1
|
Gobte NJ, Gozdzielewska L, Kc D, Sithole BL, Vorndran A, McAloney-Kocaman K, Mehtar S, Price L. Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon. Am J Infect Control 2024; 52:274-279. [PMID: 37741291 DOI: 10.1016/j.ajic.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital. METHODS It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance. RESULTS 5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml). CONCLUSIONS Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.
Collapse
Affiliation(s)
- Nkwan J Gobte
- Baptist Training School for Health Personnel, Cameroon Baptist Convention Health Services, Banso, Cameroon
| | - Lucyna Gozdzielewska
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - Deepti Kc
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | | | - Anna Vorndran
- Infection Control Africa Network (ICAN), Cape Town, South Africa
| | | | - Shaheen Mehtar
- Infection Control Africa Network (ICAN), Cape Town, South Africa
| | - Lesley Price
- Research Centre for Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| |
Collapse
|
2
|
Mendieta A, Rios Lopez L, Vargas Arteaga M, Maradiegue E, Delgadillo Arone W, Rueda Bazalar C, Holguin A, Santillan Salas C, Maza I, Homsi M, Farias Barrios F, Assayag C, Vásquez L, Pascual C, Caniza M. A multimodal strategy to improve health care for pediatric patients with cancer and fever in Peru. Rev Panam Salud Publica 2023; 47:e140. [PMID: 37799822 PMCID: PMC10548892 DOI: 10.26633/rpsp.2023.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
Objective The DoTT (Decreasing Time to Therapy) project aimed to minimize the interval between fever onset and medical interventions for children with febrile neutropenia. The objective of this study was to determine the effect of implementing the DoTT project on the hospital time to antibiotic (TTA) and patient time to arrival (PTA) at the hospital in children with febrile neutropenia admitted to the emergency department. Methods The DoTT project was implemented at a Peruvian hospital and followed the World Health Organization (WHO) multimodal improvement strategy model. Components included creating a healthcare delivery bundle and antibiotic selection pathways, training users of the bundle and pathways, monitoring patient outcomes and obtaining user feedback, encouraging use of the new system, and promoting the integration of DoTT into the institutional culture. Emergency room providers were trained in the care delivery for children with cancer and fever and taught to use the bundle and pathways. DoTT was promoted via pamphlets and posters, with a view to institutionalizing the concept and disseminating it to other hospital services. Results Admission data for 129 eligible patients in our registry were analyzed. The TTA and PTA were compared before and after the DoTT intervention. The median TTA was 146 minutes (interquartile range [IQR] 97-265 minutes) before the intervention in 99 patients, and 69 minutes (IQR 50-120 minutes) afterwards in 30 patients (p < 0.01). The median PTA was reduced from 1 483 minutes at baseline to 660 minutes after the intervention (p < 0.01). Conclusions Applying the WHO multimodal improvement strategy model to the care of children with febrile neutropenia arriving at the hospital had a positive impact on the PTA and TTA, thus potentially increasing the survival of these patients.
Collapse
Affiliation(s)
- Ana Mendieta
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Ligia Rios Lopez
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Maria Vargas Arteaga
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Essy Maradiegue
- Instituto Nacional de Enfermedades NeoplásicasLimaPeruInstituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Walter Delgadillo Arone
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Carlos Rueda Bazalar
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Alexis Holguin
- Instituto Nacional de Enfermedades NeoplásicasLimaPeruInstituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | - Ivan Maza
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Maysam Homsi
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| | | | - Claudia Assayag
- Hospital Nacional Edgardo Rebagliati MartinsLimaPeruHospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Liliana Vásquez
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Claudia Pascual
- Pan American Health OrganizationLimaPeruPan American Health Organization, Lima, Peru
| | - Miguela Caniza
- St. Jude Children’s Research HospitalMemphisUnited States of AmericaSt. Jude Children’s Research Hospital, Memphis, United States of America
| |
Collapse
|
3
|
Bredin D, O'Doherty D, Hannigan A, Kingston L. Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis. J Hosp Infect 2022; 130:20-33. [PMID: 36089071 DOI: 10.1016/j.jhin.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct observation of hand hygiene compliance is the "gold standard" despite limitations and potential for bias. Previous literature highlights poorer hand hygiene compliance amongst physicians than nurses and suggests that covert monitoring may give better compliance estimates than overt monitoring. AIM This review aimed to explore differences in compliance between physicians and nurses further, and to analyse if compliance estimates differed when observations were covert rather than overt. METHODS A systematic search of databases PubMed, EMBASE, CENTRAL and CINAHL was performed. Experimental or observational studies in hospital settings in high-income countries published in English from 2010 onwards were included if estimates for both physicians and nurses using direct observation were reported. The search yielded 4814 studies, of which 105 were included. FINDINGS The weighted pooled compliance rate for nurses was 52% (95% CI 47% to 57%) and for doctors was 45% (95% CI 40% to 49%). Heterogeneity was considerable (I2=99%). The majority of studies were at moderate or high risk of bias. Random-effects meta-analysis of low risk of bias studies suggests higher compliance for nurses than physicians for both overt (difference of 7%, 95% CI for the difference 0.8% to 13.5%, p=0.027) and covert (difference of 7%, 95% CI 3% to 11%, p=0.0002) observation. Considerable heterogeneity was found in all analyses. CONCLUSION Wide variability in compliance estimates and differences in the methodological quality of hand hygiene studies were identified. Further research with meta-regression should explore sources of heterogeneity and improve the conduct and reporting of hand hygiene studies.
