital. Additionally, up to 86 days of absence among front-line HCPs could be avoided and up to 7794 hospital bed days could be released for alternative use. Accordingly, the total annual hospital cost attributable to HCAIs could be reduced by between 3% and 23%, depending on the effectiveness of the electronic audit and feedback system. If introduction of the electronic audit and feedback system into current practice could lead to a reduction in the incidence of HCAIs by at least 15%, it would have a ≥0.75 probability of affording the National Health Service (NHS) a cost-effective intervention. CONCLUSION If the introduction of the electronic audit and feedback system into current practice in a hypothetical general hospital in England can improve hand hygiene compliance among front-line HCPs leading to a reduction in the incidence of HCAIs by ≥15%, it would potentially afford the NHS a cost-effective intervention.
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Affiliation(s)
- Julian F Guest
- Catalyst Consultants, Rickmansworth, UK
- King's College London, London, UK
| | | | - Dinah Gould
- Cardiff University School of Healthcare Studies, Cardiff, UK
- Healthcare Sciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Neil Wigglesworth
- Directorate of Infection, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Thomas AM, Kaur S, Biswal M, N Rao KL, Vig S. Effectiveness of hand hygiene promotional program based on the WHO multimodal hand hygiene improvement strategy, in terms of compliance and decontamination efficacy in an indian tertiary level neonatal surgical intensive care unit. Indian J Med Microbiol 2019; 37:496-501. [PMID: 32436870 DOI: 10.4103/ijmm.ijmm_20_47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The WHO Multimodal Hand Hygiene Improvement Strategy (MHHIS) has been proposed to improve the Hand Hygiene (HH) compliance of the WHO recommendations on HH.Therefore, the current study was planned in our neonatal unit with the objective of evaluating the effectiveness of a Hand Hygiene Promotional Program (HHPP) based on the WHO MHHIS, in terms of compliance and decontamination efficacy among the health-care workers (HCWs) in the unit. Objective The objective of the study was to evaluate the effectiveness of the WHO MHHIS on HH compliance and decontamination efficacy. Methods The HHPP was carried out in our neonatal surgical intensive care unit from July to August 2013. A pre-intervention phase consisted of assessment of ward infrastructure, HH knowledge and perception, determination of HH compliance and collection of hand rinse samples from the HCWs before and after handwashing. Intervention phase consisted of changing traditional to elbow-operated taps, display of posters and reminders, placement of soaps in water draining trays, autoclaved single-use paper towels for hand drying, availability of hand rubs and training sessions for health-care providers. In the post-intervention phase, all the assessments and observations of pre-intervention phase were repeated. Results HHPP resulted in a significant increase in overall HH compliance from 26.6% (95% confidence interval [CI] 23.9-29.3) to 65.3% (95% CI 62.4-68.2) (P < 0.001) and reduction in load of microorganisms (P = 0.013). There was a significant improvement in HH knowledge (P < 0.001), and perception surveys revealed high appreciation of each strategy component by the participants. Conclusion To the best of our knowledge, this is the first study about the effect of implementation of the WHO MHHIS from an Indian hospital. HHPP was found to be effective in terms of HH compliance and decontamination efficacy. Its implementation is highly recommended to promote HH in a developing country like India.
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Affiliation(s)
- Alphonsa Muth Thomas
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhwinder Kaur
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Biswal
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K L N Rao
- Department of Pediatric Surgery, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shashi Vig
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Gartmeier M, Baumgartner M, Burgkart R, Heiniger S, Berberat PO. Why hand hygiene is not sufficient: modeling hygiene competence of clinical staff as a basis for its development and assessment. GMS J Med Educ 2019; 36:Doc39. [PMID: 31544139 PMCID: PMC6737265 DOI: 10.3205/zma001247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/06/2019] [Accepted: 05/28/2019] [Indexed: 06/10/2023]
Abstract
Adhering to hygiene standards in daily clinical work is an important characteristic of qualitatively high-value medical care. In this regards, hand hygiene is often focused on in the literature. From the viewpoint of medical education research, we argue that this focus is too narrow to explain how staff who are working clinically with patients implement and adhere to standards of hygiene across a wide variety of tasks of their daily clinical routine. We present basic features of a differentiated concept of hygiene competence, which includes specialized knowledge, corresponding inner attitudes, and action routines that are customized to the needs of specific situations. Building on that, we present a current simulation-based course concept aimed at developing hygiene competence in medical education. Furthermore, we describe a test instrument that is designed according to the principle of a situational judgment test and that appears promising for the assessment of hygiene competence. The course and the measurement instrument are discussed in regards to their fit to the competence model and the related perspectives for research and teaching.
