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Iversen AM, Hansen MB, Kristensen B, Ellermann-Eriksen S. Hand hygiene compliance in nursing home wards: The effects of feedback with lights on alcohol-based hand rub dispensers. Am J Infect Control 2024; 52:1020-1024. [PMID: 38583777 DOI: 10.1016/j.ajic.2024.03.018] [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: 01/22/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Hand hygiene (HH) among health care workers (HCWs) is crucial in preventing infections in nursing homes. However, HH compliance (HHC) among HCWs remains low. This study aimed to investigate the effect of feedback lights on HCWs' HHC. METHODS A 5-month interventional study was conducted in 3 wards in a nursing home in Denmark. During the intervention period, a green light with a smiley appeared on the alcohol-based hand rub (ABHR) dispensers when HCWs used the ABHR, acknowledging HCWs for using the ABHR. HHC was monitored using an automatic HH monitoring system (AHHMS). RESULTS A total of 64 HCWs were enrolled. The AHHMS collected 23,696 HH opportunities in apartments and dirty utility rooms. Overall, HHC in the apartments increased from 50% at baseline (95% CI: 48, 53) to 56% (95% CI: 54, 58) during the intervention. However, the increased HHC level was not sustained during follow-up. CONCLUSIONS The AHHMS enabled the assessment of the intervention. We found a significant effect of light-guided feedback in the apartments. However, the increased HHC was not sustained after the light was switched off.
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Affiliation(s)
- Anne-Mette Iversen
- Department of Oncology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
| | | | - Brian Kristensen
- National Center of Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
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Weikert B, Kramer TS, Schwab F, Graf-Allgeier C, Wolke SI, Gastmeier P, Geffers C. Effect of a multimodal prevention strategy on dialysis-associated infection events in outpatients receiving haemodialysis: The DIPS stepped wedge, cluster-randomized trial. Clin Microbiol Infect 2024; 30:1147-1153. [PMID: 38310998 DOI: 10.1016/j.cmi.2024.01.020] [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: 09/06/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
OBJECTIVES Patients with haemodialysis catheters are susceptible to dialysis-associated infections, particularly bloodstream infections. There have been few systematic attempts to reduce this burden. Our study aimed to investigate the effect of a multimodal prevention strategy on dialysis-associated infection events (DAIE) among haemodialysis outpatients. METHODS A multicentre, stepped wedge, cluster-randomized controlled trial was done from October 2019 to September 2021. Outpatient dialysis facilities entered into the intervention phase in three randomly assigned clusters, at three predefined time points. The multimodal prevention strategy consisted of infection surveillance and hand hygiene (HH) compliance observation with active feedback and teaching aseptic procedures, and a patient flyer. The primary outcome was incidence rates of different DAIE, such as bloodstream infections, intravenous antimicrobial starts, and local access-site infections per 1000 dialysis. As secondary outcome, we analysed the HH compliance change. RESULTS A total of 43 haemodialysis outpatient facilities with 11 251 patients and 1 413 457 proceeded haemodialysis were included in the DIPS-trial. Incidence rates were 0.71 DAIE per 1000 dialysis (95% CI, 0.65-0.78) in the control and 0.31 (95% CI, 0.27-0.36) in the intervention group. The univariable analysis yielded an incidence rate ratio (IRR) of 0.44 (95% CI, 0.33-0.59) for DAIE. Especially in patients with a central venous catheter, we saw a significant decrease in DAIE in the intervention group (IRR 0.4; 95% CI, 0.28-0.58). The HH observation combined with feedback and intensified training, resulted in an increase of HH compliance from 58-65%. DISCUSSION A multimodal prevention strategy showed a significant preventive effect on DAIE among haemodialysis outpatients. This reduction also applied to bloodstream infections, especially in patients with a central venous catheter.
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Affiliation(s)
- Beate Weikert
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Tobias Siegfried Kramer
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Solvy Ingrid Wolke
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christine Geffers
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Center for the Surveillance of Nosocomial Infections, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Shin B, Jeong IS. Indication-based and patient-based hand hygiene performance among nurses working at a university hospital. Nurs Health Sci 2024; 26:e13154. [PMID: 39168832 DOI: 10.1111/nhs.13154] [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: 01/05/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 08/23/2024]
Abstract
The traditional method of monitoring hand hygiene (HH) based on specific indications does not ensure that HH is performed for all required indications during patient care. This study aimed to compare HH performance rates (HHPRs) based on specific indications versus overall patient care among nurses at a university hospital. The study retrospectively analyzed HH monitoring data for 1398 indications from 543 patients and 190 nurses. Observations were conducted continuously, tracking a single healthcare worker from before patient contact until the end of the contact within a 30-min period. The indication-based HHPR was found to be 89.1%, while the patient-based HHPR was 78.1%. In the context of patient-based HHPR, the lowest rates were observed among nurses in the emergency room (48.3%) and those with less than 1 year of work experience (66.7%). Moreover, the largest discrepancy between indication-based and patient-based HHPR was noted among emergency room nurses with less than 1 year of experience. This significant difference underscores the need for patient-based HH monitoring, particularly for nurses in emergency settings and those with limited experience.
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Affiliation(s)
- Bora Shin
- Department of Infection Control, Jeju National University Hospital, College of Nursing, Pusan National University, Yangsan-si, Korea
| | - Ihn Sook Jeong
- Department of Infection Control, Jeju National University Hospital, College of Nursing, Pusan National University, Yangsan-si, Korea
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4
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Higashionna T, Hagiya H, Fujita Y, Kiguchi T. Trends in the hand hygiene practices by alcohol-based hand rubs in Japanese hospitals before and after the novel coronavirus pandemic: an observational study using national surveillance data. J Hosp Infect 2024:S0195-6701(24)00288-3. [PMID: 39208991 DOI: 10.1016/j.jhin.2024.08.007] [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: 05/14/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a global concern in healthcare facilities, for which hand hygiene (HH) using alcohol-based hand rubs (ABHR) is fundamentally crucial for their prevention. While previous studies report improvements in HH compliance amid the COVID-19 pandemic, the real situation in Japanese medical settings remains unclear. METHODS This observational study sought data from the Japanese national surveillance, focusing on ABHR use in hospitals before and after the COVID-19 pandemic. Data were retrieved from facilities certified to receive the Additional Healthcare Reimbursements for Infection Prevention and Control I. The study spanned five years (2019-2023), segmented quarterly, and employed Joinpoint regression analysis to assess the annual percentage change (APC). RESULTS Overall, ABHR use per patient per day significantly increased both in critical care units and general wards amid the pandemic. However, the APC in the critical care units demonstrated a downward trend from Q4 of 2021 to Q1 of 2023, and ABHR use in general wards remained below the amount of WHO recommendations. CONCLUSION This trend analysis highlighted recent patterns of ABHR use in Japanese hospitals by comparing pre- and post-COVID-19 periods. Although increases in ABHR use were observed over time, sustained efforts to promote HH compliance are necessary, particularly in general wards.