Collapse
Affiliation(s)
- D Bredin
- School of Medicine, University of Limerick, Ireland
| | - D O'Doherty
- School of Medicine, University of Limerick, Ireland
| | - A Hannigan
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - L Kingston
- Department of Nursing and Midwifery, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
| |
Collapse
|
4
|
Chen W, Tseng CL. What are healthcare workers' preferences for hand hygiene interventions? A discrete choice experiment. BMJ Open 2021; 11:e052195. [PMID: 34732487 PMCID: PMC8572395 DOI: 10.1136/bmjopen-2021-052195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To understand the key attributes in designing effective interventions for improving healthcare workers' (HCWs') hand hygiene compliance and HCWs' preference for these attributes. DESIGN A discrete choice experiment (DCE) was conducted with five attributes extracted from the framework of Total Quality Management that can be applied in the design of hand hygiene interventions. They were hand hygiene monitoring, open discussion, message framing, resources accessibility and top management involvement. An addition attribute, peer hand hygiene performance, was considered as a contextual factor. Data were analysed by a conditional logit model to evaluate how these attributes impact HCWs' hand hygiene compliance. SETTING The DCE was conducted with participants from a university hospital in Taichung. PARTICIPANTS HCWs involved in daily patient-care activities (N=387). RESULTS To enhance their compliance, HCWs had strong and consistent preferences in having open discussion of hand hygiene problems ([Formula: see text], [Formula: see text]), easy access to hand hygiene resources ([Formula: see text], [Formula: see text]) and top management involvement ([Formula: see text], [Formula: see text]). For hand hygiene monitoring ([Formula: see text], [Formula: see text]), HCWs preferred to be monitored by infection control staff over their department head if their peer hand hygiene performance was low. On the other hand, when the peer performance was high, monitoring by their department head could improve their hand hygiene compliance. Similarly, how educational messages were framed impacted compliance and also depended on the peer hand hygiene performance. When the peer performance was low, HCWs were more likely to increase their compliance in reaction to loss-framed educational messages ([Formula: see text],[Formula: see text]). When the peer performance was high, gain-framed messages that focus on the benefit of compliance were more effective in inducing compliance. CONCLUSIONS Each intervention design has its unique impact on HCWs' hand hygiene compliant behaviour. The proposed approach can be used to evaluate HCWs' preference and compliance of an intervention before it is implemented.
Collapse
Affiliation(s)
- Wenlin Chen
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chung-Li Tseng
- Business School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Mouajou V, Adams K, DeLisle G, Quach C. HAND HYGIENE COMPLIANCE IN THE PREVENTION OF HOSPITAL ACQUIRED INFECTIONS: A SYSTEMATIC REVIEW. J Hosp Infect 2021; 119:33-48. [PMID: 34582962 DOI: 10.1016/j.jhin.2021.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Healthcare worker's (HCW) hands are known to be a primary source of transmission of hospital-acquired infections (HAIs). Thus, practicing hand hygiene (HH) and adhering to HH guidelines are both expected to decrease the risk of transmission but there is no consensus on the optimal hand hygiene compliance (HHC) rate that HCWs should aim for. AIM The objective of this study was to systematically review the published literature to determine an optimal threshold of HCW HHC rate associated with the lowest incidence rate of HAIs. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We searched online databases using a comprehensive search criterion for randomized controlled trials and non-randomized controlled studies, investigating the impact of HCW's HHC rate on HAI rates in patients of all ages, within healthcare facilities in high income countries. FINDINGS Of the 8,093 articles citations and abstracts screened, 35 articles were included in the review. Most studies reported overall HAIs per 1000 patient-days and device-associated HAIs per 1000 device-days. Most studies reported HHC rates between 60%-70%. Lower incidence HAI rates seemed to be achieved with HHC rates of approximately 60%. Studies included were not originally designed to assess the impact of HHC on HAI rates but risk of bias was assessed as per our predetermined exposure and outcome criterion. 11 (31%) of studies were deemed at low risk of bias. CONCLUSIONS Although HHC is part of HCW's code of conduct, very high HHC rates were difficult to reach. In observational studies, HHC and HAI followed a negative relationship up to about 60%. Due to flaws in study design, causality could not be inferred; only general trends could be discussed. Given the limitations, there is a need for high-quality evidence to support the implementation of specified targets of HHC rates.
Collapse
Affiliation(s)
- V Mouajou
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada
| | - K Adams
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - G DeLisle
- Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - C Quach
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada; Infection Prevention and Control, CHU Sainte-Justine, Montreal, QC, Canada.
| |
Collapse
|
6
|
Noh EY, Lee MH, Yi YM, Park YH. Implementation of a multimodal infection control strategy in the nursing home. Geriatr Nurs 2021; 42:767-771. [PMID: 33895498 DOI: 10.1016/j.gerinurse.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
The main cause of morbidity and mortality among residents of nursing homes (NHs) is healthcare-associated infections (HAIs). We conducted infection control intervention by applying the WHO multimodal strategy for one year from January to December 2018 in the one NH in South Korea. Healthcare workers (HCWs) in NH were observed by infection control nurse from February to December 2018. Hand hygiene (HH) compliance according WHO 5 moments and type of HH, glove use were measured as main outcomes. During the intervention period, a total of 1,461 cases were observed. HH compliance among HCWs increased from 12.6% to 55.2% after the intervention. According to WHO 5 moments, HH before touching a patient and after touching a patient saw significant improvements. Further, glove misuse decreased significantly from 45.9% to 25.4%. The multifaceted infection control program in the NH group significantly improved the HH compliance of HCWs.
