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Wang C, Jiang W, Yang K, Sarsenbayeva Z, Tag B, Dingler T, Goncalves J, Kostakos V. Use of thermal imaging to measure the quality of hand hygiene. J Hosp Infect 2023; 139:113-120. [PMID: 37301230 DOI: 10.1016/j.jhin.2023.05.016] [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: 02/08/2023] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Hand hygiene has long been promoted as the most effective way to prevent the transmission of infection. However, due to low compliance and low quality of hand hygiene reported in previous studies, constant monitoring of hand hygiene compliance and quality among healthcare workers is crucial. This study investigated the feasibility of using a thermal camera with an RGB camera to detect hand coverage of alcohol-based formulation, thereby monitoring the quality of hand rubbing. METHODS In total, 32 participants were recruited to participate in this study. Participants were required to perform four types of hand rubbing to achieve different coverage of the alcohol-based formulation. After each task, participants' hands were photographed under a thermal camera and an RGB camera, while an ultraviolet (UV) test was used to provide the ground truth of hand coverage of alcohol-based formulation. U-Net was used to segment areas exposed to alcohol-based formulation from thermal images, and system performance was evaluated by comparing differences in coverage between thermal images and UV images in terms of accuracy and Dice coefficient. RESULTS This system found promising results in terms of accuracy (93.5%) and Dice coefficient (87.1%) when observations took place 10 s after hand rubbing. At 60 s after hand rubbing, accuracy and Dice coefficient were 92.4% and 85.7%. CONCLUSIONS Thermal imaging has potential for accurate, constant and systematic monitoring of the quality of hand hygiene.
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Affiliation(s)
- C Wang
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
| | - W Jiang
- Department of Computer Science and Technology, Anhui Normal University, Wuhu, China
| | - K Yang
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - Z Sarsenbayeva
- School of Computer Science, University of Sydney, Sydney, Australia
| | - B Tag
- Faculty of Information Technology, Monash University, Melbourne, Australia
| | - T Dingler
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - J Goncalves
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - V Kostakos
- School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
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2
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Clark KC, Bailey MJ, Wasshuber S, Huntley R, Bjorkman KK, Bauer LC, Paige CL, Sawyer SL, Czarnik M, Riggs MA, Gutilla MJ, Alderete TL. High rates of observed face mask use at Colorado universities align with students' opinions about masking and support the safety and viability of in-person higher education during the COVID-19 pandemic. BMC Public Health 2023; 23:299. [PMID: 36759815 PMCID: PMC9910780 DOI: 10.1186/s12889-023-15211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Over the course of the COVID-19 pandemic, colleges and universities have focused on creating policies, such as mask mandates, to minimize COVID-19 transmission both on their campuses and in the surrounding community. Adherence to and opinions about these policies remain largely unknown. METHODS The Centers for Disease Control and Prevention (CDC) developed a cross-sectional study, the Mask Adherence and Surveillance at Colleges and Universities Project (MASCUP!), to objectively and inconspicuously measure rates of mask use at institutes of higher education via direct observation. From February 15 through April 11, 2021 the University of Colorado Boulder (CU, n = 2,808 observations) and Colorado State University Fort Collins (CSU, n = 3,225 observations) participated in MASCUP! along with 52 other institutes of higher education (n = 100,353 observations) spanning 21 states and the District of Columbia. Mask use was mandatory at both Colorado universities and student surveys were administered to assess student beliefs and attitudes. RESULTS We found that 91.7%, 93.4%, and 90.8% of persons observed at indoor locations on campus wore a mask correctly at University of Colorado, Colorado State University, and across the 52 other schools, respectively. Student responses to questions about masking were in line with these observed rates of mask use where 92.9% of respondents at CU and 89.8% at CSU believe that wearing masks can protect the health of others. Both Colorado universities saw their largest surges in COVID-19 cases in the fall of 2020, with markedly lower case counts during the mask observation window in the spring of 2021. CONCLUSION High levels of mask use at Colorado's two largest campuses aligned with rates observed at other institutes across the country. These high rates of use, coupled with positive student attitudes about mask use, demonstrate that masks were widely accepted and may have contributed to reduced COVID-19 case counts. This study supports an emerging body of literature substantiating masks as an effective, low-cost measure to reduce disease transmission and establishes masking (with proper education and promotion) as a viable tactic to reduce respiratory disease transmission on college campuses.
