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Mukerji A, Narciso J, Moore C, McGeer A, Kelly E, Shah V. An observational study of the hand hygiene initiative: a comparison of preintervention and postintervention outcomes. BMJ Open 2013; 3:bmjopen-2013-003018. [PMID: 23793705 PMCID: PMC3664348 DOI: 10.1136/bmjopen-2013-003018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To evaluate the impact of implementing a simple, user-friendly eLearning module on hand hygiene (HH) compliance and infection rates. DESIGN Preintervention and postintervention observational study. PARTICIPANTS All neonates admitted to the neonatal intensive care unit (NICU) over the study period were eligible for participation and were included in the analyses. A total of 3422 patients were admitted over a 36-month span (July 2009 to June 2012). INTERVENTIONS In the preintervention and postintervention periods (phases I and II), all healthcare providers were trained on HH practices using an eLearning module. The principles of the '4 moments of HH' and definition of 'baby space' were incorporated using interactive tools. The intervention then extended into a long-term sustainability programme (phase III), including the requirement of an annual recertification of the module and introduction of posters and screensavers throughout the NICU. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was HH compliance rates among healthcare providers in the three phases. The secondary outcome was healthcare-associated infection rates in the NICU. RESULTS HH compliance rates declined initially in phase II then improved in phase III with the addition of a long-term sustainability programme (76%, 67% and 76% in phases I, II and III, respectively (p<0.01). Infection rates showed an opposing, but concomitant trend in the overall population as well as in infants <1500 g and were 4%, 6% and 4% (p=0.02), and 11%, 21% and 16% (p<0.01), respectively, during the three phases. CONCLUSIONS Interventions to improve HH compliance are challenging to implement and sustain with the need for ongoing reinforcement and education.
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Affiliation(s)
- Amit Mukerji
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Janet Narciso
- Department of Nursing, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christine Moore
- Department of Infection Control, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Edmond Kelly
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vibhuti Shah
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Observance of hand washing procedures performed by the medical personnel after the patient contact. Part II. Int J Occup Med Environ Health 2013; 26:257-64. [PMID: 23715929 DOI: 10.2478/s13382-013-0094-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 01/03/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The Centers for Disease Control and Prevention (CDC) as well as the World Health Organization (WHO) state that adequate hand hygiene maintained by medical personnel is an indispensable prerequisite for controlling nosocomial infections. The recommendations of CDC and WHO emphasize the obligation to wash hands after each contact with a patient, after the exposure to a potentially infectious material or upon the contact with objects surrounding the patient. MATERIALS AND METHODS The study was performed by quasi-observation among the group of 188 medical staff members (nurses and physicians) working in three selected hospitals of the Łódź Province. The procedure of hand washing/disinfection performed directly after the patient contact according to the recommendations of CDC and WHO was observed. The results were subject to statistical analysis (p < 0.05). RESULTS During 1544 h of observations, 4101 activities requiring hand washing were recorded. The medical personnel followed the hand hygiene procedures after the patient contact in 26.4% of the situations that require hygiene according to the guidelines. The level of observance of the hand washing procedures depended significantly on the type of performed activity, profession, degree of workload, index of activity, and time of duty hours. The mean time of hand washing after patient contact was 9.2 s for physicians and 6.7 s for nurses. CONCLUSION Both the level of observance of hygienic procedures after the contact with patients as well as the time of hand washing are insufficient. There is an urgent need to work out educational programs on maintaining proper hand hygiene for medical personnel.