Collapse
Affiliation(s)
- Eun-Young Noh
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, Republic of Korea 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Min Hye Lee
- College of Nursing, Dong-A University, Busan, Republic of Korea 32, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea.
| | - Yu Mi Yi
- College of Nursing, Kyungnam College of Information and Technology, Busan, Republic of Korea 45, Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea.
| | - Yeon-Hwan Park
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, Republic of Korea 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| |
Collapse
|
7
|
Menegueti MG, Bellissimo-Rodrigues F, Ciol MA, Auxiliadora-Martins M, Basile-Filho A, da Silva Canini SRM, Gir E, Laus AM. Impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among healthcare workers of an intensive care unit: a quasi-experimental study. Antimicrob Resist Infect Control 2021; 10:6. [PMID: 33407882 PMCID: PMC7789181 DOI: 10.1186/s13756-020-00877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/OBJECTIVE After wearing powdered gloves, healthcare workers (HCW) are supposed to wash their hands instead of using alcohol-based hand-rub (ABHR). Washing hands takes longer than using ABHR, and the use of powdered gloves may be an obstacle to hand-hygiene compliance. This study aimed to evaluate the impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among HCW of an intensive care unit (ICU). METHODS A quasi-experimental study was conducted in a general ICU of a tertiary care university hospital in Brazil. From June 1st to July 15th, 2017, all HCW were provided with powdered latex gloves only for all clinical procedures. From July 15th to August 31st, 2017, HCW were provided with nitrile powder-free gloves only. Hand-hygiene compliance was assessed through direct observation, and evaluated according to the World Health Organization Hand Hygiene guidelines. We calculated that a sample size of 544 hand hygiene opportunities needed to be observed per period. Data analysis were performed using the STATA SE® version 14, and we compared the individual's percentage of compliance using the t test for paired data before and after the intervention. RESULTS Overall, 40 HCW were assessed before and after the introduction of nitrile powder-free gloves, with 1114 and 1139 observations of hand hygiene opportunities, respectively. The proportion of compliance with hand hygiene was 55% (95% confidence interval [CI] 51-59%) using powdered latex gloves and 60% (95% CI 57-63%) using powder-free gloves. The difference in proportions between the two types of gloves was 5.1% (95% CI 2.5-7.6%, p < 0.001). CONCLUSION Our data indicate that replacing powdered gloves with powder-free gloves positively influenced hand-hygiene compliance by HCW in an ICU setting.
Collapse
Affiliation(s)
- Mayra Gonçalves Menegueti
- Ribeirão Preto Nursing School, University of São Paulo, Campus Universitário, s/n Monte Alegre, Ribeirão Prêto, São Paulo 14048-900 Brazil
| | | | - Marcia A. Ciol
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, USA
| | - Maria Auxiliadora-Martins
- Intensive Care Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Prêto, Brazil
| | - Anibal Basile-Filho
- Intensive Care Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Prêto, Brazil
| | - Silvia Rita Marin da Silva Canini
- Ribeirão Preto Nursing School, University of São Paulo, Campus Universitário, s/n Monte Alegre, Ribeirão Prêto, São Paulo 14048-900 Brazil
| | - Elucir Gir
- Ribeirão Preto Nursing School, University of São Paulo, Campus Universitário, s/n Monte Alegre, Ribeirão Prêto, São Paulo 14048-900 Brazil
| | - Ana Maria Laus
- Ribeirão Preto Nursing School, University of São Paulo, Campus Universitário, s/n Monte Alegre, Ribeirão Prêto, São Paulo 14048-900 Brazil
| |
Collapse
|
8
|
Ye Y, Shi P, Gui Y, Li AM, Huang G, Xu H, Lu Q, Hong J, Gu Y, Hu X, Liu G, Wang C, Huang Q, Zhang X. Point-of-care training program on COVID-19 infection prevention and control for pediatric healthcare workers: a multicenter, cross-sectional questionnaire survey in Shanghai, China. Transl Pediatr 2021; 10:44-53. [PMID: 33633936 PMCID: PMC7882297 DOI: 10.21037/tp-20-247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of training on knowledge and practice of infection prevention and control (IPC) among pediatric health care workers (HCW) in Shanghai, China, in the context of COVID-19 pandemic. METHODS An online training program was designed by the Shanghai Pediatric Clinical Quality Control Center (SPQCC) during the early phase of COVID-19 pandemic on disease knowledge and practice of IPC. Training took place in the 81 partner hospitals affiliated with SPQCC. A multicenter, cross-sectional questionnaire survey was designed with a 25-item self-administered questionnaire to evaluate the knowledge gained from the training. Stratified-random sampling was used to select HCW according to three professionals (i.e., pediatricians, nurses and administrators) within each partner hospital. Awareness and knowledge of COVID-19 and its related infection control and practice were assessed by comparing survey results between different types of hospitals, professionals and professional ranks. A higher survey score meant that the respondent was more prepared and knowledgeable about COVID-19 and its infection control measures. RESULTS Completed questionnaires were returned from 1,062 subjects (385 pediatricians, 410 nurses, and 267 administrators), giving a response rate of 96.5%. Overall, awareness of clinical information related to COVID-19, importance of personal hygiene and isolation policy was high among the respondents. No statistical difference of scores on knowledge of COVID-19, IPC and relevant practice between the tertiary and peripheral hospitals. Among all respondents, middle-ranked health care personnel were most knowledgeable and achieved the highest score. CONCLUSIONS Majority of pediatric HCW showed good recognition and practice in infection protection and control measures. The online training was able to achieve its aim to enhance knowledge and awareness and could have contributed to the zero infection rate among HCW caring for confirmed COVID-19 cases in Shanghai.