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Affiliation(s)
| | - Hideharu Hagiya
- Department of Infectious Diseases, Okayama University Hospital, Okayama, Japan
| | - Yasushi Fujita
- Department of Nursing, Okayama University Hospital, Okayama, Japan
| | - Takashi Kiguchi
- Department of Nursing, Okayama University Hospital, Okayama, Japan
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Havaldar RR, Vagarali MA, Belaldavar BP, Redkar AA, Boral P. An Analysis of the Contaminants on Otoscopes of Otolaryngology Residents: An Observational Study. Indian J Otolaryngol Head Neck Surg 2024; 76:3386-3389. [PMID: 39130216 PMCID: PMC11306819 DOI: 10.1007/s12070-024-04695-8] [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: 03/08/2024] [Accepted: 04/05/2024] [Indexed: 08/13/2024] Open
Abstract
The study was conducted to learn if the otoscope, a noncritical medical device, used by ENT residents harbor pathogenic organism. This study was conducted in a medical teaching hospital in India. Total of 38 otoscopes of ENT residents were examined after taking samples using sterile cotton swabs from otoscope speculum and otoscope head and both bacterial and fungal culture were studied. The study showed that 11 otoscope heads (28.94%) and 11 otoscope speculums (28.94%) out of the 38 otoscopes studied showed bacterial growth. Most commonly isolated bacteria were skin commensals followed by Klebsiella species. Fungal growth was seen in 3 out of 38 otoscope Speculums (7.89%). All 3 fungi isolated during the study belonged to Aspergillus species. Training residents regarding hygiene of medical equipments is necessary. Residents must be periodically assessed regarding their practice in handling medical equipments. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-024-04695-8.
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Affiliation(s)
- Rajesh Radhakrishna Havaldar
- Department Of Otorhinolaryngology And Head And Neck Surgery, J.N Medical College, Kaher Belagavi, 590010 Karnataka India
| | - Manjula A Vagarali
- Department Of Microbiology, J.N Medical College Kaher Belagavi, Kaher Belagavi, 590010 Karnataka India
| | - Basavaraj P Belaldavar
- Department Of Otorhinolaryngology And Head And Neck Surgery, J.N Medical College, Kaher Belagavi, 590010 Karnataka India
| | - Aditya Achyut Redkar
- Department Of Otorhinolaryngology And Head And Neck Surgery, J.N Medical College, Kaher Belagavi, 590010 Karnataka India
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Sands M, Aunger R. Process Evaluation of an Acute-Care Nurse-Centred Hand Hygiene Intervention in US Hospitals. EVALUATION REVIEW 2024; 48:663-691. [PMID: 37611926 PMCID: PMC11193912 DOI: 10.1177/0193841x231197253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
This paper describes a process evaluation of a 'wise' intervention that took place in six acute care units in two medical-surgical teaching hospitals in the United States during 2016-2017. 'Wise' interventions are short, inexpensive interventions that depend on triggering specific psychological mechanisms to achieve behaviour change. This study sought to increase the hand hygiene compliance (HHC) rates before entering a patient's room among nurses. The intervention centred on the use of threat to professional identity to prompt improved HHC. Through questionnaires administered to intervention participants and the implementation facilitator, together with independent observation of intervention delivery, we examined whether the steps in the Theory of Change occurred as expected. We found that aspects of the implementation-including mode of delivery, use of incentives, and how nurses were recruited and complied with the intervention-affected reach and likely effectiveness. While components of the intervention's mechanisms of impact-such as the element of surprise-were successful, they ultimately did not translate into performance of the target behaviour. Performance was also not affected by use of an implementation intention as repeated performance of HHC over years of being a nurse has likely already established well-ingrained practices. Context did have an effect; the safety culture of the units, the involvement of the Nurse Managers, the level of accountability for HHC in each unit, and the hospitals themselves all influenced levels of engagement. These conclusions should have implications for those interested in the applicability of 'wise' interventions and those seeking to improve HHC in hospitals.
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Affiliation(s)
- Madeline Sands
- Health Care Provider, Oregon Health and Science University, Portland, OR, USA
| | - Robert Aunger
- Department of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
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Holt RIG, Cockram CS, Ma RCW, Luk AOY. Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment. Diabetologia 2024; 67:1168-1180. [PMID: 38374451 PMCID: PMC11153295 DOI: 10.1007/s00125-024-06102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/04/2023] [Indexed: 02/21/2024]
Abstract
An association between diabetes and infection has been recognised for many years, with infection being an important cause of death and morbidity in people with diabetes. The COVID-19 pandemic has re-kindled an interest in the complex relationship between diabetes and infection. Some infections occur almost exclusively in people with diabetes, often with high mortality rates without early diagnosis and treatment. However, more commonly, diabetes is a complicating factor in many infections. A reciprocal relationship occurs whereby certain infections and their treatments may also increase the risk of diabetes. People with diabetes have a 1.5- to 4-fold increased risk of infection. The risks are the most pronounced for kidney infection, osteomyelitis and foot infection, but are also increased for pneumonia, influenza, tuberculosis, skin infection and general sepsis. Outcomes from infection are worse in people with diabetes, with the most notable example being a twofold higher rate of death from COVID-19. Hyperglycaemia has deleterious effects on the immune response. Vascular insufficiency and neuropathy, together with altered skin, mucosal and gut microbial colonisation, contribute to the increased risk of infection. Vaccination is important in people with diabetes although the efficacy of certain immunisations may be compromised, particularly in the presence of hyperglycaemia. The principles of treatment largely follow those of the general population with certain notable exceptions.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Clive S Cockram
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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Schmaltz SP, Longo BA, Williams SC. Infection Control Measure Performance in Long-Term Care Hospitals and Their Relationship to Joint Commission Accreditation. Jt Comm J Qual Patient Saf 2024; 50:425-434. [PMID: 38492986 DOI: 10.1016/j.jcjq.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND This study evaluated the relationship between Joint Commission accreditation and health care-associated infections (HAIs) in long-term care hospitals (LTCHs). METHODS This observational study used Centers for Medicare & Medicaid Services (CMS) LTCH data for the period 2017 to June 2021. The standardized infection ratio (SIR) of three measures used by the Centers for Disease Control and Prevention's National Healthcare Safety Network were used as dependent variables in a random coefficient Poisson regression model (adjusting for CMS region, owner type, and bed size quartile): catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and central line-associated bloodstream infections (CLABSIs) for the periods 2017 to 2019 and July 1, 2020, to June 30, 2021. Data from January 1 to June 30, 2020, were excluded due to the COVID-19 pandemic. RESULTS The data set included 244 (73.3%) Joint Commission-accredited and 89 (26.7%) non-Joint Commission-accredited LTCHs. Compared to non-Joint Commission-accredited LTCHs, accredited LTCHs had significantly better (lower) SIRs for CLABSI and CAUTI measures, although no differences were observed for CDI SIRs. There were no significant differences in year trends for any of the HAI measures. For each year of the study period, a greater proportion of Joint Commission-accredited LTCHs performed significantly better than the national benchmark for all three measures (p = 0.04 for CAUTI, p = 0.02 for CDI, p = 0.01 for CLABSI). CONCLUSION Although this study was not designed to establish causality, positive associations were observed between Joint Commission accreditation and CLABSI and CAUTI measures, and Joint Commission-accredited LTCHs attained more consistent high performance over the four-year study period for all three measures. Influencing factors may include the focus of Joint Commission standards on infection control and prevention (ICP), including the hierarchical approach to selecting ICP-related standards as inputs into LTCH policy.