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Affiliation(s)
- Kevin C Clark
- Department of Integrative Physiology, University of Colorado, Boulder, CO, United States of America
| | - Maximilian J Bailey
- Department of Integrative Physiology, University of Colorado, Boulder, CO, United States of America
| | - Stefan Wasshuber
- Department of Integrative Physiology, University of Colorado, Boulder, CO, United States of America
| | - Raissa Huntley
- Colorado School of Public Health, Colorado State University, Fort Collins, CO, United States of America
| | - Kristen K Bjorkman
- BioFrontiers Institute, University of Colorado, Boulder, CO, United States of America
| | - Leisha Conners Bauer
- Health and Wellness Services, University of Colorado, Boulder, CO, United States of America
| | - Camille L Paige
- BioFrontiers Institute, University of Colorado, Boulder, CO, United States of America
| | - Sara L Sawyer
- BioFrontiers Institute, University of Colorado, Boulder, CO, United States of America
| | - Michaila Czarnik
- CDC COVID-19 Emergency Response Team, Atlanta, GA, United States of America
| | - Margaret A Riggs
- CDC COVID-19 Emergency Response Team, Atlanta, GA, United States of America
| | - Margaret J Gutilla
- Colorado School of Public Health, Colorado State University, Fort Collins, CO, United States of America
| | - Tanya L Alderete
- Department of Integrative Physiology, University of Colorado, Boulder, CO, United States of America.
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Vicentini C, Libero G, Bordino V, Zotti CM. Hand Hygiene Practices during the COVID-19 Pandemic in Northern Italy: Assessment of Compliance Rates Measured by Direct Observation and Alcohol-Based Handrub Usage. Antibiotics (Basel) 2022; 11:1510. [PMID: 36358165 PMCID: PMC9686945 DOI: 10.3390/antibiotics11111510] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 07/12/2024] Open
Abstract
Hand hygiene (HH) is among the most effective measures for reducing the transmission of healthcare-associated infections and SARS-CoV-2. We aimed to assess HH practices among healthcare workers (HCWs) of three hub hospitals in Northern Italy during the COVID-19 pandemic, by assessing HH compliance measured by direct observation and alcohol-based handrub usage. An observational study was conducted over a period of three months, between February and April 2021. HH compliance audits were conducted using the WHO My 5 Moments for HH approach. Multivariable logistic regression was used to evaluate independent predictors of HH compliance: ward type, HCW category and HH indication. Spearman correlation was used to investigate the relationship between HH compliance and alcohol-based handrub consumption. In total, 2880 HH opportunities were observed, with an overall compliance of 68%. Significant differences were found in compliance rates across ward types, HCW categories and HH indications. The mean alcohol-based handrub usage among included wards was 41.63 mL/PD. No correlation was identified between compliance rates and alcohol-based handrub consumption (ρ 0.023, p 0.943). This study provided a snapshot of HH practices in a pandemic context, which could be useful as a reference for future studies.
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Affiliation(s)
| | - Giulia Libero
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy
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Tseng C, He X, Chen W, Tseng CL. Evaluating automatic hand hygiene monitoring systems: A scoping review. PUBLIC HEALTH IN PRACTICE 2022; 4:100290. [PMID: 36588768 PMCID: PMC9801014 DOI: 10.1016/j.puhip.2022.100290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/11/2022] [Accepted: 06/23/2022] [Indexed: 01/04/2023] Open
Abstract
Objectives To categorize the extant automatic hand hygiene monitoring systems (AHHMSs) and evaluate the capacity of each to provide information on compliance rates. Study design Scoping review. Methods Three international databases, PubMed, CINAHL, and EBSCO (between 1 January 2010 and 31 December 2020), were searched according to predetermined inclusion criteria for the scoping review. Two authors screened studies for eligibility independently. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Results Twenty-seven studies were included. Three types of AHHMSs were identified: Type I provides information about the aggregate hand hygiene events (HHEs) only, while Type II adds aggregate hand hygiene opportunities (HHOs), and Type III presents both HHEs and HHOs for individuals. Results suggested that improving the accuracy of recording HHEs and/or HHOs was critical for improving the accuracy of the compliance, which could increase the acceptability of the monitoring system. In addition, the studies found that the implementation of AHHMSs, especially with prompt reminders or additional interventions, could improve the compliance significantly. Conclusions The extant AHHMSs could be decomposed into components of 3Ps (product usage monitoring, position monitoring, and performance monitoring). By identifying devices and technology as well as the type of information provided for each component, our approach can aid healthcare facilities to choose a suitable AHHMS that meets their criteria.