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Affiliation(s)
- Martin Gartmeier
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Maria Baumgartner
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Rainer Burgkart
- Technical University of Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany
| | - Susanne Heiniger
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Pascal O. Berberat
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
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Li Y, Liu Y, Zeng L, Chen C, Mo D, Yuan S. Knowledge and practice of hand hygiene among hospitalised patients in a tertiary general hospital in China and their attitudes: a cross-sectional survey. BMJ Open 2019; 9:e027736. [PMID: 31189679 PMCID: PMC6575675 DOI: 10.1136/bmjopen-2018-027736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We aimed to gain a better understanding of patients' practice of hand hygiene (HH) and their knowledge and attitudes. DESIGN A cross-sectional survey. SETTING A 3500-bed university-affiliated medical hospital in China. PARTICIPANTS Inpatients and their family members or caregivers. METHODS An anonymous, self-reported questionnaire were used to collect data. RESULTS A total of 376 questionnaires were issued, and 310 respondents completed it. Of the 310 respondents, 47.4% had received HH education, and 13.5% had a completing understanding of HH. A majority of patients believed that handwashing was important for disease recovery, and that it could prevent infection development. A total of 62.3% of patients washed their hands <5 times a day and 49.0% spent <1 min every time. With regards to the seven steps of handwashing, 96.45% of the respondents adhered to the first step (washing the palms), but only 20.6% adhered to the fifth step (thumbs) and 17.7% to the sixth step (fingertips). Most respondents washed their hands only when visibly dirty. Few patients washed their hands before drinking fluids, and before and after interacting with visitors. HH compliance was lower among intensive care unit patients than medical patients. CONCLUSIONS In conclusion, this study demonstrated that patients had a positive attitude towards HH. However, their levels of knowledge and practice were unsatisfactory. A systematical education about patientHH is needed in future to correct this knowledge and behaviour.
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Affiliation(s)
- Yunxia Li
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Yaohong Liu
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Li Zeng
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Chong Chen
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Dan Mo
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
| | - Sue Yuan
- Infectious Diseases Department, Xiangya Hospital Central South University, Changsha, China
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40
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Or PPL, Ching PTY, Chung JWY. A program to improve the hand hygiene compliance of Hong Kong preschoolers with an insight into their absenteeism. Am J Infect Control 2019; 47:498-503. [PMID: 30612818 DOI: 10.1016/j.ajic.2018.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hand hygiene prevents cross-infection and is the most effective defense against contagious diseases. Preschoolers, without proper hand hygiene skills, are a vulnerable group to such diseases. The aim of this study was to evaluate whether hand hygiene compliance training of preschoolers in Hong Kong improves their hand hygiene knowledge and performance, and whether the training reduces their absenteeism resulting from influenza symptoms. METHODS This was a quasi-experimental study with a pretest-posttest design. A total of 110 preschoolers participated in a program consisting of 4 training sessions on hand hygiene. Before and after the program, their hand hygiene knowledge was assessed by 10 true or false questions, and their handwashing skills were assessed by photos of their hands taken before and after handwashing. Before handwashing, a fluorescent stain gel was used to cover their hands. To determine whether a causal relationship existed between compliance and absenteeism, the preschoolers' absenteeism data were collected during a period of 3 months for analysis. RESULTS Significant differences were found in hand hygiene knowledge on handwashing steps, duration, and after playing with toys. Percentage increases were recorded for 8 questions. There was significant improvement in hand hygiene performance on the fronts and the backs of fingers, thumbs, and fingertips (P < .05). The findings showed a decrease in absence rates with influenza symptoms for the month before (31%), during (30%), and after (25%) the completion of the program in all participating schools. DISCUSSION After the training program, the participants' hand hygiene knowledge and performance considerably improved. They washed their hands more thoroughly and there was a significant reduction in absences owing to influenza. CONCLUSIONS Good cooperation between schools and families is found to be important in helping students build positive attitudes and habits, even in performing simple routines like hand hygiene.
