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Bastiaens GJH, Cremers AJH, Coolen JPM, Nillesen MT, Boeree MJ, Hopman J, Wertheim HFL. Nosocomial outbreak of multi-resistant Streptococcus pneumoniae serotype 15A in a centre for chronic pulmonary diseases. Antimicrob Resist Infect Control 2018; 7:158. [PMID: 30603082 PMCID: PMC6307269 DOI: 10.1186/s13756-018-0457-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022] Open
Abstract
We report nosocomial transmission of multi-resistant serotype 15A Streptococcus pneumoniae (MRSP) that resulted in two lower respiratory tract infections in a centre for chronic pulmonary diseases. This outbreak highlights the potential for transmission of MRSP among vulnerable patients when laboratory turnaround time is long and patient compliance with transmission-based precautions is low.
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Affiliation(s)
- Guido J H Bastiaens
- 1Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Amelieke J H Cremers
- 1Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Jordy P M Coolen
- 1Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Mayke T Nillesen
- 1Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Martin J Boeree
- 2Center for Pulmonary Rehabilitation, Radboud University Medical Center Dekkerswald, Nijmeegsebaan 31, 6561 KE, Groesbeek, the Netherlands
| | - Joost Hopman
- 1Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Heiman F L Wertheim
- 1Department of Medical Microbiology & Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
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152
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Dancer SJ, Kramer A. Four steps to clean hospitals: LOOK, PLAN, CLEAN and DRY. J Hosp Infect 2018; 103:e1-e8. [PMID: 30594612 DOI: 10.1016/j.jhin.2018.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Now that cleaning and decontamination are recognized as integral to infection control, it is timely to examine the process in more detail. This is because cleaning practices vary widely within healthcare districts, and it is likely that both time and energy are needlessly wasted with ill-defined duties. Furthermore, inadequate cleaning will not reduce the risk of infection but may even enhance it. The process would benefit from a systematic appraisal, with each component placed within an evidence-based and ordered protocol. METHODS A literary search was performed on 'hospital cleaning', focusing on manual aspects of cleaning, pathogen reservoirs and transmission, hand hygiene, staff responsibilities and patient comfort. RESULTS No articles providing an evidence-based practical approach to systematic cleaning in hospitals were identified. This review therefore proposes a simple four-step guide for daily cleaning of the occupied bed space. Step 1 (LOOK) describes a visual assessment of the area to be cleaned; Step 2 (PLAN) argues why the bed space needs preparation before cleaning; Step 3 (CLEAN) covers surface cleaning/decontamination; and Step 4 (DRY) is the final stage whereby surfaces are allowed to dry. CONCLUSION Given the lack of articles providing practical cleaning guidance, this review proposes a four-step protocol based on evidence if available, or justified where not. Each step is presented, discussed and risk-assessed. It is likely that a systematic cleaning process would reduce the risk of healthcare-associated infection for everyone, including outbreaks, in addition to heightened confidence in overall quality of care.
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Affiliation(s)
- S J Dancer
- Department of Laboratory Sciences, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
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153
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Likelihood of Infectious Outcomes Following Infectious Risk Moments During Patient Care-An International Expert Consensus Study and Quantitative Risk Index. Infect Control Hosp Epidemiol 2018; 39:280-289. [PMID: 29498340 DOI: 10.1017/ice.2017.327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To elicit expert consensus on the likelihood of infectious outcomes (patient colonization or infection) following a broad range of infectious risk moments (IRMs) from observations in acute care. DESIGN Expert consensus study using modified Delphi technique. PARTICIPANTS Panel of 40 international experts including nurses, physicians and microbiologists specialized in infectious diseases and infection prevention and control (IPC). METHODS The modified Delphi process consisted of 3 online survey rounds, with feedback of mean ratings and expert comments between rounds. The Delphi survey comprised 52 care scenarios representing observed IRMs organized into 6 sections: hands, gloves, medical devices, mobile objects, invasive procedures, and additional moments. For each scenario, experts indicated the likelihood of both patient colonization and infection on a scale from 0 to 5 (high). Expert ratings were plotted against frequencies of IRMs observed during actual patient care resulting in a risk index. RESULTS Following 3 rounds, consensus was achieved for 92 of 104 items (88.5%). The mean ratings across all scenarios for likelihood of colonization and infection were 2.68 and 2.02, respectively. The likelihood of colonization was rated higher than infection for 48 of 52 scenarios. Ratings were significantly higher for colonization (P=.001) and infection (P<.0005) when the scenario involved transfer of pathogens to critical patient sites. CONCLUSIONS The design of effective IPC strategies requires the selection of behaviors according to their impact on patient outcomes. The IRM index reported here provides a basis for standardizing and prioritizing targets for quality improvement initiatives, training, and future research in acute health care. Infect Control Hosp Epidemiol 2018;39:280-289.
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154
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Frequency and Nature of Infectious Risk Moments During Acute Care Based on the INFORM Structured Classification Taxonomy. Infect Control Hosp Epidemiol 2018; 39:272-279. [PMID: 29498339 DOI: 10.1017/ice.2017.326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In this study, we sought to establish a comprehensive inventory of infectious risk moments (IRMs), defined as seemingly innocuous yet frequently occurring care manipulations potentially resulting in transfer of pathogens to patients. We also aimed to develop and employ an observational taxonomy to quantify the frequency and nature of IRMs in acute-care settings. DESIGN Prospective observational study and establishment of observational taxonomy. SETTING Intensive care unit, general medical ward, and emergency ward of a university-affiliated hospital. PARTICIPANTS Healthcare workers (HCWs) METHODS Exploratory observations were conducted to identify IRMs, which were coded based on the surfaces involved in the transmission pathway to establish a structured taxonomy. Structured observations were performed using this taxonomy to quantify IRMs in all 3 settings. RESULTS Following 129.17 hours of exploratory observations, identified IRMs involved HCW hands, gloves, care devices, mobile objects, and HCW clothing and accessories. A structured taxonomy called INFORM (INFectiOus Risk Moment) was established to classify each IRM according to the source, vector, and endpoint of potential pathogen transfer. We observed 1,138 IRMs during 53.77 hours of structured observations (31.25 active care hours) for an average foundation of 42.8 IRMs per active care hour overall, and average densities of 34.9, 36.8, and 56.3 IRMs in the intensive care, medical, and emergency wards, respectively. CONCLUSIONS Hands and gloves remain among the most important contributors to the transfer of pathogens within the healthcare setting, but medical devices, mobile objects, invasive devices, and HCW clothing and accessories may also contribute to patient colonization and/or infection. The INFORM observational taxonomy and IRM inventory presented may benefit clinical risk assessment, training and education, and future research. Infect Control Hosp Epidemiol 2018;39:272-279.
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155
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Yin S, Lim PK, Chan YH. Improving hand hygiene compliance with patient zone demarcation: More than just lines on the floor. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2018. [DOI: 10.1177/2516043518816148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hand hygiene compliance can be difficult to improve as this prospective activity may not come to mind easily during busy clinical operations. Clinicians are often driven by clinical goals under time pressure, and the sudden recall to clean hands can either be disruptive or too late. Using patient zones as a reference has been known to be helpful. A low-tech solution of taping patient zones on the floor was introduced in a children’s intensive care unit. Coupled with this demarcation is a simplified protocol that uses patient zones for “just-in-time” reminders. Clinicians now clean their hands whenever they cross zone lines, namely “ before patient zone” and “ after patient zone”, along with “ before aseptic procedure” and “ after bodily fluids exposure”. Methods The mandatory national quarterly hand hygiene surveillance data for children’s intensive care unit and the entire hospital was tracked. Seven pre-intervention and seven post-intervention quarters were compared for improvement and sustainability. Results Overall, children’s intensive care unit hand hygiene compliance rose from an average of 77% to 90%, as well as physicians' hand hygiene compliance rates from 72% to 86%, and these differences are statistically significant. Hand Hygiene Moment 1 as defined by World Health Organization benefited the most from this intervention. Discussion Patient zone demarcation, along with more intuitive hand hygiene guidelines, is a cost-effective, operationally sensitive intervention that can improve hand hygiene compliance. The bundled solution taps on human factors science in understanding the cognitive challenges faced by clinicians. The positive effects are most profound in multi-bed cubicles where patient zones and infection control barriers are not clearly visible.