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Monistrol O, López ML, Riera M, Font R, Nicolás C, Escobar MA, Freixas N, Garau J, Calbo E. Hand contamination during routine care in medical wards: the role of hand hygiene compliance. J Med Microbiol 2013; 62:623-629. [DOI: 10.1099/jmm.0.050328-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Olga Monistrol
- Nosocomial Infection Control and Service of Internal Medicine, Hospital Universitari MútuaTerrassa, Plaça Dr Robert 08221 Terrassa, Barcelona, Spain
| | - M. Liboria López
- Catlab, Parc Logístic de Salut, Vial de Sant Jordi s/n Viladecavalls, Barcelona, Spain
| | - Montserrat Riera
- Nosocomial Infection Control and Service of Internal Medicine, Hospital Universitari MútuaTerrassa, Plaça Dr Robert 08221 Terrassa, Barcelona, Spain
| | - Roser Font
- Nosocomial Infection Control and Service of Internal Medicine, Hospital Universitari MútuaTerrassa, Plaça Dr Robert 08221 Terrassa, Barcelona, Spain
| | - Carme Nicolás
- Nosocomial Infection Control and Service of Internal Medicine, Hospital Universitari MútuaTerrassa, Plaça Dr Robert 08221 Terrassa, Barcelona, Spain
| | - Miguel Angel Escobar
- Nursing Faculty, Campus de Ciències de la Salut, University of Lleida, Avinguda de l’Alcalde Rovira Roure, 44, E-25198 Lleida, Spain
| | - Núria Freixas
- Nosocomial Infection Control and Service of Internal Medicine, Hospital Universitari MútuaTerrassa, Plaça Dr Robert 08221 Terrassa, Barcelona, Spain
| | - Javier Garau
- Nosocomial Infection Control and Service of Internal Medicine, Hospital Universitari MútuaTerrassa, Plaça Dr Robert 08221 Terrassa, Barcelona, Spain
| | - Esther Calbo
- Campus Sant Cugat, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
- Nosocomial Infection Control and Service of Internal Medicine, Hospital Universitari MútuaTerrassa, Plaça Dr Robert 08221 Terrassa, Barcelona, Spain
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Meadow JF, Bateman AC, Herkert KM, O'Connor TK, Green JL. Significant changes in the skin microbiome mediated by the sport of roller derby. PeerJ 2013; 1:e53. [PMID: 23638391 PMCID: PMC3628844 DOI: 10.7717/peerj.53] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/28/2013] [Indexed: 12/20/2022] Open
Abstract
Diverse bacterial communities live on and in human skin. These complex communities vary by skin location on the body, over time, between individuals, and between geographic regions. Culture-based studies have shown that human to human and human to surface contact mediates the dispersal of pathogens, yet little is currently known about the drivers of bacterial community assembly patterns on human skin. We hypothesized that participation in a sport involving skin to skin contact would result in detectable shifts in skin bacterial community composition. We conducted a study during a flat track roller derby tournament, and found that teammates shared distinct skin microbial communities before and after playing against another team, but that opposing teams’ bacterial communities converged during the course of a roller derby bout. Our results are consistent with the hypothesis that the human skin microbiome shifts in composition during activities involving human to human contact, and that contact sports provide an ideal setting in which to evaluate dispersal of microorganisms between people.
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Affiliation(s)
- James F Meadow
- Biology and the Built Environment Center, Institute of Ecology and Evolution, University of Oregon , Eugene, OR , USA
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FitzGerald G, Moore G, Wilson APR. Hand hygiene after touching a patient's surroundings: the opportunities most commonly missed. J Hosp Infect 2013; 84:27-31. [PMID: 23466294 DOI: 10.1016/j.jhin.2013.01.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Healthcare workers generally underestimate the role of environmental surfaces in the transmission of infection, and compliance with hand hygiene following contact with the environment is generally lower than following direct patient contact. To reduce the risk of onward transmission, healthcare workers must identify the need to wash hands with specific tasks or events. AIM To observe the movement of staff in critical care and general wards and determine the routes most commonly travelled and the surfaces most frequently touched with and without appropriate hand hygiene. METHODS Fifty-eight 90 min sessions of unobtrusive observation were made in open bays and isolation rooms. Link analysis was used to record staff movement from one location to another as well as the frequency of motion. Hand-hygiene audits were conducted using the World Health Organization 'five moments for hand hygiene' observational tool. FINDINGS In critical care, the majority of movement occurred within the bed space. The bedside computer and equipment trolley were the surfaces most commonly touched, often immediately after patient contact. In the general ward, movement between bed spaces was more common and observed hand hygiene ranged from 25% to 33%. Regardless of ward type, observed hand-hygiene compliance when touching the patient immediately on entering an isolation room was less than 30%. CONCLUSIONS Healthcare workers must be made aware that bacterial spread can occur even during activities of perceived low risk. Education and intervention programmes should focus on the potential contamination of ward computers, case notes and door handles.
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Affiliation(s)
- G FitzGerald
- Department of Microbiology & Virology, University College London Hospitals NHS Foundation Trust, 60 Whitfield Street, London, UK
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Abstract
There exists general agreement within neonatology that antibiotics should be administered promptly to neonates with possible bacterial sepsis and meningitis. We initiated a series of quality improvement cycles designed to reduce delays in the initiation of antibiotic therapy to less than 2 hours when hospital-acquired infection (HAI) was suspected. All infants in this study were in neonatal intensive care (level II or III) who were started on antibiotics for a suspected HAI (defined as an infection that occurred 72 hours after admission to the NICU) were audited. Through a series of quality improvement cycles, we analyzed sources of delays in the initiation of antibiotic therapy from the time the order was written through administration. In subsequent cycles, we intervened to reduce delays through education, standardize the evaluation process, and develop an online ordering system that streamlined the workflow patterns in the nurseries and pharmacy. Using a prospective cohort design, we compared antibiotic delivery times after each process improvement cycle. Antibiotic delivery time was reduced from a median of 137.5 minutes to 75 minutes and variation of practice was reduced in terms of standard deviation and range (P < .001). The use of computerized physician order entry significantly improved the writing of STAT orders (P < .0001). A systematic analysis of workflow patterns and efficiencies, coupled with improvement cycles targeting delays and development of a computerized physician order entry system, allowed us to improve antibiotic delivery time in neonates with suspected HAI in an intensive care nursery system.