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Baba H, Kanamori H, Nakayama A, Sato T, Katsumi M, Chida T, Ikeda S, Seki R, Arai T, Kamei K, Tokuda K. A cluster of Candida parapsilosis displaying fluconazole-trailing in a neonatal intensive care unit successfully contained by multiple infection-control interventions. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e86. [PMID: 38774118 PMCID: PMC11106732 DOI: 10.1017/ash.2024.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 05/24/2024]
Abstract
Objective This study aimed to investigate and contain a cluster of invasive candidiasis cases caused by fluconazole-resistant Candida parapsilosis (FRC) in a neonatal intensive care unit. Methods Active surveillance was initiated. Direct observations of hand-hygiene compliance (HHC) among staff were conducted before and after the implementation of hand-hygiene (HH) education. Thirty-five environmental cultures were obtained. Phylogenetic analysis of FRC was performed using Fourier-transform infrared spectroscopy and microsatellite genotyping. Results A total of 14 patients (mean birth weight = 860 g, gestational age = 25 weeks) infected with FRC were identified using the fully automated analyzer, including 5 with clinical infection (three with catheter-related bloodstream infection, one with cutaneous infection, and one with fatal peritonitis) and 9 with colonization. The HHC rate in nurses before performing a sterile or aseptic procedure significantly improved after the HH education (P < .05). Sinks near the patients were contaminated with FRC. All FRC strains were confirmed to be susceptible to fluconazole using the CLSI method, and the microdilution procedure indicated a trailing effect. Phylogenetic analysis showed that all the fluconazole-trailing isolates from patients were clustered together and had the same genotype. Sinks were successfully decontaminated using accelerated hydrogen peroxide and drainage pipes were replaced. Ultraviolet-C decontamination was applied in the milk preparation room. No new cases were detected after the education and disinfection interventions. Conclusions Sinks are an important reservoir of C. parapsilosis. Active surveillance, environmental hygiene, and constant staff education on maintaining a high level of HHC are necessary to limit the spread of C. parapsilosis.
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Affiliation(s)
- Hiroaki Baba
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Asami Nakayama
- Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takami Sato
- Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Makoto Katsumi
- Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Takae Chida
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shinobu Ikeda
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Rio Seki
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Teppei Arai
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Koichi Tokuda
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Division of Infection Control, Tohoku University Hospital, Sendai, Miyagi, Japan
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Boyce JM, Pittet D. Rinse, gel, and foam - is there any evidence for a difference in their effectiveness in preventing infections? Antimicrob Resist Infect Control 2024; 13:49. [PMID: 38730473 PMCID: PMC11084031 DOI: 10.1186/s13756-024-01405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Following publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs). METHODS Data regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted. RESULTS The amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs. CONCLUSIONS Current evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.
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Affiliation(s)
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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11
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Iversen AM, Hansen MB, Münster M, Kristensen B, Ellermann-Eriksen S. Hand hygiene compliance in nursing home wards: the effect of increased accessibility of alcohol-based hand rub. J Hosp Infect 2024; 147:206-212. [PMID: 38521416 DOI: 10.1016/j.jhin.2024.02.027] [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: 12/21/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission. AIM To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs). METHODS An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period. FINDINGS A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30-32). A significant +18% absolute immediate effect (first five months) (95% CI: 17-19; P < 0.0001) and +13 percentage points (95% CI: 11-14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (P < 0.0001). CONCLUSION Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential.
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Affiliation(s)
- A-M Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Denmark.
| | - M B Hansen
- Konduto ApS, Sani Nudge, Copenhagen, Denmark
| | | | - B Kristensen
- National Centre of Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - S Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Denmark
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Livshiz-Riven I, Hurvitz N, Nativ R, Borer A, Gushansky A, Eilig D, Kopitman A, Ziv-Baran T. Nursing students led simulations to improve healthcare workers' hand hygiene compliance. Contemp Nurse 2024:1-14. [PMID: 38470983 DOI: 10.1080/10376178.2024.2322994] [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: 02/09/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Hand hygiene compliance (HHC) is recognised as a major factor in the prevention of healthcare-associated infections. Healthcare workers (HCWs) compliance is still suboptimal. Simulation as an educational strategy may contribute to improved performance. OBJECTIVE This study aimed to assess the effect of simulation interventions led by nursing students on HCWs' HHC. METHOD A prospective quasi-experimental design with before and after intervention measurements was implemented in an 1150-bed tertiary hospital. Four consecutive periods, measuring before and after HHC, were examined in four hospital divisions. For each division, unique simulation activities were developed and led by nursing students, educators, and hospital leaders. Sixty seven students and 286 healthcare workers, along with two nurse educators, participated in the simulation sessions. HHC of all HCWs in the divisions was assessed by hospital infection control personnel. RESULTS Hospital HHC rose across the four periods in all four divisions during this study. In three out of four periods and divisions, HHC increased significantly more in the simulation intervention groups compared to the overall hospital improvement. CONCLUSION Student-led simulation for HCWs is an additional effective method to improve HHC. Nursing managers should consider joining forces with nursing educators to enable students to become agents of change in healthcare settings and encourage further collaboration.
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Affiliation(s)
- Ilana Livshiz-Riven
- Department of Nursing, Recanati School for Community Health ProfessionsBen-Gurion University of the Negev, Beer-Sheva, Israel
- Quality Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Nancy Hurvitz
- Department of Nursing, Recanati School for Community Health ProfessionsBen-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ronit Nativ
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Abraham Borer
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Alex Gushansky
- Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Dynai Eilig
- Orthopaedic Department, Assuta-Ashdod Medical Center, Ashdod, Israel
| | - Alina Kopitman
- Obstetrics and Gynaecology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv, Israel
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Baddal B, Taner F, Uzun Ozsahin D. Harnessing of Artificial Intelligence for the Diagnosis and Prevention of Hospital-Acquired Infections: A Systematic Review. Diagnostics (Basel) 2024; 14:484. [PMID: 38472956 DOI: 10.3390/diagnostics14050484] [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: 12/16/2023] [Revised: 01/23/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Healthcare-associated infections (HAIs) are the most common adverse events in healthcare and constitute a major global public health concern. Surveillance represents the foundation for the effective prevention and control of HAIs, yet conventional surveillance is costly and labor intensive. Artificial intelligence (AI) and machine learning (ML) have the potential to support the development of HAI surveillance algorithms for the understanding of HAI risk factors, the improvement of patient risk stratification as well as the prediction and timely detection and prevention of infections. AI-supported systems have so far been explored for clinical laboratory testing and imaging diagnosis, antimicrobial resistance profiling, antibiotic discovery and prediction-based clinical decision support tools in terms of HAIs. This review aims to provide a comprehensive summary of the current literature on AI applications in the field of HAIs and discuss the future potentials of this emerging technology in infection practice. Following the PRISMA guidelines, this study examined the articles in databases including PubMed and Scopus until November 2023, which were screened based on the inclusion and exclusion criteria, resulting in 162 included articles. By elucidating the advancements in the field, we aim to highlight the potential applications of AI in the field, report related issues and shortcomings and discuss the future directions.