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Affiliation(s)
- Shanqing Yin
- Department of Quality, Safety, & Risk Management, KK Women's & Children's Hospital, Singapore, Singapore
| | - Phaik Kooi Lim
- Children's Intensive Care Unit, KK Women's & Children's Hospital, Singapore, Singapore
| | - Yoke Hwee Chan
- Medicine: Dept of Paediatric Subspecialties, Children's Intensive Care, KK Women's & Children's Hospital, Singapore, Singapore
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156
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Tyagi M, Hanson C, Schellenberg J, Chamarty S, Singh S. Hand hygiene in hospitals: an observational study in hospitals from two southern states of India. BMC Public Health 2018; 18:1299. [PMID: 30482180 PMCID: PMC6257976 DOI: 10.1186/s12889-018-6219-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hand hygiene is a simple and low-cost measure to reduce healthcare associated infection yet it has always been a concern in low as well as high resource settings across the globe. Poor hand hygiene during intra-partum and newborn care may result in sepsis, which is a major cause of death among newborns and puts a financial burden on already strained health systems. METHODS We conducted non-participatory observations in newborn care units and labour rooms from secondary and tertiary level, public and private hospitals, as part of a baseline evaluation of a quality improvement collaborative across two southern states of India. We assessed hand hygiene compliance during examinations and common procedures, using tools adapted from internationally recommended checklists and World Health Organization's concept of five moments of hand hygiene. We assessed differences in compliance by type (public/private), level (secondary/tertiary) and case load (low/intermediate/high). Analysis was adjusted for clustering and weighted as appropriate. RESULTS We included 49 newborn care units (19 private, 30 public) and 35 labour rooms (5 private, 30 public) that granted permission. We observed 3661 contacts with newborns and their environment, 242 per-vaginal examinations and 235 deliveries. For the newborns, a greater proportion of contacts in private newborn units than public complied with all steps of hand hygiene (44% vs 12%, p < 0.001), and similarly in tertiary than secondary units (33% vs 12%, p < 0.001) but there was no evidence of a difference by case load of the facility (low load-28%; intermediate load-14%; high load- 24%, p = 0.246). The component with lowest compliance was glove usage where indicated (20%). For deliveries, hand hygiene compliance before delivery was universal in private facilities but seen in only about one-quarter of observations in public facilities (100% vs 27%, p = 0.012). Average overall compliance for hand-hygiene during per-vaginal examinations was 35% and we found no evidence of differences by type of facility. CONCLUSION Observed compliance with hand hygiene was low overall, although better in private than public facilities in both newborn units and labour rooms. Glove usage was a particular problem in newborn care units. TRIAL REGISTRATION Retrospectively registered with Clinical Trials Registry- India ( CTRI/2018/04/013014 ).
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Affiliation(s)
- Mukta Tyagi
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad 500081 India
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Swecha Chamarty
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad 500081 India
| | - Samiksha Singh
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad 500081 India
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157
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Keller J, Wolfensberger A, Clack L, Kuster SP, Dunic M, Eis D, Flammer Y, Keller DI, Sax H. Do wearable alcohol-based handrub dispensers increase hand hygiene compliance? - a mixed-methods study. Antimicrob Resist Infect Control 2018; 7:143. [PMID: 30534364 PMCID: PMC6260844 DOI: 10.1186/s13756-018-0439-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Hand Hygiene (HH) compliance was shown to be poor in several studies. Improving the availability of alcohol-based hand rub (ABHR) is a cornerstone for increasing HH compliance. Methods In this study, we introduced wearable dispensers for ABHR in an Emergency Department (ED) well equipped with mounted ABHR dispensers and accompanied this single-modal intervention by a quasi-experimental mixed-method study. The study was performed in the ED of the University Hospital Zurich, Switzerland, a 950-bed tertiary teaching hospital. During a five-week baseline period and a seven-week intervention period, we observed HH compliance according to the WHO 'Five Moments' concept, measured ABHR consumption, and investigated perceived ABHR availability, self-reported HH compliance and knowledge of HH indications by questionnaire. Multivariable logistic regression was used to identify independent determinants for HH compliance. In addition, semi-structured interviews were conducted and thematically analyzed to assess barriers and facilitators for the use of the newly introduced dispensers. Results Across 811 observed HH opportunities, the HH compliance for all moments was 56% (95% confidence interval (CI), 51-62%) during baseline and 64% (CI, 59-68%) during intervention period, respectively. In the multivariable analysis adjusted for sex, profession, and WHO HH moment, there was no difference in HH compliance between baseline and intervention (adjusted Odds ratio: 1.22 (0.89-1.66), p = 0.22), No significant changes were observed in consumption and perceived availability of ABHR. During intervention, 7.5% ABHR was consumed using wearable dispensers. HCP perceived wearable dispensers as unnecessary since mounted dispensers were readily accessible. Poor ergonomic design of the wearable dispenser emerged as a main barrier, especially its lid and fastening mechanism. Interviewees identified two ideal situations for wearable dispensers, HCP who accompany patients from ED to other wards, and HCP approaching a patient from a non-patient areas in the ED such as the central working station or the meeting room. Conclusion The introduction of wearable dispensers did not increase observed hand hygiene compliance or ABHR consumption in an ED already well equipped with mounted dispensers. For broader acceptance and use, wearable dispensers might benefit from an optimized ergonomic design.
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Affiliation(s)
- Jonas Keller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Aline Wolfensberger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Lauren Clack
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Mesida Dunic
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Doris Eis
- Emergency Department, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yvonne Flammer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.,Baraka Health Centre, German Doctors Nairobi, Nairobi, Kenya
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
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158
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Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections - an overview. Infect Drug Resist 2018; 11:2321-2333. [PMID: 30532565 PMCID: PMC6245375 DOI: 10.2147/idr.s177247] [Citation(s) in RCA: 559] [Impact Index Per Article: 93.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. Multiple studies indicate that the common types of adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications. The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one in 17) die due to these. Several studies suggest that simple infection-control procedures such as cleaning hands with an alcohol-based hand rub can help prevent HCAIs and save lives, reduce morbidity, and minimize health care costs. Routine educational interventions for health care professionals can help change their hand-washing practices to prevent the spread of infection. In support of this, the WHO has produced guidelines to promote hand-washing practices among member countries.
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Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia,
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Muhamad Abu Bakar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia,
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159
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Hoffmann M, Sendlhofer G, Pregartner G, Gombotz V, Tax C, Zierler R, Brunner G. Interventions to increase hand hygiene compliance in a tertiary university hospital over a period of 5 years: An iterative process of information, training and feedback. J Clin Nurs 2018; 28:912-919. [PMID: 30357973 DOI: 10.1111/jocn.14703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVE To explore whether an iterative process of information and training paired with a feedback system to observed healthcare professionals and the respective management improves hand hygiene (HH) compliance. BACKGROUND Healthcare-associated infections are a major risk for patient safety, and adherence to the "My five moments" (M5M) for HH varies significantly within organisations as well as within healthcare professional groups. Identified barriers in a baseline survey revealed the need of more information, training, repetitive compliance measurements and feedback to all healthcare professionals. DESIGN A quality improvement project using the method of direct observation of healthcare professionals in nonsurgical and surgical wards. METHODS Between 2013 and 2017, 6,009 healthcare professionals were informed and trained, and HH compliance measurements were performed by hygiene experts. Compliance measurement results were documented in an online tool to give an immediate feedback to observed healthcare professionals. Additionally, a report was forwarded to the management of the respective department to raise awareness. Compliance rates per year were descriptively summarised. The research and reporting methodology followed SQUIRE 2.0. RESULTS In total, 84 compliance measurements with 19,295 "M5M for HH" were observed in 49 wards. Overall, mean HH compliance increased from 81.9 ± 5.2% in 2013 to 94.0 ± 3.6% in 2017. Physicians' HH compliance rate improved from 69.0 ± 16.6% to 89.3 ± 6.6%, that of nurses from 86.0 ± 6.9% to 96.4 ± 3.1%, and that of others from 60.5 ± 27.9% to 83.8 ± 20.2%. All M5M for HH (#1-#5) increased over the study period (#1: +16.9%; #2: +20.5%; #3: +7.6%; #4: +5.9%; #5: +12.7%). CONCLUSIONS Results demonstrated that an iterative process of information, training, observation and feedback over a period of 5 years can be successful in increasing HH compliance. Positive trends were observed for HH compliance rates across all healthcare professional groups as well as for all M5M for HH.
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Affiliation(s)
- Magdalena Hoffmann
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.,Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Veronika Gombotz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | | | - Renate Zierler
- Executive Department for Hygiene Aspects, University Hospital Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,University Hospital Graz, Graz, Austria
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160
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Hand hygiene opportunities on Canadian acute-care inpatient units: A multicenter observational study. Infect Control Hosp Epidemiol 2018; 39:1378-1380. [DOI: 10.1017/ice.2018.221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIn this multicenter observational study, medical and surgical inpatient rooms were randomized to receive 1 hour of continuous direct observation to determine hand hygiene opportunities (HHOs). After multivariable adjustment, HHOs were similar across inpatient units and hospitals. This estimate could serve to calibrate electronic hand hygiene monitoring systems for Canadian medical and surgical units.