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Kotsanas D, Lovegrove A, Sloane TL, Gillespie EE. Disposable biocidal cubical curtains: can they prevent the transfer of bacterial pathogens? ACTA ACUST UNITED AC 2012. [DOI: 10.1071/hi12015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gray J, Arvelo W, McCracken J, Lopez B, Lessa FC, Kitchel B, Wong B, Reyes L, Lindblade K. An outbreak of Klebsiella pneumoniae late-onset sepsis in a neonatal intensive care unit in Guatemala. Am J Infect Control 2012; 40:516-20. [PMID: 22854378 DOI: 10.1016/j.ajic.2012.02.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 02/08/2012] [Accepted: 02/09/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gram-negative bloodstream infections are an important cause of neonatal mortality. In October 2009, we investigated a Klebsiella spp outbreak in a neonatal intensive care unit in Guatemala. METHODS Probable cases were defined as a Klebsiella spp isolated from blood in neonates aged <28 days in the neonatal intensive care unit between October 1 and November 10, 2009; confirmed cases were identified as Klebsiella pneumoniae. Clinical data were abstracted from medical charts. K pneumoniae isolates were genotyped by pulsed-field gel electrophoresis (PFGE) and tested for antimicrobial susceptibility. Infection control practices were inspected. RESULTS There were 14 confirmed cases. The median age at onset of infection was 3 days (range, 2-8 days). Nine patients died (64%). K pneumoniae isolates were resistant to multiple antimicrobials. PFGE revealed 2 distinct clusters. Breaches in infection control procedures included inappropriate intravenous solution use and inadequate hand hygiene and contact precautions. CONCLUSIONS We report a K pneumoniae outbreak with high neonatal mortality in Guatemala. PFGE clustering suggested a common source possibly related to reuse of a single-use intravenous medication or solution. The risk for K pneumoniae bloodstream infections in neonates in low-resource settings where sharing of solutions is common needs to be emphasized.
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Chou DTS, Achan P, Ramachandran M. The World Health Organization '5 moments of hand hygiene': the scientific foundation. ACTA ACUST UNITED AC 2012; 94:441-5. [PMID: 22434456 DOI: 10.1302/0301-620x.94b4.27772] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The World Health Organization (WHO) launched the first Global Patient Safety Challenge in 2005 and introduced the '5 moments of hand hygiene' in 2009 in an attempt to reduce the burden of health care associated infections. Many NHS trusts in England adopted this model of hand hygiene, which prompts health care workers to clean their hands at five distinct stages of caring for the patient. Our review analyses the scientific foundation for the five moments of hand hygiene and explores the evidence, as referenced by WHO, to support these recommendations. We found no strong scientific support for this regime of hand hygiene as a means of reducing health care associated infections. Consensus-based guidelines based on weak scientific foundations should be assessed carefully to prevent shifting the clinical focus from more important issues and to direct limited resources more effectively. We recommend caution in the universal adoption of the WHO '5 moments of hand hygiene' by orthopaedic surgeons and other health care workers and emphasise the need for evidence-based principles when adopting hospital guidelines aimed at promoting excellence in clinical practice.
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Affiliation(s)
- D T S Chou
- Royal London Hospital, Barts and The London NHS Trust, Whitechapel Road, London E1 1BB, UK
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Conceição T, Aires de Sousa M, Miragaia M, Paulino E, Barroso R, Brito MJ, Sardinha T, Sancho L, Carreiro H, de Sousa G, Machado MDC, de Lencastre H. Staphylococcus aureusReservoirs and Transmission Routes in a Portuguese Neonatal Intensive Care Unit: A 30-Month Surveillance Study. Microb Drug Resist 2012; 18:116-24. [DOI: 10.1089/mdr.2011.0182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Teresa Conceição
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Oeiras, Portugal
| | | | - Maria Miragaia
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Oeiras, Portugal
| | | | | | | | | | | | | | | | | | - Hermínia de Lencastre
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Oeiras, Portugal
- Laboratory of Microbiology, The Rockefeller University, New York, New York
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Nakamura RK, Tompkins E, Braasch EL, Martinez JG, Bianco D. Hand hygiene practices of veterinary support staff in small animal private practice. J Small Anim Pract 2012; 53:155-60. [DOI: 10.1111/j.1748-5827.2011.01180.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hospital-Associated Infections in the Neonate. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2012. [PMCID: PMC7151960 DOI: 10.1016/b978-1-4377-2702-9.00096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lima KVB, Carvalho RGC, Carneiro ICDRS, Lima JLDS, Sousa CDO, Loureiro ECB, Sá LLCD, Bastos FC. Outbreak of neonatal infection by an endemic clone of Serratia marcescens. Rev Soc Bras Med Trop 2011; 44:106-9. [PMID: 21340420 DOI: 10.1590/s0037-86822011000100024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 10/06/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The outbreak occurred between February and June 2006 and included identification of the cases, analysis of medical records, cultures from environmental sources, resistance analyses and genotyping profile of Serratia marcescens. METHODS The cultures were composed of 13 blood isolates, 17 rectal and hand swabs and air sampling. RESULTS The data obtained by pulsed-field gel electrophoresis exhibited three strains that contaminated 24 patients. Systemic infection was the most common in neonates with lower weight, long periods of hospitalization, premature delivery and the use of mechanical ventilation. CONCLUSIONS This investigation revealed the multifactorial nature of the outbreak. An endemic clone of S. marcescens was detected.
