Patient, family, and visitor hand hygiene knowledge, attitudes, and practices at pediatric and maternity hospitals: A descriptive study

Becoming Hand Hygiene Heroes: implementation of an infection prevention and control campaign for patient and family hospital safety

BACKGROUND

The COVID-19 pandemic highlighted that hand hygiene is key in preventing healthcare-associated infections. Patients and families are understudied targets for infection prevention and control practices. Previous campaigns to change hand hygiene behavior have been effective, but often face systemic challenges with implementation.

METHODS

The "Hand Hygiene Heroes" educational campaign was developed to improve patient and family hand hygiene at two tertiary care pediatric and obstetrics hospitals. Its multiple phases included visual materials, tailored activities for nine hospital units, and long-term evaluation during a two-year period. Hand hygiene rates among patients/families and healthcare workers were measured at baseline and throughout the campaign via direct observation.

RESULTS

Overall, hand hygiene significantly increased for both patients/families (OR 1.82, p 0.041) and healthcare workers (OR 2.15, p <0.001) after campaign initiation. However, individual units had varying degrees of sustainment on follow-up evaluations.

DISCUSSION

Duration of intervention, activity simplicity, active participation, and resource availability may affect success of campaign initiatives. Positive prognostic factors included mixed leadership support from administration and front-line workers, pre-determined sustainability plans, and tailored activities by target audience.

CONCLUSIONS

Implementation of hospital educational campaigns can be resource-intensive but can positively impact patient and family hand hygiene.

Barriers to Effective Infection Prevention in the Neonatal Intensive Care Unit: A Qualitative Study

BACKGROUND

Infection prevention (IP) behaviors such as hand hygiene (HH) and mobile device disinfection are important to reduce the risk of infection transmission from both family members and hospital staff to critically ill neonates.

PURPOSE

To inform the design of educational interventions to improve both patient family and staff IP behaviors, we engaged separate groups of nurses and family members to understand perceptions about the spread of infection and barriers to implementing effective IP strategies.

METHODS

This was a qualitative study using focus groups to gather data from neonatal nurses and patient family members. Data were triangulated with hospital-wide survey data and analyzed using inductive content analysis.

RESULTS

Twelve nurses and 4 patient family members participated. Themes related to communication about IP between staff and family members emerged: stakeholders expressed discomfort with the timing and nature of just-in-time HH education. These communication challenges contributed to stress levels within the neonatal intensive care unit. This finding was reflected in the hospital-wide survey.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Steps should be taken to improve communication about IP behaviors between patient family members and frontline staff. Reducing nurse burden of providing just-in-time HH reminders to patient family members through increased IP education may decrease stress and facilitate IP behaviors. This has the potential to decrease infection spread and improve patient outcomes. The development of interventions targeting stakeholder communication is therefore warranted, but additional research is needed to understand the timing and process for delivery of the educational material.

Hand hygiene knowledge and practices of family caregivers in inpatient pediatrics

Family caregivers are essential inpatient pediatric care partners, yet their handwashing knowledge and compliance are rarely studied. Through hand hygiene audits and self-administered questionnaires, we observed 9% compliance, significantly lower than self-reported practice. We suggest interventions to improve caregiver handwashing behaviors to decrease infection transmission risk to hospitalized children.

Novel hand hygiene promotion method in a pediatric and maternity hospital: A quality improvement pilot project using auditory feedback

A pilot quality improvement project was conducted to examine the effect of playing an applause sound effect at a busy hospital concourse for three consecutive days whenever hand hygiene behavior was observed. The immediate effect was documented. The project demonstrated observable interest among people passing by, and hand hygiene events triggered by the sound effect represented 10.1% of all hand hygiene events documented. This supports the possible utility of this intervention in generating public awareness and increasing hand hygiene behavior and demonstrates the feasibility of a longer trial utilizing audio devices.

COMPLIANCE OF PATIENT COMPANIONS AND VISITORS WITH HAND HYGIENE: AN OBSERVATIONAL STUDY

BACKGROUND

Hand hygiene is a simple and low-cost practice to prevent the spread of many microorganisms that cause healthcare-associated infections (HCAIs). Compliance with hand hygiene, especially by patient companions and visitors, is very important in order to prevent the transmission of pathogenic microorganisms between the health institutions and the community.

AIM

This is a descriptive study designed to investigate the compliance of patient companions and visitors with hand hygiene.

METHODS

The sample of the study included 209 individuals who were the companions and visitors of the patients who were hospitalized in a University Hospital in the west of Turkey. A questionnaire containing Demographics and Hand Hygiene and the Observation Form to assess Hand Hygiene Practice were used to acquire data. In order to conduct the research, permission was obtained from the ethics committee and the institution, and consent was obtained from the patient companions and visitors. To evaluate the data, the numbers, percentage calculations, mean and independent inter-observer agreement coefficient were used.

FINDINGS

96.2% of the patient companions and visitors stated that they did not receive training on the importance of hand washing during their stay in the hospital, and 74.6% stated that hand washing was very important in the prevention of diseases. The patient families reported that they most often washed their hands after touching bodily fluids (91.7%), and that they rarely washed their hands before touching a patient (34.0%). The rates were decreased in the observations, and the lowest rate for handwashing was before touching a patient (22.4%) and the highest rate for handwashing was after the risk for contamination with body fluids of patient (68.6%).

CONCLUSION

The results of this study indicate that patient companions and visitors did not receive any training on the importance of hand hygiene during the hospital stay, and the observed rate of compliance with hand hygiene was lower than stated. Recommendations include delivering planned handwashing training to patient companions and visitors using different teaching methods, and to conduct longer observational studies.

Viral Respiratory Infections in Hospitalized Children With Symptomatic Caregivers

OBJECTIVES

The burden of healthcare-associated viral respiratory infections (HAVRIs) among children is significant. While healthcare workers are often the focus for infection prevention strategies, little is known about the impact of sick caregivers and hospital visitors on the incidence of pediatric HAVRIs. The objective of this descriptive study was to determine the proportion of pediatric HAVRIs following contact with a sick caregiver or visitor.

METHODS

A retrospective chart review was performed of all HAVRIs that occurred between December 2017 and July 2019 in a pediatric tertiary care center. A HAVRI was defined as a laboratory-confirmed respiratory viral illness occurring more than 72 hours after admission.

RESULTS

Forty-four HAVRIs occurred in 37 patients during the study, predominantly among patients aged <24 months (n = 32, 72.7%) and with comorbidities (n = 42, 95.5%). For 9 HAVRIs (20.5%), contact with a sick caregiver (n = 8, 18.2%) or visitor (n = 2, 4.5%) in the 7 days before diagnosis was documented. In the 72 hours before HAVRI onset, 18 of the 44 patients (40.9%) were in a single-bed room and 6 of them (33.3%) were under additional precautions. Twelve patients (27.3%) had new or increased oxygen requirements and 4 (9.1%) were transferred to the ICU. There were no associated deaths.

CONCLUSIONS

Contact with a sick caregiver or visitor is a potential risk factor for acquiring a HAVRI. Our study reinforces the importance of engaging family caregivers in infection prevention and control strategies in pediatric care settings.