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161
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Saeed O, Tribble DR, Biever KA, Crouch HK, Kavanaugh M. Infection Prevention in Combat-Related Injuries. Mil Med 2018; 183:137-141. [DOI: 10.1093/milmed/usy077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Omar Saeed
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - David R Tribble
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Kimberlie A Biever
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Helen K Crouch
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
| | - Michael Kavanaugh
- Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX
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162
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Gray J, Oppenheim B, Mahida N. The Journal of Hospital Infection - a history of infection prevention and control in 100 volumes. J Hosp Infect 2018; 100:1-8. [PMID: 30173875 DOI: 10.1016/j.jhin.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/04/2018] [Indexed: 02/04/2023]
Affiliation(s)
- J Gray
- Journal of Hospital Infection, London, UK.
| | | | - N Mahida
- Journal of Hospital Infection, London, UK
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163
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Wałaszek M, Kołpa M, Różańska A, Wolak Z, Bulanda M, Wójkowska-Mach J. Practice of hand hygiene and use of protective gloves: Differences in the perception between patients and medical staff. Am J Infect Control 2018; 46:1074-1076. [PMID: 29548708 DOI: 10.1016/j.ajic.2018.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 10/17/2022]
Abstract
This study investigated differences in perceptions of hand hygiene and protective glove use among patients and health care workers (HCWs) in Poland. We conducted a survey using an original questionnaire among 462 respondents, including 173 (37.4%) patients and 289 (62.6%) HCWs; HCWs demonstrated poor familiarity with the My 5 Moments for Hand Hygiene. The role of protective gloves in preventing health care-associated infection was overestimated by both patients and HCWs.
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164
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Preventing ventilator-associated pneumonia-a mixed-method study to find behavioral leverage for better protocol adherence. Infect Control Hosp Epidemiol 2018; 39:1222-1229. [PMID: 30165916 DOI: 10.1017/ice.2018.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Preventing ventilator-associated pneumonia (VAP) is an important goal for intensive care units (ICUs). We aimed to identify the optimal behavior leverage to improve VAP prevention protocol adherence. DESIGN Mixed-method study using adherence measurements to assess 4 VAP prevention measures and qualitative analysis of semi-structured focus group interviews with frontline healthcare practitioners (HCPs). SETTING The 6 ICUs in the 900-bed University Hospital Zurich in Zurich, Switzerland.Patients and participantsAdherence to VAP prevention measures were assessed in patients with a device for invasive ventilation (ie, endotracheal tube, tracheostomy tube). Participants in focus group interviews included a convenience samples of ICU nurses and physicians. RESULTS Between February 2015 and July 2017, we measured adherence to 4 protocols: bed elevation showed adherence at 27% (95% confidence intervals [CI], 23%-31%); oral care at 41% (95% CI, 36%-45%); sedation interruption at 81% (95% CI, 74%-85%); and subglottic suctioning at 88% (95% CI, 83%-92%). Interviews were analyzed first inductively according a grounded theory approach then deductively against the behavior change wheel (BCW) framework. Main behavioral facilitators belonged to the BCW component 'reflective motivation' (ie, perceived seriousness of VAP and self-efficacy to prevent VAP). The main barriers belonged to 'physical capability' (ie, lack of equipment and staffing and side-effects of prevention measures). Furthermore, 2 primarily technical approaches (ie, 'restructuring environment' and 'enabling HCP') emerged as means to overcome these barriers. CONCLUSIONS Our findings suggest that technical, rather than education-based, solutions should be promoted to improve VAP prevention. This theory-informed mixed-method approach is an effective means of guiding infection prevention efforts.
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165
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Wu AW. The easy part is over: Creating safe systems of care. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2018. [DOI: 10.1177/2516043518792167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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166
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Risk behaviours for organism transmission in daily care activities: a longitudinal observational case study. J Hosp Infect 2018; 100:e146-e150. [PMID: 30081148 DOI: 10.1016/j.jhin.2018.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/30/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND To understand healthcare personnel's infection prevention behaviour has long been viewed as a key factor in preventing healthcare-associated infections. Suboptimal hand hygiene compliance and handling of materials, equipment, and surfaces present the main risks for potential organism transmission. Further exploration is needed regarding the role of context-specific conditions and the infection prevention behaviours of healthcare personnel. Such knowledge could enable the development of new intervention strategies for modifying behaviour. AIM To describe risk behaviours for organism transmission in daily care activities over time. METHODS Unstructured observations of healthcare personnel carrying out patient-related activities were performed on 12 occasions over a period of 18 months. FINDINGS Risk behaviours for organism transmission occur frequently in daily care activities and the results show that the occurrence is somewhat stable over time. Interruptions in care activities contribute to an increased risk for organism transmission that could lead to subsequent healthcare-associated infection. CONCLUSION Interventions aimed at reducing the risks of healthcare-associated infections need to focus on strategies that address: hand hygiene compliance; the handling of materials, equipment, work clothes and surfaces; the effects of interruptions in care activities if they are to alter healthcare personnel's infection prevention behaviour sufficiently.
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167
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Knighton SC, Davis J. Journal Club: Quantifying the Hawthorne effect using overt and covert observation of hand hygiene at a tertiary care hospital in Saudi Arabia. Am J Infect Control 2018; 46:928-929. [PMID: 30072160 DOI: 10.1016/j.ajic.2018.04.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Shanina C Knighton
- Cleveland Veterans Affairs Medical Center, Cleveland, OH; Case Western Reserve University, Cleveland, OH.
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168
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Development of a novel prevention bundle for pediatric healthcare-associated viral infections. Infect Control Hosp Epidemiol 2018; 39:1086-1092. [DOI: 10.1017/ice.2018.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveTo reduce the healthcare-associated viral infection (HAVI) rate to 0.70 infections or fewer per 1,000 patient days by developing and sustaining a comprehensive prevention bundle.SettingA 546-bed quaternary-care children’s hospital situated in a large urban area.PatientsInpatients with a confirmed HAVI were included. These HAVIs were identified through routine surveillance by infection preventionists and were confirmed using National Healthcare Safety Network definitions for upper respiratory infections (URIs), pneumonia, and gastroenteritis.MethodsQuality improvement (QI) methods and statistical process control (SPC) analyses were used in a retrospective observational analysis of HAVI data from July 2012 through June 2016.ResultsIn total, 436 HAVIs were identified during the QI initiative: 63% were URIs, 34% were gastrointestinal infections, and 2.5% were viral pneumonias. The most frequent pathogens were rhinovirus (n=171) and norovirus (n=83). Our SPC analysis of HAVI rate revealed a statistically significant reduction in March 2014 from a monthly average of 0.81 to 0.60 infections per 1,000 patient days. Among HAVIs with event reviews completed, 15% observed contact with a sick primary caregiver and 15% reported contact with a sick visitor. Patient outcomes identified included care escalation (37%), transfer to ICU (11%), and delayed discharge (19%).ConclusionsThe iterative development, implementation, and refinement of targeted prevention practices was associated with a significant reduction in pediatric HAVI. These practices were ultimately formalized into a comprehensive prevention bundle and provide an important framework for both patient and systems-level interventions that can be applied year-round and across inpatient areas.
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169
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Pong S, Holliday P, Fernie G. Effect of electronic real-time prompting on hand hygiene behaviors in health care workers. Am J Infect Control 2018; 46:768-774. [PMID: 29502882 DOI: 10.1016/j.ajic.2017.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/21/2017] [Accepted: 12/23/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Poor hand hygiene by health care workers is a major cause of nosocomial infections. This research evaluated the ability of an electronic monitoring system with real-time prompting capability to change hand hygiene behaviors. METHODS Handwashing activity was measured by counting dispenser activations on a single nursing unit before, during, and after installation of the system. The effect of changing the prompt duration on hand hygiene performance was determined by a cluster-randomized trial on 3 nursing units with 1 acting as control. Sustainability of performance and participation was observed on 4 nursing units over a year. All staff were eligible to participate. RESULTS Between June 2015 and December 2016, a total of 459,376 hand hygiene opportunities and 330,740 handwashing events from 511 staff members were recorded. Dispenser activation counts were significantly influenced by use of the system (χ2[3] = 75.76; P < .0001). Hand hygiene performance dropped from 62.61% to 24.94% (odds ratio, 0.36; 95% confidence interval, 0.34-0.38) when the prompting feature was removed. Staff participation had a negative trajectory of -0.72% (P < .001), whereas change in average performance was -0.18% (P < .001) per week for the year. CONCLUSIONS Use of electronic monitoring with real-time prompts of 20 seconds' duration nearly doubles handwashing activity and causes handwashing to occur sooner after entering a patient room. These improvements are sustainable over a year.
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Öncü E, Vayısoğlu SK, Lafcı D, Yıldız E. An evaluation of the effectiveness of nursing students' hand hygiene compliance: A cross-sectional study. NURSE EDUCATION TODAY 2018; 65:218-224. [PMID: 29604605 PMCID: PMC7115509 DOI: 10.1016/j.nedt.2018.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/04/2018] [Accepted: 02/20/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Emine Öncü
- Community Health Nursing Department, Faculty of Nursing, Mersin University, Mersin, Turkey.
| | | | - Diğdem Lafcı
- Fundementals of Nursing Department, Faculty of Nursing, Mersin University, Mersin, Turkey
| | - Ebru Yıldız
- Fundementals of Nursing Department, Faculty of Nursing, Mersin University, Mersin, Turkey
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171
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Hand hygiene "hall monitors": Leveraging the Hawthorne effect. Am J Infect Control 2018; 46:706-707. [PMID: 29361363 DOI: 10.1016/j.ajic.2017.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/24/2022]
Abstract
Unfortunately, more than a decade after the World Health Organization's campaign launched, many centers still face challenges with low rates of hand hygiene compliance. Several electronic hand hygiene monitoring systems are available, and the cost of setup and maintenance varies by institution. At our institution, with extremely limited funds for complex interventions, we instead hired a pragmatic teenager in search of a summer job and trained her as a hand hygiene "hall monitor." We describe an effective, inexpensive intervention that improved our unit's hand hygiene performance while also providing youth employment.
