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Wilson S, Jacob CJ, Powell D. Behavior-change interventions to improve hand-hygiene practice: a review of alternatives to education. CRITICAL PUBLIC HEALTH 2011. [DOI: 10.1080/09581591003786122] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vindigni SM, Riley PL, Jhung M. Systematic review: handwashing behaviour in low- to middle-income countries: outcome measures and behaviour maintenance. Trop Med Int Health 2011; 16:466-77. [PMID: 21226794 DOI: 10.1111/j.1365-3156.2010.02720.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe global approaches to handwashing research in low- and middle-income communities, schools and health care settings using behavioural outcome measurement and temporal study design. METHODS Peer-reviewed and grey literature was screened for handwashing studies that evaluated behaviour change. Relevant articles were assessed by their research approach, including the investigator's selected outcome measure and time frame of various study components (e.g., formative research, intervention and evaluation). RESULTS The initial search yielded 527 relevant articles. After application of exclusion criteria, we identified 27 unique studies (30 total articles). Of the 27 articles, most were focused in the community setting. Fifteen (56%) documented observed handwashing behaviour, while 18 (67%) used proxy measures (e.g., soap presence, diarrhoea) and 14 (52%) used self-reported behaviour. Several studies used multiple outcome measures. While all studies had an evaluation of behaviour change, there was a dearth of studies that evaluated long-term maintenance of behaviour change after the intervention's conclusion. CONCLUSIONS While the literature is replete with a variety of handwashing studies in community, school and health care settings, none have been able to definitively document long-term behaviour change, thereby challenging the sustainability of various interventions. Additionally, there is a need to better understand which research approach is most effective in promoting long-term behaviour compliance in global low- and middle-income settings.
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Doron SI, Kifuji K, Hynes BT, Dunlop D, Lemon T, Hansjosten K, Cheng T, Curley B, Snydman DR, Fairchild DG. A Multifaceted Approach to Education, Observation, and Feedback in a Successful Hand Hygiene Campaign. Jt Comm J Qual Patient Saf 2011; 37:3-10. [DOI: 10.1016/s1553-7250(11)37001-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Erasmus V, Kuperus MN, Richardus JH, Vos MC, Oenema A, van Beeck EF. Improving hand hygiene behaviour of nurses using action planning: a pilot study in the intensive care unit and surgical ward. J Hosp Infect 2010; 76:161-4. [PMID: 20619931 DOI: 10.1016/j.jhin.2010.04.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 04/30/2010] [Indexed: 11/28/2022]
Abstract
Compliance with hand hygiene guidelines by hospital physicians and nurses is universally low and there is a need to apply powerful intervention methods from social sciences in order to improve compliance. One method is the formation of implementation intentions (or action planning) in which concrete 'if then' plans are formulated to link an environmental cue with performance of an intended behavioural action. This pilot study explored the practicality and effects of action planning on the hand hygiene behaviour (HHB) of nurses in an ICU and surgical ward of a university teaching hospital. A pre-post test design was used, and 17 nurses were invited to participate. A trained researcher observed HHB of nurses before and three weeks after the intervention in which action plans were formulated. Frequencies were calculated and logistic regression analysis was performed to assess changes in HHB. Of the 17 participants, 10 (seven in surgical ward, three in ICU) had complete data and were included in the analyses. In total, 283 potential moments for hand hygiene were identified, 142 in the surgical ward and 141 in the ICU. HHB increased from 9.3% at baseline to 25.4% post intervention (odds ratio: 3.3; confidence interval: 1.7-6.5; P<0.001). Although this was a small scale study, the results show promise for the use of action planning to improve the HHB of nurses in the short term. Action planning has shown success in closing the intention-behaviour gap in other fields, and its use for improving HHB in healthcare should be further investigated.
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Affiliation(s)
- V Erasmus
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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156
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Marjadi B, McLaws ML. Hand hygiene in rural Indonesian healthcare workers: barriers beyond sinks, hand rubs and in-service training. J Hosp Infect 2010; 76:256-60. [DOI: 10.1016/j.jhin.2010.06.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 06/23/2010] [Indexed: 10/19/2022]
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Alemagno SA, Guten SM, Warthman S, Young E, Mackay DS. Online Learning to Improve Hand Hygiene Knowledge and Compliance Among Health Care Workers. J Contin Educ Nurs 2010; 41:463-71. [DOI: 10.3928/00220124-20100610-06] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 02/08/2010] [Indexed: 11/20/2022]
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Abstract
AIM This review seeks to identify the most effective hand-washing and hand-cleansing practice that could be used in primary care. BACKGROUND Healthcare associated infection is a major problem in the UK causing 5000 deaths every year. Current guidelines indicate expert opinion is the level of evidence for hand washing as an activity to reduce infection. DESIGN Systematic review. METHOD Publications on hand-washing, hand-cleansing studies, policy and practice-based documents were sought by searching several databases. Terms used included hand washing, hand cleansing, hand hygiene, hand decontamination, infection control and primary care. RESULTS Few articles described the hand-washing technique in detail and some publications simply referred to either the European and British Standards or the Centre for Disease Control statement on hand washing. Major discrepancies in hand position and water flow direction were found. Several methodological problems were also identified and few studies were undertaken in primary care. CONCLUSION This review has found a lack of evidence for hand-washing techniques being undertaken in practice today. Findings from hand-washing technique studies were inconclusive and methodological issues exist resulting in sparse reliable evidence. There is an urgent need to undertake methodologically sound studies of hand-washing techniques for use in the ever expanding scope of primary care practice. RELEVANCE TO CLINICAL PRACTICE Evidence for hand-washing and hand-cleansing techniques will inform healthcare professional practice, and contribute to the overall management of infection control in primary care.