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Miller T, Patrick D, Ormrod D. Hand decontamination: influence of common variables on hand-washing efficiency. ACTA ACUST UNITED AC 2011. [DOI: 10.1071/hi10027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
BACKGROUND Notifiable diseases in England and Wales include cholera, plague, relapsing fever, smallpox, typhus and food poisoning. S 26(1) of the Public Health (Control of Disease) Act 1984 Part II made it a criminal offence to place material which is known to have been exposed to infection from a notifiable disease or one of a number of additional diseases, and which has not been disinfected, in a dustbin. One such potential infection risk that is often placed in dustbins is the disposable nappy, particularly from children who are suffering from gastroenteritis. METHOD A literature review was undertaken using PubMed on the relationship between nappies and the transmission of infectious disease. RESULTS The literature review did not reveal any evidence of notifiable disease transmission through discarded nappies in dustbins. CONCLUSIONS As a result of a recent review, Part II of the Public Health (Control of Disease) Act 1984 has now been replaced by Part IIA by virtue of the Health and Social Care Act 2008, and so s 26(1) no longer applies. This is both an evidence-based decision and more importantly, decriminalizes thousands of parents who decide to discard their baby's nappy in the dustbin.
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HealthCare–Associated Infections in the Nursery. INFECTIOUS DISEASES OF THE FETUS AND NEWBORN 2011:1126-1143. [PMCID: PMC7152384 DOI: 10.1016/b978-1-4160-6400-8.00035-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
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Abstract
AIM This review seeks to identify the most effective hand-washing and hand-cleansing practice that could be used in primary care. BACKGROUND Healthcare associated infection is a major problem in the UK causing 5000 deaths every year. Current guidelines indicate expert opinion is the level of evidence for hand washing as an activity to reduce infection. DESIGN Systematic review. METHOD Publications on hand-washing, hand-cleansing studies, policy and practice-based documents were sought by searching several databases. Terms used included hand washing, hand cleansing, hand hygiene, hand decontamination, infection control and primary care. RESULTS Few articles described the hand-washing technique in detail and some publications simply referred to either the European and British Standards or the Centre for Disease Control statement on hand washing. Major discrepancies in hand position and water flow direction were found. Several methodological problems were also identified and few studies were undertaken in primary care. CONCLUSION This review has found a lack of evidence for hand-washing techniques being undertaken in practice today. Findings from hand-washing technique studies were inconclusive and methodological issues exist resulting in sparse reliable evidence. There is an urgent need to undertake methodologically sound studies of hand-washing techniques for use in the ever expanding scope of primary care practice. RELEVANCE TO CLINICAL PRACTICE Evidence for hand-washing and hand-cleansing techniques will inform healthcare professional practice, and contribute to the overall management of infection control in primary care.
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Affiliation(s)
- Sheree M S Smith
- Centre for Evidence-Based Medicine, Department of Primary Health Care, University of Oxford, Oxford, UK.
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Poultsides LA, Liaropoulos LL, Malizos KN. The socioeconomic impact of musculoskeletal infections. J Bone Joint Surg Am 2010; 92:e13. [PMID: 20810849 DOI: 10.2106/jbjs.i.01131] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Lazaros A Poultsides
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Biopolis, 41110 Larissa, Greece.