Collapse
Affiliation(s)
- Yingzi Ye
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.,Center for Pediatric Clinical Quality Control of Shanghai, Shanghai, China
| | - Peng Shi
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yonghao Gui
- Center for Pediatric Clinical Quality Control of Shanghai, Shanghai, China.,Shanghai Medical College, Fudan University, Shanghai, China
| | - Albert M Li
- Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Guoying Huang
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.,Center for Pediatric Clinical Quality Control of Shanghai, Shanghai, China
| | - Hong Xu
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.,Center for Pediatric Clinical Quality Control of Shanghai, Shanghai, China
| | - Quan Lu
- Center for Pediatric Clinical Quality Control of Shanghai, Shanghai, China.,Department of Respiratory Disease, Children's Hospital of Shanghai, Shanghai Jiao Tong University, Shanghai, China
| | - Jianguo Hong
- Center for Pediatric Clinical Quality Control of Shanghai, Shanghai, China.,Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Gu
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaojing Hu
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Gongbao Liu
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Chuanqing Wang
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Qin Huang
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaobo Zhang
- Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.,Center for Pediatric Clinical Quality Control of Shanghai, Shanghai, China
| |
Collapse
|
9
|
Salcedo-Cifuentes M, Ordóñez-Hernández CA, Calvo-Soto AP. Cumplimiento de una estrategia de higiene de las manos en ambientes asistenciales. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2020. [DOI: 10.11144/javeriana.ie22.cehm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introducción: Si bien la higiene de las manos es la medida más importante en la mitigación del riesgo biológico en ambientes hospitalarios, evidencia científica muestra un escaso cumplimiento de las recomendaciones entre los trabajadores asistenciales. Objetivo: Evaluar el cumplimiento de cinco dimensiones que fortalecen la estrategia de higiene de las manos para la prevención del riesgo biológico en ambientes asistenciales. Método: Estudio observacional, de corte transversal, en cinco instituciones prestadoras de servicios de salud. Se aplicó estadística descriptiva. Con el Test de Medianas se evaluó si había diferencias significativas entre el grupo de profesionales por institución de salud, considerando significante una p ≤ 0,05. El análisis finalizó con un análisis discriminante. Resultados: La representatividad estuvo en las instituciones hospitalarias de primer nivel en las cuales el personal de enfermería, seguido por los médicos, tuvo un mejor cumplimiento del protocolo de lavado de manos. Este porcentaje se vio impactado por el menor cumplimiento de suministro de insumos e infraestructura. Hay una perfecta diferenciación entre los resultados del municipio de Cali con relación al de Caicedonia, en contraste con los de Popayán, Buga y Buenaventura. Conclusión: Se encontró un incumplimiento del protocolo de higiene de las manos, con una calificación inaceptable para los factores de insumos/infraestructura y técnica de higiene de las manos, respectivamente.
Collapse
|
10
|
Suzuki Y, Morino M, Morita I, Yamamoto S. The effect of a 5-year hand hygiene initiative based on the WHO multimodal hand hygiene improvement strategy: an interrupted time-series study. Antimicrob Resist Infect Control 2020; 9:75. [PMID: 32460892 PMCID: PMC7251720 DOI: 10.1186/s13756-020-00732-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/08/2020] [Indexed: 01/09/2023] Open
Abstract
Background A World Health Organization (WHO) guideline-based multimodal hand hygiene (HH) initiative was introduced hospital-wide to a nonteaching Japanese hospital for 5 years. The objective of this study was to assess the effect of this initiative in terms of changes in alcohol-based hand rub (ABHR) consumption and the Hand Hygiene Self-Assessment Framework (HHSAF) score. Methods The consumption of monthly hospital-wide ABHR was calculated in L per 1000 patient days (PDs). The change in ABHR consumption was analysed by an interrupted time series analysis with a pre-implementation period of 36 months and an implementation period of 60 months. The correlation between annual ABHR consumption and the HHSAF score was estimated using Pearson’s correlation coefficients. Results The annual ABHR consumption was 4.0 (L/1000 PDs) to 4.4 in the pre-implementation period and 10.4 to 34.4 in the implementation period. The HHSAF score was 117.5 (out of 500) in the pre-implementation period and 267.5 to 445 in the implementation period. A statistically significant increase in the monthly ABHR consumption (change in slope: + 0.479 L/1000 PDs, p < 0.01) was observed with the implementation of the initiative. Annual ABHR consumption was strongly correlated with the annual HHSAF score (r = 0.971, p < 0.01). Conclusions A 5-year WHO-based HH initiative significantly increased ABHR consumption. Our study suggested that the HHSAF assessment can be a good process measure to improve HH in a single facility, as ABHR consumption increased with the HHSAF score.
Collapse
Affiliation(s)
- Yumi Suzuki
- Department of Pediatrics, National Hospital Organization (NHO) Shimoshizu National Hospital, 934-5 Shikawatashi, Yotsukaido, 284-0003, Chiba, Japan. .,Division of Infection Control, NHO Shimoshizu National Hospital, Yotsukaidou, Japan.