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Affiliation(s)
- Sheree M S Smith
- Centre for Evidence-Based Medicine, Department of Primary Health Care, University of Oxford, Oxford, UK.
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Educating healthcare workers to optimal hand hygiene practices: addressing the need. Infection 2010; 38:349-56. [PMID: 20857314 DOI: 10.1007/s15010-010-0047-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
Abstract
The education of healthcare workers is essential to improve practices and is an integral part of hand hygiene promotional strategies. According to the evidence reviewed here, healthcare worker education has a positive impact on improving hand hygiene and reducing healthcare-associated infection. Detailed practical guidance on steps for the organization of education programmes in healthcare facilities and teaching-learning strategies are provided using the World Health Organization (WHO) Guidelines for Hand Hygiene in Health Care as the basis for recommendations. Several key elements for a successful educational programme are also identified. A particular emphasis is placed on concepts included in the tools developed by WHO for education, monitoring and performance feedback.
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161
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Using an interdisciplinary approach to identify factors that affect cliniciansʼ compliance with evidence-based guidelines. Crit Care Med 2010; 38:S282-91. [DOI: 10.1097/ccm.0b013e3181e69e02] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jackson R, Cole M. Healthcare workers' uniforms: roles, types and determining policy. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2010; 19:438-41. [PMID: 20505603 DOI: 10.12968/bjon.2010.19.7.47445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Demonstrating reductions in healthcare-associated infection has become a political and clinical priority in the NHS. A plethora of strategies have received the attention of evidence-based practice, one of which is the healthcare worker's uniform and the extent to which it may be implicated in the transmission of infection. Although existing evidence suggests that this risk is low, public opinion believes that such a correlation exists. However, it is difficult for researchers to quantify the level of risk, and organizations should be wary about developing uniform policies based on tenuous infection control evidence. Although professional standards dictate that healthcare workers perform their duties in a well-groomed, appropriately attired manner, it is infection control that should underpin an organization's uniform policy; patients should be well-informed and reassured by this.
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Molina-Cabrillana J, Alvarez-León EE, Quori A, García-de Carlos P, López-Carrió I, Bolaños-Rivero M, Hernández-Vera JR, Ojeda-García I, Córdoba-Tasi E, Ramírez-Rodríguez A, Henríquez-Ojeda A. [Assessment of a hand hygiene program on healthcare-associated infection control]. ACTA ACUST UNITED AC 2010; 25:215-22. [PMID: 20456994 DOI: 10.1016/j.cali.2010.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 09/09/2009] [Accepted: 02/22/2010] [Indexed: 10/19/2022]
Abstract
AIM to assess the impact of a hand hygiene campaign on the rate of healthcare-associated infections in a teaching hospital in Las Palmas. METHODS Ecological design by hand hygiene frequency measurement at three high risk areas along with infection rates calculation over four periods of time: baseline (2005), phase 1 (2006), phase 2 (2007), and post-intervention (2008). Multi-modal intervention comprised the introduction of alcoholic solutions for rubbing hands, feedback on observed compliance, design and placement of posters, and healthcare workers training through all clinician areas. Variables measurement was carried out according to standardized criteria. RESULTS an increase in hand hygiene compliance was achieved over the tree periods of compliance surveillance, from 19.6% at baseline to 40.0% (p<0.001) at the last period. The increase was higher among those opportunities for hand hygiene considered as high risk for pathogen transmission (from 12.0% to 28.4%; p<0.001), but only after phase 1, and for medium risk opportunities. Infection rates did not low in every area under surveillance, especially prevalence of infected patients, which increased from 8% in 2005 to 12.2% in 2008. CONCLUSIONS Despite the increase in adherence to hand hygiene at the areas under surveillance, health-care associated infections were not lowered hospital-wide. A more comprehensive strategy should be implemented, increasing managers and directors support in every task related to infection control.
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Affiliation(s)
- J Molina-Cabrillana
- Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, España.
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Allegranzi B, Sax H, Bengaly L, Richet H, Minta DK, Chraiti MN, Sokona FM, Gayet-Ageron A, Bonnabry P, Pittet D. Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol 2010; 31:133-41. [PMID: 20017633 DOI: 10.1086/649796] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country. DESIGN A before-and-after study from December 2006 through June 2008, with a 6-month baseline evaluation period and a follow-up period of 8 months from the beginning of the intervention. SETTING University Hospital, Bamako, Mali. Participants. Two hundred twenty-four healthcare workers. METHODS The intervention consisted of introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Hand hygiene infrastructure, compliance, healthcare workers' knowledge and perceptions, and handrub consumption were evaluated at baseline and at follow-up. RESULTS Severe deficiencies in the infrastructure for hand hygiene were identified before the intervention. Local handrub production and quality control proved to be feasible, affordable, and satisfactory. At follow-up, handrubbing was the quasi-exclusive hand hygiene technique (93.3%). Compliance increased from 8.0% at baseline to 21.8% at follow-up (P < .001). Improvement was observed across all professional categories and medical specialities and was independently associated with the intervention (odds ratio, 2.50; 95% confidence interval, 1.8-3.5). Knowledge enhanced significantly (P < .05), and perception surveys showed a high appreciation of each strategy component by staff. CONCLUSIONS Multimodal hand hygiene promotion is feasible and effective in a low-income country. Access to handrub was critical for its success. These findings motivated the government of Mali to expand the intervention nationwide. This experience represents a significant advancement for patient safety in developing countries.