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172
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Lee AS, de Lencastre H, Garau J, Kluytmans J, Malhotra-Kumar S, Peschel A, Harbarth S. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Primers 2018; 4:18033. [PMID: 29849094 DOI: 10.1038/nrdp.2018.33] [Citation(s) in RCA: 736] [Impact Index Per Article: 122.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Since the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has emerged, disseminated globally and become a leading cause of bacterial infections in both health-care and community settings. However, there is marked geographical variation in MRSA burden owing to several factors, including differences in local infection control practices and pathogen-specific characteristics of the circulating clones. Different MRSA clones have resulted from the independent acquisition of staphylococcal cassette chromosome mec (SCCmec), which contains genes encoding proteins that render the bacterium resistant to most β-lactam antibiotics (such as methicillin), by several S. aureus clones. The success of MRSA is a consequence of the extensive arsenal of virulence factors produced by S. aureus combined with β-lactam resistance and, for most clones, resistance to other antibiotic classes. Clinical manifestations of MRSA range from asymptomatic colonization of the nasal mucosa to mild skin and soft tissue infections to fulminant invasive disease with high mortality. Although treatment options for MRSA are limited, several new antimicrobials are under development. An understanding of colonization dynamics, routes of transmission, risk factors for progression to infection and conditions that promote the emergence of resistance will enable optimization of strategies to effectively control MRSA. Vaccine candidates are also under development and could become an effective prevention measure.
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Affiliation(s)
- Andie S Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Hermínia de Lencastre
- Laboratory of Microbiology and Infectious Diseases, The Rockefeller University, New York, NY, USA.,Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Javier Garau
- Department of Medicine, Hospital Universitari Mutua de Terrassa, Barcelona, Spain
| | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Universiteit Antwerpen, Wilrijk, Belgium
| | - Andreas Peschel
- Interfaculty Institute of Microbiology and Infection Medicine, Infection Biology Department, University of Tübingen, Tübingen, Germany.,German Center for Infection Research, Partner Site Tübingen, Tübingen, Germany
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, WHO Collaborating Center, Geneva, Switzerland
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173
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Hand hygiene mantra: teach, monitor, improve, and celebrate. J Hosp Infect 2018; 95:335-337. [PMID: 28364826 DOI: 10.1016/j.jhin.2017.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 12/31/2022]
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174
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Defining the Role of the Environment in the Emergence and Persistence of vanA Vancomycin-Resistant Enterococcus (VRE) in an Intensive Care Unit: A Molecular Epidemiological Study. Infect Control Hosp Epidemiol 2018; 39:668-675. [PMID: 29611491 DOI: 10.1017/ice.2018.29] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVETo describe the transmission dynamics of the emergence and persistence of vanA vancomycin-resistant enterococcus (VRE) in an intensive care unit (ICU) using whole-genome sequencing of patient and environmental isolates.DESIGNRetrospective cohort study.SETTINGICU in a tertiary referral center.PARTICIPANTSPatients admitted to the ICU over an 11-month period.METHODS VanA VRE isolated from patients (n=31) were sequenced using the Illumina MiSeq platform. Environmental samples from bed spaces, equipment, and waste rooms were collected. All vanA VRE-positive environmental samples (n=14) were also sequenced. Data were collected regarding patient ward and bed movements.RESULTSThe 31 patient vanA VRE isolates were from screening (n=19), urine (n=4), bloodstream (n=3), skin/wound (n=3), and intra-abdominal (n=2) sources. The phylogeny from sequencing data confirmed several VRE clusters, with 1 group accounting for 38 of 45 isolates (84%). Within this cluster, cross-transmission was extensive and complex across the ICU. Directionality indicated that colonized patients contaminated environmental sites. Similarly, environmental sources not only led to patient colonization but also to infection. Notably, shared equipment acted as a conduit for transmission between different ICU areas. Infected patients, however, were not linked to further VRE transmission.CONCLUSIONSGenomic sequencing confirmed a predominantly clonal outbreak of VRE with complex transmission dynamics. The environmental reservoir, particularly from shared equipment, played a key role in ongoing VRE spread. This study provides evidence to support the use of multifaceted strategies, with an emphasis on measures to reduce bacterial burden in the environment, for successful VRE control.Infect Control Hosp Epidemiol 2018;39:668-675.
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175
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Jeanes A, Coen PG, Drey NS, Gould DJ. The development of hand hygiene compliance imperatives in an emergency department. Am J Infect Control 2018; 46:441-447. [PMID: 29269167 DOI: 10.1016/j.ajic.2017.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Monitoring results showing poor hand hygiene compliance in a major, busy emergency department prompted a quality improvement initiative to improve hand hygiene compliance. PURPOSE To identify, remove, and reduce barriers to hand hygiene compliance in an emergency department. METHODS A barrier identification tool was used to identify key barriers and opportunities associated with hand hygiene compliance. Hand hygiene imperatives were developed and agreed on with clinicians, and a framework for monitoring and improving hand hygiene compliance was developed. RESULTS Barriers to compliance were ambiguity about when to clean hands, the pace and urgency of work in some areas of the department, which left little time for hand hygiene and environmental and operational issues. Sore hands were a problem for some staff. Expectations of compliance were agreed on with staff, and changes were made to remove barriers. A monitoring tool was designed to monitor progress. Gradual improvement occurred in all areas, except in emergency situations, which require further improvement work. CONCLUSIONS The context of care and barriers to compliance should be reflected in hand hygiene expectations and monitoring. In the emergency department, the requirement to deliver urgent live-saving care can supersede conventional hand hygiene expectations.
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176
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Matar MJ, Moghnieh RA, Awad LS, Kanj SS. Effective Strategies for Improving Hand Hygiene in Developing Countries. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0152-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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177
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Jeanes A, Dick J, Coen P, Drey N, Gould DJ. Hand hygiene compliance monitoring in anaesthetics: Feasibility and validity. J Infect Prev 2018; 19:116-122. [DOI: 10.1177/1757177418755306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/10/2017] [Indexed: 11/17/2022] Open
Abstract
Background: Hand hygiene compliance scores in the anaesthetic department of an acute NHS hospital were persistently low. Aims: To determine the feasibility and validity of regular accurate measurement of HHC in anaesthetics and understand the context of care delivery, barriers and opportunities to improve compliance. Methods: The hand hygiene compliance of one anaesthetist was observed and noted by a senior infection control practitioner (ICP). This was compared to the World Health Organization five moments of hand hygiene and the organisation hand hygiene tool. Findings: In one sequence of 55 min, there were approximately 58 hand hygiene opportunities. The hand hygiene compliance rate was 16%. The frequency and speed of actions in certain periods of care delivery made compliance measurement difficult and potentially unreliable. During several activities, taking time to apply alcohol gel or wash hands would have put the patients at significant risk. Discussion: We concluded that hand hygiene compliance monitoring by direct observation was invalid and unreliable in this specialty. It is important that hand hygiene compliance is optimal in anaesthetics particularly before patient contact. Interventions which reduce environmental and patient contamination, such as cleaning the patient and environment, could ensure anaesthetists encounter fewer micro-organisms in this specialty.
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Affiliation(s)
- A Jeanes
- Infection Control Department, University College London Hospitals, London, UK
| | - J Dick
- University College Hospital, London, UK
| | - P Coen
- Infection Control Department, University College London Hospitals, London, UK
| | - N Drey
- City University London, London, UK
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Pfattheicher S, Strauch C, Diefenbacher S, Schnuerch R. A field study on watching eyes and hand hygiene compliance in a public restroom. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2018. [DOI: 10.1111/jasp.12501] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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179
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Schaffner DW, Jensen D, Gerba CP, Shumaker D, Arbogast JW. Influence of Soap Characteristics and Food Service Facility Type on the Degree of Bacterial Contamination of Open, Refillable Bulk Soaps. J Food Prot 2018; 81:218-225. [PMID: 29320234 DOI: 10.4315/0362-028x.jfp-17-251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Concern has been raised regarding the public health risks from refillable bulk-soap dispensers because they provide an environment for potentially pathogenic bacteria to grow. This study surveyed the microbial quality of open refillable bulk soap in four different food establishment types in three states. Two hundred ninety-six samples of bulk soap were collected from food service establishments in Arizona, New Jersey, and Ohio. Samples were tested for total heterotrophic viable bacteria, Pseudomonas, coliforms and Escherichia coli, and Salmonella. Bacteria were screened for antibiotic resistance. The pH, solids content, and water activity of all soap samples were measured. Samples were assayed for the presence of the common antibacterial agents triclosan and parachlorometaxylenol. More than 85% of the soap samples tested contained no detectable microorganisms, but when a sample contained any detectable microorganisms, it was most likely contaminated at a very high level (∼7 log CFU/mL). Microorganisms detected in contaminated soap included Klebsiella oxytoca, Serratia liquefaciens, Shigella sonnei, Enterobacter gergoviae, Serratia odorifera, and Enterobacter cloacae. Twenty-three samples contained antibiotic-resistant organisms, some of which were resistant to two or more antibiotics. Every sample containing less than 4% solids had some detectable level of bacteria, whereas no samples with greater than 14% solids had detectable bacteria. This finding suggests the use of dilution and/or low-cost formulations as a cause of bacterial growth. There was a statistically significant difference ( P = 0.0035) between the fraction of bacteria-positive samples with no detected antimicrobial agent (17%) and those containing an antimicrobial agent (7%). Fast food operations and grocery stores were more likely to have detectable bacteria in bulk-soap samples compared with convenience stores ( P < 0.05). Our findings underscore the risk to public health from use of refillable bulk-soap dispensers in food service establishments.