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Affiliation(s)
- Buket Baddal
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
- DESAM Research Institute, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
| | - Ferdiye Taner
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
- DESAM Research Institute, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
| | - Dilber Uzun Ozsahin
- Department of Medical Diagnostic Imaging, College of Health Science, University of Sharjah, Sharjah 27272, United Arab Emirates
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Operational Research Centre in Healthcare, Near East University, North Cyprus, Mersin 10, 99138 Nicosia, Turkey
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From-Hansen M, Hansen MB, Hansen R, Sinnerup KM, Emme C. Empowering health care workers with personalized data-driven feedback to boost hand hygiene compliance. Am J Infect Control 2024; 52:21-28. [PMID: 37776899 DOI: 10.1016/j.ajic.2023.09.014] [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: 08/29/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Achieving high hand hygiene compliance among health care workers is a challenge, requiring effective interventions. This study investigated the impact of individualized feedback on hand hygiene compliance using an electronic monitoring system. METHODS A quasi-experimental intervention design with pretest-post-test was conducted in an orthopedic surgical ward. Participants served as their own controls. A 3-month baseline was followed by a 3-month intervention period. Hand hygiene events were recorded through sensors on dispensers, name tags, and near patient beds. Health care workers received weekly email feedback reports comparing their compliance with colleagues. RESULTS Nineteen health care workers (17 nurses, 2 doctors) were included. Hand hygiene compliance significantly improved by approximately 15% (P < .0001) across all rooms during the intervention. The most substantial improvement occurred in patient rooms (17%, P < .0001). Compliance in clean and contaminated rooms increased by 10% (P = .0068) and 5% (P = .0232). The average weekly email open rate for feedback reports was 46%. CONCLUSIONS Individualized feedback via email led to significant improvements in hand hygiene compliance among health care workers. The self-directed approach proved effective, and continuous exposure to the intervention showed promising results.
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Affiliation(s)
- Michelle From-Hansen
- The Infection Control Unit, Department of Quality and Education, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Rosa Hansen
- Department of Orthopedic, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Kirstine M Sinnerup
- Department of Orthopedic, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Christina Emme
- Department of Quality and Education, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
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15
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Iversen AM, Hansen MB, Alsner J, Kristensen B, Ellermann-Eriksen S. Effects of light-guided nudges on health care workers' hand hygiene behavior. Am J Infect Control 2023; 51:1370-1376. [PMID: 37209875 DOI: 10.1016/j.ajic.2023.05.006] [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: 02/13/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Hospital-acquired infections are the most frequent adverse events in health care and can be reduced by improving the hand hygiene compliance (HHC) of health care workers (HCWs). We aimed to investigate the effect of nudging with sensor lights on HCWs' HHC. METHODS An 11-month intervention study was conducted in 2 inpatient departments at a university hospital. An automated monitoring system (Sani NudgeTM) measured the HHC. Reminder and feedback nudges with lights were displayed on alcohol-based hand rub dispensers. We compared the baseline HHC with HHC during periods of nudging and used the follow-up data to establish if a sustained effect had been achieved. RESULTS A total of 91 physicians, 135 nurses, and 15 cleaning staff were enrolled in the study. The system registered 274,085 hand hygiene opportunities in patient rooms, staff restrooms, clean rooms, and unclean rooms. Overall, a significant, sustained effect was achieved by nudging with lights in relation to contact with patients and patient-near surroundings for both nurses and physicians. Furthermore, a significant effect was observed on nurses' HHC in restrooms and clean rooms. No significant effect was found for the cleaning staff. CONCLUSIONS Reminder or feedback nudges with light improved and sustained physicians' and nurses' HHC, and constitute a new way of changing HCWs' hand hygiene behavior.
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Affiliation(s)
- Anne-Mette Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
| | - Marco Bo Hansen
- Konduto ApS, Sani Nudge, Department of Medical & Science, Copenhagen, Denmark
| | - Jan Alsner
- Department of Oncology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Brian Kristensen
- National Center of Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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16
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Marano RBM, Merezhko D, Resnick KA, Moran-Gilad J, Oster Y. Evaluation of a novel surface-coating formulation with time-extended antimicrobial activity for healthcare environment disinfection. Antimicrob Resist Infect Control 2023; 12:133. [PMID: 37996872 PMCID: PMC10666328 DOI: 10.1186/s13756-023-01341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/18/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The importance of environmental contamination in the transmission of pathogens among hospitalized patients is universally recognized, and disinfection of surfaces is a widely accepted modality for reducing healthcare-associated infections. Nevertheless, hospital disinfection is still suboptimal. In this study, we evaluated the sustained effects of the novel formulation OxiLast™ which extends the antimicrobial effects of chlorine-based disinfectants. METHODS In an experimental lab phase, PVC surfaces were coated with OxiLast™ and then inoculated with representative Gram-positive and Gram-negative pathogenic bacteria. Cells were recovered at different contact times (5, 15, 30 min) to assess the reduction in bacterial counts compared to uncoated surfaces and also subject to various challenges to assess robustness. A similar methodology was then applied in an unoccupied hospital room to evaluate the sustained effect of OxiLast™ on high-touch surfaces. RESULTS OxiLast™ demonstrated notable activity against the range of bacterial strains tested with ≥ 4 log10 reduction in bacterial counts observed for up to seven days following one surface application, for various strains and contact times. Similar results were observed following challenges such as simulated abrasion of coated surfaces, organic contamination or successive inoculations. The results were confirmed in a simulated patient care environment. CONCLUSIONS The addition of OxiLast™ to common chlorine-based disinfectants has shown a substantial and sustained reduction in bacterial pathogen counts for up to 7 days following one application. The consistent results in the laboratory and hospital are promising and should be tested in a real-life clinical scenario.
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Affiliation(s)
- Roberto Bruno Maria Marano
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Diana Merezhko
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Keren Anat Resnick
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jacob Moran-Gilad
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Yonatan Oster
- Clinical Microbiology Laboratory, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Paiva-Santos F, Santos-Costa P, Bastos C, Graveto J. Nurses' Adherence to the Portuguese Standard to Prevent Catheter-Associated Urinary Tract Infections (CAUTIs): An Observational Study. NURSING REPORTS 2023; 13:1432-1441. [PMID: 37873827 PMCID: PMC10594504 DOI: 10.3390/nursrep13040120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023] Open
Abstract
Urinary tract infections are among the most prevalent types of healthcare-associated infections (HAIs) in hospitals and nursing homes, and they are primarily a result of unnecessary catheter usage and inadequate care. In Portugal, epidemiological data indicate that catheter-associated urinary tract infections (CAUTIs) remain widespread in clinical settings, resulting in increased morbidity and mortality rates among vulnerable populations. This study aimed to assess urinary catheter use in an oncology ward in Portugal and to evaluate nurses' adherence to the government-endorsed standards for preventing CAUTIs. An observational study was conducted over a four-month period with daily assessments of nurses' practices during urinary catheter insertion and maintenance using a government-endorsed auditing tool. Data were collected through on-site observations and nurses' feedback. The findings revealed a urinary catheter utilization rate of 17.99%. However, there was a lack of complete adherence to government-endorsed standards among oncology nurses (0%). These results indicate that current practices lack evidence-based standardization. Therefore, there is a need to develop and implement quality improvement initiatives to enhance patient safety and experiences.
