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Müller SA, Diallo AOK, Wood R, Bayo M, Eckmanns T, Tounkara O, Arvand M, Diallo M, Borchert M. Implementation of the WHO hand hygiene strategy in Faranah regional hospital, Guinea. Antimicrob Resist Infect Control 2020; 9:65. [PMID: 32410673 PMCID: PMC7227248 DOI: 10.1186/s13756-020-00723-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare-associated infections are the most frequent adverse events in healthcare worldwide, with limited available evidence suggesting highest burden in resource-limited settings. Recent Ebola epidemics emphasize the disastrous impact that spread of infectious agents within healthcare facilities can have, accentuating the need for improvement of infection control practices. Hand hygiene (HH) measures are considered to be the most effective tool to prevent healthcare-associated infections. However, HH knowledge and compliance are low, especially in vulnerable settings such as Guinea. The aim of PASQUALE (Partnership to Improve Patient Safety and Quality of Care) was to assess knowledge and compliance with HH and improve HH by incorporating the WHO HH Strategy within the Faranah Regional Hospital (FRH), Guinea. METHODS In a participatory approach, a team of FRH staff and leadership was invited to identify priorities of the hospital prior to the start of PASQUALE. The local hygiene committee was empowered to increase its activities and take ownership of the HH improvement strategy. A baseline assessment of knowledge, perception and compliance was performed months before the intervention. The main intervention consisted of local alcohol-based-hand-rub (ABHR) production, with final product efficacy testing, in conjunction with a training adapted to the needs identified in the baseline assessment. A follow-up assessment was conducted directly after the training. Effectiveness of the intervention was assessed via uncontrolled before-and-after comparison. RESULTS Baseline knowledge score (13.0/25) showed a significant increase to 19.0/25 in follow-up. Baseline-Compliance was 23.7% and increased significantly to 71.5% in follow-up. Compliance rose significantly across all professional groups except for midwifes and in all indications for HH, with the largest in the indication "Before aseptic tasks". The increase in compliance was associated with the intervention and remained significant after adjusting for confounders. The local pharmacy successfully supplies the entire hospital. The local supply resulted in a ten-fold increase of monthly hospital disinfectant consumption. CONCLUSION The WHO HH strategy is an adaptable and effective method to improve HH knowledge and compliance in a resource-limited setting. Local production is a feasible method for providing self-sufficient supply of ABHR to regional hospitals like the FRH. Participatory approaches like hygiene committee ownership builds confidence of sustainability.
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Affiliation(s)
- S. A. Müller
- Charité – Universitätsmedizin Berlin, Institute of Tropical Medicine and International Health, Berlin, Germany
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | | | - R. Wood
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - M. Bayo
- Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Conakry, Guinea
| | - T. Eckmanns
- Unit for healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption, Robert Koch Institute, Berlin, Germany
| | | | - M. Arvand
- Unit for Hospital Hygiene, Infection Prevention and Control, Robert Koch Institute, Berlin, Germany
| | - M. Diallo
- Faranah Regional Hospital, Faranah, Guinea
| | - M. Borchert
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
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Martischang R, Peters A, Guitart C, Tartari E, Pittet D. Promises and limitations of a digitalized infection control program. J Adv Nurs 2020. [PMID: 32285960 DOI: 10.1111/jan.14390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Romain Martischang
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alexandra Peters
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Chloe Guitart
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Phan HT, Zingg W, Tran HTT, Dinh APP, Pittet D. Sustained effects of a multimodal campaign aiming at hand hygiene improvement on compliance and healthcare-associated infections in a large gynaecology/obstetrics tertiary-care centre in Vietnam. Antimicrob Resist Infect Control 2020; 9:51. [PMID: 32276646 PMCID: PMC7146877 DOI: 10.1186/s13756-020-00712-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background Hung Vuong Hospital (HVH) is a 900-bed maternity hospital in Ho-Chi-Minh-City, Vietnam. Due to low compliance, a quasi-experimental, observational study was conducted with the aim to improve hand hygiene. Methods A multimodal promotion strategy was established in 2010 and further developed towards ongoing, repetitive and inventive campaigns including patient participation. Hand hygiene compliance was monitored by direct observation and healthcare-associated infections (HAIs) by applying standard definitions. Results Between 2010 and 2018, a total of 43,711 hand hygiene opportunities were observed. Compliance improved from 21.5% (95%CI: 20.2–22.8%) in 2010 to 75.1% (73.9–76.2%) in 2018 (incidence rate ratio, IRR , 1.10; 95%CI, 1.10–1.11). This was achieved through increasing recourse to alcohol-based hand rubbing. A total of 554,720 women were admitted to HVH during the study period for 353,919 deliveries (198,679 vaginal; 155,240 by C-section) and 257,127 surgical procedures. The HAI-incidence decreased significantly from 1.10 episodes per 1000 patient-days in 2010 to 0.45 per 1000 patient-days in 2018 (IRR 0.85; 95%CI, 0.79–0.90). Significant improvement was observed also for surgical site infections after gynaecological surgery (IRR 0.95; 95%CI, 0.92–0.99) and endometritis after abortion (IRR 0.80; 95%CI, 0.68–0.93). Conclusions A multimodal strategy aiming at behaviour change significantly improved and sustained hand hygiene, which contributed to the reduction of healthcare-associated infections.
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Affiliation(s)
- Hang Thi Phan
- Infection control programme, Hung Vuong hospital, Ho Chi Minh City, Vietnam
| | - Walter Zingg
- Infection control programme and WHO collaborating centre on patient safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland.
| | - Hang Thi Thuy Tran
- Infection control programme, Hung Vuong hospital, Ho Chi Minh City, Vietnam
| | | | - Didier Pittet
- Infection control programme and WHO collaborating centre on patient safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland
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CAMBIL-MARTIN J, FERNANDEZ-PRADA M, GONZALEZ-CABRERA J, RODRIGUEZ-LOPEZ C, ALMARAZ-GOMEZ A, LANA-PEREZ A, BUENO-CAVANILLAS A. Comparison of knowledge, attitudes and hand hygiene behavioral intention in medical and nursing students. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E9-E14. [PMID: 32490263 PMCID: PMC7225645 DOI: 10.15167/2421-4248/jpmh2020.61.1.741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 10/22/2019] [Indexed: 11/16/2022]
Abstract
Introduction Hand hygiene is crucial to prevent cross infection. Healthcare students are in a prime position to learn hand hygiene skills. The aim of this study was to analyze hand hygiene behavioral intentions of healthcare students before and after contact with the patient and to compare the knowledge of and attitude towards hand hygiene between medical and nursing students. Methods In a descriptive survey research design, convenience selection of a sample of medical students (n=657) and nursing students (n=303) was done from modules taught by the Department of Preventive Medicine and Public Health in both Medicine and Nursing undergraduate degrees in four Spanish universities. The hand hygiene Questionnaire, a validated instrument to evaluate behavior, knowledge, and attitudes, was used. Results A significantly lower percentage of students reported always or almost always carrying out hand hygiene before contact with the patient or invasive procedures in comparison to the percentage complying after contact with secretions or with the patient. Although hand hygiene knowledge appears acceptable, its importance is not sufficiently valued. Conclusions There are deficiencies in behavioral intention, knowledge, and attitudes related to hand hygiene in medical and nursing students. Better results are observed among nursing students, especially those who have received specific training.
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Affiliation(s)
| | - M. FERNANDEZ-PRADA
- Department of Preventive Medicine and Public Health, University of Granada, Spain, Preventive Medicine Unit, San Cecilio Universitary Hospital of Granada, Spain
| | - J. GONZALEZ-CABRERA
- Department of Social Psychology and Methodology of Science Human Behavior, University of Granada, Spain
| | - C. RODRIGUEZ-LOPEZ
- Department of Obstetrics and Gynecology, Pediatrics, Preventive Medicine and Public Health, Toxicology and Forensic Medicine, University of La Laguna, Spain
| | - A. ALMARAZ-GOMEZ
- Department of Pathology, Microbiology, Preventive Medicine and Public Health, Forensic Medicine, University of Valladolid, Spain
| | | | - A. BUENO-CAVANILLAS
- Department of Preventive Medicine and Public Health, University of Granada, Spain, Preventive Medicine Unit, San Cecilio Universitary Hospital of Granada, Spain
- Correspondence: Aurora Bueno-Cavanillas, Departament of Preventive Medicine and Public Health. University of Granada. (Spain). Preventive Medicine Unit. San Cecilio Universitary Hospital of Granada, Spain, Ciber of Epidemiology and Public Health (CIBERESP), Faculty of Medicine, 11, La Investigación Avenue, 18016 Granada, Spain - Tel. 0034 958248855 - E-mail:
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Late-onset sepsis and mortality among neonates in a Brazilian Intensive Care Unit: a cohort study and survival analysis. Epidemiol Infect 2020; 147:e208. [PMID: 31364533 PMCID: PMC6624867 DOI: 10.1017/s095026881900092x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A cohort study was performed from January 2014 to December 2016 in a Brazilian neonatal intensive care unit, including neonates with high risk for infection and death. We estimated bloodstream infection (BSI) incidence and conducted a survival analysis, considering the time to death and to the first episode of BSI as outcomes, comparing very low birth weight (VLBW) neonates with the remaining neonates. An extended Cox model was performed and the hazard ratio (HR) was calculated for different time periods. The study had 1560 neonates included, the incidence and the incidence density of BSI was 22% and 18.6 per 1000 central venous catheter-days, respectively. Considering VLBW neonates as the reference group, the HR for time to death was 4.06 (95% CI 2.75–6.00, P < 0.01) from day 0 to 60 and for time to the first episode of BSI was 1.76 (95% CI 1.31–2.36, P < 0.01) from day 0 to 36. Having the heavier neonates group as reference, the HR for time to the first episode of BSI was 2.94 (95% CI 1.92–4.34, P < 0.01) from day 37 to 90. Late-onset neonatal sepsis prevention measures should consider the differences in risk during time, according to neonates' birth weight.