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165
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Jang JH, Wu S, Kirzner D, Moore C, Youssef G, Tong A, Lourenco J, Stewart RB, McCreight LJ, Green K, McGeer A. Focus group study of hand hygiene practice among healthcare workers in a teaching hospital in Toronto, Canada. Infect Control Hosp Epidemiol 2010; 31:144-50. [PMID: 20017635 DOI: 10.1086/649792] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To understand the behavioral determinants of hand hygiene in our hospital. DESIGN Qualitative study based on 17 focus groups. SETTING Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto. PARTICIPANTS We recruited 153 healthcare workers (HCWs) representing all major patient care job categories. METHODS Focus group discussions were transcribed verbatim. Thematic analysis was independently conducted by 3 investigators. RESULTS Participants reported that the realities of their workload (eg, urgent care and interruptions) make complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and participants expressed that their judgement is adequate to determine when to perform hand hygiene. Discussions revealed gaps in knowledge among participants; most participants expressed interest in more information and education. Participants reported self-protection as the primary reason for the performance of hand hygiene, and many admitted to prolonged glove use because it gave them a sense of protection. Limited access to hand hygiene products was a source of frustration, as was confusion related to hospital equipment as potential vehicles for transmission of infection. Participants said that they noticed other HCWs' adherence and reported that others HCWs' hygiene practices influenced their own attitudes and practices. In particular, HCWs perceive physicians as role models; physicians, however, do not see themselves as such. CONCLUSIONS Our results confirm previous findings that hand hygiene is practiced for personal protection, that limited access to supplies is a barrier, and that role models and a sense of team effort encourage hand hygiene. Educating HCWs on how to manage workload with guideline adherence and addressing contaminated hospital equipment may improve compliance.
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Affiliation(s)
- Ji-Hyun Jang
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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166
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A multifaceted program to prevent ventilator-associated pneumonia: Impact on compliance with preventive measures*. Crit Care Med 2010; 38:789-96. [DOI: 10.1097/ccm.0b013e3181ce21af] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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167
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McLaws ML, Pantle AC, Fitzpatrick KR, Hughes CF. Improvements in hand hygiene across New South Wales public hospitals: clean hands save lives, part III. Med J Aust 2010; 191:S18-24. [PMID: 19835527 DOI: 10.5694/j.1326-5377.2009.tb02901.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 08/10/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe improvements in hand hygiene compliance after a statewide hand hygiene campaign conducted in New South Wales public hospitals. DESIGN AND SETTING The campaign was conducted in all area health services in NSW (covering all 208 public hospitals). Alcohol-based hand rub (AHR) was introduced into all hospitals between March and June 2006. In each hospital, five overt observation surveys of hand hygiene compliance by health care workers (HCWs) were conducted: one pre-implementation survey and four post-implementation surveys (in August 2006, November 2006, February 2007 and July 2008). MAIN OUTCOME MEASURES Overtly observed hand hygiene compliance rates by HCWs, stratified by before- and after-patient contact, Fulkerson's contact risk categories, and four health care professional groupings. RESULTS The overall hand hygiene compliance rate improved from 47% before the intervention to an average of 61% over the last three observation periods (P < 0.001). All professional groups sustained improved compliance rates except medical staff, whose practices reverted to pre-intervention rates. Nursing staff maintained significantly improved compliance, with an average rate of 67% after the intervention. Overall hand hygiene compliance before patient contact improved from 39% (pre-campaign) to 52% (July 2008) (P < 0.001). Overall compliance after patient contact improved from 57% to 64% (P < 0.001) over the same period. Compliance associated with medium-risk contacts increased from an average of 51% in the first two observation periods to an average of 62% over the last three observation periods (P < 0.001). The corresponding compliance rates associated with low-risk contacts were 35% and 56%, respectively (P < 0.001). CONCLUSION An overall improvement in hand hygiene rates was achieved with the introduction of AHR. Increased adherence to before-patient contact compliance, especially by nursing staff, contributed to the progress made, but an acceptable overall level of hand hygiene practice is yet to be achieved. It is now time to focus on a long-term behavioural change program directed specifically at medical staff.
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Affiliation(s)
- Mary-Louise McLaws
- Hospital Infection Epidemiology and Surveillance Unit, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
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168
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Pittet D. Statewide hand hygiene improvement: embarking on a crusade. Med J Aust 2009; 191:S5-7. [DOI: 10.5694/j.1326-5377.2009.tb02898.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 08/23/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Didier Pittet
- Infection Control Programme, University of Geneva hospitals, Geneva, Switzerland
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169
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Griffiths P, Renz A, Hughes J, Rafferty A. Impact of organisation and management factors on infection control in hospitals: a scoping review. J Hosp Infect 2009; 73:1-14. [DOI: 10.1016/j.jhin.2009.05.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
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170
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Pittet D, Allegranzi B, Boyce J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009; 30:611-22. [PMID: 19508124 DOI: 10.1086/600379] [Citation(s) in RCA: 434] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative. The Guidelines represent the contribution of more than 100 international experts and provide a comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensus-based recommendations, and lessons learned from testing their Advanced Draft and related implementation tools.
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Affiliation(s)
- Didier Pittet
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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171
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Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009; 73:305-15. [PMID: 19720430 DOI: 10.1016/j.jhin.2009.04.019] [Citation(s) in RCA: 523] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 04/03/2009] [Indexed: 12/26/2022]
Abstract
Healthcare workers' hands are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment. Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections (HCAIs), but healthcare worker compliance with optimal practices remains low in most settings. This paper reviews factors influencing hand hygiene compliance, the impact of hand hygiene promotion on healthcare-associated pathogen cross-transmission and infection rates, and challenging issues related to the universal adoption of alcohol-based hand rub as a critical system change for successful promotion. Available evidence highlights the fact that multimodal intervention strategies lead to improved hand hygiene and a reduction in HCAI. However, further research is needed to evaluate the relative efficacy of each strategy component and to identify the most successful interventions, particularly in settings with limited resources. The main objective of the First Global Patient Safety Challenge, launched by the World Health Organization (WHO), is to achieve an improvement in hand hygiene practices worldwide with the ultimate goal of promoting a strong patient safety culture. We also report considerations and solutions resulting from the implementation of the multimodal strategy proposed in the WHO Guidelines on Hand Hygiene in Health Care.