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Affiliation(s)
- Donald W Schaffner
- 1 Department of Food Science, Rutgers, The State University of New Jersey, 65 Dudley Road, New Brunswick, New Jersey 08901
| | - Dane Jensen
- 1 Department of Food Science, Rutgers, The State University of New Jersey, 65 Dudley Road, New Brunswick, New Jersey 08901
| | - Charles P Gerba
- 2 Department of Soil, Water and Environmental Science, University of Arizona, Tucson, Arizona 85721; and
| | - David Shumaker
- 3 GOJO Industries, Inc., 1 GOJO Plaza #500, Akron, Ohio 44311, USA
| | - James W Arbogast
- 3 GOJO Industries, Inc., 1 GOJO Plaza #500, Akron, Ohio 44311, USA
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180
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Gould D, Moralejo D, Drey N, Chudleigh J, Taljaard M. Interventions to improve hand hygiene compliance in patient care: Reflections on three systematic reviews for the Cochrane Collaboration 2007-2017. J Infect Prev 2018; 19:108-113. [PMID: 29796092 DOI: 10.1177/1757177417751285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/10/2017] [Indexed: 11/15/2022] Open
Abstract
This article presents highlights from a recently updated systematic Cochrane review evaluating the effectiveness of interventions to improve hand hygiene compliance in patient care. It is an advance on the two earlier reviews we undertook on the same topic as it has, for the first time, provided very rigorous synthesis of evidence that such interventions can improve practice. In this article, we provide highlights from a recently updated Cochrane systematic review. We identify omissions in the information reported and point out important aspects of hand hygiene intervention studies that were beyond the scope of the review. A full report of the review is available free of charge on the Cochrane website.
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Affiliation(s)
- Dinah Gould
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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181
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Abstract
PURPOSE OF REVIEW Humanitarian medical organizations focus on vulnerable patients with increased risk for healthcare-associated infections (HAIs) and are obligated to minimize them in inpatient departments (IPDs). However, in doing so humanitarian groups face considerable obstacles. This report will focus on approaches to reducing common HAIs that the authors have found to be helpful in humanitarian settings. RECENT FINDINGS HAIs are common in humanitarian contexts but there are few interventions or guidelines adapted for use in poor and conflict-affected settings to improve prevention and guide surveillance. Based on existing recommendations and studies, it appears prudent that all humanitarian IPDs introduce a basic infection prevention infrastructure, assure high adherence to hand hygiene with wide accessibility to alcohol-based hand rub, and develop pragmatic surveillance based on clinically evident nosocomial infection. Although microbiology remains out of reach for most humanitarian hospitals, rapid tests offer the possibility of improving the diagnosis of HAIs in humanitarian hospitals in the decade ahead. SUMMARY There is a dearth of new studies that can direct efforts to prevent HAIs in IPDs in poor and conflict-affected areas and there is a need for practical, field-adapted guidelines from professional societies, and international bodies to guide infection prevention efforts in humanitarian environments.
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Strickler S, Gupta RR, Doucette JT, Kohli-Seth R. A quality assurance investigation of CLABSI events: are there exceptions to never? J Infect Prev 2018; 19:22-28. [PMID: 29317911 PMCID: PMC5753946 DOI: 10.1177/1757177417720997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/19/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In the USA, central line associated blood stream infections (CLABSIs) have been designated as 'never events', prompting initiatives towards a 'zero CLABSIs' standard. We propose that there are cascading risk factors predisposing certain patient cohorts to higher CLABSIs rates. METHODS A retrospective review of all CLABSI infections over a 12-month period was undertaken. Risk factors examined included catheter type, insertion site and parenteral nutrition (PN) status. Additional factors analysed included acute kidney injury (AKI), chronic kidney disease (CKD) and hospital-acquired infections (HAIs). RESULTS Thirty-four CLABSIs were identified in 33 adult patients (median age = 57 years). Temporary central venous catheters accounted for 12 (35%), peripherally inserted central catheters for five (14.7%), and permanent catheters for 17 CLABSIs (50%); the median duration from insertion was 15 days (interquartile range = 9-26). Among patient factors, immunosuppression and hyperglycaemia were the most common (n = 19, 55%), followed by PN and CKD (n = 17, 50.0%), AKI (n = 16, 47.1%) and HAIs (n = 13, 38.2%). A majority of patients with CLABSIs (n = 20 58.8%) had at least three risk factors. DISCUSSION These findings reflect the complexity of CLABSIs with multiple patient and hospital factors influencing incidence. It suggests the need for further studies to re-calibrate the zero CLABSI model towards one with greater relevance.
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Affiliation(s)
| | - Rohit R Gupta
- Assistant Professor of Surgery, Mount Sinai Hospital, New York, NY, USA
| | - John T Doucette
- Associate Professor, Department of Preventive Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Roopa Kohli-Seth
- Director of Surgical Intensive Care Unit, Mount Sinai Hospital, New York, NY, USA
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183
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Affiliation(s)
- June Young Chun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Larson EL, Murray MT, Cohen B, Simpser E, Pavia M, Jackson O, Jia H, Hutcheon RG, Mosiello L, Neu N, Saiman L. Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial. Behav Med 2018; 44. [PMID: 28632004 PMCID: PMC5732083 DOI: 10.1080/08964289.2017.1288607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children in pediatric long-term care facilities (pLTCF) represent a highly vulnerable population and infectious outbreaks occur frequently, resulting in significant morbidity, mortality, and resource use. The purpose of this quasi-experimental trial using time series analysis was to assess the impact of a 4-year theoretically based behavioral intervention on infection prevention practices and clinical outcomes in three pLTCF (288 beds) in New York metropolitan area including 720 residents, ages 1 day to 26 years with mean lengths of stay: 7.9-33.6 months. The 5-pronged behavioral intervention included explicit leadership commitment, active staff participation, work flow assessments, training staff in the World Health Organization "'five moments of hand hygiene (HH)," and electronic monitoring and feedback of HH frequency. Major outcomes were HH frequency, rates of infections, number of hospitalizations associated with infections, and outbreaks. Mean infection rates/1000 patient days ranged from 4.1-10.4 pre-intervention and 2.9-10.0 post-intervention. Mean hospitalizations/1000 patient days ranged from 2.3-9.7 before and 6.4-9.8 after intervention. Number of outbreaks/1000 patient days per study site ranged from 9-24 pre- and 9-18 post-intervention (total = 95); number of cases/outbreak ranged from 97-324 (total cases pre-intervention = 591 and post-intervention = 401). Post-intervention, statistically significant increases in HH trends occurred in one of three sites, reductions in infections in two sites, fewer hospitalizations in all sites, and significant but varied changes in the numbers of outbreaks and cases/outbreak. Modest but inconsistent improvements occurred in clinically relevant outcomes. Sustainable improvements in infection prevention in pLTCF will require culture change; increased staff involvement; explicit administrative support; and meaningful, timely behavioral feedback.
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185
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Moro ML, Morsillo F, Nascetti S, Parenti M, Allegranzi B, Pompa MG, Pittet D. Determinants of success and sustainability of the WHO multimodal hand hygiene promotion campaign, Italy, 2007-2008 and 2014. ACTA ACUST UNITED AC 2017; 22:30546. [PMID: 28661390 PMCID: PMC5479978 DOI: 10.2807/1560-7917.es.2017.22.23.30546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 04/28/2017] [Indexed: 11/20/2022]
Abstract
A national hand hygiene promotion campaign based on the World Health Organization (WHO) multimodal, Clean Care is Safer Care campaign was launched in Italy in 2007. One hundred seventy-five hospitals from 14 of 20 Italian regions participated. Data were collected using methods and tools provided by the WHO campaign, translated into Italian. Hand hygiene compliance, ward infrastructure, and healthcare workers’ knowledge and perception of healthcare-associated infections and hand hygiene were evaluated before and after campaign implementation. Compliance data from the 65 hospitals returning complete data for all implementation tools were analysed using a multilevel approach. Overall, hand hygiene compliance increased in the 65 hospitals from 40% to 63% (absolute increase: 23%, 95% confidence interval: 22–24%). A wide variation in hand hygiene compliance among wards was observed; inter-ward variability significantly decreased after campaign implementation and the level of perception was the only item associated with this. Long-term sustainability in 48 of these 65 hospitals was assessed in 2014 using the WHO Hand Hygiene Self-Assessment Framework tool. Of the 48 hospitals, 44 scored in the advanced/intermediate categories of hand hygiene implementation progress. The median hand hygiene compliance achieved at the end of the 2007–2008 campaign appeared to be sustained in 2014.