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Affiliation(s)
- Filipe Paiva-Santos
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (P.S.-C.); (J.G.)
- School of Medicine and Biomedical Sciences (ICBAS), University of Porto, 4050-313 Porto, Portugal
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (P.S.-C.); (J.G.)
| | | | - João Graveto
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000-232 Coimbra, Portugal; (P.S.-C.); (J.G.)
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18
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Cui J, Cho S, Kamruzzaman M, Bielskas M, Vullikanti A, Prakash BA. Using spectral characterization to identify healthcare-associated infection (HAI) patients for clinical contact precaution. Sci Rep 2023; 13:16197. [PMID: 37758756 PMCID: PMC10533902 DOI: 10.1038/s41598-023-41852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Healthcare-associated infections (HAIs) are a major problem in hospital infection control. Although HAIs can be suppressed using contact precautions, such precautions are expensive, and we can only apply them to a small fraction of patients (i.e., a limited budget). In this work, we focus on two clinical problems arising from the limited budget: (a) choosing the best patients to be placed under precaution given a limited budget to minimize the spread (the isolation problem), and (b) choosing the best patients to release when limited budget requires some of the patients to be cleared from precaution (the clearance problem). A critical challenge in addressing them is that HAIs have multiple transmission pathways such that locations can also accumulate 'load' and spread the disease. One of the most common practices when placing patients under contact precautions is the regular clearance of pathogen loads. However, standard propagation models like independent cascade (IC)/susceptible-infectious-susceptible (SIS) cannot capture such mechanisms directly. Hence to account for this challenge, using non-linear system theory, we develop a novel spectral characterization of a recently proposed pathogen load based model, 2-MODE-SIS model, on people/location networks to capture spread dynamics of HAIs. We formulate the two clinical problems using this spectral characterization and develop effective and efficient algorithms for them. Our experiments show that our methods outperform several natural structural and clinical approaches on real-world hospital testbeds and pick meaningful solutions.
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Affiliation(s)
- Jiaming Cui
- College of Computing, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
| | - Sungjun Cho
- College of Computing, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Methun Kamruzzaman
- Biocomplexity Institute, University of Virginia, Charlottesville, VA, 22904, USA
| | - Matthew Bielskas
- Biocomplexity Institute, University of Virginia, Charlottesville, VA, 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA, 22904, USA
| | - Anil Vullikanti
- Biocomplexity Institute, University of Virginia, Charlottesville, VA, 22904, USA
- Department of Computer Science, University of Virginia, Charlottesville, VA, 22904, USA
| | - B Aditya Prakash
- College of Computing, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
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Shi C, O'Donoghue M, Yang L, Tsang H, Chen J, Zou J, Qin J, Mak YW, Pittet D, Xie YJ, Lai T, Li C, Cao J. Factors associated with hand washing effectiveness: an institution-based observational study. Antimicrob Resist Infect Control 2023; 12:85. [PMID: 37649107 PMCID: PMC10469426 DOI: 10.1186/s13756-023-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Few studies have investigated how the effectiveness of hand washing in removing hand contaminants is influenced by the performance and duration of each step involved. We conducted an observational study by recruiting participants from a university campus, with the aim to comprehensively evaluate how performance, duration and demographic factors influence hand washing effectiveness. METHODS A total of 744 videos were collected from 664 participants in July-October 2022 and independently evaluated by two infection control experts through labelling videos for correct and incorrect performance of each step. The individual hand washing effectiveness was determined by quantifying the percentage of residual fluorescent gel on the dorsum and palm areas of each participant's hands. A logistic regression analysis was conducted to identify factors that were significantly associated with better hand washing effectiveness. An exposure-response relationship was constructed to identify optimal durations for each step. Approximately 2300 hand images were processed using advanced normalization algorithms and overlaid to visualize the areas with more fluorescence residuals after hand washing. RESULTS Step 3 (rub between fingers) was the most frequently omitted step and step 4 (rub the dorsum of fingers) was the most frequently incorrectly performed step. After adjustment for covariates, sex, performance of step 4 and step 7 (rub wrists), rubbing hands during rinsing, and rinsing time were significantly associated with hand washing effectiveness. The optimal overall hand washing time was 31 s from step 1 to step 7, and 28 s from step 1 to step 6, with each step ideally lasting 4-5 s, except step 3. The palms of both hands had less fluorescence residuals than the dorsums. The areas where residuals most likely appeared were wrists, followed by finger tips, finger webs and thumbs. CONCLUSIONS Performance and duration of some hand washing steps, sex and rinsing time were associated with hand washing effectiveness. The optimal duration might be applied to all seven steps to achieve the best decontamination results. Further studies are needed to refine hand hygiene standards and enhance compliance.
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Affiliation(s)
- Chen Shi
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | | | - Lin Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Hilda Tsang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jing Chen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jing Zou
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jing Qin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yim-Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Timothy Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chen Li
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jiannong Cao
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
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20
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Liu P, Cao F, Yao Q, Xu L, Dai H. Effectiveness of educational and training intervention for improving hand hygiene compliance amongst nurses: a systematic review and meta-analysis of randomised controlled trials. Scott Med J 2023; 68:72-79. [PMID: 37253461 DOI: 10.1177/00369330231178909] [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] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND AIMS Developing and implementing an educational and training programmes for improving hand hygiene compliance of the nursing personnel might help in increasing their knowledge, promoting positive attitude and follow adequate practice measures. MATERIAL AND METHODS Systematic search was done in PubMed, SCOPUS, CENTRAL, EMBASE, ScienceDirect, Clinicaltrials.gov and Google Scholar databases for articles published between 1964 and December 2022. Meta-analysis was carried out using a random-effects model, and the results were reported as pooled risk ratio (RR) with 95% confidence intervals (CIs), pooled standardised mean differences (SMD) or risk ratios (RR). RESULTS Eight studies were included in the analysis. Most studies had higher risk of bias. Nurses receiving educational and training programmes had significantly higher compliance to hand hygiene practices (pooled RR of 1.69 [95% CI: 1.23-2.31; I2 = 99.1%], p = 0.001). The pooled analysis based on studies reporting the compliance to hand hygiene as continuous outcome has reported the pooled SMD as 1.28 with 95% CI: 0.62 to 1.95 and I2 = 74.5%. There were no single-study effects with respect to this outcome, since the sensitivity analysis showed no difference in either direction or strength of effect estimate. CONCLUSION Educational and training programmes are effective in improving the hand hygiene compliance amongst the nursing professionals.