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Affiliation(s)
- B Allegranzi
- First Global Patient Safety Challenge, World Alliance for Patient Safety, IER/PSP, Room L319, L Building, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
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172
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Tai JWM, Mok ESB, Ching PTY, Seto WH, Pittet D. Nurses and physicians' perceptions of the importance and impact of healthcare-associated infections and hand hygiene: a multi-center exploratory study in Hong Kong. Infection 2009; 37:320-33. [PMID: 19636497 DOI: 10.1007/s15010-009-8245-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 12/18/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hand hygiene promotion for patient safety is a challenge worldwide, and local data are critical to tailor strategies to the setting. METHODS This is a cross-sectional study of nurses and physicians providing direct patient care in four hospitals in Hong Kong using an anonymous questionnaire survey. Cognitive factors related to hand hygiene and the perception of effective interventions promoting hand hygiene were assessed. RESULTS The overall response rate was 59.3%. Among respondents, 70% of the nurses and 49% of the physicians perceived that over 15% of patients would suffer from healthcare-associated infections. A total of 79% of the nurses and 68% of the physicians believed that more than 5% of patients would die as a result of healthcare-associated infection. A total of 60% of the nurses and 46% of the physicians acknowledged that over 75% of healthcare-associated infections could be prevented by optimal hand hygiene practices, although 36% of the nurses and 23% of the physicians claimed that six to ten hand cleansing times per hour would be necessary. Bivariate analysis showed significant differences between professionals in self-reported performance. A multivariate regression model revealed that perceived behavioral control and subjective norms were the most important factors associated with the nurses and physicians' self-reported hand hygiene performance. However when gender was taken into account among professionals, subjective norms was the only consistent one. CONCLUSION These results could be used as a tool to create goal-specific strategies for motivating hand hygiene amongst nurses and physicians in Hong Kong, with appropriate promotional interventions delivered to the different professional groups and specialties.
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Affiliation(s)
- J W M Tai
- Infection Control Unit, Queen Mary Hospital, Pokfulam Road, Hong Kong, Special Administrative Region of China.
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173
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Abstract
As part of a package of measures aimed at preventing cross-infection the isolation of patients in single rooms or through cohort nursing is a well-documented policy. However, the evidence base for an isolation policy is unclear it can cause logistical problems through inadequate resources and may result in physical, psychological and social harm to patients. Notwithstanding these problems, isolation can be said to have a practical utility in that it may impact on a nurses behaviour as they enact compliance as part of their infection control duties. It is nevertheless important for policymakers to note that it is not the location of the patient per se that is of primary importance in the transmission of contact spread organisms, but the behaviour of staff within the isolated environment.
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Affiliation(s)
- Mark Cole
- University of Nottingham, Grantham & District Hospital, Lincolnshire
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174
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Nicol P, Watkins R, Donovan R, Wynaden D, Cadwallader H. The power of vivid experience in hand hygiene compliance. J Hosp Infect 2009; 72:36-42. [DOI: 10.1016/j.jhin.2009.01.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 01/21/2009] [Indexed: 10/21/2022]
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175
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Herud T, Nilsen RM, Svendheim K, Harthug S. Association between use of hand hygiene products and rates of health care-associated infections in a large university hospital in Norway. Am J Infect Control 2009; 37:311-7. [PMID: 18945514 DOI: 10.1016/j.ajic.2008.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 06/10/2008] [Accepted: 06/11/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND An association between use of hand hygiene products and health care-associated infection rates was investigated in a large Norwegian university hospital. METHODS We conducted an ecologic study by combining data from purchasing and admission systems with data from 32 point prevalence surveys (27,248 patients) in 1998-2005. Data on purchase of hand disinfectants and soap, and patient-days, were collected for 20 bed wards similar to those of the prevalence surveys. RESULTS The prevalence of infections was 7.1%. We found no significant decline in overall infections (P = .19), but use of hand hygiene products significantly increased from 28.5 L per 1000 patients-days in 1998 to 43.3 L per 1000 patient-days in 2005 (P < .001). After examining a linear dose-response relation between use and infection rates, we observed a borderline significant decline in infections from 8% to 6% with increased use of hand hygiene products (P = .05). This association appeared stronger for wards that were registered with infections >9% at study start in 1998 (P < .001). CONCLUSION These data suggests that infection rates may be reflected by amount of hand hygiene products used. Quantification of such products over time may serve as an indicator for hand hygiene performance in hospitals.
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Affiliation(s)
- Trine Herud
- Centre of Infection Control, Haukeland University Hospital, Bergen, Norway.