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Affiliation(s)
- Maria Luisa Moro
- Agenzia Sanitaria e Sociale Regione Emilia-Romagna, Bologna, Italy
| | | | - Simona Nascetti
- Dipartimento di Sanità Pubblica, Area Igiene e Sanità Pubblica, Azienda USL, Bologna, Italy
| | - Mita Parenti
- Azienda Ospedaliero-Universitaria di Bologna Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, WHO Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | - Maria Grazia Pompa
- Ufficio 5 - Rapporti con l'Unione Europea, il Consiglio d'Europa, l'OCSE, l'OMS, e le altre agenzie ONU ed Organizzazioni internazionali, Direzione generale della comunicazione e dei rapporti europei e internazionali, Ministero della Salute, Rome, Italy
| | - 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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von Lengerke T, Lutze B, Krauth C, Lange K, Stahmeyer JT, Chaberny IF. Promoting Hand Hygiene Compliance: PSYGIENE—a Cluster-Randomized Controlled Trial of Tailored Interventions. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:29-36. [PMID: 28179049 DOI: 10.3238/arztebl.2017.0029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/04/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The German "Clean Hands Campaign" (an adaptation of the WHO "Clean Care is Safer Care" programme) to promote hand hygiene among hospital personnel at Hannover Medical School (MHH, Medizinische Hochschule Hannover), known as Aktion Saubere Hände (ASH), met with initial success. By 2013, however, compliance rates with hygienic hand disinfection in the hospital's ten intensive care units (ICUs) and two hematopoietic stem cell transplantation units (HSCTUs) had relapsed to their initial levels (physicians: 48%; nurses: 56%). The cluster- randomized controlled trial PSYGIENE was conducted to investigate whether interventions tai - lored in ways suggested by research in behavioral psychology might bring about more sustainable improvements than the ASH. METHODS The "Health Action Process Approach" (HAPA) compliance model specifies key psychological determinants of compliance. These determinants were assessed among health care workers in the ICUs and HSCTUs of the MHH by questionnaire (response rates: physicians: 71%; nurses: 63%) and by interviews of the responsible ward physicians and head nurses (100%). In 2013, 29 tailored behavior change techniques were implemented in educational training sessions and feedback discussions in the six wards that constituted the intervention arm of the trial, while ASH training sessions were provided in the control arm. The compliance rates for 2014 and 2015 (the primary outcomes of the trial) were determined by nonparticipating observation of hygienic hand disinfection, in accordance with the World Health Organization's gold standard. RESULTS The two groups did not differ in their baseline compliance rates in 2013 (intervention: 54%, control: 55%, p = 0.581). The tailored interventions led to increased compliance in each of the two follow-up years (2014: 64%, p<0.001; 2015: 70%, p = 0.001), while the compliance in the control arm increased to 68% in 2014 (p<0.001) but fell back to 64% in 2015 (p = 0.007). The compliance increases from 2013-2015 and the compliance rate in 2015 were higher in the intervention arm (p<0.005). This was mainly attributable to the nurses' behavior, as the corresponding parameters for physicians did not differ significantly between the two study arms in stratified analysis. CONCLUSION Tailored interventions based on behavioral psychology principles led to more sustainable increases in compliance with hand hygiene guidelines than ASH training sessions did. This was true among nurses, and thus also for hospital ward personnel as a whole (i.e., nurses and physicians combined). Further studies are needed to identify more target group-specific interventions that may improve compliance among physicians.
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Affiliation(s)
- Thomas von Lengerke
- Centre for Public Health and Healthcare, Medical Psychology Unit, Hannover Medical School; Department of Diagnostics, Institute of Hygiene/Hospital Epidemiology, Leipzig University Hospital; Center for Public Health and Healthcare, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School; Centre for Laboratory Medicine, Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School
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Bazzano AN, Martin J, Hicks E, Faughnan M, Murphy L. Human-centred design in global health: A scoping review of applications and contexts. PLoS One 2017; 12:e0186744. [PMID: 29091935 PMCID: PMC5665524 DOI: 10.1371/journal.pone.0186744] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/08/2017] [Indexed: 12/01/2022] Open
Abstract
Health and wellbeing are determined by a number of complex, interrelated factors. The application of design thinking to questions around health may prove valuable and complement existing approaches. A number of public health projects utilizing human centered design (HCD), or design thinking, have recently emerged, but no synthesis of the literature around these exists. The results of a scoping review of current research on human centered design for health outcomes are presented. The review aimed to understand why and how HCD can be valuable in the contexts of health related research. Results identified pertinent literature as well as gaps in information on the use of HCD for public health research, design, implementation and evaluation. A variety of contexts were identified in which design has been used for health. Global health and design thinking have different underlying conceptual models and terminology, creating some inherent tensions, which could be overcome through clear communication and documentation in collaborative projects. The review concludes with lessons learned from the review on how future projects can better integrate design thinking with global health research.
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Affiliation(s)
- Alessandra N. Bazzano
- Taylor Canter for Social Innovation and Design Thinking, Tulane University, New Orleans, United States of America
- * E-mail:
| | - Jane Martin
- Creative Social Change, London, United Kingdom
| | - Elaine Hicks
- Tulane University School of Public Health and Tropical Medicine, New Orleans, United States of America
| | - Maille Faughnan
- Taylor Canter for Social Innovation and Design Thinking, Tulane University, New Orleans, United States of America
- Tulane University School of Public Health and Tropical Medicine, New Orleans, United States of America
| | - Laura Murphy
- Taylor Canter for Social Innovation and Design Thinking, Tulane University, New Orleans, United States of America
- Tulane University School of Public Health and Tropical Medicine, New Orleans, United States of America
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Kolola T, Gezahegn T. A twenty-four-hour observational study of hand hygiene compliance among health-care workers in Debre Berhan referral hospital, Ethiopia. Antimicrob Resist Infect Control 2017; 6:109. [PMID: 29093813 PMCID: PMC5663127 DOI: 10.1186/s13756-017-0268-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/25/2017] [Indexed: 11/16/2022] Open
Abstract
Background Hand hygiene (HH) is recognized as the single most effective strategy for preventing health care–associated infections. In developing countries, data on hand hygiene compliance is available only for few health-care facilities. This study aimed to assess hand hygiene compliance among health-care workers in Debre Berhan referral hospital, Ethiopia. Methods This study employed the WHO hand hygiene observation method. Direct observation of the health care workers (HCWs) was conducted using an observation record form in five different wards. Trained and validated observers watched HCWs while they had direct contact with patients or their surroundings, and the observers then recorded all possible hand hygiene opportunities and hand hygiene actions. Observation was conducted over a 24 h period to minimize selection bias. More than 200 opportunities per ward were observed according to WHO recommendation, except in neonatal intensive care unit. HH compliance was calculated by dividing the number of times hand hygiene was performed by the total number of opportunities for hand hygiene. A 95% confidence interval (CI) was computed for compliance with the exact binomial method. Results A total of 917 hand hygiene opportunities were observed during the study. Overall HH compliance was 22.0% (95% CI: 19.4–24.9). HH compliance was similar across all professional categories and did not vary by shift. Levels of compliance were lower before patient contact (2.4%; 95% CI: 0.9–5.3), before an aseptic procedure (3.6%; 95% CI: 1.6–7.6) and after contact with patient surroundings (3.3%; 95% CI: 1.2–7.9), whereas better levels of compliance were found after body fluid exposure (75.8%; 95% CI: 68.0–82.3) and after patient contact (42.8%; 95% CI: 35.2–50.7). Conclusion HH compliance of HCWs was found to be low in Debre Berhan referral hospital. Compliance with indications that protect patients from infection was lower than that protect the HCWs. The findings of this study indicate that HH compliance needs further improvement. Electronic supplementary material The online version of this article (doi:10.1186/s13756-017-0268-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tufa Kolola
- Department of public health, Debre Berhan University, P.O.Box 445, Debre Berhan, Ethiopia
| | - Takele Gezahegn
- Department of public health, Debre Berhan University, P.O.Box 445, Debre Berhan, Ethiopia
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Clack L, Scotoni M, Wolfensberger A, Sax H. "First-person view" of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool. Antimicrob Resist Infect Control 2017; 6:108. [PMID: 29093812 PMCID: PMC5661930 DOI: 10.1186/s13756-017-0267-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/17/2017] [Indexed: 01/29/2023] Open
Abstract
Background Healthcare workers' hands are the foremost means of pathogen transmission in healthcare, but detailed hand trajectories have been insufficiently researched so far. We developed and applied a new method to systematically document hand-to-surface exposures (HSE) to delineate true hand transmission pathways in real-life healthcare settings. Methods A head-mounted camera and commercial coding software were used to capture ten active care episodes by eight nurses and two physicians and code HSE type and duration using a hierarchical coding scheme. We identified HSE sequences of particular relevance to infectious risks for patients based on the WHO 'Five Moments for Hand Hygiene'. The study took place in a trauma intensive care unit in a 900-bed university hospital in Switzerland. Results Overall, the ten videos totaled 296.5 min and featured eight nurses and two physicians. A total of 4222 HSE were identified (1 HSE every 4.2 s), which concerned bare (79%) and gloved (21%) hands. The HSE inside the patient zone (n = 1775; 42%) included mobile objects (33%), immobile surfaces (5%), and patient intact skin (4%), while HSE outside the patient zone (n = 1953; 46%) included HCW's own body (10%), mobile objects (28%), and immobile surfaces (8%). A further 494 (12%) events involved patient critical sites. Sequential analysis revealed 291 HSE transitions from outside to inside patient zone, i.e. "colonization events", and 217 from any surface to critical sites, i.e. "infection events". Hand hygiene occurred 97 times, 14 (5% adherence) times at colonization events and three (1% adherence) times at infection events. On average, hand rubbing lasted 13 ± 9 s. Conclusions The abundance of HSE underscores the central role of hands in the spread of potential pathogens while hand hygiene occurred rarely at potential colonization and infection events. Our approach produced a valid video and coding instrument for in-depth analysis of hand trajectories during active patient care that may help to design more efficient prevention schemes.