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Affiliation(s)
- Cynthia Tseng
- Johns Hopkins University Applied Physics Laboratory, Maryland, USA
| | - Xueying He
- University of Electronic Science and Technology of China, Shenzhen, China
| | - Wenlin Chen
- University of Electronic Science and Technology of China, Chengdu, China,Corresponding author. No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731, Chengdu, Sichuan, China.
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Ortiz MB, Karapetrovic S. Developing Internet of Things-related ISO 10001 Hand Hygiene Privacy Codes in healthcare. TQM JOURNAL 2022. [DOI: 10.1108/tqm-03-2022-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeAugmentation of an ISO 10001 code system for healthcare worker (HW) satisfaction with ISO/IEC 27701 and ISO/IEC 29184 privacy-related subsystems is shown. Four specific codes regarding the privacy of HWs using electronic devices for hand hygiene (HH) monitoring and the related activities are presented.Design/methodology/approachHWs’ concerns involving automated hand hygiene monitoring technologies were identified through a literature review and classified. Privacy codes (PCs) that deal with such concerns were developed. ISO/IEC 27701 requirements for privacy information were mapped to the elements of these codes, labelled as “Healthcare Workers’ Hand Hygiene Privacy Codes (HW-HH-PCs)”. Both ISO/IEC 27701 and ISO/IEC 29184 guidelines for Privacy Notices and consent were linked with the activities for preparing the code resources.FindingsComponents of an ISO/IEC 27701 system, the guidance of ISO/IEC 29184 and the definitions provided in ISO/IEC 29100 can assist the preparation of HW-HH-PCs and the required resources. An ISO/IEC 29184 Privacy Notice can be used as input for developing an Informed Consent Form, which can be implemented to suit two of the four developed HW-HH-PCs.Practical implicationsHW-HH-PCs and the supporting resources, which healthcare organizations could implement to potentially increase quality assurance of an automated HH monitoring service, are illustrated.Originality/valueIntegrative augmentation of ISO 10001:2018, ISO/IEC 27701:2019 and ISO/IEC 29184:2020 within an underlying framework from ISO/IEC 20000–1:2018 for information technology service, together with the related examples of privacy-related customer satisfaction codes and the corresponding resources, is introduced.
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Wang C, Jiang W, Yang K, Yu D, Newn J, Sarsenbayeva Z, Goncalves J, Kostakos V. Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology. J Med Internet Res 2021; 23:e27880. [PMID: 34821565 PMCID: PMC8663600 DOI: 10.2196/27880] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/04/2021] [Accepted: 10/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hand hygiene is one of the most effective ways of preventing health care-associated infections and reducing their transmission. Owing to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into the daily routines of health care workers to measure their hand hygiene compliance and quality. OBJECTIVE This review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss the capabilities and limitations of these systems. METHODS A systematic search of PubMed, ACM Digital Library, and IEEE Xplore Digital Library was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were initially screened and assessed independently by the 2 authors, and disagreements between them were further summarized and resolved by discussion with the senior author. RESULTS In total, 1035 publications were retrieved by the search queries; of the 1035 papers, 89 (8.60%) fulfilled the eligibility criteria and were retained for review. In summary, 73 studies used electronic monitoring systems to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7%), camera-assisted observation (10/73, 14%), sensor-assisted observation (29/73, 40%), and real-time locating system (32/73, 44%). A total of 21 studies evaluated hand hygiene quality, consisting of compliance with the World Health Organization 6-step hand hygiene techniques (14/21, 67%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33%). CONCLUSIONS Electronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, associated costs, and infrastructure improvements. Moreover, this review found that standardized measurement tools to evaluate system performance are lacking; thus, future research is needed to establish standardized metrics to measure system performance differences among electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation to improve system performance and address other hand hygiene-related issues.