| | - Motoko Morino
- Division of Infection Control, NHO Shimoshizu National Hospital, Yotsukaidou, Japan.,Department of Nursing, NHO Shimoshizu National Hospital, Yotsukaidou, Japan
| | - Ichizo Morita
- Japanese Red Cross Toyota College of Nursing, 12-33 Nanamagari Hakusancho, Toyota, 471-8565, Aichi, Japan
| | - Shigenori Yamamoto
- Department of Pediatrics, National Hospital Organization (NHO) Shimoshizu National Hospital, 934-5 Shikawatashi, Yotsukaido, 284-0003, Chiba, Japan
| |
Collapse
|
11
|
Irehovbude J, Okoye CA. Hand hygiene compliance: bridging the awareness-practice gap in sub-Saharan Africa. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc06. [PMID: 32547906 PMCID: PMC7273322 DOI: 10.3205/dgkh000341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review provides an exploratory overview of hand hygiene compliance in sub-Saharan Africa and examines strategies to bridge the compliance gap. While there is increasing awareness on hand hygiene, empirical evidence suggests that there is no concurrent increase in correct hand hygiene practice among key populations in sub-Saharan Africa. Children, adolescents and even healthcare providers (HCPs) in sub-Saharan Africa consistently assume poor hand hygiene compliance levels resulting in negative health consequences. Faecal-oral diseases remain common among schoolchildren, leading to school absenteeism and disease-specific morbidity. Additionally, the incidence of nosocomial infections in health facilities in sub-Saharan Africa remains high, as many HCPs do not adopt good hand hygiene practice. Increased disease burden, high healthcare costs and eroding public confidence in the healthcare system are a few implications of HCPs’ poor compliance with hand hygiene. These trends underscore the inadequacies of educational approaches (cognition model) to hand hygiene promotion commonly adopted in sub-Saharan Africa. It was therefore recommended that the governments of sub-Saharan Africa should focus on promoting skill-based hygiene education which will help schoolchildren develop good hand hygiene practice as a lifelong skill. In addition, efforts should be made to implement a multimodal hand hygiene strategy in healthcare facilities in order to increase compliance by healthcare providers.
Collapse
Affiliation(s)
- Jahmai Irehovbude
- Department of Human Kinetics and Health Education, Ambrose Alli University, Ekpoma, Edo State, Nigeria
| | | |
Collapse
|
12
|
Bezerra TB, Valim MD, Bortolini J, Ribeiro RP, Marcon SR, Moura MEB. Adherence to hand hygiene in critical sectors: Can we go on like this? J Clin Nurs 2020; 29:2691-2698. [PMID: 32301162 DOI: 10.1111/jocn.15293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Abstract
AIMS AND OBJECTIVES The rates of healthcare-associated infections are high around the world. Hand hygiene is considered the most effective measure to reduce the transmission of pathogens in the hospital environment. Our objective was to evaluate adherence to hand hygiene in critical units of a tertiary-level hospital in Central-West Brazil. DESIGN Observational study employing cross-sectional data. Reporting rigour was demonstrated using the STROBE checklist. METHODS Observation of hand hygiene practices of 129 professionals from the health team, including nursing staff, physicians and physical therapists. Data collection was carried out using the World Health Organization form. RESULTS A total of 3,025 hand hygiene opportunities were observed, and the overall rate of adherence was only 46.25%. There was a greater frequency of hand hygiene after risk of exposure to bodily fluids and after contact with patients, 60.80% and 53.45%, respectively. Nurses obtained a higher rate of adherence to hand hygiene (59.80%). The neonatal ICU had a higher rate of adherence to hand hygiene when compared to other sectors. CONCLUSIONS The physical structure for hand hygiene in the institution was poor, and no professionals reached the minimum time required for execution of hand hygiene techniques. There were low rates of adherence to hand hygiene by professionals at all five times and in all categories and sectors observed, which may have been influenced by poor infrastructure present in the institution. RELEVANCE TO CLINICAL PRACTICE This study is of great relevance to patient safety, given the rates of healthcare-associated infections worldwide, with emphasis on underdeveloped countries. It is hoped that the results of this research can guide organisations to validly and systematically evaluate adherence to hand hygiene and achieve higher rates of adherence to hand hygiene and consequently reduce the number of infections in health environments.
Collapse
Affiliation(s)
| | | | - Juliano Bortolini
- Statistics Department, Federal University of Mato Grosso, Cuiabá, Brazil
| | | | | | | |
Collapse
|
13
|
A new approach to infection prevention: A pilot study to evaluate a hand hygiene ambassador program in hospitals and clinics. Am J Infect Control 2020; 48:246-248. [PMID: 31917012 DOI: 10.1016/j.ajic.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND A pilot study was conducted to assess the perceptions of visitors, patients, and staff to the presence of a hand hygiene ambassador (HHA). METHODS Two hundred and twenty-five entrants to various health care settings were surveyed. Only entrants who failed to clean their hands at the alcohol-based handrub (ABHR) station on entry to the lobby were offered application of ABHR by an HHA. Several questions were also asked to assess their attitudes about the presence of an HHA. RESULTS When asked whether they think it is a good idea to have an HHA place ABHR on an entrant's hands, the majority of staff, visitors, and patients agreed. No one refused administration of handrub by the HHA. DISCUSSION HHA programs have direct and indirect benefits. Although the cost of such an initiative should be considered prior to implementation, it should be weighed against the annual spending for health care-associated infections. CONCLUSIONS Considering that hand hygiene compliance and health care-associated infection are clearly linked, a new approach using an HHA may help reduce infection, acting as a source of hand hygiene on entry to the hospital and possibly as a reminder to perform hand hygiene elsewhere in the hospital and clinics.