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176
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Evans MW, Ramcharan M, Floyd R, Globe G, Ndetan H, Williams R, Ivie R. A proposed protocol for hand and table sanitizing in chiropractic clinics and education institutions. J Chiropr Med 2009; 8:38-47. [PMID: 19646384 PMCID: PMC2697580 DOI: 10.1016/j.jcm.2008.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/01/2008] [Accepted: 09/10/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE By nature, chiropractic is a hands-on profession using manipulation applied to the joints with direct skin-to-skin contacts. Chiropractic tables are designed with a face piece to accommodate the prone patient's head in a neutral position and hand rests to allow for relaxed shoulders and upper spine so treatment is facilitated. The purpose of this article is to present a proposed guideline for hand and treatment table surface sanitizing for the chiropractic profession that is evidence-based and can easily be adopted by teaching institutions and doctors in the field. METHODS A review of the chiropractic literature demonstrated that pathogenic microbes are present on treatment tables in teaching clinics at multiple facilities, yet no standardized protocols exist in the United States regarding table sanitizing and hand hygiene in chiropractic clinics or education institutions. This article reviews the scientific literature on the subject by using several search engines, databases, and specific reviews of documents pertaining to the topic including existing general guidelines. RESULTS The literature has several existing guidelines that the authors used to develop a proposed protocol for hand and table sanitizing specific to the chiropractic profession. Recommendations were developed and are presented on hand hygiene and table sanitizing procedures that could lower the risk of infection for both clinical personnel and patients in chiropractic facilities. CONCLUSION This article offers a protocol for hand and table sanitizing in chiropractic clinics and education institutions. The chiropractic profession should consider adoption of these or similar measures and disseminate them to teaching clinics, institutions, and private practitioners.
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Affiliation(s)
- Marion Willard Evans
- Director, Health Promotion Degree Programs, Cleveland Chiropractic College, Overland Park, KS 66210
| | - Michael Ramcharan
- Research Clinician, Cleveland Chiropractic College, Overland Park, KS 66210
| | - Rod Floyd
- Coordinator of Clinical Academics, Palmer College of Chiropractic-Florida, Port Orange, FL 32129
| | - Gary Globe
- Provost and Academic Dean, Cleveland Chiropractic College-Los Angeles, Los Angeles, CA 90004
| | - Harrison Ndetan
- Assistant Professor, Parker Research Institute, Dallas, TX 75229
| | - Ronald Williams
- Assistant Professor, Department of Health, Human Performance and Recreation, Southeast Missouri State University, Cape Girardeau, MO 63701
| | - Ronald Ivie
- Adjunct Research Faculty, Cleveland Chiropractic College, Overland Park, KS 66210
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177
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Humphreys H, Grundmann H, Skov R, Lucet JC, Cauda R. Prevention and control of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2009; 15:120-4. [DOI: 10.1111/j.1469-0691.2009.02699.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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178
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Religion and culture: potential undercurrents influencing hand hygiene promotion in health care. Am J Infect Control 2009; 37:28-34. [PMID: 18834738 PMCID: PMC7115273 DOI: 10.1016/j.ajic.2008.01.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 01/10/2008] [Accepted: 01/11/2008] [Indexed: 11/08/2022]
Abstract
Background Health care–associated infections affect hundreds of millions of patients worldwide each year. The World Health Organization's (WHO) First Global Patient Safety Challenge, “Clean Care is Safer Care,” is tackling this major patient safety problem, with the promotion of hand hygiene in health care as the project's cornerstone. WHO Guidelines on Hand Hygiene in Healthcare have been prepared by a large group of international experts and are currently in a pilot-test phase to assess feasibility and acceptability in different health care settings worldwide. Methods An extensive literature search was conducted and experts and religious authorities were consulted to investigate religiocultural factors that may potentially influence hand hygiene promotion, offer possible solutions, and suggest areas for future research. Results Religious faith and culture can strongly influence hand hygiene behavior in health care workers and potentially affect compliance with best practices. Interesting data were retrieved on specific indications for hand cleansing according to the 7 main religions worldwide, interpretation of hand gestures, the concept of “visibly dirty” hands, and the use of alcohol-based hand rubs and prohibition of alcohol use by some religions. Conclusions The impact of religious faith and cultural specificities must be taken into consideration when implementing a multimodal strategy to promote hand hygiene on a global scale.
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179
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Factors affecting compliance with glove removal after contact with a patient or environment in four intensive care units. J Hosp Infect 2009; 71:186-8. [DOI: 10.1016/j.jhin.2008.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 11/13/2008] [Indexed: 11/17/2022]
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180
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Can the emotion of disgust be harnessed to promote hand hygiene? Experimental and field-based tests. Soc Sci Med 2009; 68:1006-12. [PMID: 19181428 DOI: 10.1016/j.socscimed.2009.01.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Indexed: 11/22/2022]
Abstract
Two studies carried out in Sydney, Australia explored whether inducing disgust may be a useful addition to hand-hygiene interventions. Experiment 1 employed a novel laboratory measure of hand hygiene, and tested whether a brief (3-min) video-based intervention using disgust/education, improved hand hygiene relative to education alone and a control condition. On test, a week later, the disgust intervention significantly exceeded the education and control condition combined, although the effect size was modest. Experiment 2 examined the generality of this effect in a field study. During a baseline period, soap and paper towel use in a series of washrooms were covertly monitored. This was followed by an intervention period, in which two washrooms received disgust/education-based posters and a further two, educational posters, exhorting participants to wash their hands. A follow-up period, after the posters were removed, was also monitored. The disgust-based intervention was significantly better at promoting hand hygiene. These findings suggest that even brief disgust-based interventions may be successful and that these can be tested and developed under laboratory conditions.