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Affiliation(s)
- Chaofan Wang
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Weiwei Jiang
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Kangning Yang
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Difeng Yu
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Joshua Newn
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Zhanna Sarsenbayeva
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Jorge Goncalves
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Vassilis Kostakos
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
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Mills JP, Marchaim D. Multidrug-Resistant Gram-Negative Bacteria: Infection Prevention and Control Update. Infect Dis Clin North Am 2021; 35:969-994. [PMID: 34752228 DOI: 10.1016/j.idc.2021.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Multidrug-resistant gram-negative bacteria (MDR-GNB) pose one of the greatest challenges to health care today because of their propensity for human-to-human transmission and lack of therapeutic options. Containing the spread of MDR-GNB is challenging, and the application of multifaceted infection control bundles during an evolving outbreak makes it difficult to measure the relative impact of each measure. This article will review the utility of various infection control measures in containing the spread of various MDR-GNB and will provide the supporting evidence for these interventions.
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Affiliation(s)
- John P Mills
- Division of Infectious Diseases, University of Michigan Medical School, F4177 University Hospital South, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5226, USA.
| | - Dror Marchaim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
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Methodological and technical considerations for video-based auditing of hand hygiene compliance in clinical practice: an exploratory study. Am J Infect Control 2021; 49:1384-1391. [PMID: 33940065 DOI: 10.1016/j.ajic.2021.04.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Direct observation is the gold standard method for measuring hand hygiene compliance but its utility is increasingly being questioned. Various alternative electronic methods have been proposed, yet there is a paucity of research examining the use of these according to the World Health Organization's (WHO) '5 Moments for Hand Hygiene'. As a part of the process of developing a video-based monitoring system (VMS) capable of measuring hand hygiene compliance against the 5 moments criteria this paper reports methodological and technical issues that might arise from the use of a VMS for auditing in clinical practice. METHODS In-depth semi-structured interviews were conducted with 27 Australian content experts in hand hygiene auditing and infection prevention to explore their responses to proposed VMS auditing approaches. Transcripts were analyzed using thematic and content analysis. RESULTS Technical and methodological considerations for the use of VMS were interrelated and included concerns surrounding privacy, footage security, fears of surveillance and the potential for medico-legal consequences. Additionally, possible detrimental impacts on healthcare worker (HCW) -patient relationships, issues of cost versus benefits, HCW and patient safety and changes to feedback were also identified. CONCLUSIONS The primary methodological and technical issues to overcome in order to implement VMS for hand hygiene auditing in clinical practice, centered upon issues of acceptability to patients and health professionals, privacy, consent and liability. CHECKLIST COREQ.
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M. J, Rubeshkumar P, Raju M, Sakthivel M, Murali S, Nagarajan R, Sendhilkumar M, Sambath I, Ilangovan K, Harikrishnan D, Venkatasamy V, Ganeshkumar P, Reddy M, Kaur P. Surveillance for face mask compliance, Chennai, Tamil Nadu, India, October-December, 2020. PLoS One 2021; 16:e0257739. [PMID: 34559845 PMCID: PMC8462676 DOI: 10.1371/journal.pone.0257739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Government of Tamil Nadu, India, mandated the face mask wearing in public places as one of the mitigation measures of COVID-19. We established a surveillance system for monitoring the face mask usage. This study aimed to estimate the proportion of the population who wear face masks appropriately (covering nose, mouth, and chin) in the slums and non-slums of Chennai at different time points. METHODS We conducted cross-sectional surveys among the residents of Chennai at two-time points of October and December 2020. The sample size for outdoor mask compliance for the first and second rounds of the survey was 1800 and 1600, respectively, for each of the two subgroups-slums and non-slums. In the second round, we included 640 individuals each in the slums and non-slums indoor public places and 1650 individuals in eleven shopping malls. We calculated the proportions and 95% confidence interval (95%CI) for the mask compliance outdoors and indoors by age, gender, region, and setting (slum and non-slum). RESULTS We observed 3600 and 3200 individuals in the first and second surveys, respectively, for outdoor mask compliance. In both rounds, the prevalence of appropriate mask use outdoors was significantly lower in the slums (28%-29%) than non-slum areas (36%-35%) of Chennai (p<0.01). Outdoor mask compliance was similar within slum and non-slum subgroups across the two surveys. Lack of mask use was higher in the non-slums in the second round (50%) than in the first round of the survey (43%) (p<0.05). In the indoor settings in the 2nd survey, 10%-11% among 1280 individuals wore masks appropriately. Of the 1650 observed in the malls, 947 (57%) wore masks appropriately. CONCLUSION Nearly one-third of residents of Chennai, India, correctly wore masks in public places. We recommend periodic surveys, enforcement of mask compliance in public places, and mass media campaigns to promote appropriate mask use.