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106
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Ben Fredj S, Ben Cheikh A, Bhiri S, Ghali H, Khefacha S, Dhidah L, Merzougui L, Ben Rejeb M, Said Latiri H. Multimodal intervention program to improve hand hygiene compliance: effectiveness and challenges. J Egypt Public Health Assoc 2020; 95:11. [PMID: 32813132 PMCID: PMC7364722 DOI: 10.1186/s42506-020-00039-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hand hygiene (HH) is considered the most important measure to tackle the transmission of healthcare-associated pathogens. However, compliance with recommendations is usually low and effective improvement strategies are needed. We aimed to assess the effectiveness of an intervention targeting hand hygiene promotion among healthcare workers (HCWs). METHODS We conducted a pre-post interventional study design in the university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The intervention program consisted of training sessions and distribution of posters of hand hygiene guidelines. To assess the evolution of HH observance at pre- and post-intervention, the same observation form was distributed and collected at healthcare workers' workplace. RESULTS Of the 1201 and 1057 opportunities for hand hygiene observed among all categories of HCWs, overall compliance enhanced significantly from 32.1 to 39.4% (p < 0.001) respectively at pre- and post-intervention. Nurses were the most compliant with a significant improvement from 34.1 to 45.7% (p < 0.001) respectively at pre- and post-intervention. Furthermore, analysis by department showed significant improvement of compliance in orthopedic department (p < 0.001), maxillofacial-surgery department (p < 0.001), pediatrics department (p = 0.013), and emergencies (p = 0.038). CONCLUSION This study showed the feasibility and effectiveness of a health-setting-based intervention to enhance hand hygiene observance in the context of a developing country.
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Affiliation(s)
- Sihem Ben Fredj
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
| | - Asma Ben Cheikh
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Sana Bhiri
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Hela Ghali
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
| | - Salwa Khefacha
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
| | - Lamine Dhidah
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Latifa Merzougui
- Department of Epidemiology, University Hospital Ibn El Jazzar, 3100 Kairouan, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Houyem Said Latiri
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
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107
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Contact isolation versus standard precautions to decrease acquisition of extended-spectrum β-lactamase-producing Enterobacterales in non-critical care wards: a cluster-randomised crossover trial. THE LANCET. INFECTIOUS DISEASES 2020; 20:575-584. [PMID: 32087113 DOI: 10.1016/s1473-3099(19)30626-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/02/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effectiveness of contact isolation for decreasing the spread of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) has been questioned. The aim of this study was to establish the benefits of contact isolation over standard precautions for reducing the incidence density of ESBL-E colonisation and infection in adult medical and surgical wards with an active surveillance culture programme. METHODS We did a cluster-randomised crossover trial in adult wards in four European university hospitals. Medical, surgical, or combined medical-surgical wards without critical care were randomised to continue standard precautions alone or implement contact isolation alongside standard precautions for 12 months, followed by a 1 month washout period and 12 months of the alternate strategy. Randomisation was done via a computer-generated sequence, with a block size of two consecutive wards. Only laboratory technicians and data analysts were masked to allocation. Patients were screened for ESBL-E carriage within 3 days of admission, once a week thereafter, and on discharge. The primary outcome was the incidence density of ESBL-E, defined as the acquisition rate per 1000 patient-days at risk at the ward level and assessed in the per-protocol population, which included all patients screened at least twice with a length of stay of more than 1 week for each intervention period. No specific safety measures were assessed given the minimal risk of adverse events. The trial is registered, ISRCTN57648070. FINDINGS We enrolled 20 wards from four hospitals in Germany (eight wards), the Netherlands (four wards), Spain (four wards), and Switzerland (four wards). Between Jan 6, 2014, and Aug 31, 2016, 38 357 patients were admitted to these wards. Among 15 184 patients with a length of stay of more than 1 week, 11 368 patients (75%) were screened at least twice. The incidence density of ward-acquired ESBL-E was 6·0 events per 1000 patient-days at risk (95% CI 5·4-6·7) during periods of contact isolation and 6·1 (5·5-6·7) during periods of standard precautions (p=0·9710). Multivariable analysis adjusted for length of stay, percentage of patients screened, and prevalence in first screening cultures yielded an incidence rate ratio of 0·99 (95% CI 0·80-1·22; p=0·9177) for care under contact isolation compared with standard precautions. INTERPRETATION Contact isolation showed no benefit when added to standard precautions for controlling the spread of ESBL-E on non-critical care wards with extensive surveillance screening. FUNDING European Commission.
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108
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Onyedibe KI, Shehu NY, Pires D, Isa SE, Okolo MO, Gomerep SS, Ibrahim C, Igbanugo SJ, Odesanya RU, Olayinka A, Egah DZ, Pittet D. Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross sectional study. Antimicrob Resist Infect Control 2020; 9:30. [PMID: 32046790 PMCID: PMC7014740 DOI: 10.1186/s13756-020-0693-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600-bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million. Methods An in-house facility assessment tool and the World Health Organization (WHO) direct observation method were used to assess the HH facilities and compliance, respectively. Factors associated with good compliance were determined by multivariate analysis. Results The facility survey was carried out in all 46 clinical units of the hospital. 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying facilities. A total of 406 HH opportunities were observed among 175 HCWs. The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students. Based on WHO “5 moments” for HH, average compliance was 21% before patient contact, 23% before aseptic procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients’ surrounding. Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70–112.88). Conclusions Availability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor. Our findings confirm that HCWs seem more sensitized to their risk of exposure to potential pathogens than to the prevention of HAI cross-transmission. Inadequate HH facilities probably contributed to the poor compliance. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.
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Affiliation(s)
| | - Nathan Y Shehu
- Infectious Diseases Unit, Department of Medicine, University of Jos, Jos, Nigeria
| | - Daniela Pires
- Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.,Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Samson E Isa
- Infectious Diseases Unit, Department of Medicine, University of Jos, Jos, Nigeria
| | - Mark O Okolo
- Department of Medical Microbiology, University of Jos, Jos, Nigeria
| | - Simji S Gomerep
- Infectious Diseases Unit, Department of Medicine, University of Jos, Jos, Nigeria
| | - Comfort Ibrahim
- Department of Nursing Services, Jos University Teaching Hospital, Jos, Nigeria
| | - Sunday J Igbanugo
- Department of Pharmacy, Jos University Teaching Hospital, Jos, Nigeria
| | - Rachel U Odesanya
- Department of Pharmacy, Jos University Teaching Hospital, Jos, Nigeria
| | - Adebola Olayinka
- Department of Medical Microbiology, Ahmadu Bello University, Zaria, Nigeria
| | - Daniel Z Egah
- Department of Medical Microbiology, University of Jos, Jos, Nigeria
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Lotfinejad N, Assadi R, Aelami MH, Pittet D. Emojis in public health and how they might be used for hand hygiene and infection prevention and control. Antimicrob Resist Infect Control 2020; 9:27. [PMID: 32041666 PMCID: PMC7011445 DOI: 10.1186/s13756-020-0692-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/03/2020] [Indexed: 12/13/2022] Open
Abstract
Emojis are frequently used picture characters known as possible surrogates for non-verbal aspects of behavior. Considering the ability of emojis to enhance and facilitate communication, there has been a growing interest in studying their effects in scientific and health-related topics over the past few years. Infection prevention and control (IPC) is a field of medicine that is directly associated with specific behaviors. These include hand hygiene, which is the cornerstone of the prevention of healthcare-associated infections, and essential in stemming the spread of antimicrobial resistance. This paper aims to provide an overview of how emojis have been used in the medical and public health literature and proposes their possible use in IPC and hand hygiene to put forth a vision for the future research.
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Affiliation(s)
- Nasim Lotfinejad
- Department of Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Hand Hygiene and Infection Control Research Center, Imam Reza Hospital, Mashhad, Iran
| | - Reza Assadi
- E-Learning Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hassan Aelami
- Department of Pediatrics & Hand Hygiene and Infection Control Research Center, Imam Reza Hospital, Mashhad, Iran
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland.
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van der Westhuizen D, Conrad N, Douglas TS, Mutsvangwa T. Engaging Communities on Health Innovation: Experiences in Implementing Design Thinking. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 41:101-114. [DOI: 10.1177/0272684x19900880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Design thinking is an approach gaining momentum as a strategy for promoting empathy-driven, human-centered innovation. To evaluate the implementation of design thinking for engaging with communities about health and well-being, we undertook a qualitative analysis of an engagement between students and relevant community stakeholders during a project to develop a health intervention aimed at increasing medication compliance in an elderly community in South Africa. Major findings from this research indicated that design thinking offers opportunities for enriching community–university engagements. However, given constraints on time and procedure that are associated with the academy, the fast, dynamic style of design thinking is not optimally suited for developing the level of trust and rapport that is required for engagements in communities where social-cultural differences operate as barriers. Researchers who wish to utilize design thinking will need to devise and tailor additions to tool kits to meet the specific needs of engagements related to personal health and well-being.