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181
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Yuan CT, Dembry LM, Higa B, Fu M, Wang H, Bradley EH. Perceptions of hand hygiene practices in China. J Hosp Infect 2008; 71:157-62. [PMID: 19013685 PMCID: PMC7132447 DOI: 10.1016/j.jhin.2008.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 09/26/2008] [Indexed: 11/29/2022]
Abstract
Hand hygiene is considered one of the most important infection control measures for preventing healthcare-associated infections. However, compliance rates with recommended hand hygiene practices in hospitals remain low. Previous literature on ways to improve hand hygiene practices has focused on the USA and Europe, whereas studies from developing countries are less common. In this study, we sought to identify common issues and potential strategies for improving hand hygiene practices in hospitals in China. We used a qualitative survey design based on in-depth interviews with 25 key hospital and public health staff in eight hospitals selected by the Chinese Ministry of Health. We found that hospital workers viewed hand hygiene as paramount to effective infection control and had adequate knowledge about proper hand hygiene practices. Despite these positive attitudes and adequate knowledge, critical challenges to improving rates of proper hand hygiene practices were identified. These included lack of needed resources, limited organisational authority of hospital infection control departments, and ineffective use of data monitoring and feedback to motivate improvements. Our study suggests that a pivotal issue for improving hand hygiene practice in China is providing infection control departments adequate attention, priority, and influence within the hospital, with a clear line of authority to senior management. Elevating the place of infection control on the hospital organisational chart and changing the paradigm of surveillance to continuous monitoring and effective data feedback are central to achieving improved hand hygiene practices and quality of care.
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Affiliation(s)
- C T Yuan
- Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut 06520-8034, USA
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182
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Increasing hand hygiene compliance: a mystery? CLIN NURSE SPEC 2008; 22:263-7. [PMID: 18955841 DOI: 10.1097/01.nur.0000325379.07342.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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183
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Rose L, Rogel K, Redl L, Cade JF. Implementation of a multimodal infection control program during an Acinetobacter outbreak. Intensive Crit Care Nurs 2008; 25:57-63. [PMID: 18952433 DOI: 10.1016/j.iccn.2008.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 08/05/2008] [Accepted: 09/14/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Acinetobacter in the ICU presents a challenge worldwide due to its capacity for long-term survival on environmental surfaces. This report describes a multimodal infection control program designed to control a sustained outbreak Acinetobacter colonization. METHODS Multimodal interventions implemented by unit-appointed infection control nurses in an Australian intensive care unit (ICU) during a sustained outbreak of Acinetobacter colonization. RESULTS In the first 12 months of the outbreak, the mean monthly colonization rate was 3.1 (+/-1.2) cases per 100 bed-days (increased from 0.5 [+/-0.4] in the previous 6 months). In the subsequent 20-months, the mean monthly colonization rates declined to 1.5 (+/-1.5) cases per 100 bed-days (P=0.004). Hand hygiene compliance increased from 33% (95% CI 30-36%) before action plan implementation to 49% (95% CI 46-52%) measured 6-months after implementation. Compliance subsequently dropped to 39% (95% CI 36-42%) 12-months after implementation. The median volume of alcohol/chlorhexidine hand rub solution used per 1000 bed-days increased from 24L (interquartile range (IQR) 12-47L) to 148L (IQR 120-165L) per 1000 bed-days (P<0.001). CONCLUSIONS Introduction of ICU-appointed infection control nurses, who then led multimodal interventions, was effective in reducing the rate of Acinetobacter colonization.
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Affiliation(s)
- Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.
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184
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Bhojani S, D'Costa S, Gupta A. Hand hygiene: “Simple, inexpensive and an effective tool”. ACTA ACUST UNITED AC 2008. [DOI: 10.1177/1469044608092806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hospital acquired infection severely affects patients, prolongs hospital stays and presents a major challenge for quality of patients' care (Emmerson et al, 1996; Hand washing Liaison Group, 1999). Improvement in hand hygiene can help in reduction of hospital acquired infection (Hand washing Liaison Group, 1999; Kilpatrick et al, 2007; Whitby et al, 2007; Duerink et al, 2006; Sohn et al, 2005; Jumaa 2005; Randle et al, 2006). Three observational audits were carried out to ascertain existing hand hygiene practice. In the first audit, prescribed standards were achieved in only 29% of cases. After appropriate educational interventions, a repeat study after three months showed significant improvement in up to 84% of cases. The final audit, eight months after the second study, showed that although consultants and registrars had maintained high standards (90%), senior house officers' (SHOs) practice deteriorated (46%). Although both SHOs and registrars changed during this period, only SHO performance deteriorated. Possible reasons may be either that SHOs need more education, or that because they have a busier workload, omission is more common among them, but, this requires more exploration. Conclusion: Hand hygiene is a simple but important practice. Repeat audits plus education appears to drive up standards. Recommendations: To achieve desirable and sustained behaviour change, there is a need to present information on hand hygiene to all doctors at regular intervals. Regular but random covert surveillance observation of practice with a professionals' prior consent appeared to assist in improving practice in this study.