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Affiliation(s)
- Ping Liu
- Department of Medical Cosmetology, Chengdu Second People's Hospital, Chengdu City, Sichuan Province, China
| | - Fang Cao
- Department of Surgical Anaesthesia, Chengdu Second People's Hospital, Chengdu City, Sichuan Province, China
| | - Qian Yao
- Department of Nursing, Chengdu Second People's Hospital, Chengdu City, Sichuan Province, China
| | - Lin Xu
- Department of Surgery, Chengdu Second People's Hospital, Chengdu City, Sichuan Province, China
| | - Hao Dai
- Department of Emergency, Chengdu Second People's Hospital, Chengdu City, Sichuan Province, China
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Serra Neto A, Marques SG, Bomfim MRQ, Monteiro SG, de Souza RC, Nunes RA. Microbiological Analysis of Surgeons' Hands in a Public Hospital in São Luis, Maranhão State, Brazil: A Cross-Sectional Study. Microorganisms 2023; 11:1895. [PMID: 37630455 PMCID: PMC10456775 DOI: 10.3390/microorganisms11081895] [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: 06/11/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
Antisepsis of the hands of medical personnel is one of the most important steps in the process of patient care, since direct contact can cause the cross-transfer of potentially pathogenic microorganisms at surgical sites. This study aimed to analyze the prevalence of microorganisms on the hands of 131 surgeons in a university hospital before the surgical procedure. Swabs were collected from each clinician's hands before and after handwashing. The samples were placed in a transport medium and immediately delivered to a private clinical analysis laboratory from São Luis-Maranhão. The microorganisms were identified by ionization source mass spectrometry and matrix-assisted laser desorption (MALDI-TOF), and antibiotic susceptibility tests (AST) were performed using the Vitek2 and Phoenix-BD automated system. The results showed a high frequency (100%) of microorganisms before handwashing, but after surgical antisepsis, the rate dropped significantly (p < 0.05) to 27.5%. The gram-positive species most detected were Staphylococcus spp. and Micrococcus luteus, representing 83.9%, followed by gram-negative species, Stenotrophomonas maltophilia, Acinetobacter baumanii, Pseudomonas aeruginosa, Pseudomonas gessardi, Pantoea septica, Serratia marcescens, and Burkholderia lata. The effectiveness of hand antisepsis was 72.5%, demonstrating that surgeons' hands are an important source of microorganisms that can cause infections in hospitalized patients in different care settings.
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Affiliation(s)
- Artur Serra Neto
- Departamento de Cirurgia Geral, Hospital Universitário da Universidade Federal do Maranhão (HUUFMA), São Luís 65020-070, Brazil
| | - Sirlei G. Marques
- Departamento de Planejamento de Gestão da Qualidade e Vigilância em Saúde, Hospital Universitário da Universidade Federal do Maranhão (HUUFMA), São Luís 65020-070, Brazil;
| | - Maria Rosa Q. Bomfim
- Departamento de Biologia Molecular, Universidade Ceuma (UNICEUMA), São Luís 65075-120, Brazil;
| | - Silvio G. Monteiro
- Departamento de Biologia, Universidade Federal do Maranhão (UFMA), São Luís 65080-805, Brazil;
| | - Rosangela C. de Souza
- Departamento de Medicina, Universidade Federal do Maranhão (UFMA), São Luís 65080-805, Brazil;
| | - Rodolfo A. Nunes
- Departamento de Cirurgia Geral, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro 20550-900, Brazil;
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Krishnamoorthy Y, M K, Kuberan D, Krishnan M, Tondare D. Compliance with hand hygiene practices and its appropriateness among healthcare workers during COVID-19 pandemic in public health facilities of Tamil Nadu, India. Heliyon 2023; 9:e15410. [PMID: 37089396 PMCID: PMC10104598 DOI: 10.1016/j.heliyon.2023.e15410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
Background Compliance with appropriate hand hygiene practises is the most efficient and cost-effective intervention that can be implemented in the healthcare setting. Given its importance, we tried to capture the compliance with hand hygiene practises and their appropriateness among healthcare workers during the COVID-19 pandemic in public health facilities in Tamil Nadu. Methods This cross-sectional study involved doctors, nurses, and allied healthcare professionals from various departments in 18 public healthcare facilities spanning six districts in Tamil Nadu. A random-intercept model was employed for the multivariable logistic regression analysis to evaluate the factors influencing hand hygiene compliance and its adequacy. The effect size was presented as an adjusted odds ratio (aOR) accompanied by a 95% confidence interval (CI). Results In total, 2733 hand hygiene observations were made. Only during 19.4% (95%CI: 17.9%-20.9%) of these observations, hand washing was done. Only during 37.9% (95%CI: 33.9%-42.1%) of these observations, hand washing was done appropriately by following all the essential steps of hand hygiene. Nurses (aOR = 2.49; 95%CI: 1.90-3.26), healthcare workers in General Surgery (aOR = 2.18; 95%CI: 1.53-3.10) and Obstetrics & Gynaecology departments (aOR = 1.75; 95%CI: 1.26-2.43), working in inpatient departments (aOR = 2.64; 95%CI: 1.38-5.04) had significantly higher compliance to hand hygiene practices. Nurses (aOR = 2.58; 95%CI: 1.33-5.01) and General Medicine department healthcare workers (aOR = 1.98; 95%CI: 1.09-3.61) had significantly higher compliance to appropriate hand hygiene practices. Conclusion Our study shows that only during one-fifth of the observations did healthcare workers do hand washing, and less than 10% did it appropriately by following all the essential steps of hand hygiene.
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Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai, India
| | - Kala M
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai, India
| | - Deivasigamani Kuberan
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai, India
| | - Murali Krishnan
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai, India
| | - Devidas Tondare
- Department of Community Medicine, ESIC Medical College and PGIMSR, K.K. Nagar, Chennai, India
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Ragonese B, Mularoni A, Valeri A, Campanella M, Corso B, Fazzina ML, Barone MA, Arena G, Lombardo R, Luca A. Reducing Carbapenem-Resistant Enterobacteriaceae Using the Targeted Solution Tool: A Quality Improvement Project. J Nurs Care Qual 2023; 38:47-54. [PMID: 36066885 DOI: 10.1097/ncq.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) is a worldwide urgent health problem. Hand hygiene (HH) is an effective intervention to reduce the spread of CRE. LOCAL PROBLEM In 2017, an increase in the rate of health care-associated (HA) CRE colonization was observed in a large multiorgan transplant center in Italy. This study aimed to reduce the HA-CRE colonization rates by improving HH compliance. METHODS A pre-/post-intervention project was conducted from November 2017 through December 2020. INTERVENTIONS The DMAIC (Define, Measure, Analyze, Improve, and Control) framework was used to implement the HH Targeted Solution Tool (TST). RESULTS Hand hygiene compliance increased from 49% to 76.9% after the Improve phase ( P = .0001), and to 81.9% after the second Control phase ( P = .0001). The rate of HA-CRE decreased from 24.9% to 5.6% ( P = .0001). CONCLUSIONS Using the DMAIC framework to implement the TST can result in significant improvements in HH compliance and HA-CRE colonization rates.