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Affiliation(s)
- Donné van der Westhuizen
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa
| | - Nailah Conrad
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa
| | - Tania S. Douglas
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa
| | - Tinashe Mutsvangwa
- Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, South Africa
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111
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Hand hygiene promotion delivered by change agents-Two attitudes, similar outcome. Infect Control Hosp Epidemiol 2020; 41:273-279. [PMID: 31928551 DOI: 10.1017/ice.2019.339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the effect of peer-identified change agents (PICAs) compared to management-selected change agents (MSCAs) on hand hygiene behavior in acute care. DESIGN Randomized-controlled study. SETTING Two internal medicine wards of a public, university-affiliated, tertiary-care hospital in Malaysia. METHODS We randomly allocated 2 wards to hand hygiene promotion delivered either by PICAs (study arm 1) or by MSCAs (study arm 2). The primary outcome was hand hygiene compliance using direct observation by validated auditors. Secondary outcomes were hand hygiene knowledge and observations from ward tours. RESULTS Mean hand hygiene compliance in study arm 1 and study arm 2 improved from 48% (95% confidence interval [CI], 44%-53%) and 50% (95% CI, 44%-55%) in the preintervention period to 66% (63%-69%) and 65% (60%-69%) in the intervention period, respectively. We detected no statistically significant difference in hand hygiene improvement between the 2 study arms. Knowledge scores on hand hygiene in study arm 1 and study arm 2 improved from 60% and 63% to 98% and 93%, respectively. Staff in study arm 1 improved hand hygiene because they did not want to disappoint the efforts taken by the PICAs. Staff in study arm 2 felt pressured by the MSCAs to comply with hand hygiene to obtain good overall performance appraisals. CONCLUSION Although the attitude of PICAs and MSCAs in terms of leadership, mode of action and perception of their task by staff were very different, or even opposed, both PICAs and MSCAs effectively changed behavior of staff toward improved hand hygiene to comparable levels.
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Baek EH, Kim SE, Kim DH, Cho OH, Hong SI, Kim S. The difference in hand hygiene compliance rate between unit-based observers and trained observers for World Health Organization checklist and optimal hand hygiene. Int J Infect Dis 2020; 90:197-200. [DOI: 10.1016/j.ijid.2019.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/28/2022] Open
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Tartari E, Fankhauser C, Masson-Roy S, Márquez-Villarreal H, Fernández Moreno I, Rodriguez Navas ML, Sarabia O, Bellissimo-Rodrigues F, Hernández-de Mezerville M, Lee YF, Aelami MH, Mehtar S, Agostinho A, Camilleri L, Allegranzi B, Pires D, Pittet D. Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control. Antimicrob Resist Infect Control 2019; 8:206. [PMID: 32005230 PMCID: PMC6937710 DOI: 10.1186/s13756-019-0666-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
Background Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a “Train-the-Trainers” (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries. Methods We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training. Results Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively. Conclusions The TTT in hand hygiene model proved to be effective in enhancing participant’s knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.
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Affiliation(s)
- Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Carolina Fankhauser
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Sarah Masson-Roy
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Hotel-Dieu de Lévis, Lévis, Canada
| | | | | | | | - Odet Sarabia
- Universidad Anáhuac, Naucalpan de Juárez, Mexico
| | | | | | - Yew Fong Lee
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Ministry of Health, Putrajaya, Malaysia
| | - Mohammad Hassan Aelami
- Department of Pediatrics and Hand Hygiene and Infection Control Research Center, Imam Reza Hospital ,Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shaheen Mehtar
- Infection Control Africa Network, Unit of IPC, Tygerberg Hospital, Cape Town, South Africa
| | - Américo Agostinho
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | - Daniela Pires
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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A family empowerment strategy is associated with increased healthcare worker hand hygiene in a resource-limited setting. Infect Control Hosp Epidemiol 2019; 41:202-208. [PMID: 31822321 DOI: 10.1017/ice.2019.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Guidelines recommend empowering patients and families to remind healthcare workers (HCWs) to perform hand hygiene (HH). The effectiveness of empowerment tools for patients and their families in Southeast Asia is unknown. METHODS We performed a prospective study in a pediatric intensive care unit (PICU) of a Vietnamese pediatric referral hospital. With family and HCW input, we developed a visual tool for families to prompt HCW HH. We used direct observation to collect baseline HH data. We then enrolled families to receive the visual tool and education on its use while continuing prospective collection of HH data. Multivariable logistic regression was used to identify independent predictors of HH in baseline and implementation periods. RESULTS In total, 2,014 baseline and 2,498 implementation-period HH opportunities were observed. During the implementation period, 73 families were enrolled. Overall, HCW HH was 46% preimplementation, which increased to 73% in the implementation period (P < .001). The lowest HH adherence in both periods occurred after HCW contact with patient surroundings: 16% at baseline increased to 24% after implementation. In multivariable analyses, the odds of HCW HH during the implementation period were significantly higher than baseline (adjusted odds ratio [aOR], 2.94; 95% confidence interval [CI], 2.54-3.41; P < .001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs evening or weekend), and HH moment. CONCLUSIONS The introduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese PICU. Future research should explore acceptability and barriers to use of similar tools in low- and middle-income settings.
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115
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Birnbach DJ, McKenty NT, Rosen LF, Arheart KL, Everett-Thomas R, Lindsey SF. Does Adherence to World Health Organization Hand Hygiene Protocols in the Operating Room Have the Potential to Produce Irritant Contact Dermatitis in Anesthesia Providers? Anesth Analg 2019; 129:e182-e184. [PMID: 31743176 DOI: 10.1213/ane.0000000000004112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anesthesia providers have the burden of constant hand hygiene during task dense periods. The requirement for hand hygiene often demands frequent application of alcohol-based hand rub. To assess whether frequent alcohol-based hand rub use leads to skin changes or irritant contact dermatitis, volunteers cleaned their hands with alcohol-based hand rub every 15 minutes for 8 hours for 5 sequential days. They were examined by a dermatologist before and after and asked about subjective skin changes. Results suggest an increase in irritant contact dermatitis scores and subjective complaints.
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Affiliation(s)
- David J Birnbach
- From the Department of Anesthesiology, University of Miami Miller School of Medicine
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Nathan T McKenty
- From the Department of Anesthesiology, University of Miami Miller School of Medicine
| | - Lisa F Rosen
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | | | - Scott F Lindsey
- Department of Dermatology, University of Miami Miller School of Medicine
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116
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Segal S, Harris HM, Gunawan A, Schumann R. A Simple Method for Estimating Hand Hygiene Use Among Anesthesia Personnel: Development, Validation, and Use in a Quality Improvement Project. Anesth Analg 2019; 129:1549-1556. [PMID: 31743174 DOI: 10.1213/ane.0000000000004106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Frequent hand hygiene by anesthesia personnel may be an important factor in reducing contamination of IV lines and medication access ports and may reduce hospital-acquired infections. Measurement of hand hygiene frequency at the individual clinician level by direct observation or electronic devices is cumbersome and expensive. We developed and validated a simple method for estimating hand hygiene frequency by individual anesthesia providers and utilized it in a quality improvement initiative to increase hand hygiene use. METHODS Pump-style, alcohol-based hand hygiene container weight at the anesthesia work station was measured before and after each surgical operation and converted to estimated number of accesses (pumps) per hour. Video observation was used to validate the estimated hand hygiene use. A quality improvement initiative utilized periodic measurement of hand hygiene frequency via the validated method, and incorporated individual provider feedback, email reminders, monthly departmental performance reports, and reminders in the electronic anesthesia record. Segmented linear regression was used to evaluate the effect of the intervention on hand hygiene use. RESULTS Delivered product per pump was consistent for containers at least half-full and averaged (mean ± SD) 0.92 ± 0.13 g per pump. Video observation in 26 cases showed a strong correlation between observed hand hygiene episodes and estimated hand hygiene use frequency based on weight change of the container (linear regression, R = 0.97, P < .0001). Median hand hygiene frequency was near 0 at baseline but increased progressively throughout the intervention period (segmented linear regression, overall R = 0.76, P < .0001; change of intercept or mean hand hygiene after initiation of intervention [parameter estimate ± SE] [0.970 ± 0.29], P = .0008). CONCLUSIONS A low-cost, simple method for measuring individual anesthesia clinician use of hand hygiene intraoperatively based on container weight change is feasible and sufficiently accurate to support a quality improvement initiative to increase its use.
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Affiliation(s)
- Scott Segal
- From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Hannah M Harris
- From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Antonius Gunawan
- From the Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Roman Schumann
- Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts
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117
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Blood collection guidelines for inpatients and outpatients, home-based care and long-term care facilities. J Hosp Infect 2019; 104:600-602. [PMID: 31796238 DOI: 10.1016/j.jhin.2019.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/14/2019] [Accepted: 10/30/2019] [Indexed: 11/22/2022]
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118
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Abella Álvarez A, Janeiro Lumbreras D, Lobo Valbuena B, Naharro Abellán A, Torrejón Pérez I, Enciso Calderón V, Varillas Delgado D, Conejo Márquez I, García Manzanedo S, López de la Oliva Calvo L, García Arias M, Gordo Vidal F. [Analysis of the predictive value of preventive isolation criteria in the intensive care unit]. Med Intensiva 2019; 45:205-210. [PMID: 31780256 DOI: 10.1016/j.medin.2019.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/23/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs). DESIGN A prospective observational study was carried out from May 2014 to May 2015. SETTING Polyvalent Intensive Care Unit. PATIENTS A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the "Zero Resistance" project: hospital length of stay>4 days in the last three months ("hospital"); antibiotherapy during one week in the last month ("antibiotic"); institutionalized patients or recurrent contact with healthcare ("institution or care"); MRM carrier in the last 6 months ("previous MRM"). VARIABLES Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status. RESULTS During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was "previous MRM", with OR=12.14 (95%CI 4.24-34.77). CONCLUSIONS The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of "previous MRM".
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Affiliation(s)
- A Abella Álvarez
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - D Janeiro Lumbreras
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - B Lobo Valbuena
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - A Naharro Abellán
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - I Torrejón Pérez
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - V Enciso Calderón
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - D Varillas Delgado
- Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - I Conejo Márquez
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | - S García Manzanedo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España
| | | | - M García Arias
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España
| | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España.
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119
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Multidisciplinary Quality Improvement Intervention to Achieve Sustained Improvement in Hand Hygiene Reliability in a Pediatric Intensive Care Unit. Pediatr Qual Saf 2019; 4:e227. [PMID: 32010854 PMCID: PMC6946241 DOI: 10.1097/pq9.0000000000000227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/02/2019] [Indexed: 02/05/2023] Open
Abstract
Suboptimal hand hygiene (HH) remains a significant modifiable cause of healthcare-associated infections in the intensive care unit. We report a single-center, quality improvement project aimed at improving adherence to optimal HH among physicians, nurse practitioners, and nursing staff, and to sustain any improvement over time.