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Affiliation(s)
- Peggy P L Or
- Department of Health and Physical Education, The Education University of Hong Kong, New Territories, Hong Kong.
| | - Patricia T Y Ching
- World Health Organization Collaboration Centre for Infectious Disease Epidemiology and Control, The School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Joanne W Y Chung
- Department of Health and Physical Education, The Education University of Hong Kong, New Territories, Hong Kong
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Suen LKP, Wong JWS, Lo KYK, Lai TKH. The use of hand scanner to enhance hand hygiene practice among nursing students: A single-blinded feasibility study. Nurse Educ Today 2019; 76:137-147. [PMID: 30784842 DOI: 10.1016/j.nedt.2019.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/29/2019] [Indexed: 05/25/2023]
Affiliation(s)
- Lorna K P Suen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; Hospital Authority, Hong Kong, China.
| | - Joy W S Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; Hospital Authority, Hong Kong, China
| | - Kiki Y K Lo
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; Hospital Authority, Hong Kong, China.
| | - Timothy K H Lai
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; Hospital Authority, Hong Kong, China.
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Plemmons MM, Marcenaro J, Oermann MH, Thompson J, Vacchiano CA. Improving infection control practices of nurse anesthetists in the anesthesia workspace. Am J Infect Control 2019; 47:551-557. [PMID: 30665777 DOI: 10.1016/j.ajic.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anesthesia providers commonly cross-contaminate their workspace and subsequently put patients at risk for a health care-acquired infection. The primary objective of this project was to determine if education and implementation of standardized infection control guidelines that address evidence-based best practices would improve compliance with infection control procedures in the anesthesia workspace. METHODS Patient care-related hand hygiene of nurse anesthetists was observed in 3 areas of anesthesia practice before and 3 weeks and 3 months after staff education, placement of visual reminders, and the implementation of infection control guidelines. After the observation periods, the percent compliance on the part of the providers was calculated for each of the 3 areas of anesthesia practice, and the results were compared using the Fisher exact test. RESULTS There were a total of 95 observations performed during the 3 observation periods. When compared with preimplementation baseline data, there was a 26.2% increase in the number of providers compliant with hand hygiene practices after airway instrumentation (P = .029) and a 71.9% increase in the number of providers who separated clean from contaminated items in the workspace (P = .0001). CONCLUSIONS Education, visual reminders, and standardized infection control guidelines were shown to improve compliance with infection control best practices in a group of nurse anesthetists.
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Affiliation(s)
| | | | | | | | - Charles A Vacchiano
- Duke University School of Nursing, Durham, NC; Duke University Hospital, Durham, NC
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Ataiyero Y, Dyson J, Graham M. Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. Am J Infect Control 2019; 47:565-573. [PMID: 30470526 DOI: 10.1016/j.ajic.2018.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hand hygiene (HH) is the primary measure in the prevention of health care-associated infections; however, from published studies, compliance of health care workers (HCWs) to HH guidelines is low. There is currently no review on HH compliance rates in developing countries, specifically sub-Saharan Africa (SSA), or the barriers to compliance. We therefore, through a narrative review, sought to identify the compliance with and the barriers to HH in SSA. METHODS From 3 databases, we performed a search of peer-reviewed studies from SSA, conducted among HCWs, published in the English language between 2005 and 2017. Only studies that reported HH compliance and/or barriers were included. RESULTS A total of 278 articles were identified, and the final sample of 27 articles was analyzed in full length. Overall, the HH compliance rate was estimated to be 21.1%, and doctors had better compliance irrespective of the type of patient contact. The main barriers identified were heavy workload, infrastructural deficit (eg, lack of water, soap, hand sanitizers, and blocked/leaking sinks), and poorly positioned facilities. CONCLUSIONS HH compliance is poor among SSA HCWs. There is a need for more reports of HH compliance in SSA, and emphasis needs to be placed on surgical wards in which surgical site infections-the most common form of health care-associated infections in SSA-are most likely to occur. Barriers identified in this review are consistent with the findings of studies conducted elsewhere; however, it appears that heavy workload, infrastructural deficit, and poorly positioned facilities are more likely in developing countries.