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Mathai E, Allegranzi B, Kilpatrick C, Pittet D. Prevention and control of health care-associated infections through improved hand hygiene. Indian J Med Microbiol 2010; 28:100-6. [PMID: 20404452 DOI: 10.4103/0255-0857.62483] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Determined actions are required to address the burden due to health care-associated infections worldwide and improve patient safety. Improving hand hygiene among health care workers is an essential intervention to achieve these goals. The World Health Organization (WHO) First Global Patient Safety Challenge, Clean Care is Safer Care, pledged to tackle the problem of health care-associated infection at its launch in 2005 and has elaborated a comprehensive set of guidelines for use in both developed and developing countries worldwide. The final version of the WHO Guidelines on Hand Hygiene in Health Care was issued in March 2009 and includes recommendations on indications, techniques, and products for hand hygiene. In this review, we discuss the role of hands in the transmission of health care-associated infection, the benefits of improved compliance with hand hygiene, and the recommendations, implementation strategies and tools recommended by WHO. We also stress the need for action to increase the pace with which these recommendations are implemented in facilities across India.
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Affiliation(s)
- E Mathai
- World Health Organization Patient Safety, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland
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Toltzis P, Walsh M. Recently tested strategies to reduce nosocomial infections in the neonatal intensive care unit. Expert Rev Anti Infect Ther 2010; 8:235-42. [PMID: 20109052 DOI: 10.1586/eri.09.129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Recent years have witnessed a renewed interest in reducing hospital-acquired infections in critically ill patients. We review three recently tested strategies to decrease nosocomial infections specifically in the neonatal intensive care unit. These include improvement of hand hygiene, the incorporation of hand-hygiene practices into broader care bundles, and the prophylactic administration of antimicrobials, especially fluconazole, to infants at high risk prior to the onset of infection. The effectiveness of the first two interventions is well supported, particularly in older patient populations, while the effectiveness of the third is counterbalanced by the threat of the emergence of resistant-organism infections.
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Affiliation(s)
- Philip Toltzis
- Division of Pharmacology and Critical Care, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, USA.
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Pittet D, Allegranzi B, Boyce J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009; 30:611-22. [PMID: 19508124 DOI: 10.1086/600379] [Citation(s) in RCA: 434] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative. The Guidelines represent the contribution of more than 100 international experts and provide a comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensus-based recommendations, and lessons learned from testing their Advanced Draft and related implementation tools.
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Affiliation(s)
- Didier Pittet
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Agthe N, Terho K, Kurvinen T, Routamaa M, Peltonen R, Laitinen K, Kanerva M. Microbiological efficacy and tolerability of a new, non-alcohol-based hand disinfectant. Infect Control Hosp Epidemiol 2009; 30:685-90. [PMID: 19496646 DOI: 10.1086/598239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Alcohol-based hand disinfectants are widely used in hospitals. Occasionally, there is a need for non-alcohol-based products, but alternatives have been scarce. We studied the microbiological efficacy and tolerability of a water-based hand disinfectant for healthcare workers. DESIGN A water-based hand disinfectant was introduced as the only hand disinfectant in 5 wards in Turku University Hospital, Finland. Ninety-nine healthcare workers participated in fingerprint sampling during the 7-week study period. In another ward, 26 healthcare workers who were using alcohol-based hand disinfectant acted as control subjects for the skin reaction studies. The water-based product was tested in the laboratory according to the European standard EN 12791. We obtained 292 fingerprint samples before disinfection and 302 after disinfection. The opinions of healthcare workers were collected by use of a questionnaire, and skin reactions were assessed subjectively by use of questionnaires and objectively by measuring moisture and transepidermal water loss. RESULTS When tested in accordance with the European standard, the product met the requirements for short-term and long-term efficacy. The results of the fingerprint test showed that there was a statistically significant decrease in colonization of the fingertips before and after disinfection (P<.001). The users of the water-based hand disinfectant reported dry skin more often than did control subjects, but visual inspection and the results of the moisture measurement showed no difference between the users of the water-based hand disinfectant and the control subjects. Transepidermal water loss measurement also showed no deterioration of skin condition. CONCLUSIONS The water-based hand disinfectant was shown to be an effective hand disinfectant that caused relatively little skin irritation and can serve as a hand hygiene alternative in situations in which alcohol-based disinfectant cannot be used.