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120
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Smith F, Lee K, Binnie-McLeod E, Higgins M, Irvine E, Henderson A, Orr A, Clark F, Spence J. Identifying the World Health Organization's fifth moment for hand hygiene: Infection prevention in the operating room. J Infect Prev 2019; 21:28-34. [PMID: 32030101 DOI: 10.1177/1757177419879996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 08/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background The World Health Organization have designed the fifth of their '5 moments' for hand hygiene to account for microbial transfer from patients to equipment in a narrow area around that patient, known as the patient zone. The study was prompted by emerging local confusion about application of the patient zone in the operating room (OR). Aim/Objectives In two phases, we aimed to create a '5 moments' style poster displaying an OR patient zone: phase 1, quantify equipment, in direct contact with the patient and, touched by non-scrubbed staff immediately after touching the patient; and phase 2, categorise equipment identified in phase 1 into patient zone and healthcare zone. An objective is to produce a '5 moments' poster for the OR. Methods The first phase used non-participant direct overt observation. In phase 2, phase 1 data were collaboratively assigned to patient zone or healthcare zone. Photography and graphic design were used to produce the OR '5 moments' poster. Results In 11 full-length surgeries, 20 pieces of equipment were in direct contact with the patient and 57 pieces of equipment were touched. In phase 2, a '5 moments' poster showing an OR patient zone was designed. Discussion Content of the patient zone was identified and displayed in a novel resource. Having shared understanding of the patient zone has potential to sustain hand hygiene compliance and equipment cleaning in the OR. Conclusion Limitations in methods were balanced by collaboration with frontline staff. The study has been used as a teaching tool in the OR and similar settings.
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Affiliation(s)
- Fiona Smith
- NHS Grampian Infection Prevention and Control Nurse, Aberdeen, UK
| | - Karen Lee
- University of Dundee Senior Lecturer Infection Prevention and Control, Dundee, Tayside, UK
| | | | - Mark Higgins
- NHS Grampian Operating Room Department, Aberdeen, UK
| | | | | | - Ann Orr
- NHS Grampian Operating Room Department, Aberdeen, UK
| | - Fiona Clark
- NHS Grampian Operating Room Department, Aberdeen, UK
| | - Joanne Spence
- NHS Grampian Operating Room Department, Aberdeen, UK
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121
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Govender NP, Avenant T, Brink A, Chibabhai V, Cleghorn J, du Toit B, Govind C, Lewis E, Lowman W, Mahlangu H, Maslo C, Messina A, Mer M, Pieton K, Seetharam S, Sriruttan C, Swart K, van Schalkwyk E. Federation of Infectious Diseases Societies of Southern Africa guideline: Recommendations for the detection, management and prevention of healthcare-associated Candida auris colonisation and disease in South Africa. S Afr J Infect Dis 2019; 34:163. [PMID: 34485460 PMCID: PMC8377779 DOI: 10.4102/sajid.v34i1.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 11/03/2022] Open
Abstract
Candida auris has been detected at almost 100 South African hospitals, causing large outbreaks in some facilities, and this pathogen now accounts for approximately 1 in 10 cases of candidaemia. The objective of this guideline is to provide updated, evidence-informed recommendations outlining a best-practice approach to prevent, diagnose and manage C. auris disease in public- and private-sector healthcare settings in South Africa. The 18 practical recommendations cover five focus areas: laboratory identification and antifungal susceptibility testing, surveillance and outbreak response, infection prevention and control, clinical management and antifungal stewardship.
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Affiliation(s)
- Nelesh P Govender
- National Institute for Communicable Diseases, Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, Division of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Theunis Avenant
- Kalafong Provincial Tertiary Hospital and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Adrian Brink
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Ampath Laboratories, Cape Town, South Africa
| | - Vindana Chibabhai
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,National Health Laboratory Service, Johannesburg, South Africa.,Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Joy Cleghorn
- Life Healthcare Group, Johannesburg, South Africa
| | | | | | - Elsie Lewis
- Steve Biko Pretoria Academic Hospital, Pretoria, South Africa
| | - Warren Lowman
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,WITS Donald Gordon Medical Centre and Vermaak and Partners Pathologists, Johannesburg, South Africa
| | | | | | - Angeliki Messina
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Netcare Hospitals Limited, Johannesburg, South Africa
| | - Mervyn Mer
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Kim Pieton
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | - Charlotte Sriruttan
- National Institute for Communicable Diseases [Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses], a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karin Swart
- Netcare Hospitals Limited, Johannesburg, South Africa
| | - Erika van Schalkwyk
- National Institute for Communicable Diseases [Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses], a Division of the National Health Laboratory Service, Johannesburg, South Africa
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122
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Affiliation(s)
- Didier Pittet
- Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization (WHO), Geneva, Switzerland
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123
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Abstract
A large proportion of community wound care consists of managing chronic wounds. Given the increasingly complex patient comorbidities, early identification and treatment of wound infection can impact greatly not only on wound healing but also on the patient physically, psychologically and socially. Identifying wound infection can be challenging for clinicians, particularly in the chronic wound where infection may not always present itself as it does in acute wounds. The management of infected wounds can be complicated. Managing multiple symptoms and recognising these as being due to infection is not always straightforward and relies on the practitioner's knowledge and skills. An understanding of more commonly used antimicrobial treatments and when to employ these is paramount in enabling the practitioner to provide care that is effective, evidence based and cost efficient.
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Affiliation(s)
- Leah Rutter
- Nurse Specialist (Tissue Viability), Newcastle upon Tyne Hospitals NHS Foundation Trust
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124
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Sowole L, Ming DK, Davies F. Multidrug-resistant bacteria. Br J Hosp Med (Lond) 2019; 79:C66-C69. [PMID: 29727225 DOI: 10.12968/hmed.2018.79.5.c66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Luciana Sowole
- Speciality Trainee in Infectious Diseases and Microbiology, Department of Microbiology, Imperial College Healthcare NHS Trust, London W6 8RF
| | - Damien K Ming
- Academic Clinical Fellow in Infectious Diseases and General Internal Medicine, Department of Microbiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London
| | - Frances Davies
- Consultant Microbiologist, Department of Microbiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London
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125
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Agreli H, Barry F, Burton A, Creedon S, Drennan J, Gould D, May CR, Smiddy MP, Murphy M, Murphy S, Savage E, Wills T, Hegarty J. Ethnographic study using Normalization Process Theory to understand the implementation process of infection prevention and control guidelines in Ireland. BMJ Open 2019; 9:e029514. [PMID: 31462475 PMCID: PMC6720340 DOI: 10.1136/bmjopen-2019-029514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore how infection prevention and control (IPC) guidelines are used and understood by healthcare professionals, patients and families. DESIGN Ethnographic study with 59 hours of non-participant observation and 57 conversational interviews. Data analysis was underpinned by the Normalization Process Theory (NPT) as a theoretical framework. SETTING Four hospitals in Ireland. PARTICIPANTS Healthcare professionals, patient and families. RESULTS Five themes emerged through the analysis. Four themes provided evidence of the NPT elements (coherence, cognitive participation, collective action and reflexive monitoring). Our findings revealed the existence of a 'dissonance between IPC guidelines and the reality of clinical practice' (theme 1) and 'Challenges to legitimatize guidelines' recommendations in practice' (theme 3). These elements contributed to 'Symbolic implementation of IPC guidelines' (theme 2), which was also determined by a 'Lack of shared reflection upon IPC practices' (theme 4) and a clinical context of 'Workforce fragmentation, time pressure and lack of prioritization of IPC' (theme 5). CONCLUSIONS Our analysis identified themes that provide a comprehensive understanding of elements needed for the successful or unsuccessful implementation of IPC guidelines. Our findings suggest that implementation of IPC guidelines is regularly operationalised through the reproduction of IPC symbols, rather than through adherence to performance of the evidence-based recommendations. Our findings also provide insights into changes to make IPC guidelines that align with clinical work.
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Affiliation(s)
- Heloise Agreli
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Fiona Barry
- Public Health and Epidemiology, University College Cork National University of Ireland, Cork, Ireland
| | - Aileen Burton
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Sile Creedon
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Jonathan Drennan
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Dinah Gould
- Healthcare Sciences, Cardiff University School of Healthcare Studies, Cardiff, UK
| | - Carl R May
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - M P Smiddy
- Public Health and Epidemiology, University College Cork National University of Ireland, Cork, Ireland
| | - Michael Murphy
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Siobhan Murphy
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Eileen Savage
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Teresa Wills
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork National University of Ireland, Cork, Ireland
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126
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Bogdanovic J, Petralito S, Passerini S, Sax H, Manser T, Clack L. Exploring healthcare providers' mental models of the infection prevention "patient zone" - a concept mapping study. Antimicrob Resist Infect Control 2019; 8:138. [PMID: 31428315 PMCID: PMC6694681 DOI: 10.1186/s13756-019-0593-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/07/2019] [Indexed: 12/20/2022] Open
Abstract
Background Pathogen transmission plays a major role in the development of healthcare-associated infections. The “patient zone” concept developed as part of the World Health Organization’s “Five moments of hand hygiene” aims to distinguish surfaces primarily contaminated by flora of a single patient, i.e. inside the patient zone, from those outside the patient zone containing foreign and potentially harmful microorganisms. Discrepancies in healthcare provider (HCP) internal conceptual representations (i.e. mental models) of the patient zone may lead to missed infection prevention measures that could result in patient harm. We explored HCPs’ mental models of the patient zone that shape how they interact with the work environment. Methods We conducted individual concept mapping interviews supported by a card-sorting technique to examine HCPs’ mental models of the patient zone and compared these to IPC expert models. Ten participants (five nurses, five physicians) without IPC specialization and two IPC experts provided definitions of the patient zone and allocated 32 items to “inside” or “outside” the patient zone while verbalizing their thought processes. We calculated similarity as percent agreement among participants and accuracy as percent allocated consistently with expert consensus. A content analysis of interview recordings served to identify mental models underlying the allocation decisions. Results Our study revealed limited similarity among participants, with seven of 32 items allocated consistently among all participants. Overall, 68% of items were sorted accurately according to expert consensus. Identified mental models were categorized as follows: “Patient contact”, the patient zone defined according to objects having patient contact; “Sectors”, the patient zone as a defined physical space; “Disinfection”, the patient zone deduced based on need to disinfect hands and objects; and “Context-dependency”, the patient zone defined depending on the context of an object’s use. Conclusions Our study revealed ambiguity surrounding the patient zone concept as evidenced by low similarity between participants and important discrepancies between participant and expert mental models. Such ambiguity may lead to inconsistent application of the patient zone concept and represents a patient safety risk. Initiatives to improve understanding and application of the patient zone concept should focus on establishing consistent, theoretically founded mental models.