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Affiliation(s)
- S. Bhojani
- Darent Valley Hospital, Darenth Wood, Dartford, Kent DA2 8DA,
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185
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Assanasen S, Edmond M, Bearman G. Impact of 2 different levels of performance feedback on compliance with infection control process measures in 2 intensive care units. Am J Infect Control 2008; 36:407-13. [PMID: 18675146 DOI: 10.1016/j.ajic.2007.08.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 08/14/2007] [Accepted: 08/16/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Performance monitoring and feedback of infection control process measures is an important tool for improving guideline adherence. Different feedback strategies may lead to distinctive outcomes. OBJECTIVES Our objective was to determine the relative impact of 2 different levels of feedback on compliance in an intensive care unit (ICU) setting. METHODS Proportion of head of bed (HOB) elevation, hand hygiene (HH) compliance, and proportion of femoral catheter (FC) to all central venous catheter-days were observed in a medical ICU and a surgical ICU. After a 3-month baseline observation phase (phase 1; P1), we provided quarterly feedback on these process measures and major health care-associated infections (HAIs) to unit leaders from July 2004 to June 2005 (P2). From July 2005 to June 2006 (P3), feedback parameters were also provided to unit leaders and to all staff via 48 x 72-inch color posters in ICU personnel-only areas. At the end of the study, a survey was performed to assess the influence of the posters and HH observations. RESULTS The analysis of IC process measures included 6948 HOB elevation observations, 1576 HH opportunities, and 16,591 catheter-days. In P2, the overall compliance with HOB elevation and the proportion of FC use significantly improved from 51% to 88% (P < .001) and 13% to 7% (P < .001), respectively. No significant difference in HH compliance was observed during this phase (40% vs 47%, respectively; P = .28). Comparing P3 with P2, HH compliance significantly improved from 47% to 71% (P < .001), and there was a slight improvement in HOB elevation rate from 88% to 93% (P < .001). There was no significant change in FC use in P3. There were 53 survey respondents. Sixty percent reported that the poster information changed their practices. Nearly all respondents (92%) knew that their HH behavior was being observed; however, 61% claimed that HH compliance was not influenced by observation. CONCLUSION Feedback of infection control process measures and major HAIs to unit leadership significantly improved compliance with HOB elevation rate and FC use but not HH. Multilevel feedback significantly improved HH compliance and delivered a satisfactory level of compliance with HOB and FC use in both ICUs during the study period.
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Affiliation(s)
- Susan Assanasen
- Divisions of Infectious Diseases and Quality Health Care, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
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186
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Methicillin-resistant Staphylococcus aureus control in the 21st century: beyond the acute care hospital. Curr Opin Infect Dis 2008; 21:372-9. [DOI: 10.1097/qco.0b013e3283013add] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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187
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Vernaz N, Sax H, Pittet D, Bonnabry P, Schrenzel J, Harbarth S. Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile. J Antimicrob Chemother 2008; 62:601-7. [PMID: 18468995 DOI: 10.1093/jac/dkn199] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the temporal relation between the use of antibiotics and alcohol-based hand rubs (ABHRs) and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. METHODS An interventional time-series analysis was performed to evaluate the impact of two promotion campaigns on the consumption of ABHRs and to assess their effect on the incidence of non-duplicate clinical isolates of MRSA and C. difficile from February 2000 through September 2006. This analysis was combined with a transfer function model of aggregated data on antibiotic use. RESULTS Consumption of ABHRs correlated with MRSA, but not with C. difficile. The final model demonstrated the immediate effect of the second hand hygiene promotion campaign and an additional temporal effect of fluoroquinolone (time lag, 1 month; i.e. antibiotic effect delayed for 1 month), macrolide (lag 1 and 4 months), broad-spectrum cephalosporins (lag 3, 4 and 5 months) and piperacillin/tazobactam (lag 3 months) use. The final model explained 57% of the MRSA variance over time. In contrast, the model for C. difficile showed only an effect for broad-spectrum cephalosporins (lag 1 month). CONCLUSIONS We observed an aggregate-level relation between the monthly MRSA incidence and the use of different antibiotic classes and increased consumption of ABHR after a successful hand hygiene campaign, while no association with ABHR use was detected for C. difficile.
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Affiliation(s)
- Nathalie Vernaz
- Pharmacy Department, University of Geneva Hospitals and Medical School, Geneva, Switzerland
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188
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Research or audit? The benefits and limitations of structured observation of the hand hygiene practice of named staff. ACTA ACUST UNITED AC 2008. [DOI: 10.1177/1469044607087608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A pilot research study was undertaken on two tertiary care wards to examine factors influencing hand hygiene compliance. This comprised environmental audit and observation of individual staff for two hour periods. Although it was labour intensive, observation proved a valuable tool in highlighting problems in risk assessment. The results show that hand hygiene was performed following a high proportion (59%) of hand hygiene opportunities, but not in accordance with local guidelines, due predominately to choice of inappropriate hand decontamination agent and/or unnecessary use of gloves. These errors in individual decision-making processes about the choice of hand hygiene measures may be the reason why motivational interventions can be ineffective, and they need to be addressed before audit of compliance can be meaningful.
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189
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Bloomfield SF, Aiello AE, Cookson B, O'Boyle C, Larson EL. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. Am J Infect Control 2007. [PMCID: PMC7115270 DOI: 10.1016/j.ajic.2007.07.001] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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190
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Pittet D, Allegranzi B, Sax H, Chraiti MN, Griffiths W, Richet H. Double-blind, randomized, crossover trial of 3 hand rub formulations: fast-track evaluation of tolerability and acceptability. Infect Control Hosp Epidemiol 2007; 28:1344-51. [PMID: 17994514 DOI: 10.1086/523272] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 07/26/2007] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare healthcare workers' skin tolerance for and acceptance of 3 alcohol-based hand rub formulations. DESIGN Double-blind, randomized, crossover clinical trial. SETTING Intensive care unit in a university hospital. PARTICIPANTS Thirty-eight healthcare workers (HCWs). INTERVENTION A total of 3 alcohol-based hand rub formulations (hereafter, formulations A, B, and C) were used in random order for 3-5 consecutive working days during regular nursing shifts. Formulations A and B contained the same emollient, and formulations B and C contained the same alcohol at the same concentration. Use of each test formulation was separated by a "washout" period of at least 2 days. A visual assessment of skin integrity by a blinded observer using a standard 6-item scale was conducted before and after the use of each formulation. Univariate and multivariate analyses were used for the assessment of risk factors for skin alteration, and product acceptability was assessed by use of a customized questionnaire after the use of each formulation. RESULTS Thirty-eight HCWs used each of 3 formulations for a median of 3 days (range, 3-5 days). The mean amount of product used daily (+/-SD) was 54.9+/-23.5 mL (median, 50.9 mL). Both subjective and objective evaluation of skin conditions after use showed lower HCW tolerance for product C. Male sex (odds ratio [OR], 3.17 [95% confidence interval {CI}, 1.1-8.8]), fair or very fair skin (OR, 3.01 [95% CI, 1.1-7.9]), skin alteration before hand rub use (OR, 3.73 [95% CI, 1.7-8.1]), and use of formulation C (OR, 8.79 [95% CI, 2.7-28.4]) were independently associated with skin alteration. CONCLUSIONS This protocol permits a fast-track comparison of HCWs' skin tolerance for different alcohol-based hand rub formulations that are used in healthcare settings. The emollient in formulation C may account for its inferior performance.