Collapse
|
14
|
|
15
|
Valim MD, Rocha ILDS, Souza TPM, Cruz YAD, Bezerra TB, Baggio É, Morais RBD, Ribeiro AC. Efficacy of the multimodal strategy for Hand Hygiene compliance: an integrative review. Rev Bras Enferm 2019; 72:552-565. [PMID: 31017221 DOI: 10.1590/0034-7167-2018-0584] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/01/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Evaluate, from the literature, the effectiveness of the implementation of the multimodal strategy for health professionals compliance with Hand Hygiene and its sustainability over time. METHOD Integrative review, with a view to answering the following question: "Is the implementation of the multimodal strategy effective in health professionals compliance with Hand Hygiene and can it be sustained over time?". The MEDLINE, SCOPUS, LILACS and CINAHL databases were used to retrieve the primary articles. RESULTS Twenty-five studies were analyzed. Among the components of the multimodal strategy, three need to be better worked: health education, feedback from practices and management involvement. Although it needs to focus more on its five elements, interventions based on the multimodal strategy have favored HH compliance and its long-term sustainability. CONCLUSION The strategy proved to be effective for HH compliance, especially when all integrating components are adequately addressed.
Collapse
Affiliation(s)
| | | | | | | | | | - Érica Baggio
- Universidade Federal de Mato Grosso,Faculdade de Enfermagem. Cuiabá-MT, Brasil
| | | | | |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Implementation of a national quality improvement program to enhance hand hygiene in nursing homes in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:345-351. [PMID: 30316727 DOI: 10.1016/j.jmii.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE This study investigated the cause of hand hygiene deficit, and further implemented a quality improvement program using WHO's hand-hygiene strategy to enhance the compliance of hand hygiene in the nursing home in Taiwan. METHODS This prospective study was conducted in eleven nursing homes in Taiwan from January 2015 to December 2016. After intervention, we monitor the compliance, and accuracy of hand hygiene. In addition, we also calculated the number of episodes of infection per 1000 resident-days in each nursing home in the intervention period (July-December 2015) and post-intervention period (January-October 2016). RESULTS Overall, the consumption of alcohol-based handrubs increased from 10.1 ml per resident-day in intervention period to 12.2 ml per resident-day in post intervention period. The compliance of hand hygiene increased from 74% in intervention period to 79% in post-intervention period and the rate of correct hand hygiene increased from 81% in intervention period to 87% in post-intervention period. Most importantly, the infection density decreased from 2.39 per 1000 resident-day in intervention period to 1.89 per 1000 resident-day. CONCLUSIONS A national quality-improvement program using WHO's hand-hygiene strategy to enhance hand hygiene and reduce healthcare associated infection is effective in nursing homes in Taiwan.
Collapse
|
18
|
How to make hand hygiene interventions more attractive to nurses: A discrete choice experiment. PLoS One 2018; 13:e0202014. [PMID: 30092024 PMCID: PMC6084975 DOI: 10.1371/journal.pone.0202014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 07/26/2018] [Indexed: 12/15/2022] Open
Abstract
Background Better understanding of the characteristics of interventions which are attractive to nurses is required in order to implement effective hand hygiene interventions. Methods The intervention characteristics were derived from diffusion of innovation theory (DIT): relative advantage, compatibility, simplicity, trialability, and observability. To identify nurses’ preferences for the five characteristics, a discrete choice experiment (DCE) was conducted. Participants were nurses working at Taiwanese tertiary care hospitals selected through stratified sampling. In addition, the hand hygiene moment (before or after patient contact) was taken into consideration in the DCE to investigate whether nurses’ preferences for the intervention characteristics were the same at different hand hygiene moments. Results This survey was conducted between 1 October and 31 December 2014. Among 200 nurses from three Taiwanese tertiary care hospitals, significant preferences for the five intervention characteristics were observed. That is, when an intervention makes the hand hygiene activity more convenient (p<0.001), when nurses participate in the design of the intervention (p<0.001), when an intervention is explained well to nurses before implementing it (p<0.001), when the evidence of hand hygiene is provided at a trial stage to show its effectiveness (p<0.001), and when nurses’ hand hygiene performance is observable to their peers (p<0.001), nurses are more willing to wash their hands with high compliance. In addition, nurses preferred for providing evidence at a trial stage most, and well explanation about the intervention to increase simplicity was least. The rankings of the preference for the five intervention characteristics were the same at different hand hygiene moments (p = 0.453) Conclusions The findings suggest policy directions for decision makers aiming to improve overall hand hygiene compliance in healthcare facilities.
Collapse
|
19
|
Identifying heterogeneity in the Hawthorne effect on hand hygiene observation: a cohort study of overtly and covertly observed results. BMC Infect Dis 2018; 18:369. [PMID: 30081843 PMCID: PMC6090841 DOI: 10.1186/s12879-018-3292-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 08/01/2018] [Indexed: 12/19/2022] Open
Abstract
Background Observation and feedback are core strategies of hand hygiene (HH) improvement. Direct overt observation is currently the gold standard method. Observation bias, also known as the Hawthorne effect, is a major disadvantage of this method. Our aim was to examine the variation of the Hawthorne effect on HH observation in different healthcare groups and settings. Methods A prospective cohort study was performed in a tertiary teaching hospital during a 15-month period. Up to 38 overt observers (82% nurses) and 93 covert observers (81% medical students) participated in HH observation. The HH events observed overtly were matched for occupation, department, observation time, and location with those observed covertly. The data of matched pairs were then analysed to detect possible Hawthorne effects on different variables. Results A total of 31,522 HH opportunities were observed (4581 overtly, 26,941 covertly). There were 3047 matched pairs after 1:1 matching of overt and covert observations. The overall HH compliance was higher with overt observation than with covert observation (78% vs. 55%, p < 0.001). The Hawthorne effect was nearly three times larger in nurses (30 percentage points) than in physicians (11 percentage points) and was significantly greater in outpatient clinics (41 percentage points) than in intensive care units (11 percentage points). The magnitude of the Hawthorne effect varied among healthcare worker occupations and observation locations (p values both < 0.001) but not among departments, observation times, or HH indications. Conclusions Heterogeneity in the Hawthorne effect may influence the interpretation of overt observations and prevent the correct identification of target populations with poor HH compliance. Therefore, directly observed HH compliance may not be an adequate performance indicator for infection control.