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Affiliation(s)
- Niina Agthe
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Levin PD, Shatz O, Sviri S, Moriah D, Or-Barbash A, Sprung CL, Moses AE, Block C. Contamination of portable radiograph equipment with resistant bacteria in the ICU. Chest 2009; 136:426-432. [PMID: 19376843 DOI: 10.1378/chest.09-0049] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Approximately 15% of nosocomial infections in the ICU result from spread of bacteria on caregivers' hands. The routine chest radiograph provides an unexamined opportunity for bacterial spread: close contact with each patient and sequential examination of ICU patients. This study examined infection control procedures performed during routine chest radiographs, assessed whether resistant bacteria were transferred to the radiograph machine, and determined whether improved infection control practices by radiograph technicians could reduce bacterial transfer. METHODS Radiograph technicians were observed performing chest radiographs on all ICU patients. Culture specimens were taken from the radiograph machine. An educational intervention directed at technicians was instituted, and its effect on infection control and machine contamination was measured. RESULTS Surveillance of 173, 113, and 120 chest radiographs during observation, intervention, and follow-up periods was performed. Adequate infection control was practiced during the performance of 2 of 173 observation period radiographs (1%), 48 of 113 intervention period radiographs (42%; p < 0.001), and 12 of 120 follow-up period radiographs (10%; (p < 0.001) [follow-up vs intervention and observation periods]. Radiograph machine surface culture samples yielded resistant Gram-negative bacteria on 12 of 30 occasions (39%), 0 of 29 occasions, and 7 of 14 occasions (50%), respectively, for the observation, intervention, and follow-up periods (p < 0.001). CONCLUSION Multiresistant bacteria are frequently transferred from patients to the radiograph machine in the presence of poor infection control practices, and may be a source of cross-infection/colonization. Improved infection control practices decrease the occurrence of resistant organisms on the radiograph equipment. Radiograph technicians should be included in efforts to improve infection control measures.
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Affiliation(s)
- Phillip D Levin
- Departments of Anesthesiology and Critical Care Medicine, Jerusalem, Israel.
| | | | | | - Dvora Moriah
- Departments of Anesthesiology and Critical Care Medicine, Jerusalem, Israel
| | - Adi Or-Barbash
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Charles L Sprung
- Departments of Anesthesiology and Critical Care Medicine, Jerusalem, Israel
| | - Allon E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Colin Block
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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75
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Lingaas E, Fagernes M. Development of a method to measure bacterial transfer from hands. J Hosp Infect 2009; 72:43-9. [PMID: 19282052 DOI: 10.1016/j.jhin.2009.01.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 01/16/2009] [Indexed: 11/30/2022]
Abstract
A method was developed to investigate the transfer of bacteria from the hands of healthcare workers (HCWs). The method involved standardised hand contact between the HCW and a recipient wearing sterile gloves, followed by sampling of the bare hands of the HCW and the gloved hands of the recipient by the glove juice method. The duration of contact, degree of friction and dryness of the hands could be varied. We investigated the applicability of the method for measuring transfer from hands artificially contaminated with Escherichia coli as well as from naturally contaminated hands following a 30s contact time with moderate friction and dry hands. Only a small proportion of bacteria on donor hands was recovered from the recipient: 0.15% for E. coli and 0.07% for natural hand flora. A smaller proportion of E. coli was recovered from bare skin compared with gloves, suggesting reduced survival of bacteria as a result of contact with natural skin. We suggest that these data are clinically relevant, and may indicate low transfer of bacteria during short contact with dry hands. This method is suitable to investigate the effect of potential risk factors for ineffective hand hygiene and the effect of hand hygiene procedures on contact transmission in clinical studies with large numbers of HCWs.
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Affiliation(s)
- E Lingaas
- Department of Infection Prevention, Rikshospitalet University Hospital, Oslo, Norway.
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76
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Sato Y. [Infections and their management in special wards. 1. Newborn infants' ward]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2008; 97:2648-2655. [PMID: 19156991 DOI: 10.2169/naika.97.2648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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77
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Pittet D, Dharan S. Alcohol-based rubs for hand antisepsis. THE LANCET. INFECTIOUS DISEASES 2008; 8:585-6. [DOI: 10.1016/s1473-3099(08)70208-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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78
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Boyce JM. Hand hygiene compliance monitoring: current perspectives from the USA. J Hosp Infect 2008; 70 Suppl 1:2-7. [DOI: 10.1016/s0195-6701(08)60003-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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79
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Karlowicz MG, Buescher ES. Nosocomial Infections in the Neonate. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASE 2008. [PMCID: PMC7310940 DOI: 10.1016/b978-0-7020-3468-8.50102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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80
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Posfay-Barbe KM, Zerr DM, Pittet D. Infection control in paediatrics. THE LANCET. INFECTIOUS DISEASES 2008; 8:19-31. [DOI: 10.1016/s1473-3099(07)70310-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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81
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Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007; 67:9-21. [PMID: 17719685 DOI: 10.1016/j.jhin.2007.06.004] [Citation(s) in RCA: 456] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 06/01/2007] [Indexed: 11/17/2022]
Abstract
Hand hygiene is a core element of patient safety for the prevention of healthcare-associated infections and the spread of antimicrobial resistance. Its promotion represents a challenge that requires a multi-modal strategy using a clear, robust and simple conceptual framework. The World Health Organization First Global Patient Safety Challenge 'Clean Care is Safer Care' has expanded educational and promotional tools developed initially for the Swiss national hand hygiene campaign for worldwide use. Development methodology involved a user-centred design approach incorporating strategies of human factors engineering, cognitive behaviour science and elements of social marketing, followed by an iterative prototype test phase within the target population. This research resulted in a concept called 'My five moments for hand hygiene'. It describes the fundamental reference points for healthcare workers (HCWs) in a time-space framework and designates the moments when hand hygiene is required to effectively interrupt microbial transmission during the care sequence. The concept applies to a wide range of patient care activities and healthcare settings. It proposes a unified vision for trainers, observers and HCWs that should facilitate education, minimize inter-individual variation and resource use, and increase adherence. 'My five moments for hand hygiene' bridges the gap between scientific evidence and daily health practice and provides a solid basis to understand, teach, monitor and report hand hygiene practices.