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Affiliation(s)
- Yetunde Ataiyero
- School of Health and Social Work, University of Hull, Hull, United Kingdom.
| | - Judith Dyson
- School of Health and Social Work, University of Hull, Hull, United Kingdom
| | - Moira Graham
- School of Health and Social Work, University of Hull, Hull, United Kingdom
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Buxton H, Flynn E, Oluyinka O, Cumming O, Esteves Mills J, Shiras T, Sara S, Dreibelbis R. Hygiene During Childbirth: An Observational Study to Understand Infection Risk in Healthcare Facilities in Kogi and Ebonyi States, Nigeria. Int J Environ Res Public Health 2019; 16:ijerph16071301. [PMID: 30979005 PMCID: PMC6479678 DOI: 10.3390/ijerph16071301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 11/18/2022]
Abstract
Background: Infections acquired during labour and delivery are a significant cause of maternal and child morbidity and mortality. Adherence to hand hygiene protocols is a critical component of infection prevention strategies, but few studies have closely examined the hand hygiene of health care providers with sufficient detail to understand infection risks and prioritize prevention strategies. Methods: This observational study was conducted in six healthcare facilities in Nigeria. In each, five women were observed from the onset of labour through to delivery of the placenta. Hand hygiene infection risk was estimated for all procedures requiring aseptic technique compared against adherence to proper hand hygiene protocol and potential recontamination events. Results: Hands were washed with soap and sterile gloves applied with no observed recontamination before only 3% of all observed procedures requiring aseptic technique. There was no significant difference in hygiene compliance between midwives and doctors nor facilities or states. Adherence to proper hygiene protocol was observed more in morning compared to afternoon and night shifts. Conclusions: This study highlights that hand hygiene remains a barrier to delivering high-quality and safe care in health facilities. Improving hygiene practices during labour and delivery will require strategies that extend beyond infrastructure provision.
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Affiliation(s)
- Helen Buxton
- Disease Control Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Erin Flynn
- Infection and Immunity, South Australian Health and Medical Research Institute, Adelaide 5000, Australia.
| | - Olutunde Oluyinka
- Maternal and Child Survival Program (MCSP)/Save the Children Nigeria, Abuja, Nigeria.
| | - Oliver Cumming
- Disease Control Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Joanna Esteves Mills
- Disease Control Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Tess Shiras
- Disease Control Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Stephen Sara
- Maternal and Child Survival Program (MCSP)/Save the Children US, Washington, DC 20036, USA.
| | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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ANWAR M, ELAREED H. Improvement of hand hygiene compliance among health care workers in intensive care units. J Prev Med Hyg 2019; 60:E31-E35. [PMID: 31041408 PMCID: PMC6477560 DOI: 10.15167/2421-4248/jpmh2019.60.1.918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 12/03/2018] [Indexed: 01/11/2023]
Abstract
Aim Hand hygiene (HH) is an essential component in preventing healthcare associated infections. The purpose of this study was to evaluate HH compliance among health care workers (HCWs) in intensive care units at Beni-Suef university hospital, Egypt before and after an intervention educational program. Methods Data were collected by using the standardized WHO method for direct observation ‘‘Five moments for HH’’ approach. Observations were conducted in six ICUs before intervention (March to April 2017) and after the intervention (July to August 2017). The study included 608 opportunities (observations) among 177 HCWs collected before and 673 opportunities among 163 HCWs collected after the intervention. Results Overall HH compliance increased significantly from 30.9 (95% CI: 27.2-34.6%) before intervention to 69.5 (95% CI: 65.2-72.6%) post intervention; with the highest HH compliance rate among nurses compared to physicians and workers (P = 0.001). Significantly higher HH compliance rates were observed after body fluid exposure, before aseptic procedures, and after patient contact compared to before patient contact and after patient surrounding contact (P = 0.001). In binary logistic regression analyses a statistically significant difference was shown (P = 0.047) for HH compliance among events before and after patient contact (OR = 1.399, 95% CI: 1.004-1.948). Conclusions The interventional educational program improved the HH compliance among ICUs-HCWs at Beni-Suef university hospital. The hospital should conduct monthly observational monitoring for the ICUs units sharing the findings to spread best practices. Provision of sustained training programs to help efficient and effective HH for care delivery is mandatory.
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Affiliation(s)
- M.M ANWAR
- Manal Mohamed Anwar, Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Egypt - Tel +20 82 2324879 - Fax +20 82 2333367 - E-mail:
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Merino-Plaza MJ, Rodrigo-Bartual V, Boza-Cervilla M, García-Llopis A, Gomez-Pajares F, Carrera-Hueso FJ, Fikri-Benbrahim N. [How to increase the health staff adherence to the hands hygiene protocol?]. Rev Esp Salud Publica 2018; 92:e201810072. [PMID: 30337517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 10/02/2018] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE Nosocomial infection is a frequent adverse event in health care. Hand hygiene (HH) reduces cross-transmission, but staff adherence is not always adequate. The objectives of this work were evaluating the effectiveness of the HH technique applied in the workplace and monitoring the adherence of the healthcare staff of a Hospital of Medium-Long Stay to the HH protocol. METHODS Two cross sectional studies were carried out (2010-2012), to determine the prevalence of colonization of the hands of the staff by pathogenic microorganisms, a cross-sectional study (2015), to evaluate their knowledge of the HH technique and two cross-sectional studies (2015-2016), to evaluate the compliance of the protocol in the healthcare practice. The WHO Self-Assessment Framework was applied annually. The hydroalcoholic solution consumption was monitored as a process indicator. RESULTS The prevalence of colonization of the staff hands went from 28.3% to 21.2%. Compliance with hand hygiene went from 39.5% to 72% and the results of the WHO Self-Assessment Framework went from an intermediate level with 287.5 points to an advanced level with 432.5 points. The consumption of hydroalcoholic solution went from 3.9 to 19.3 liters/1000 stays. CONCLUSIONS Staff adherence to the HH protocol has increased, having significantly improved the compliance with the recommendations, the hydroalcoholic solution consumption and the HH level assigned to the hospital. The most effective measures to improve the results have been the development of specific improvement plans, having been decisive, the involvement of managers and the use of direct observation as a regular method of work.
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Affiliation(s)
- María José Merino-Plaza
- Programa de Farmacia Social. Universidad de Granada. Granada. España
- Hospital Dr. Moliner. Valencia. España
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Koornneef EJ, Dariel A, Elbarazi I, Alsuwaidi AR, Robben PBM, Nikiforakis N. Surveillance cues do not enhance altruistic behavior among anonymous strangers in the field. PLoS One 2018; 13:e0197959. [PMID: 30114252 PMCID: PMC6095487 DOI: 10.1371/journal.pone.0197959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 05/13/2018] [Indexed: 11/24/2022] Open
Abstract
The degree of altruistic behavior among strangers is an evolutionary puzzle. A prominent explanation is the evolutionary legacy hypothesis according to which an evolved reciprocity-based psychology affects behavior even when reciprocity is impossible, i.e., altruistic behavior in such instances is maladaptive. Empirical support for this explanation comes from laboratory experiments showing that surveillance cues, e.g., photographs of watching eyes, increase altruistic behavior. A competing interpretation for this evidence, however, is that the cues signal the experimenter's expectations and participants, aware of being monitored, intentionally behave more altruistically to boost their reputation. Here we report the first results from a field experiment on the topic in which participants are unaware they are being monitored and reciprocity is precluded. The experiment investigates the impact of surveillance cues on a textbook example of altruistic behavior-hand hygiene prior to treating a 'patient'. We find no evidence surveillance cues affect hand hygiene, despite using different measures of hand-hygiene quality and cues that have been previously shown to be effective. We argue that surveillance cues may have an effect only when participants have reasons to believe they are actually monitored. Thus they cannot support claims altruistic behavior between strangers is maladaptive.