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Affiliation(s)
- Lauren Clack
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Manuela Scotoni
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Aline Wolfensberger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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What Healthcare Workers Should Know about Environmental Bacterial Contamination in the Intensive Care Unit. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6905450. [PMID: 29214175 PMCID: PMC5682046 DOI: 10.1155/2017/6905450] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/07/2017] [Accepted: 09/28/2017] [Indexed: 12/21/2022]
Abstract
Intensive care unit- (ICU-) acquired infections are a major health problem worldwide. Inanimate surfaces and equipment contamination may play a role in cross-transmission of pathogens and subsequent patient colonization or infection. Bacteria contaminate inanimate surfaces and equipment of the patient zone and healthcare area, generating a reservoir of potential pathogens, including multidrug resistant species. Traditional terminal cleaning methods have limitations. Indeed patients who receive a bed from prior patient carrying bacteria are exposed to an increased risk (odds ratio 2.13, 95% confidence intervals 1.62-2.81) of being colonized and potentially infected by the same bacterial species of the previous patient. Biofilm formation, even on dry surfaces, may play a role in reducing the efficacy of terminal cleaning procedures since it enables bacteria to survive in the environment for a long period and provides increased resistance to commonly used disinfectants. No-touch methods (e.g., UV-light, hydrogen peroxide vapour) are under investigation and further studies with patient-centred outcomes are needed, before considering them the standard of terminal cleaning in ICUs. Healthcare workers should be aware of the role of environmental contamination in the ICU and consider it in the broader perspective of infection control measures and stewardship initiatives.
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Labrague LJ, McEnroe-Petitte DM, van de Mortel T, Nasirudeen AMA. A systematic review on hand hygiene knowledge and compliance in student nurses. Int Nurs Rev 2017; 65:336-348. [PMID: 29077198 DOI: 10.1111/inr.12410] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hand hygiene competence is one of the critical outcomes in nursing education. Ensuring nursing students recognize the what, when and how of hand hygiene is critical in the light of the increasing rates of healthcare-associated infections. AIM To systematically appraise and synthesize articles on hand hygiene knowledge and compliance among nursing students. METHODS This is a systematic review of scientific articles published from 2006 to 2016. The primary databases used were as follows: PubMed, Embase, Cumulative Index to Nursing & Allied Health Literature, Proquest and PsychINFO. Key search terms utilized were as follows: 'handwashing', 'hand hygiene', 'compliance', 'knowledge', 'practice' and 'nursing students'. FINDINGS Nineteen studies met the review criteria. The findings revealed a low-to-moderate knowledge of and compliance with hand hygiene among nursing students. In addition, there were significantly higher rates of hand hygiene compliance in nursing students when compared to medical students. Relatively few studies attempted to identify predictors of hand hygiene knowledge and compliance. CONCLUSION This review demonstrated suboptimal knowledge and compliance to hand hygiene among student nurses. In addition, this review also highlighted the paucity of studies that examined individual and organizational factors, which influence nursing students hand hygiene knowledge and compliance. IMPLICATIONS FOR NURSING AND POLICY The findings of this review emphasized the role of nurse educators in enhancing hand hygiene competence in nursing students. Implementation of empirically tested strategies such as utilizing multidimensional interventions, scenario-based hand hygiene simulation activities and hand hygiene education programmes that would enhance nursing students' hand hygiene knowledge and compliance is an asset. Hospital and nursing administrators should ensure continuous support and monitoring to guarantee that hand hygiene programmes are institutionalized in every healthcare setting by every healthcare worker.
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Affiliation(s)
- L J Labrague
- College of Nursing, Sultan Qaboos University, Muscat, Oman
| | | | - T van de Mortel
- School of Nursing and Midwifery, Griffith University, Southport, QLD, Australia
| | - A M A Nasirudeen
- School of Health Sciences, Ngee Ann Polytechnic, Singapore, Singapore
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Marques dos Santos C, Carvalho R, Toniolo AR, Kawagoe JY, Menezes FG, Silva CV, Gonçalves P, Castagna HMF, Correa L. Multiple interventions in a postanesthesia care unit: Impact on hand hygiene compliance. Am J Infect Control 2017; 45:1171-1173. [PMID: 28844379 DOI: 10.1016/j.ajic.2017.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 10/18/2022]
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Hand Hygiene Improvement and Sustainability: Assessing a Breakthrough Collaborative in Western Switzerland. Infect Control Hosp Epidemiol 2017; 38:1420-1427. [DOI: 10.1017/ice.2017.180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVETo assess hand hygiene improvement and sustainability associated with a Breakthrough Collaborative.DESIGNMulticenter analysis of hand hygiene compliance through direct observation by trained observers.SETTINGA total of 5 publicly funded hospitals in 14 locations, with a total of 1,152 beds, in the County of Vaud, Switzerland.PARTICIPANTSClinical staff.INTERVENTIONSIn total, 59,272 opportunities for hand hygiene were monitored for the duration of the study, for an average of 5,921 per audit (range, 5,449–6,852). An 18-month Hand Hygiene Breakthrough Collaborative was conducted to implement the WHO multimodal promotional strategy including improved access to alcohol-based hand rub, education, performance measurement and feedback, reminders and communication, leadership engagement, and safety culture.RESULTSOverall hand hygiene compliance improved from 61.9% to 88.3% (P<.001) over 18 months and was sustained at 88.9% (P=.248) 12 months after the intervention. Hand hygiene compliance among physicians increased from 62% to 85% (P<.001) and finally 86% at follow-up (P=.492); for nursing staff, compliance improved from 64% to 90% (P<.001) and finally 90% at follow-up (P=.464); for physiotherapists compliance improved from 50% to 90% (P<.001) and finally 91% at follow-up (P=.619); for X-ray technicians compliance improved from 45% to 80% (P<.001) and finally 81% at follow-up (P=.686). Hand hygiene compliance also significantly increased with sustained improvement across all hand hygiene indications and all hospitals.CONCLUSIONSA rigorously conducted multicenter project combining the Breakthrough Collaborative method for its structure and the WHO multimodal strategy for content and measurement was associated with significant and substantial improvement in compliance across all professions, all hand hygiene indications, and all participating hospitals.Infect Control Hosp Epidemiol 2017;38:1420–1427
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Poor Hand Hygiene Procedure Compliance among Polish Medical Students and Physicians-The Result of an Ineffective Education Basis or the Impact of Organizational Culture? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091026. [PMID: 28880205 PMCID: PMC5615563 DOI: 10.3390/ijerph14091026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/25/2017] [Accepted: 09/04/2017] [Indexed: 02/08/2023]
Abstract
Objective: The objective of the study was to examine the knowledge of Polish physicians and medical students about the role of hand hygiene (HH) in healthcare-associated infection (HAI) prevention. Study design: A survey was conducted using an author-prepared questionnaire, which was filled out on the first day of hospital work (or internship) by newly admitted physicians who had worked in other hospitals and students of different medical schools in Poland. Methods: 100 respondents participated in the study: 28 students, 18 medical interns and 54 physicians. Results: As many as 3/4 of physicians and students did not use the HH techniques correctly. The respondents declared that they perform HH in the following situations: 74.4% of respondents before an aseptic task; 60.8% before patient contact; 57.0% after patient contact; 11.5% after body fluid exposure risk, and only two respondents (1.1%) after contact with patient surroundings. 64% of respondents declared that their supervisor checked their knowledge of the HH technique when they were touching patients, but their supervisors checked the five instances for HH only in the case of 27 respondents (27%). Students experienced any control of HH in the workplace less often. Interns and physicians mentioned that the most important preventive action in HAI is HH, but for students it is the use of gloves. Conclusions: The level of knowledge and skills of physicians and students in the field of HH is insufficient. Deficiencies in skills and knowledge of HH were identified as early as at the level of the first internship.