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Affiliation(s)
- H Sax
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland; Global Patient Safety Challenge, World Alliance for Patient Safety, World Health Organization, Geneva, Switzerland
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82
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Pessoa-Silva CL, Hugonnet S, Pfister R, Touveneau S, Dharan S, Posfay-Barbe K, Pittet D. Reduction of health care associated infection risk in neonates by successful hand hygiene promotion. Pediatrics 2007; 120:e382-90. [PMID: 17664257 DOI: 10.1542/peds.2006-3712] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Hand hygiene promotion interventions rarely result in sustained improvement, and an assessment of their impact on individual infection risk has been lacking. We sought to measure the impact of hand hygiene promotion on health care worker compliance and health care-associated infection risk among neonates. METHODS We conducted an intervention study with a 9-month follow-up among all of the health care workers at the neonatal unit of the Children's Hospital, University of Geneva Hospitals, between March 2001 and February 2004. A multifaceted hand hygiene education program was introduced with compliance assessed during successive observational surveys. Health care-associated infections were prospectively monitored, and genotypic relatedness of bloodstream pathogens was assessed by pulsed-field gel electrophoresis. A comparison of observed hand hygiene compliance and infection rates before, during, and after the intervention was conducted. RESULTS A total of 5325 opportunities for hand hygiene were observed. Overall compliance improved gradually from 42% to 55% across study phases. This trend remained significant after adjustment for possible confounders and paralleled the measured increase in hand-rub consumption (from 66.6 to 89.2 L per 1000 patient-days). A 9-month follow-up survey showed sustained improvement in compliance (54%), notably with direct patient contact (49% at baseline vs 64% at follow-up). Improved compliance was independently associated with infection risk reduction among very low birth weight neonates. Bacteremia caused by clonally related pathogens markedly decreased after the intervention. CONCLUSIONS Hand hygiene promotion, guided by health care workers' perceptions, identification of the dynamics of bacterial contamination of health care workers' hands, and performance feedback, is effective in sustaining compliance improvement and is independently associated with infection risk reduction among high-risk neonates.
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Affiliation(s)
- Carmem Lucia Pessoa-Silva
- Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
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83
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Ferrer C, Almirante B. Higiene de manos: una prioridad para la seguridad de los pacientes hospitalizados. Enferm Infecc Microbiol Clin 2007; 25:365-8. [PMID: 17583648 DOI: 10.1157/13106960] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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84
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Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SRLJ, McDougall C, Wilcox MH. epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007; 65 Suppl 1:S1-64. [PMID: 17307562 PMCID: PMC7134414 DOI: 10.1016/s0195-6701(07)60002-4] [Citation(s) in RCA: 407] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001. These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters. The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence). A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines. These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations. Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of healthcare in NHS hospitals in England can be minimised.
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Affiliation(s)
- R J Pratt
- Richard Wells Research Centre, Faculty of Health and Human Sciences, Thames Valley University, London.
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85
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Whitby M, Pessoa-Silva CL, McLaws ML, Allegranzi B, Sax H, Larson E, Seto WH, Donaldson L, Pittet D. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2006; 65:1-8. [PMID: 17145101 DOI: 10.1016/j.jhin.2006.09.026] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 09/27/2006] [Indexed: 10/23/2022]
Abstract
Hand hygiene is considered to be the most effective measure to prevent microbial pathogen cross-transmission and healthcare-associated infections. In October 2005, the World Health Organization (WHO) World Alliance for Patient Safety launched the first Global Patient Safety Challenge 2005-2006, 'Clean Care is Safer Care', to tackle healthcare-associated infection on a large scale. Within the Challenge framework, international infection control experts and consultative taskforces met to develop new WHO Guidelines on Hand Hygiene in Healthcare. The taskforce was asked to explore aspects underlying hand hygiene behaviour that may influence its promotion among healthcare workers. The dynamics of behavioural change are complex and multi-faceted, but are of vital importance when designing a strategy to improve hand hygiene compliance. A reflection on challenges to be met and areas for future research are also proposed.