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Affiliation(s)
- Barbara Ragonese
- Quality and Accreditation Department (Mss Ragonese, Corso, Fazzina, and Barone), Department of Infectious Diseases (Dr Mularoni), and Department of Diagnostic and Therapeutic Services (Dr Luca), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy; Quality and Accreditation Department, University of Pittsburgh Medical Centre (UPMC), Rome, Italy (Mr Valeri); Infection Control and Infectious Diseases, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy (Ms Campanella); and Corporate Nursing, Technical, and Rehabilitation Services, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy (Messrs Arena and Lombardo)
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Neumark Y, Bar-Lev A, Barashi D, Benenson S. A feasibility study of the use of medical clowns as hand-hygiene promoters in hospitals. PLoS One 2022; 17:e0279361. [PMID: 36548383 PMCID: PMC9778928 DOI: 10.1371/journal.pone.0279361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Healthcare-acquired infections (HAI) pose vast health and economic burdens. Proper hand-hygiene is effective for reducing healthcare-acquired infections (HAI) incidence, yet staff compliance is generally low. This study assessed the feasibility, acceptability and preliminary effect of employing medical clowns to enhance hand-hygiene among physicians and nurses. Staff perception of the intervention and its impact on hand-hygiene was assessed via self-report questionnaires. Nearly 1,500 hand-hygiene compliance observations were conducted in accordance with WHO guidelines before, during and after the intervention. In each of three hospitals in Israel, two departments were selected-one in which medical clowns routinely operate and one clown-naive department. Professional medical clowns acted as hand-hygiene promoters employing humorous tactics to encourage hand-sanitizing based on the WHO "5 Moments" model. The clown appeared in each department seven times during the 2-week intervention phase. Pre-intervention hand-hygiene compliance ranged from just over 50% to 80% across hospitals and departments. Overall, about 70% of nurses (N = 132) and 80% of physicians (N = 49) felt the intervention improved personal and departmental hand-hygiene, with large inter-department variation. Pre- to post-intervention hand-hygiene compliance increased by 4% -25% (3.5-14.8 percentage points) in four departments, three of which had low baseline compliance levels. Results of this feasibility study suggest that employing medical clowns as hand-hygiene promoters as a novel approach toward HAI prevention is feasible and welcome by hospital staff.
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Affiliation(s)
- Yehuda Neumark
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- * E-mail:
| | - Adina Bar-Lev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Shmuel Benenson
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Al-Anazi S, Al-Dhefeery N, Al-Hjaili R, Al-Duwaihees A, Al-Mutairi A, Al-Saeedi R, Al-Dhaen R, Al-Rabiah S, Sharaf-Alddin R. Compliance with hand hygiene practices among nursing staff in secondary healthcare hospitals in Kuwait. BMC Health Serv Res 2022; 22:1325. [PMID: 36348401 PMCID: PMC9640802 DOI: 10.1186/s12913-022-08706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hand hygiene (HH) among healthcare workers, especially nurses, is the main preventive measure to control healthcare associated infections but compliance with hand hygiene (CwHH) remains low in various settings including Kuwait. This study aimed to assess the knowledge of, attitudes towards, and CwHH among nursing staff in secondary care hospitals in Kuwait. Methods A cross-sectional study was conducted on nursing staff in all six secondary care hospitals in Kuwait. Data on knowledge of, attitudes towards, and self-reported CwHH were collected through a self-administered questionnaire that was developed based on WHO’s questionnaire, while the data on actual compliance were objectively collected through direct observation of nurses during routine care by two independent observers using WHO’s observation form. Results Of 829 nurses approached, 765 (92.2%) responded and participated. Of all participants, 524 (68.5%) were able to list “My Five Moments for Hand Hygiene” fully and appropriately. However, several misconceptions (e.g. air circulation in hospital is the main route of infection) about HH were found among the nurses. CwHH was (25.0%) by direct observation while self-reported compliance was (69.5%) each varied significantly (p < 0.001) between different hospitals. Female nurses compared to male nurses and non-Arab compared to Arab nationalities were more likely to report CwHH in multivariable analysis. Several items on knowledge of and attitudes towards HH were also associated with self-reported CwHH. Conclusion Observed CwHH among nursing staff in secondary care hospitals in Kuwait was low, which highlights the need to make more efforts to improve HH practices. Interventions that have been used elsewhere and found to be effective may be tested in Kuwait. Despite the good overall knowledge on HH among nurses, there are several misconceptions that need to be corrected.
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Reske KA, Park D, Bach TH, Stewart HB, Vogt LC, Arter OG, Stoeckel D, Steinkamp HM, Liang SY, Durkin MJ, Kwon JH. Assessment of dental health care personnel protocol deviations and self-contamination during personal protective equipment donning and doffing. J Am Dent Assoc 2022; 153:1070-1077.e1. [PMID: 36175202 PMCID: PMC9511115 DOI: 10.1016/j.adaj.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/24/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022]
Abstract
Background Dental health care personnel (DHCP) may be at increased risk of exposure to severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, as well as other clinically important pathogens. Proper use of personal protective equipment (PPE) reduces occupational exposure to pathogens. The authors performed an assessment of PPE donning and doffing practices among DHCP, using a fluorescent marker as a surrogate for pathogen transmission. Methods Participants donned PPE (that is, disposable gown, gloves, face mask, and eye protection) and the fluorescent marker was applied to their palms and abdomen. DHCP then doffed PPE according to their usual practices. The donning and doffing processes were video recorded, areas of fluorescence were noted, and protocol deviations were assessed. Statistical analyses included frequency, type, and descriptions of protocol deviations and factors associated with fluorescence. Results Seventy DHCP were enrolled. The donning and doffing steps with the highest frequency of protocol deviations were hand hygiene (66% of donning and 78% of doffing observations involved a deviation) and disposable gown use (63% of donning and 60% of doffing observations involved a deviation). Fluorescence was detected on 69% of DHCP after doffing, most frequently on hands. An increasing number of protocol deviations was significantly associated with increased risk of fluorescence. DHCP with a gown doffing deviation, excluding doffing out of order, were more likely to have fluorescence detected. Conclusions DHCP self-contamination was common with both donning and doffing PPE. Practical Implications Proper use of PPE is an important component of occupational health.
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Seid M, Yohanes T, Goshu Y, Jemal K, Siraj M. The effect of compliance to Hand hygiene during COVID-19 on intestinal parasitic infection and intensity of soil transmitted helminthes, among patients attending general hospital, southern Ethiopia: Observational study. PLoS One 2022; 17:e0270378. [PMID: 35767582 PMCID: PMC9242515 DOI: 10.1371/journal.pone.0270378] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/08/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intestinal parasitic infection (IPIs) is one of the major health problems in Sub -Saharan Africa where water, sanitation and hygiene practices are inadequate. Taking into account the national level implementation of intensive hand hygiene against COVID-19 pandemic and general protective effect this study assessed its effect on intestinal parasite. OBJECTIVE This study aim to investigate the effect of compliance to hand hygiene practice on the prevalence of intestinal parasitic infection (IPIs) and intensity of Soil transmitted helminthes (STH) among patients attending tertiary care hospital in southern Ethiopia. METHODS Observational study was conducted from June to September 2021. Data on socio demographic, hand hygiene practice and intestinal parasite (prevalence and intensity of helminthic infection) was collected from randomly selected and consented patients. Compliance to hand hygiene practice was assessed using pre-tested questionnaire. Fresh stool sample from each participant was examined by direct wet mount, concentration and Ziehl-Neelson (ZN) staining technique to detect intestinal parasite. Intensity of STH measurements was done through direct egg-count per gram using Kato Katz methods. Data analysis was done using SPSS version 25. Odds ratio with 95% confidence interval was used to measure association and p-value <0.05 was considered as statistically significant. RESULTS The study population (N = 264) consisted of 139(52.65%) male and 125 (47.34%) female with the mean ages of 36 ±16.12(±SD). The proportion of good compliance to hand hygiene during COVID-19 to was 43.93% (95%CI: 37% to 47) and prevalence of intestinal parasite was 26.14% (95%CI:21.2% to 31.75) comprising 23.48% intestinal protozoa and 6.43% of soil transmitted helminthic infection. Gardia lamblia, Entamoeba histolytica/dispar, Ascaris lumbricoides were the common parasite in the study area with prevalence of 15.53%, 6.44%, and 1.52% respectively. Prevalence of intestinal parasite among participants with good compliance to hand hygiene group and poor compliance to hand hygiene were (14.65% vs. 35.13%)(AOR: 0.48,95%CI:0.13 to 0.68) (p = 0.002) implying that good compliance to hand hygiene can reduce the risk of IPIs by 52%. Moreover significantly lower odds of intestinal protozoa among good compliance to hand hygiene group than the control (OR:0.38; (95%CI: 0.20 to 0.71);P = 0.001. However, no significant difference in the odds of intensity of STH infection in good compliance hand hygiene and poor compliance group. The result of this study also confirmed the association between intestinal parasitic infections and younger /adolescent age, education status, habit of eating raw vegetable and figure nail status. CONCLUSION Good hand hygiene compliance during COVID-19 significantly associated with reduction of intestinal parasitic infection. This finding highlights the secondary protective effect of improved hand hygiene against IPIs and suggest it can used in augmenting the existing parasitic control strategies in the study setting.