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Affiliation(s)
- Didier Pittet
- Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland.
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191
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Allegranzi B, Storr J, Dziekan G, Leotsakos A, Donaldson L, Pittet D. The First Global Patient Safety Challenge "Clean Care is Safer Care": from launch to current progress and achievements. J Hosp Infect 2007; 65 Suppl 2:115-23. [PMID: 17540254 DOI: 10.1016/s0195-6701(07)60027-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Healthcare-associated infection is a major safety issue affecting the quality of care of hundreds of millions of patients every year in both developed and developing countries. To meet the goal of ensuring patient safety across healthcare settings around the globe, the World Health Organization launched the World Alliance for Patient Safety in October 2004. Healthcare-associated infections were identified as a fundamental work priority and selected as the topic of the First Global Patient Safety Challenge launched by the Alliance. Under the banner "Clean Care is Safer Care", the Challenge aims at implementing several actions to reduce healthcare-associated infections worldwide, regardless of the level of development of healthcare systems and the availability of resources. Implementation strategies include the integration of multiple interventions in the areas of blood safety, injection safety, clinical procedure safety, and water, sanitation and waste management, with the promotion of hand hygiene in healthcare as the cornerstone. Several initiatives have been undertaken to raise global awareness and to obtain country commitment to support action on this issue. The new Guidelines on Hand Hygiene in Health Care, including the most consistent scientific evidence available, have been issued in an advanced draft form. An implementation strategy is proposed therein to provide solutions to overcome obstacles to improvement in compliance with hand hygiene practices, together with a range of practical tools for use in healthcare settings. The latter are currently undergoing testing in several pilot sites to evaluate feasibility, acceptability and sustainability.
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Affiliation(s)
- Benedetta Allegranzi
- First Global Patient Safety Challenge, WHO World Alliance for Patient Safety, World Health Organization, Geneva, Switzerland
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192
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Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007; 67:9-21. [PMID: 17719685 DOI: 10.1016/j.jhin.2007.06.004] [Citation(s) in RCA: 456] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 06/01/2007] [Indexed: 11/17/2022]
Abstract
Hand hygiene is a core element of patient safety for the prevention of healthcare-associated infections and the spread of antimicrobial resistance. Its promotion represents a challenge that requires a multi-modal strategy using a clear, robust and simple conceptual framework. The World Health Organization First Global Patient Safety Challenge 'Clean Care is Safer Care' has expanded educational and promotional tools developed initially for the Swiss national hand hygiene campaign for worldwide use. Development methodology involved a user-centred design approach incorporating strategies of human factors engineering, cognitive behaviour science and elements of social marketing, followed by an iterative prototype test phase within the target population. This research resulted in a concept called 'My five moments for hand hygiene'. It describes the fundamental reference points for healthcare workers (HCWs) in a time-space framework and designates the moments when hand hygiene is required to effectively interrupt microbial transmission during the care sequence. The concept applies to a wide range of patient care activities and healthcare settings. It proposes a unified vision for trainers, observers and HCWs that should facilitate education, minimize inter-individual variation and resource use, and increase adherence. 'My five moments for hand hygiene' bridges the gap between scientific evidence and daily health practice and provides a solid basis to understand, teach, monitor and report hand hygiene practices.
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Affiliation(s)
- H Sax
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland; Global Patient Safety Challenge, World Alliance for Patient Safety, World Health Organization, Geneva, Switzerland
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193
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Ferrer C, Almirante B. Higiene de manos: una prioridad para la seguridad de los pacientes hospitalizados. Enferm Infecc Microbiol Clin 2007; 25:365-8. [PMID: 17583648 DOI: 10.1157/13106960] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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194
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Lohiniva AL, Saeed M, El-Sayeed N, Talaat M. Clean hands: prevention of typhoid fever in rural communities in Egypt. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2007; 28:215-27. [PMID: 19095588 DOI: 10.2190/iq.28.3.d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Typhoid fever is a serious public health problem in Egypt. Effective prevention strategies include the promotion of handwashing. This study explores factors that influence handwashing practices in the Egyptian setting and makes recommendations on how to use this information in a handwashing campaign. In addition to key informant interviews, 16 focus group discussions and 21 in-depth interviews were carried out with female respondents in three different rural sites. The data was analyzed by using content analysis technique. The findings showed that the concept of dirt (microbaat and talaus) influences hygiene behavior as it relates to the outside (i.e., real and visible things). The respondents have low risk perceptions related to typhoid fever and they do not conceptualize long disease transmission chains. The scarcity of water and problems with disposal of waste water hinder handwashing. These findings were incorporated into a pilot campaign to promote handwashing using strategies that included the visualization of germs in critical areas during critical times, discussions of germ theory, and encouragement to solve environmental and infrastructural constraints that hinder handwashing practices at the household level.
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