Collapse
|
20
|
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]
|
21
|
Al Kuwaiti A. Impact of a multicomponent hand hygiene intervention strategy in reducing infection rates at a university hospital in Saudi Arabia. Interv Med Appl Sci 2017; 9:137-143. [PMID: 29201437 PMCID: PMC5700699 DOI: 10.1556/1646.9.2017.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Few studies have reported the correlation between hand hygiene (HH) practices and infection rates in Saudi Arabia. This work was aimed to study the effect of a multicomponent HH intervention strategy in improving HH compliance and reducing infection rates at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia between January 2014 and December 2016. METHODS A yearlong multicomponent HH intervention, which included various strategies recommended by the World Health Organization, was introduced. HH compliance among staff and infection rates observed in the inpatient wards were assessed and compared at pre- and post-interventional phases. RESULTS There was a significant increase in mean HH compliance from 50.17% to 71.75% after the intervention (P < 0.05). Hospital-acquired infection (HAI) and catheter-associated urinary tract infection (CAUTI) rates decreased from 3.37 to 2.59 and from 3.73 to 1.75, respectively (P < 0.05). HH compliance was found to be negatively correlated with HAI (r = -0.278) and CAUTI (r = -0.523) rates. CONCLUSIONS Results show that multicomponent intervention is effective in improving HH compliance, and that an increase in HH compliance among hospital staff decreases infection rates. Further studies on cost-effectiveness of such a model could augment to these findings.
Collapse
Affiliation(s)
- Ahmed Al Kuwaiti
- Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University (Formerly University of Dammam), Al-Khobar, Kingdom of Saudi Arabia
| |
Collapse
|
22
|
Ibeneme S, Maduako V, Ibeneme GC, Ezuma A, Ettu TU, Onyemelukwe NF, Limaye D, Fortwengel G. Hand Hygiene Practices and Microbial Investigation of Hand Contact Swab among Physiotherapists in an Ebola Endemic Region: Implications for Public Health. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5841805. [PMID: 28691027 PMCID: PMC5485314 DOI: 10.1155/2017/5841805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/13/2017] [Accepted: 04/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand hygiene practices (HHP), as a critical component of infection prevention/control, were investigated among physiotherapists in an Ebola endemic region. METHOD A standardized instrument was administered to 44 randomly selected physiotherapists (23 males and 21 females), from three tertiary hospitals in Enugu, Nigeria. Fifteen participants (aged 22-59 years) participated in focus group discussions (FGDs) and comprised 19 participants in a subsequent laboratory study. After treatment, the palms/fingers of physiotherapists were swabbed and cultured, then incubated aerobically overnight at 37°C, and examined for microbial growths. An antibiogram of the bacterial isolates was obtained. RESULTS The majority (34/77.3%) of physiotherapists were aware of the HHP protocol, yet only 15/44.1% rated self-compliance at 71-100%. FGDs identified forgetfulness/inadequate HHP materials/infrastructure as the major barriers to HHP. Staphylococcus aureus were the most prevalent organisms, prior to (8/53.33%) and after (4/26.67%) HPP, while Pseudomonas spp. were acquired thereafter. E. coli were the most antibiotic resistant microbes but were completely removed after HHP. Ciprofloxacin and streptomycin were the most effective antibiotics. CONCLUSION Poor implementation of HPP was observed due to inadequate materials/infrastructure/poor behavioral orientation. Possibly, some HPP materials were contaminated; hence, new microbes were acquired. Since HPP removed the most antibiotic resistant microbes, it might be more effective in infection control than antibiotic medication.
Collapse
Affiliation(s)
- S. Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
- UNIRED Research Group, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
| | - V. Maduako
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - G. C. Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria, Enugu Campus, Abakaliki, Ebonyi State, Nigeria
| | - A. Ezuma
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - T. U. Ettu
- National Open University of Nigeria, Owerri Study Centre, Owerri, Imo State, Nigeria
| | - N. F. Onyemelukwe
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - D. Limaye
- UNIRED Research Group, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
- German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
| | - G. Fortwengel
- UNIRED Research Group, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
- German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
| |
Collapse
|
23
|
Oliveira ACD, Gama CS, Paula AOD. Adherence and factors related to acceptance of alcohol for antiseptic hand rubbing among nursing professionals. Rev Esc Enferm USP 2017; 51:e03217. [PMID: 28403370 DOI: 10.1590/s1980-220x2016037803217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/17/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Identify rates of adhesion and related factors to acceptance of an alcohol based preparation to hands antiseptic friction among nursing professionals in a unit of intensive therapy. METHOD A cross-sectional study, which involved direct observation of hand hygiene opportunities and nursing professionals' completion of questionnaires, was conducted at a university hospital between January and July 2015. Descriptive and univariate analyses were performed, with a 5% significance level. RESULTS It was observed 956 opportunities of hand hygiene among 46 nursing professionals. The rate of adhesion to alcohol-based handrub (ABH) was 34.8% and about 87.0% preferred handwashing. Nurses used ABH more frequently than nursing technicians (p <0.001), and the report of feeling of clean hands after using the alcohol product was directly related to higher rates of adherence to antiseptic friction through observation (P <0.05). CONCLUSION The finding indicating low ABH usage highlights the need for greater institutional investment in strategies that help health professionals to recognize the advantages of this type of HH with respect to time spent, ease of access to dispensers, effectiveness in eliminating microorganisms, and maintaining skin moisturization.