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Affiliation(s)
- Mohammed Seid
- Department of Medical Laboratory Science, College of medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Ethiopia
| | - Tsegaye Yohanes
- Department of Medical Laboratory Science, College of medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Ethiopia
| | - Yitagesu Goshu
- Department of Medical Laboratory Science, College of medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Ethiopia
| | - Kiyar Jemal
- Department of Medical Laboratory Science, College of medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Ethiopia
| | - Munira Siraj
- Department of Medical Laboratory Science, College of medicine and Health Sciences, Arba Minch University, Arba Minch, Southern Ethiopia
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Direct hand hygiene observations and feedback increased hand hygiene compliance among nurses and doctors in medical and surgical wards - an eight-year observational study. J Hosp Infect 2022; 127:83-90. [PMID: 35724953 DOI: 10.1016/j.jhin.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The improvement of hand hygiene compliance (HHC) is critical to preventing healthcare-associated infections (HCAIs). The present study explored how direct observation and feedback influences HHC among nurses and doctors in surgical and medical wards, and whether these actions impact HCAI incidence. METHODS In this longitudinal observational study, HHC and the incidence of HCAIs were observed in six medical and seven surgical wards in a tertiary hospital in Finland from May 2013 to Dec 2020. Data of the observations of five hand hygiene (HH) moments were collected from the hospital HH and the HCAI monitoring registries. For statistical analyses a multivariable logistic regression analysis and a Poisson regression model were used. FINDINGS HH monitoring included 24 614 observations among nurses and 6 396 observations among doctors. In medical wards, HHC rates increased 10.8% - from 86.2% to 95.5%, and HCAI incidence decreased from 15.9 to 13.5 per 1000 patient days (p<0.0001). In surgical wards, HHC increased 32.7% - from 67.6% to 89.7%, and HCAI incidence decreased from 13.7 to 12.0 per 1000 patient days (p< 0.0001). The overall HHC increased significantly among nurses (17.8%) and doctors (65.8%). The HHC was better among nurses than doctors (in medical wards; OR 3.36; 95% CI 2.90-3.90, p<0.001 and in surgical wards; OR 9.85; 95% CI 8.97-10.8, p<0.001). CONCLUSION Direct observations and feedback of HH increased significantly HHC among nurses and doctors over an eight-year period. During the same period, the incidence of HCAIs significantly decreased in both medical and surgical wards.
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Poulose V, Punithavathi A, Ali M, Mohamad Assalam F, Phyo KK, Soh A, Tan SH, Li J, Ang WB, Chew A. Improving hand hygiene in a medical ward: a multifaceted approach. BMJ Open Qual 2022; 11:bmjoq-2021-001659. [PMID: 35393292 PMCID: PMC8991053 DOI: 10.1136/bmjoq-2021-001659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hand hygiene is a fundamental action which is simple, inexpensive and an effective tool in reducing hospital-acquired infections, yet compliance remains low in healthcare settings. In 2014, Changi General Hospital embarked on a pilot project to improve hand hygiene compliance in a pilot ward with the intention to eventually spread a multifaceted set of interventions hospital wide. Methods A before and after interventional study of a pilot project. Hand hygiene data collection was through direct observations by auditors using WHO monitoring standards and techniques based on the five-moment model. Setting A medical ward in an acute hospital in Singapore. Results Overall hand hygiene compliance improved from a median of 53% in 2015 to 80% by end of 2017. Hand hygiene compliance of doctors increased from 43% to 60% (p=0.00), nurses from 62% to 89% (p=0.014) and allied health staff from 67% to 83% (p=0.002). Conclusions A multifaceted set of interventions developed by the project team was effective in improving hand hygiene compliance of doctors, nurses and allied health staff.
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Affiliation(s)
- Vijo Poulose
- Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | | | | | | | | | - Amanda Soh
- Rehabilitative Services, Changi General Hospital, Singapore
| | - Shi Hua Tan
- Rehabilitative Services, Changi General Hospital, Singapore
| | - Jie Li
- Infection Prevention and Control, Changi General Hospital, Singapore
| | - Woo Boon Ang
- Office of Improvement Science, Changi General Hospital, Singapore
| | - Alvin Chew
- Office of Improvement Science, Changi General Hospital, Singapore
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Engel FD, Dos Santos Cunha K, Magalhães ALP, Meirelles BHS, de Mello ALSF. Management Actions for Prevention and Control of Healthcare-associated Infections: A Grounded Theory approach. J Nurs Manag 2022; 30:1355-1365. [PMID: 35318756 DOI: 10.1111/jonm.13605] [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: 08/24/2021] [Revised: 01/17/2022] [Accepted: 03/17/2022] [Indexed: 11/30/2022]
Abstract
AIM To understand the management actions for prevention and control of healthcare-associated infections performed by health professionals. BACKGROUND Prevention of nosocomial infections has evidence-based practice at its essence, but not all institutions are successful in implementing prevention methodology. METHODS Qualitative research with Grounded Theory methodological framework. The research was carried out in two southern Brazilian hospitals. Data collected was employed through open interviews with twenty-one health professionals and managers. This process occurred concurrently with the data analysis, through constant comparative analysis. RESULTS The understanding of the co-responsibility of managerial actions emerged as a central phenomenon of the theoretical model. Management actions for the prevention and control of healthcare-associated infections are a collective phenomenon, in which co-responsibility sustains the effectiveness of the offered assistance. The behaviors of health teams in the face of structural and human weaknesses influence the construction of a supportive relationship in the effectiveness of patient safety actions. CONCLUSIONS The sharing of responsibilities between professionals, and the actions of prevention and control of healthcare-associated infections arising from this conduct, positively influence the promotion of safer and improved quality care. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers should consider applying the tools to prevent and control HAIs and generate in-depth discussion to promote institution's cultural changes.
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Affiliation(s)
- Franciely Daiana Engel
- Post-graduate Program in Nursing, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Kamylla Dos Santos Cunha
- Post-graduate Program in Nursing, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Aline Lima Pestana Magalhães
- Post-graduate Program in Nursing, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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