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Affiliation(s)
- Jasmina Bogdanovic
- 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.,2Institute of Nursing Science, University Basel, Basel, Switzerland
| | - Serge Petralito
- 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Simone Passerini
- 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Hugo Sax
- 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern, Northwestern, Switzerland
| | - Lauren Clack
- 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
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127
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Drews FA, Visnovsky LC, Mayer J. Human Factors Engineering Contributions to Infection Prevention and Control. HUMAN FACTORS 2019; 61:693-701. [PMID: 30884250 PMCID: PMC7207010 DOI: 10.1177/0018720819833214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/30/2019] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This article provides a review of areas that present significant challenges in infection prevention and control and describes human factors engineering (HFE) approaches that have been applied successfully to these areas. In addition, implications and recommendations for HFE use in future research are discussed. BACKGROUND Infection prevention and control aims to prevent patients and health care personnel from acquiring preventable infections in healthcare. Effective infection control practices of healthcare-associated infections have recently become even more critical with the emergence of life-threatening infections. HFE could benefit infection prevention and control in addressing older and more recent challenges, but uptake has been limited. METHOD/RESULTS This literature review is an integration and synthesis of recently published research that describes HFE-based approaches in infection prevention and control to address the challenges for three specific topics. The results of the review suggests that HFE is in a position to support work in infection prevention and control and improve overall healthcare safety. CONCLUSION HFE provides conceptual frameworks and methods that have significant potential to improve infection prevention and control. APPLICATION The work reviewed can provide potential solutions for current infection prevention and control challenges by applying HFE based recommendations.
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128
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Diefenbacher S, Pfattheicher S, Keller J. On the Role of Habit in Self-Reported and Observed Hand Hygiene Behavior. Appl Psychol Health Well Being 2019; 12:125-143. [PMID: 31353823 DOI: 10.1111/aphw.12176] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The present contribution tests the main ideas that (a) hand hygiene behavior is associated with habit, and (b) this association is robust when deliberative constructs (i.e. knowledge and intention) are controlled for, indicating an automatic component in hand hygiene behavior. METHODS Two correlational studies using different operationalisations of hand hygiene behavior are reported. In Study 1, hand hygiene was assessed in the context of food preparation; data were measured using the Day Reconstruction Method in a sample of the general population. Study 2 considered hand hygiene compliance of healthcare workers applying video observation by body cameras and additionally self-reported behavior. In both studies, habit was assessed using the Self-Report Behavioral Automaticity Index. RESULTS Both studies found the expected positive association between habit and hand hygiene (0.271 < r < 0.570). Habit was further analyzed in combination with knowledge and intention (Study 2), and emerged as a significant predictor of observed hand hygiene, while knowledge and intention were marginally significant. No significant interactions were found. CONCLUSIONS The present work provides evidence that hand hygiene behavior is reliably related to habit. The findings speak to the notion that addressing the automatic route to hand hygiene behavior when designing interventions can be fruitful.
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Loftus MJ, Guitart C, Tartari E, Stewardson AJ, Amer F, Bellissimo-Rodrigues F, Lee YF, Mehtar S, Sithole BL, Pittet D. Hand hygiene in low- and middle-income countries. Int J Infect Dis 2019; 86:25-30. [PMID: 31189085 DOI: 10.1016/j.ijid.2019.06.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 02/05/2023] Open
Abstract
A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview evidence based strategies to reduce the transmission of pathogens via the hands of healthcare workers and the subsequent incidence of hospital acquired infections with a focus on implementing these strategies in low- and middle-income countries. Existing data suggests that hospital patients in low- and middle-income countries are exposed to rates of healthcare associated infections at least 2-fold higher than in high income countries. In addition to the universal challenges to the implementation of effective hand hygiene strategies, hospitals in low- and middle-income countries face a range of unique barriers, including overcrowding and securing a reliable and sustainable supply of alcohol-based handrub. The WHO Multimodal Hand Hygiene Improvement Strategy and its associated resources represent an evidence-based framework for developing a locally-adapted implementation plan for hand hygiene promotion.
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Affiliation(s)
- Michael J Loftus
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Chloe Guitart
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Andrew J Stewardson
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Fatma Amer
- Department of Microbiology, Zagazig University, Zagazig, Egypt
| | | | - Yew Fong Lee
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Shaheen Mehtar
- Infection Control Africa Network, Unit of IPC, Tygerberg Hospital, Cape Town, South Africa
| | - Buyiswa L Sithole
- Infection Control Africa Network, Unit of IPC, Tygerberg Hospital, Cape Town, South Africa
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Abstract
PURPOSE OF REVIEW Human factors engineering (HFE) approaches are increasingly being used in healthcare, but have been applied in relatively limited ways to infection prevention and control (IPC). Previous studies have focused on using selected HFE tools, but newer literature supports a system-based HFE approach to IPC. RECENT FINDINGS Cross-contamination and the existence of workarounds suggest that healthcare workers need better support to reduce and simplify steps in delivering care. Simplifying workflow can lead to better understanding of why a process fails and allow for improvements to reduce errors and increase efficiency. Hand hygiene can be improved using visual cues and nudges based on room layout. Using personal protective equipment appropriately appears simple, but exists in a complex interaction with workload, behavior, emotion, and environmental variables including product placement. HFE can help prevent the pathogen transmission through improving environmental cleaning and appropriate use of medical devices. SUMMARY Emerging evidence suggests that HFE can be applied in IPC to reduce healthcare-associated infections. HFE and IPC collaboration can help improve many of the basic best practices including use of hand hygiene and personal protective equipment by healthcare workers during patient care.
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131
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Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:608-626. [PMID: 29671025 DOI: 10.1007/s00103-018-2718-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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132
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Ngugi SK, Murila FV, Musoke RN. Hand hygiene practices among healthcare workers in a newborn unit of a tertiary referral hospital in Kenya. J Infect Prev 2019. [DOI: 10.1177/1757177418815556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Health care-associated infection (HCAI) is a significant cause of morbidity and mortality among hospitalised patients, particularly neonates. Compliance with hand hygiene (HH) recommendations is the simplest and most effective measure in preventing this infection. Objectives: To determine the HH practices among healthcare workers (HCWs) in the newborn unit of a tertiary referral hospital in Kenya, their knowledge and perceptions regarding HCAI and importance of HH, and barriers to the recommended HH practices. Methods: A descriptive cross-sectional study was conducted to evaluate the HCWs’ compliance with the World Health Organization (WHO) ‘5 Moments for Hand Hygiene’ and a structured self-administered questionnaire adopted from the WHO knowledge and perception of HCW questionnaires was used to answer the secondary objectives. Results: The overall HH compliance rate was 15%. HCWs were twice more likely to take a HH action ‘after’ than ‘before’ a patient care procedure (odds ratio [OR] = 2.05; 95% confidence interval [CI] = 1.02–4.19; P = 0.03). Nurses and nursing students had statistically significant lower compliance (OR 0.41; 95% CI = 0.18-0.91; p=0.016) and (OR 0.21; 95% CI = 0.06-0.70; p = 0.004) respectively, compared to the doctors. More than half (52%) of the HCWs were unaware of the five moments/indication for HH. Lack of supplies, forgetfulness and use of gloves were the commonly cited barriers to HH compliance. Discussion: HH compliance rate among HCWs in the newborn unit of the tertiary referral hospital was very low. The observed and reported barriers to optimal HH compliance demonstrate a necessity for the adoption of the WHO recommended multimodal HH improvement strategy in this unit.
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Affiliation(s)
- Serah K Ngugi
- Department of Paediatrics and Child Health, University of Nairobi, Kenya
- Ministry of Health, Nyandarua County, Kenya
| | - Florence V Murila
- Department of Paediatrics and Child Health, University of Nairobi, Kenya
| | - Rachel N Musoke
- Department of Paediatrics and Child Health, University of Nairobi, Kenya
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133
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Beyond entry and exit: Hand hygiene at the bedside. Am J Infect Control 2019; 47:487-491. [PMID: 30584017 DOI: 10.1016/j.ajic.2018.10.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to assess compliance, knowledge, and attitudes regarding the World Health Organization (WHO) 5 moments for hand hygiene (HH). METHODS We assessed HH compliance from July-August 2016, using a modified WHO HH observation form. A 26-question survey was used to assess health care personnel (HCP) knowledge, opinions, and barriers to HH. A subgroup of HCPs participated in a 2-round focused survey to assign priority to the moments. RESULTS Three hundred two HH opportunities were observed in 104 unique HCP-patient interactions. HH was performed at 106 (35%) opportunities, 37% (25 of 68) before touching a patient, 9% (6 of 70) before aseptic procedures, 5% (1 of 22) after body fluid exposure or risk, 63% (55 of 88) after touching a patient, and 35% (19 of 54) after touching patient surroundings. Two hundred eighteen HCPs completed the survey; 63 (29%) were familiar with the WHO 5 moments but only 13 (21%) were able to recall all 5 moments. In the focused surveys, 46% (6 of 13) ranked "before aseptic procedure" as the most important HH moment, and 86% (11 of 13) identified "after touching patient surroundings" as the least important. CONCLUSIONS We found frequent opportunities for HH with infrequent compliance. Lack of recognition of opportunities at the bedside and frequent glove use may contribute to lower compliance.