Collapse
Affiliation(s)
| | - Camila Sarmento Gama
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil
| | | |
Collapse
|
24
|
Evaluation of the Multimodal Strategy for Improvement of Hand Hygiene as Proposed by the World Health Organization. J Nurs Care Qual 2017; 32:E11-E19. [DOI: 10.1097/ncq.0000000000000197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Wu KS, Chen YS, Lin HS, Hsieh EL, Chen JK, Tsai HC, Chen YH, Lin CY, Hung CT, Sy CL, Tseng YT, Lee SSJ. A nationwide covert observation study using a novel method for hand hygiene compliance in health care. Am J Infect Control 2017; 45:240-244. [PMID: 27838163 DOI: 10.1016/j.ajic.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evaluation and feedback is a core hand hygiene (HH) improvement strategy. The covert observation method avoids observation bias inherent to the overt method. The aim of the study was to observe HH compliance by a novel covert method in a real-world setting. METHODS We conducted a 2-year, nationwide, prospective, observational study in teaching hospitals across Taiwan. Medical students and students who may have contact with patients in their careers were recruited as participants. A novel, shorthand notation method for covert observation was used. Observation results were reported through a study website. RESULTS There were a total of 25,379 HH opportunities covertly observed by 93 observers. Overall HH compliance was 32.0%. Health care workers had the highest HH compliance for indication 4 (42.6%), and the lowest for indication 5 (21.7%). Overall handrubbing percentage was high, reaching 83.6%. The HH compliance increased significantly with an increase in the number of indications within 1 HH opportunity (P < .001). CONCLUSIONS The overall HH compliance by the covert observation method was low. An innovative shorthand notation method facilitated covert observation, and website reporting was demonstrated to be feasible for large-scale observation.
Collapse
|
26
|
Sopjani I, Jahn P, Behrens J. Training as an Effective Tool to Increase the Knowledge About Hand Hygiene Actions. An Evaluation Study of Training Effectiveness in Kosovo. Med Arch 2017; 71:16-19. [PMID: 28428667 PMCID: PMC5364797 DOI: 10.5455/medarh.2017.71.16-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Hand hygiene (HH) compliance with World Health Organization (WHO) guidelines is essential to prevent bacterial transmission and infections acquired from hospital settings. Aim: The aim of this study was to evaluate the impact of training tool of World Health Organization’s (WHOs) Hand Hygiene multi modal campaign at all public hospitals and at the University Clinical Center in Kosovo (UCCK). Method: During February 2016, 691 questionnaires were distributed to health care workers. The data collection was conducted through a questionnaire distributed before and after training. Measurement of questions was realized through a 5 point Likert scale. Results: The gender structure of participants turned out to be greater for women (n=571, 85%). The knowledge of health care workers differed significantly before and after the training (p<0.001), emphasizing that the impact of the training was important to improve the knowledge of participants. Thus, the average value of improvement of HCW’ knowledge was about 41.66 %. Conclusion: The findings emphasized the role of the training to improve the knowledge of participants about hand hygiene as well as prevention from infection.
Collapse
|
27
|
Gudza-Mugabe M, Magwenzi MT, Mujuru HA, Bwakura-Dangarembizi M, Robertson V, Aiken AM. Effect of handrubbing using locally-manufactured alcohol-based handrubs in paediatric wards in Harare, Zimbabwe. Antimicrob Resist Infect Control 2017; 6:8. [PMID: 28096976 PMCID: PMC5225549 DOI: 10.1186/s13756-016-0166-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/27/2016] [Indexed: 12/02/2022] Open
Abstract
We assessed bacterial contamination of hands of adults present in paediatric wards in two tertiary-care hospitals in Harare, Zimbabwe and the microbiologic efficacy of locally-manufactured alcohol-based hand rub (ABHR). During unannounced visits, samples were collected using hand-print and hand-rinse methods. Samples were collected from 152 individuals (16 nurses, 10 doctors, 28 students, 86 parents/guardians, 12 others). Contamination of hands with Gram-negative bacteria was found in 91% of adults tested with a mean of 14.6 CFU (hand-rinse method; IQR 3–65), representing a high risk for transmission of pathogens potentially leading to nosocomial infections. A single application of ABHR under controlled conditions achieved an average of 82% (or 0.72 log) reduction in detectable counts. Amongst 49 Enterobacteriaceae isolates from hands, 53% were resistant to gentamicin and 63% were resistant to cefpodoxime. Use of ABHR represents an attractive intervention for reducing nosocomial infections in this setting.
Collapse
Affiliation(s)
| | - Marcelyn T Magwenzi
- Department of Medical Microbiology, University of Zimbabwe-College of Health Sciences, Harare, Zimbabwe
| | - Hilda A Mujuru
- Department of Paediatrics and Child Health, University of Zimbabwe-College of Health Sciences, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Department of Paediatrics and Child Health, University of Zimbabwe-College of Health Sciences, Harare, Zimbabwe ; Parirenyatwa Hospital, Harare, Zimbabwe
| | - Valerie Robertson
- Department of Medical Microbiology, University of Zimbabwe-College of Health Sciences, Harare, Zimbabwe
| | - Alexander M Aiken
- London School of Hygiene and Tropical Medicine, London, UK ; Biomedical Research and Training Institute, Harare, Zimbabwe
| |
Collapse
|