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Gould DJ, Moralejo D, Drey N, Chudleigh JH, Taljaard M. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2017; 9:CD005186. [PMID: 28862335 PMCID: PMC6483670 DOI: 10.1002/14651858.cd005186.pub4] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. OBJECTIVES To assess the short- and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection. SEARCH METHODS We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. SELECTION CRITERIA We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol-based hand rub (ABHR), or both. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta-analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. MAIN RESULTS This review includes 26 studies: 14 randomised trials, two non-randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long-term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention.Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes.Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low.Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence).Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence.Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence.Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence.Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. AUTHORS' CONCLUSIONS With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context.
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Affiliation(s)
- Dinah J Gould
- Cardiff UniversitySchool of Healthcare SciencesEastgate HouseCardiffWalesUK
| | - Donna Moralejo
- Memorial UniversitySchool of NursingH2916, Health Sciences Centre300 Prince Philip DriveSt. John'sNLCanadaA1B 3V6
| | - Nicholas Drey
- City, University of LondonCentre for Health Services ResearchNorthampton SquareLondonUKEC1V 0HB
| | - Jane H Chudleigh
- City, University of LondonSchool of Health SciencesNorthampton SquareLondonUKEC1V 0HB
| | - Monica Taljaard
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramThe Ottawa Hospital ‐ Civic Campus1053 Carling Ave, Box 693OttawaONCanadaK1Y 4E9
- University of OttawaSchool of Epidemiology, Public Health and Preventive MedicineOttawaONCanada
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Zottele C, Magnago TSBDS, Dullius AIDS, Kolankiewicz ACB, Ongaro JD. Hand hygiene compliance of healthcare professionals in an emergency department. Rev Esc Enferm USP 2017; 51:e03242. [PMID: 28902323 DOI: 10.1590/s1980-220x2016027303242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 03/21/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To analyze compliance with hand hygiene by healthcare professionals in an emergency department unit. METHOD This is a longitudinal quantitative study developed in 2015 with healthcare professionals from a university hospital in the state of Rio Grande do Sul. Each professional was monitored three times by direct non-participant observation at WHO's five recommended moments in hand hygiene, taking the concepts of opportunity, indication and action into account. Descriptive and analytical statistics were used. RESULTS Fifty-nine healthcare professionals participated in the study. The compliance rate was 54.2%. Nurses and physiotherapists showed a compliance rate of 66.6% and resident physicians, 41.3%. When compliance was compared among professional categories, nurses showed greater compliance than resident physicians (OR = 2.83, CI = 95%: 1.09-7.34). CONCLUSION Hand hygiene compliance was low. Multidisciplinary approaches could be important strategies for forming partnerships to develop learning and implementation of hand hygiene practices. OBJETIVO Analisar a adesão à higienização das mãos dos profissionais de saúde em unidade de Pronto-Socorro. MÉTODO Estudo quantitativo longitudinal desenvolvido com profissionais de saúde de um Hospital Universitário do Rio Grande do Sul, em 2015. Para cada profissional, realizaram-se três acompanhamentos com observação direta não participante nos cinco momentos preconizados para higienização das mãos, levando-se em conta os conceitos de Oportunidade, Indicação e Ação. Utilizou-se da estatística descritiva e analítica. RESULTADOS Participaram do estudo 59 profissionais de saúde. A taxa de adesão foi de 54,2%. Os enfermeiros e fisioterapeutas obtiveram a taxa de adesão de 66,6% e os médicos residentes, de 41,3%. Ao ser comparada a adesão entre as categorias profissionais, os enfermeiros tiveram maior aderência do que os médicos residentes (RC=2,83; IC=95%:1,09-7,34). CONCLUSÃO A adesão à higienização das mãos foi baixa. Abordagens multidisciplinares podem ser estratégias importantes para formar parcerias que desenvolvam a aprendizagem e a efetivação de práticas de HM.
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Affiliation(s)
- Caroline Zottele
- Universidade Federal de Santa Maria, Hospital Universitário de Santa Maria, Santa Maria, RS, Brazil
| | | | | | | | - Juliana Dal Ongaro
- Universidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil
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Contaminated Portable Equipment Is a Potential Vector for Dissemination of Pathogens in the Intensive Care Unit. Infect Control Hosp Epidemiol 2017; 38:1247-1249. [PMID: 28780909 DOI: 10.1017/ice.2017.160] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A DNA marker inoculated onto shared portable equipment in surgical and medical intensive care units disseminated widely to surfaces in patient rooms and provider work areas and to other types of portable equipment. These results demonstrate the potential for contaminated portable equipment to serve as a vector for dissemination of pathogens. Infect Control Hosp Epidemiol 2017;38:1247-1249.
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Hand hygiene compliance in a universal gloving setting. Am J Infect Control 2017; 45:830-834. [PMID: 28768591 DOI: 10.1016/j.ajic.2017.02.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions. However, gloves may carry organisms unless they are changed properly. In addition, hand hygiene is required before donning and after removing gloves, and there are scarce data regarding glove changing and hand hygiene in a universal gloving setting. METHODS This nonrandomized observational before-after study evaluated the effect of education and feedback regarding hand hygiene. Compliance with hand hygiene and glove use was directly observed in a universal gloving setting at a 10-bed intensive care unit in a Japanese tertiary care university teaching hospital. RESULTS A total of 6,050 hand hygiene opportunities were identified. Overall, hand hygiene compliance steadily increased from study period 1 (16.1%) to period 5 (56.8%), although there were indication-specific differences in the baseline compliance, the degree of improvement, and the reasons for noncompliance. There were decreases in the compliance with universal gloving and the incidence of methicillin-resistant Staphylococcus aureus. CONCLUSION It is difficult to properly perform glove use and hand hygiene in a universal gloving setting, given its complexity. Direct observation with specific feedback and education may be effective in improving compliance.
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Holmen IC, Niyokwizerwa D, Nyiranzayisaba B, Singer T, Safdar N. Challenges to sustainability of hand hygiene at a rural hospital in Rwanda. Am J Infect Control 2017; 45:855-859. [PMID: 28596020 DOI: 10.1016/j.ajic.2017.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/06/2017] [Accepted: 04/06/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Many hand hygiene (HH) programs have been implemented across Sub-Saharan Africa (SSA); however, most of these have been in large, referral hospitals. Our objective was to assess the impact of HH programs aimed at improving compliance at a rural hospital, and to identify unique challenges to HH sustainability. METHODS Interventions to improve HH through providing handwashing stations, health care worker (HCW) training, and alcohol handrub were completed in 2014 and 2015. HH infrastructure, compliance, and glove use were assessed among HCWs after the intervention in 2015 and 2016. HCWs were interviewed about challenges to sustainability of HH compliance. RESULTS Total HH compliance decreased 32.1% between 2015 and 2016 (P < .001). HH for patient protection was completed significantly less than HH for HCW protection in 2016, and HCWs appeared to substitute HH for patient protection with glove use. A high rate of physician turnover was associated with a larger decrease in HH compliance compared with nurses, and interviews suggested recruiting and retention of key personnel might play a role in HH sustainability. Availability of alcohol-based handrub in patient rooms decreased from 100% in 2015 to 79.5% in 2016 (P < .01). CONCLUSIONS Many challenges exist to sustaining HH compliance in SSA. In rural settings, difficulty recruiting and retaining trained personnel, inconsistent availability in HH infrastructure, and variability in HCW HH training may be contributing factors.
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Affiliation(s)
| | | | | | | | - Nasia Safdar
- Department of Medicine, University of Wisconsin SMPH, Madison, WI; Williams S. Middleton Memorial Veterans Hospital, Madison, WI.
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Edmisten C, Hall C, Kernizan L, Korwek K, Preston A, Rhoades E, Shah S, Spight L, Stradi S, Wellman S, Zygadlo S. Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals. Am J Infect Control 2017; 45:860-865. [PMID: 28526308 DOI: 10.1016/j.ajic.2017.03.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. METHODS An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. RESULTS The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. DISCUSSION Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. CONCLUSIONS Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff.
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Affiliation(s)
| | | | | | | | | | - Evan Rhoades
- Hospital Corporation of America West Florida Division, Tampa, FL
| | - Shalin Shah
- Regional Medical Center Bayonet Point, Hudson, FL
| | - Lori Spight
- Regional Medical Center Bayonet Point, Hudson, FL
| | | | | | - Scott Zygadlo
- Hospital Corporation of America West Florida Division, Tampa, FL
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