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134
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Arbogast JW, Moore L, Clark T, Thompson M, Wagner P, Young E, Parker AE. Who goes in and out of patient rooms? An observational study of room entries and exits in the acute care setting. Am J Infect Control 2019; 47:585-587. [PMID: 30528169 DOI: 10.1016/j.ajic.2018.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
Abstract
The objective of this study is to determine what percentage of patient room entries and exits (opportunities) are attributed to health care personnel (HCP) and non-HCP. A total of 14,876 opportunities were observed by clinicians in 29 units of 16 hospitals. HCP accounted for 83.6%; 95% confidence interval, 81.3%-87.6%. This finding provides hospitals an initial baseline for HCP room traffic when implementing community-based automated hand hygiene monitoring and compliance improvement efforts.
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135
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Gilbert GL, Kerridge I. The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians' perceptions of professional and cultural factors that influence doctors' attitudes and practices in a large Australian hospital. BMC Health Serv Res 2019; 19:212. [PMID: 30940153 PMCID: PMC6444390 DOI: 10.1186/s12913-019-4044-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/27/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hospital infection prevention and control (IPC) programs are designed to minimise rates of preventable healthcare-associated infection (HAI) and acquisition of multidrug resistant organisms, which are among the commonest adverse effects of hospitalisation. Failures of hospital IPC in recent years have led to nosocomial and community outbreaks of emerging infections, causing preventable deaths and social disruption. Therefore, effective IPC programs are essential, but can be difficult to sustain in busy clinical environments. Healthcare workers' adherence to routine IPC practices is often suboptimal, but there is evidence that doctors, as a group, are consistently less compliant than nurses. This is significant because doctors' behaviours disproportionately influence those of other staff and their peripatetic practice provides more opportunities for pathogen transmission. A better understanding of what drives doctors' IPC practices will contribute to development of new strategies to improve IPC, overall. METHODS This qualitative case study involved in-depth interviews with senior clinicians and clinician-managers/directors (16 doctors and 10 nurses) from a broad range of specialties, in a large Australian tertiary hospital, to explore their perceptions of professional and cultural factors that influence doctors' IPC practices, using thematic analysis of data. RESULTS Professional/clinical autonomy; leadership and role modelling; uncertainty about the importance of HAIs and doctors' responsibilities for preventing them; and lack of clarity about senior consultants' obligations emerged as major themes. Participants described marked variation in practices between individual doctors, influenced by, inter alia, doctors' own assessment of patients' infection risk and their beliefs about the efficacy of IPC policies. Participants believed that most doctors recognise the significance of HAIs and choose to [mostly] observe organisational IPC policies, but a minority show apparent contempt for accepted rules, disrespect for colleagues who adhere to, or are expected to enforce, them and indifference to patients whose care is compromised. CONCLUSIONS Failure of healthcare and professional organisations to address doctors' poor IPC practices and unprofessional behaviour, more generally, threatens patient safety and staff morale and undermines efforts to minimise the risks of dangerous nosocomial infection.
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Affiliation(s)
- Gwendolyn L Gilbert
- Sydney Health Ethics, University of Sydney, Level 1, Building 1, Medical Foundation Building, 92/94 Parramatta Rd, Camperdown, NSW, 2050, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW, 2145, Australia.
| | - Ian Kerridge
- Sydney Health Ethics, University of Sydney, Level 1, Building 1, Medical Foundation Building, 92/94 Parramatta Rd, Camperdown, NSW, 2050, Australia.,Department of Haematology, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW, 2065, Australia
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136
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Diefenbacher S, Fliss P, Tatzel J, Wenk J, Keller J. A quasi-randomized controlled before–after study using performance feedback and goal setting as elements of hand hygiene promotion. J Hosp Infect 2019; 101:399-407. [DOI: 10.1016/j.jhin.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022]
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137
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Seo HJ, Sohng KY, Chang SO, Chaung SK, Won JS, Choi MJ. Interventions to improve hand hygiene compliance in emergency departments: a systematic review. J Hosp Infect 2019; 102:394-406. [PMID: 30935982 DOI: 10.1016/j.jhin.2019.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/23/2019] [Indexed: 11/16/2022]
Abstract
The emergency department (ED) is where hand hygiene problems are significant as the procedures in the ED are often high risk and invasive. To date, there have been no comprehensive reviews on hand hygiene in EDs. The aim of this study was to investigate hand hygiene compliance (HHC) rate, factors affecting the HHC rate, and intervention strategies to improve HHC in EDs. Electronic databases were used to search for research published from 1948 to January 2018. The databases included ovidMEDLINE, ovidEMBASE, the Cochrane Library, CINAHL, Koreamed, and Kmbase. All study designs were included. Two reviewers independently extracted the data and assessed the bias risk using reliable and validated tools. A narrative synthesis was performed. Twenty-four studies, including 12 cross-sectional surveys and 12 interventional studies, were included. Of the 12 interventional studies reviewed, only 33% (N = 4) reported HHC rates of more than 50%. Factors that influenced HHC included types of healthcare worker, hand hygiene indication, ED crowding, positive attitudes towards HHC, patient location, auditing hand hygiene, and type of shift. Almost all of the studies (83.3%) applied multimodal or dual interventions to improve HHC. A range of strategies, including education, monitoring and providing feedback, campaigns, and cues, effectively improved HHC. The review findings indicate that there is a room for improvement in HHC in EDs. Future randomized controlled trials are necessary to determine which intervention modalities are most effective and sustainable for HHC improvement.
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Affiliation(s)
- H-J Seo
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
| | - K-Y Sohng
- College of Nursing, The Catholic University of Korea, Seoul, South Korea
| | - S O Chang
- College of Nursing, Korea University, Seoul, South Korea
| | - S K Chaung
- Department of Nursing, Semyung University, Jecheon, South Korea
| | - J S Won
- College of Nursing, Eulji University, Sungnam, South Korea
| | - M-J Choi
- College of Nursing, The Catholic University of Korea, Seoul, South Korea.
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138
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Tartari E, Fankhauser C, Peters A, Sithole BL, Timurkaynak F, Masson-Roy S, Allegranzi B, Pires D, Pittet D. Scenario-based simulation training for the WHO hand hygiene self-assessment framework. Antimicrob Resist Infect Control 2019; 8:58. [PMID: 30962920 PMCID: PMC6437984 DOI: 10.1186/s13756-019-0511-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
The WHO SAVE LIVES: Clean Your Hands global hand hygiene campaign, launched in 2009 and celebrated annually on the 5th of May, features specific calls to action seeking to increase engagement from stakeholders' collaborations in hand hygiene improvement. WHO calls on everyone to be inspired by the global movement towards universal health coverage (UHC). Infection prevention and control (IPC), including hand hygiene, is critical to achieve UHC as it has a direct impact on quality of care and patient safety across all levels of the health services. In the framework of UHC, the theme for 5 May 2019 is "Clean care for all - it's in your hands". In this context, the WHO has launched a global survey to assess the current level of progress of IPC programmes and hand hygiene activities in healthcare facilities (HCFs) worldwide. This involved the creation of two tools for healthcare facilities: the WHO Infection Prevention and Control Assessment Framework (IPCAF) and the WHO Hand Hygiene Self-Assessment Framework (HHSAF). The objective of this paper is to provide case scenario-based simulation for IPC specialists to simulate and fully assimilate the correct completion of the HHSAF framework in a standardized format. The three case scenarios have been tested and are proposed for the reader to assess the HHSAF of different HCFs in a variety of contexts, even in low-resouce settings. They were designed for simulation training purposes to achieve standardization and interactive learning. These scenarios are meant to be used by professionals in charge of implementing a hand hygiene improvement strategy within their HCF, as well as for simulation and standardized training purposes prior to completing and submitting data for the 2019 WHO Global Survey. Additionally, information provided by the use of the HHSAF can easily be translated into action plans to support the implementation and improvement related to specific indicators of hand hygiene promotion. We invite all HCFs to participate in the 2019 WHO global survey and monitor the level of progress of their IPC programme and hand hygiene activities.
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Affiliation(s)
- Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Carolina Fankhauser
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Alexandra Peters
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Buyiswa Lizzie Sithole
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
- Infection Control Africa Network, Unit of IPC, Tygerberg Hospital, Cape Town, South Africa
| | - Funda Timurkaynak
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Sarah Masson-Roy
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | - Daniela Pires
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
- Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
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Wyeth J. The importance of infection control in tackling the antimicrobial resistance crisis. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:284-286. [PMID: 30907644 DOI: 10.12968/bjon.2019.28.5.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jennifer Wyeth
- Lead Nurse Infection Prevention and Control, Frimley Health NHS Foundation Trust (Heatherwood and Wexham Park Hospitals)
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140
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Kampf G. Adaptive bacterial response to low level chlorhexidine exposure and its implications for hand hygiene. MICROBIAL CELL 2019; 6:307-320. [PMID: 31294043 PMCID: PMC6600115 DOI: 10.15698/mic2019.07.683] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chlorhexidine digluconate (CHG) is commonly used in healthcare, e.g. in skin antiseptics, antimicrobial soaps, alcohol-based hand rubs and oral or wound antiseptics. Aim of the literature review was to evaluate the potential of bacteria to adapt to low level CHG exposure. A maximum 4fold MIC increase to CHG was found after low level exposure in most of the 71 evaluated bacterial species. A strong adaptive mostly stable MIC change was described in strains or isolates of the healthcare-associated species E. coli, S. marcescens and P. aeruginosa (up to 500fold, 128fold or 32fold, respectively). The highest MIC values after adaptation were 2,048 mg/l (S. marcescens) and 1,024 mg/l (P. aeruginosa). A new resistance to tetracycline, gentamicin, meropeneme or triclosan was found in some adapted isolates. In E. coli horizontal gene transfer was induced (sulfonamide resistance by conjugation), pointing out an additional risk of sublethal CHG. The use of CHG in patient care - but also all other settings such as consumer products and households - should therefore be critically assessed and restricted to indications with a proven health benefit or justifiable public health benefits. Additional CHG has no health benefit when used in alcohol-based hand rubs and is not recommended by the WHO. For routine hand washing of soiled hands the use of plain soap is sufficient, CHG in soaps has no health benefit. In surgical hand antisepsis alcohol-based hand rubs should be preferred to CHG soaps. Implementation of these principles will help to reduce avoidable selection pressure.