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Affiliation(s)
- M Whitby
- Centre for Healthcare Related Infection Surveillance and Prevention, Princess Alexandra Hospital, Brisbane, Australia
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86
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Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, Boyce JM. Evidence-based model for hand transmission during patient care and the role of improved practices. THE LANCET. INFECTIOUS DISEASES 2006; 6:641-52. [PMID: 17008173 DOI: 10.1016/s1473-3099(06)70600-4] [Citation(s) in RCA: 446] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Hand cleansing is the primary action to reduce health-care-associated infection and cross-transmission of antimicrobial-resistant pathogens. Patient-to-patient transmission of pathogens via health-care workers' hands requires five sequential steps: (1) organisms are present on the patient's skin or have been shed onto fomites in the patient's immediate environment; (2) organisms must be transferred to health-care workers' hands; (3) organisms must be capable of surviving on health-care workers' hands for at least several minutes; (4) handwashing or hand antisepsis by the health-care worker must be inadequate or omitted entirely, or the agent used for hand hygiene inappropriate; and (5) the caregiver's contaminated hand(s) must come into direct contact with another patient or with a fomite in direct contact with the patient. We review the evidence supporting each of these steps and propose a dynamic model for hand hygiene research and education strategies, together with corresponding indications for hand hygiene during patient care.
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Affiliation(s)
- Didier Pittet
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland.
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87
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Iijima S, Ohzeki T. Bacterial contamination on the hands of nursing staff in the most basic neonatal care. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.jnn.2006.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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88
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Berthelot P, Dietemann J, Fascia P, Ros A, Mallaval FO, Lucht F, Pozzetto B, Grattard F. Bacterial contamination of nonsterile disposable gloves before use. Am J Infect Control 2006; 34:128-30. [PMID: 16630975 DOI: 10.1016/j.ajic.2005.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 08/21/2005] [Accepted: 08/22/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND After Bacillus cereus recovery in opened boxes of disposable gloves, the bacteriological contamination of disposable nonsterile gloves kept stored in native packages was investigated prospectively. METHODS Thirty-six commercially available nonsterile nonpowdered disposable gloves made of latex, vinyl, or nitrile were cultured. RESULTS A large variety of spore-forming and non-spore-forming bacteria was recovered, including Bacillus cereus and Clostridium perfringens. CONCLUSION This finding must be taken into consideration for care involving gloves in very immunocompromised patients.
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Affiliation(s)
- Philippe Berthelot
- Infection Control Unit, Infectious Diseases Department, University Hospital of Saint-Etienne, France.
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89
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20. HAND HYGIENE. JOURNAL OF INFUSION NURSING 2006. [DOI: 10.1097/00129804-200601001-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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90
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Pessoa-Silva CL, Posfay-Barbe K, Pfister R, Touveneau S, Perneger TV, Pittet D. Attitudes and perceptions toward hand hygiene among healthcare workers caring for critically ill neonates. Infect Control Hosp Epidemiol 2005; 26:305-11. [PMID: 15796285 DOI: 10.1086/502544] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Infectious complications are frequent among critically ill neonates. Hand hygiene is the leading measure to prevent healthcare-associated infections, but poor compliance has been repeatedly documented, including in the neonatal setting. Hand hygiene promotion requires a complex approach that should consider personal factors affecting healthcare workers' attitudes. OBJECTIVE To identify beliefs and perceptions associated with intention to comply with hand hygiene among neonatal healthcare workers. METHODS An anonymous, self-administered questionnaire (74 items) based on the theory of planned behavior was distributed to 80 neonatal healthcare workers to assess intention to comply, attitude toward hand hygiene, behavioral and subjective norm perceptions, and perception of difficulty to comply. Variables were assessed using multi-item measures and answers to 7-point bipolar scales. All multi-item scales had satisfactory internal consistency (alpha > 0.7). Multivariate logistic regression identified independent perceptions or beliefs associated with a positive intention to comply. RESULTS The response rate was 76% (61 of 80). Of the 49 nurses and 12 physicians responding, 75% believed that they could improve their compliance with hand hygiene. Intention to comply was associated with perceived control over the difficulty to perform hand hygiene (OR, 3.12; CI95, 1.12 to 8.70; P = .030) and a positive perception of how superiors valued hand hygiene (OR, 2.89; CI95, 1.08 to 7.77; P = .035). CONCLUSION Our data highlight the importance of the opinions of superiors and a strong perceived controllability over the difficulty to perform hand hygiene as possible internal factors that may influence hand hygiene compliance.
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Affiliation(s)
- Carmem Lucia Pessoa-Silva
- Infection Control Program, Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
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91
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