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Affiliation(s)
- Erik J. Koornneef
- Institute for Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Aurelie Dariel
- Division of Social Science, New York University Abu Dhabi, Abu Dhabi, UAE
| | | | | | - Paul B. M. Robben
- Institute for Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Nikos Nikiforakis
- Division of Social Science, New York University Abu Dhabi, Abu Dhabi, UAE
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Karaoglu MK, Akin S. Effectiveness of Hygienic Hand Washing Training on Hand Washing Practices and Knowledge: A Nonrandomized Quasi-Experimental Design. J Contin Educ Nurs 2018; 49:360-371. [PMID: 30053307 DOI: 10.3928/00220124-20180718-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/12/2018] [Indexed: 11/20/2022]
Abstract
Nurses undertake important responsibilities in patient care and the prevention of hospital-acquired infections. However, adherence to hand hygiene practices among nurses has been reported to be low. This study aims to evaluate the effectiveness of hygienic hand washing training on hand washing practices and knowledge. The study design was a nonrandomized, quasi-experimental study, with pretest-posttest for one group. Pre- and postobservations were also conducted using an observation form on any 5 workdays to evaluate the effectiveness of hygienic hand washing training on hand washing practices. The study was conducted with 63 nurses working at a hospital in Istanbul. Hand Hygiene Knowledge Form scores after hygienic hand washing training were higher than the pretraining scores. The number of the nurses' hand hygiene actions after hand hygiene training increased significantly compared with that before training. The results indicate that training in proper hand washing techniques and hygienic hand washing practices positively affects the knowledge level of nurses and their hand washing behavior. J Contin Educ Nurs. 2018;49(8):360-371.
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Sharif F, Khan A, Samad MA, Hamid A, Aijaz A, Asad I, Fatima M, Panni UY, Irshad A, Awais MB, Rizvi N. Knowledge, attitude, and practices regarding infection control measures among medical students. J PAK MED ASSOC 2018; 68:1065-1069. [PMID: 30317303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the knowledge, attitude and reported practices of medical students regarding infection control measures. METHODS The cross-sectional, questionnaire-based study was conducted at one public and one private medical university in Karachi from January to February 2016. The students enrolled were in their clinical years of the Bachelor of Medicine, Bachelor of Surgery course and their knowledge, attitude and practice were measured regarding infection control measures. SPSS 19 was used to analyse data. RESULTS There were 413 medical students with a mean age of 21.78±1.10 years. Overall, 206(49.9%) students were from the private university and 207(50.1%) from the public institution. Students from the private institution had better knowledge compared to those from the public institution regarding hand hygiene (p<0.001), needlestick injuries (p<0.001) and surgical scrubbing (p=0.007), as well as better reported practices regarding hand hygiene (p<0.001) and surgical scrubbing (p=0.001). CONCLUSIONS Knowledge and practices of medical students regarding the method of surgical scrubbing and needlestick injury protocols in particular needed improvement.
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Affiliation(s)
| | - Aysha Khan
- Medical College, The Aga Khan University
| | | | | | - Amna Aijaz
- Medical College, The Aga Khan University
| | - Iqra Asad
- Medical College, The Aga Khan University
| | | | | | | | | | - Narjis Rizvi
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi
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