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Affiliation(s)
- Günter Kampf
- Institute for Hygiene and Environmental Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straβe, 17475 Greifswald, Germany
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141
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Curran ET, Wilkinson M, Bradley T. Chemical disinfectants: Controversies regarding their use in low risk healthcare environments (part 1). J Infect Prev 2019; 20:76-82. [PMID: 30944591 DOI: 10.1177/1757177419828139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/07/2019] [Indexed: 11/17/2022] Open
Abstract
In recent years, the number of disinfectants designed to decontaminate healthcare environments and reusable, non-invasive care equipment (NICE) has increased markedly, making the selection of the most appropriate disinfectant a somewhat daunting prospect. In addition to the microbial challenge, there are numerous factors to consider including: efficacy; range and speed of activity; stability of the ingredients; compatibility of the disinfectant with surfaces; inactivation of the disinfectant by organic matter; method of application; convenience; health and safety concerns; and cost. While the microbial challenge continues to evolve, and novel disinfectants continue to emerge, guidance updates have been notably absent. Most healthcare surfaces belong to a UK-defined category of 'low risk' for which guidance dictates 'cleaning and drying is usually sufficient'. This paper assesses the evidence and arguments regarding the use of disinfectants for low-risk healthcare surfaces. A novel subcategorisation of 'low risk' is presented to provide a more specific up-to-date disinfectant needs assessment.
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Affiliation(s)
- Evonne T Curran
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Martyn Wilkinson
- Hospital Infection Research Laboratory, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tina Bradley
- Hospital Infection Research Laboratory, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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142
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Tarantini C, Brouqui P, Wilson R, Griffiths K, Patouraux P, Peretti-Watel P. Healthcare workers' attitudes towards hand-hygiene monitoring technology. J Hosp Infect 2019; 102:413-418. [PMID: 30831187 DOI: 10.1016/j.jhin.2019.02.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Automated radio-frequency identification (RFID)-based hand-hygiene monitoring technology was implemented in an infectious disease department to study healthcare workers' (HCWs') practices and to improve hand hygiene. AIM To assess HCWs' attitudes towards this innovative monitoring device in order to anticipate resistance to change and facilitate future implementation. METHODS In-depth interviews and an ethnographic approach. FINDINGS From the perspective of HCWs, while they recognize the usefulness of RFID technology to prevent the transmission of infections to patients, they expressed concerns about risks related to RFID electromagnetic waves, as well as control by their superiors. Overall, HCWs' opinions oscillated between positive feelings characterized by enthusiasm for the possibility of changing their practices using technologies and research, and negative feelings marked by strong criticisms of these technologies and research. These criticisms included blaming hand-hygiene monitoring technology for decontextualizing HCWs' practices. They perceived the technologies through the prism of the local and national contexts in which they are embedded. From their point of view, technologies are primarily in the best interests of the project team. Thus, they affirm and maintain the different interests and objectives between themselves and the project team, crystallizing a conflict of professional norms and values between these two groups. The forms of resistance taken by HCWs were practical as well as oral. CONCLUSION Innovative technologies should be developed to address HCWs' attitudes surrounding RFIDs. It is crucial to inform HCWs about the nature of these technologies, although some criticisms about monitoring systems are based on more structural causes.
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Affiliation(s)
- C Tarantini
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France; EHESS, CNRS, Aix Marseille Université, CNELIAS UMR 8562, Marseille, France
| | - P Brouqui
- Aix Marseille University, IRD, IHU-Méditerranée Infection, MEPHI, VITROME, Marseille, France
| | - R Wilson
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
| | - K Griffiths
- Aix Marseille University, IRD, IHU-Méditerranée Infection, MEPHI, VITROME, Marseille, France
| | | | - P Peretti-Watel
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France.
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143
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Jeanes A, Coen PG, Gould DJ, Drey NS. Validity of hand hygiene compliance measurement by observation: A systematic review. Am J Infect Control 2019; 47:313-322. [PMID: 30322815 DOI: 10.1016/j.ajic.2018.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hand hygiene is monitored by direct observation to improve practice, but this approach can potentially cause information, selection, and confounding bias, threatening the validity of findings. The aim of this study was to identify and describe the potential biases in hand hygiene compliance monitoring by direct observation; develop a typology of biases and propose improvements to reduce bias; and increase the validity of compliance measurements. METHODS This systematic review of hospital-based intervention studies used direct observation to monitor health care workers' hand hygiene compliance. RESULTS Seventy-one publications were eligible for review. None was free of bias. Selection bias was present in all studies through lack of data collection on the weekends (n = 61, 86%) and at night (n = 46, 65%) and observations undertaken in single-specialty settings (n = 35, 49%). We observed inconsistency of terminology, definitions of hand hygiene opportunity, criteria, tools, and descriptions of the data collection. Frequency of observation, duration, or both were not described or were unclear in 58 (82%) publications. Observers were trained in 56 (79%) studies. Inter-rater reliability was measured in 26 (37%) studies. CONCLUSIONS Published research of hand hygiene compliance measured by direct observation lacks validity. Hand hygiene should be measured using methods that produce a valid indication of performance and quality. Standardization of methodology would expedite comparison of hand hygiene compliance between clinical settings and organizations.
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Affiliation(s)
- Annette Jeanes
- Infection Control Department, University College London Hospitals, London, United Kingdom.
| | - Pietro G Coen
- Infection Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Nicolas S Drey
- School of Health Sciences, Cardiff, University of London, London, United Kingdom
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144
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Vikke HS, Vittinghus S, Giebner M, Kolmos HJ, Smith K, Castrén M, Lindström V. Compliance with hand hygiene in emergency medical services: an international observational study. Emerg Med J 2019; 36:171-175. [PMID: 30692145 PMCID: PMC6580871 DOI: 10.1136/emermed-2018-207872] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Healthcare-associated infection caused by insufficient hygiene is associated with mortality, economic burden, and suffering for the patient. Emergency medical service (EMS) providers encounter many patients in different surroundings and are thus at risk of posing a source of microbial transmission. Hand hygiene (HH), a proven infection control intervention, has rarely been studied in the EMS. METHODS A multicentre prospective observational study was conducted from December 2016 to May 2017 in ambulance services from Finland, Sweden, Australia and Denmark. Two observers recorded the following parameters: HH compliance according to WHO guidelines (before patient contact, before clean/aseptic procedures, after risk of body fluids, after patient contact and after contact with patient surroundings). Glove use and basic parameters such as nails, hair and use of jewellery were also recorded. RESULTS Sixty hours of observation occurred in each country, for a total of 87 patient encounters. In total, there were 1344 indications for HH. Use of hand rub or hand wash was observed: before patient contact, 3%; before clean/aseptic procedures, 2%; after the risk of body fluids, 8%; after patient contact, 29%; and after contact with patient-related surroundings, 38%. Gloves were worn in 54% of all HH indications. Adherence to short or up done hair, short, clean nails without polish and no jewellery was 99%, 84% and 62%, respectively. HH compliance was associated with wearing gloves (OR 45; 95% CI 10.8 to 187.8; p=0.000) and provider level (OR 1.7; 95% CI 1.1 to 2.4; p=0.007), but not associated with gender (OR 1.3; 95% CI 0.9 to 1.9; p=0.107). CONCLUSION HH compliance among EMS providers was remarkably low, with higher compliance after patient contacts compared with before patient contacts, and an over-reliance on gloves. We recommend further research on contextual challenges and hygiene perceptions among EMS providers to clarify future improvement strategies.
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Affiliation(s)
- Heidi Storm Vikke
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Medical Office, Falck Danmark A/S, Kolding, Denmark
| | | | | | - Hans Jørn Kolmos
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Karen Smith
- Centre fro Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- SamordnareAkademisk ambulans SLL, Academic EMS, Stockholm, Sweden
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145
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Hand Hygiene Compliance Study at a Large Central Hospital in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040607. [PMID: 30791457 PMCID: PMC6406810 DOI: 10.3390/ijerph16040607] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 12/03/2022]
Abstract
Lack of proper hand hygiene among healthcare workers has been identified as a core facilitator of hospital-acquired infections. Although the concept of hand hygiene quality assurance was introduced to Vietnam relatively recently, it has now become a national focus in an effort to improve the quality of care. Nonetheless, barriers such as resources, lack of education, and cultural norms may be limiting factors for this concept to be properly practiced. Our study aimed to assess the knowledge and attitude of healthcare workers toward hand hygiene and to identify barriers to compliance, as per the World Health Organization’s guidelines, through surveys at a large medical center in Vietnam. In addition, we aimed to evaluate the compliance rate across different hospital departments and the roles of healthcare workers through direct observation. Results showed that, in general, healthcare workers had good knowledge of hand hygiene guidelines, but not all believed in receiving reminders from patients. The barriers to compliance were identified as: limited resources, patient overcrowding, shortage of staff, allergic reactions to hand sanitizers, and lack of awareness. The overall compliance was 31%; physicians had the lowest rate of compliance at 15%, while nurses had the highest rate at 39%; internal medicine had the lowest rate at 16%, while the intensive care unit had the highest rate at 40%. In summary, it appears that addressing cultural attitudes in addition to enforcing repetitive quality assurance and assessment programs are needed to ensure adherence to safe hand washing.
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146
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Cheng HC, Peng BY, Lin ML, Chen SLS. Hand hygiene compliance and accuracy in a university dental teaching hospital. J Int Med Res 2019; 47:1195-1201. [PMID: 30646785 PMCID: PMC6421388 DOI: 10.1177/0300060518819610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective This study aimed to evaluate compliance with guidelines on hand hygiene by
examining five handwashing categories in postgraduate year (PGY) dentists at
a university teaching hospital and to evaluate the accuracy rates of
handwashing. Methods Through direct observation, trained PGY dentists were monitored throughout
their daily care routine of before contact with patients, before using an
instrument, after contact with patients, upon direct exposure to patients’
fluids, and while touching the patients’ surrounding area. Hand hygiene
opportunities were considered complete in each category. A total of 16,597
hand hygiene opportunities across 37 individuals were observed from July to
October 2012 and from September to October 2013. Results The overall handwashing compliance rate was 34.7%. The handwashing compliance
rate was higher during work in oral surgery services (92.8%) than during
work in general clinical practice (34.2%). The accuracy rate of handwashing
was also higher during work in oral surgery services (87.5%) than during
work in general clinical practice (51.0%). Similar results were obtained
across all five handwashing categories. Conclusions Handwashing compliance and accuracy rates are low in PGY dentists. More
education and continuous monitoring are suggested to improve handwashing
compliance, as well as the correct handwashing procedures for dentists.
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Affiliation(s)
- Hsin-Chung Cheng
- 1 School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei.,2 Division of Orthodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei
| | - Bou-Yue Peng
- 1 School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei.,2 Division of Orthodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei
| | - Meei-Liang Lin
- 3 Nursing Department, Taipei Medical University Hospital, Taipei
| | - Sam Li-Sheng Chen
- 4 School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei
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147
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Harrison BL, Ogara C, Gladstone M, Carrol ED, Dusabe-Richards J, Medina-Lara A, Ditai J, Weeks AD. "We have to clean ourselves to ensure that our children are healthy and beautiful": findings from a qualitative assessment of a hand hygiene poster in rural Uganda. BMC Public Health 2019; 19:1. [PMID: 30606151 PMCID: PMC6318918 DOI: 10.1186/s12889-018-6343-3] [Citation(s) in RCA: 323] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Neonatal sepsis is a major cause of mortality worldwide, with most deaths occurring in low-income countries. The World Health Organisation (WHO) ‘5 Moments for Hand Hygiene’ poster has been used to reduce hospital-acquired infections, but there is no similar tool to prevent community-acquired newborn infections in low-resource settings. This assessment, part of the BabyGel Pilot study, evaluated the acceptability of the ‘Newborn Moments for Hand Hygiene in the Home’ poster. This was an educational tool which aimed to remind mothers in rural Uganda to clean their hands to prevent neonatal infection. Methods The BabyGel pilot was a cluster randomised trial that assessed the post-partum use of alcohol-based hand rub (ABHR) to prevent neonatal infections in Mbale, Uganda. Fifty-five women in 5 village clusters received the ABHR and used it from birth to 3 months postnatally, with use guided by the new poster. Following the study, 5 focus group discussions (FGDs) were conducted consisting of 6–8 purposively sampled participants from intervention villages. FGDs were audio-recorded, transcribed then translated into English. Transcripts were inductively coded using ATLAS.ti® and qualitatively analysed using thematic content analysis. Results Most mothers reported that they understood the message in the poster (“The picture shows me you must use these drugs to keep your baby healthy”) and that they could adhere to the moments from the poster. Some participants used the information from the poster to encourage other caregivers to use the ABHR (“after explaining to them, they liked it”). Other potential moments for hand hygiene were introduced by participants, such as after tending to domestic animals and gardening. Conclusion The poster was well-received, and participants reported compliance with the moments for hand hygiene (although the full body wipe of the baby has since been removed). The poster will be adapted into a sticker format on the ABHR bottle. More focus could be put into an education tool for other caregivers who wish to hold the baby. Overall, the study demonstrated the acceptability of an adapted version of the WHO Moments for Hand Hygiene poster in the introduction of an intervention in the community. Trial registration ISRCTN67852437, registered 02/03/2015. Trial funding Medical Research Council/ Wellcome Trust/ DfID (Global Health Trials Scheme).
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Affiliation(s)
- B L Harrison
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
| | - C Ogara
- Sanyu Africa Research Institute (SAfRI), Mbale, Uganda
| | - M Gladstone
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - E D Carrol
- Institute of Infection and Global Health, University of Liverpool, Mbale, Uganda
| | | | | | - J Ditai
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.,Sanyu Africa Research Institute (SAfRI), Mbale, Uganda.,Busitema University Faculty of Health Sciences, Tororo, Uganda
| | - A D Weeks
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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148
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Lacey G, Showstark M, Van Rhee J. Training to Proficiency in the WHO Hand Hygiene Technique. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519867681. [PMID: 31428680 PMCID: PMC6683317 DOI: 10.1177/2382120519867681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Hand hygiene is critical to patient safety, but low performance in terms of the quantity and quality of hand hygiene is often reported. Training-to-proficiency is common for other clinical skills, but no proficiency-based training program for hand hygiene has been reported in the literature. This study developed a proficiency-based training program to improve hand hygiene quality in line with World Health Organization (WHO) guidelines and assessed the amount of training required to reach proficiency. The training was delivered as part of a 5-day induction for students on the Physician Assistant online program. METHODS A total of 42 students used a simulator to objectively measure hand hygiene technique over a 5-day period. Proficiency was achieved when students demonstrated all 6 steps of the WHO technique in less than 42 seconds. The students also completed a postintervention questionnaire. RESULTS The average training episode lasted 2.5 minutes and consisted of 4.5 hand hygiene exercises. The average student completed 5 training episodes (1 per day) taking a total of 17 minutes. A total of 40% (17) of the students achieved proficiency within the 5 days. Proficiency was strongly correlated with the number of training exercises completed (r = 0.79, P < .001) and the total time spent training (r = 0.75, P < .001). Linear regression predicted that the 32 hand hygiene exercises or a total of 23-minute training were required to achieve proficiency. CONCLUSIONS This is the first study to develop a train-to-proficiency program for hand hygiene quality and estimate the amount of training required. Given the importance of hand hygiene quality to preventing health care-associated infections (HAIs), medical education programs should consider using proficiency-based training in hand hygiene technique.
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Affiliation(s)
- Gerard Lacey
- School of Computer Science and Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Mary Showstark
- Physician Assistant Online Program, Yale School of Medicine, New Haven, CT, USA
| | - James Van Rhee
- Physician Assistant Online Program, Yale School of Medicine, New Haven, CT, USA
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149
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Sharma S, Khandelwal V, Mishra G. Video Surveillance of Hand Hygiene: A Better Tool for Monitoring and Ensuring Hand Hygiene Adherence. Indian J Crit Care Med 2019; 23:224-226. [PMID: 31160839 PMCID: PMC6535993 DOI: 10.5005/jp-journals-10071-23165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Hand hygiene practice, as correctly said, is the backbone of infection control and it has been proven to limit infections in hospital settings. Currently most healthcare facilities monitor hand hygiene compliance by direct observation technique. We decided to use video surveillance as a tool to monitor hand hygiene compliance and its impact. Materials and Methods This study was conducted over a period of 6 months from March 2018 to August 2018 at Apex Hospital, Jaipur, India. We compared direct observation of ICU, High Dependency Units, and Emergency with video surveillance in these areas. Results and Observations In this study, direct observation and video audit were compared from March 2018 to August 2018. During March to August, average compliance rates of direct observation and video surveillance were compared. In month of march, they were 67% and 20%, respectively and in the month of august, they were 81% and 47%, respectively. Conclusion In our study, We can conclude in our study that video monitoring combined with direct observation can produce a significant and sustained improvement in hand hygiene compliance and can improve quality of patient care. How to cite this article Sharma S, Khandelwal V, Mishra G. Video Surveillance of Hand Hygiene: A Better Tool for Monitoring and Ensuring Hand Hygiene Adherence. Indian J Crit Care Med 2019;23(5):224–226.
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Affiliation(s)
- Shruti Sharma
- Department of Microbiology, Apex Hospital, Jaipur, Rajasthan, India
| | - Vipul Khandelwal
- Department of Internal Medicine and Critical Care, Apex Hospital, Jaipur, Rajasthan, India
| | - Gajendra Mishra
- Department of Microbiology, Apex Hospital, Jaipur, Rajasthan, India
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150
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Johnson K. Technical Tips: Surviving a Joint Commission Visit in the Neurodiagnostic Department. Neurodiagn J 2019; 59:1-22. [PMID: 30916631 DOI: 10.1080/21646821.2019.1571802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
An accreditation site visit from The Joint Commission (TJC) can strike fear in the heart of staff, but knowing what surveyors expect can go a long way toward reducing anxiety. Embedding TJC standards into our everyday routine increases the likelihood of a positive survey. Although TJC accredits many different types of organizations (and specialty services within organizations), the focus of this article will be on hospital-based, neurodiagnostic (ND) departments and includes information specific to infection prevention; medication management; provision of care, treatment, and services; rights and responsibilities of the individual; environment of care; fire safety; hazardous materials; human resources; performance improvement; and record of care, treatment, and services.
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Affiliation(s)
- Kathy Johnson
- a Neurophysiology Department , St. Mary's Medical Center , Huntington , West Virginia
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