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Affiliation(s)
- Jagadeesan M.
- Public Health Department, Greater Chennai Corporation, Chennai, Tamil Nadu, India
| | - Polani Rubeshkumar
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Mohankumar Raju
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Manikandanesan Sakthivel
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Sharan Murali
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Ramya Nagarajan
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Muthappan Sendhilkumar
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Irene Sambath
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Kumaravel Ilangovan
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Dineshkumar Harikrishnan
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Vettrichelvan Venkatasamy
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Parasuraman Ganeshkumar
- Division of Epidemiology, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Madhusudhan Reddy
- Public Health Department, Greater Chennai Corporation, Chennai, Tamil Nadu, India
| | - Prabhdeep Kaur
- Division of Noncommunicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Chong CY, Catahan MA, Lim SH, Jais T, Kaur G, Yin S, de Korne D, Thoon KC, Ng KC. Patient, staff empowerment and hand hygiene bundle improved and sustained hand hygiene in hospital wards. J Paediatr Child Health 2021; 57:1460-1466. [PMID: 33908109 DOI: 10.1111/jpc.15526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022]
Abstract
AIM We piloted a hand hygiene (HH) project in a ward, focusing on World Health Organization moments 1 and 4. Our aim was to design highly reliable interventions to achieve >90% compliance. METHODS Baseline HH compliance was 57 and 67% for moments 1, 4, respectively, in 2015. After the pilot ward showed sustained improvement, we launched the 'HH bundle' throughout the hospital. This included: (i) appointment of HH champions; (ii) verbal/visual bedside reminders; (iii) patient empowerment; (iv) hand moisturisers; (v) tagging near-empty handrub (HR) bottles. Other hospital-wide initiatives included: (vi) Smartphone application for auditing; (vii) 'Speak up for Patient Safety' Campaign in 2017 for staff empowerment; (viii) making HH a key performance indicator. RESULTS Overall HH compliance increased from a baseline median of 79.6-92.6% in end-2019. Moments 1 and 4 improved from 71 to 92.7% and from 77.6 to 93.2%, respectively. Combined HR and hand wash consumption increased from a baseline median of 82.6 ml/patient day (PD) to 109.2 mL/PD. Health-care-associated rotavirus infections decreased from a baseline median of 4.5 per 10 000 PDs to 1.5 per 10 000 PDs over time. CONCLUSIONS The 'HH Bundle' of appointing HH champions, active reminders and feedback, patient education and empowerment, availability of hand moisturisers, tagging near-empty hand rub bottles together with hospital-wide initiatives including financial incentives and the 'Speak Up for Patient Safety' campaign successfully improved the overall HH compliance to >90%. These interventions were highly reliable, sustained over 4 years and also reduced health-care-associated rotavirus infection rates.
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Affiliation(s)
- Chia Yin Chong
- Infectious Diseases, Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Siok Hong Lim
- Infection Control, Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Thuraiya Jais
- Ward 55, Urgent Obstetric and Gynecology Centre, Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Gian Kaur
- Specialty and Ambulatory Services, KK Women's and Children's Hospital, Singapore
| | - Shanqing Yin
- Chairman Medical Board Office, KK Women's and Children's Hospital, Singapore
| | - Dirk de Korne
- Medical Innovation & Care Transformation, KK Women's & Children's Hospital, Singapore.,Department of Care and Welfare, SVRZ Cares in Zeeland, Middelburg, Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Koh Cheng Thoon
- Infectious Diseases, Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kee Chong Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Chairman Medical Board Office, KK Women's and Children's Hospital, Singapore
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Barrios LC, Riggs MA, Green RF, Czarnik M, Nett RJ, Staples JE, Welton MD, Muilenburg JL, Zullig KJ, Gibson-Young L, Perkins AV, Prins C, Lauzardo M, Shapiro J, Asimellis G, Kilgore-Bowling G, Ortiz-Jurado K, Gutilla MJ. Observed Face Mask Use at Six Universities - United States, September-November 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:208-211. [PMID: 33571175 PMCID: PMC7877579 DOI: 10.15585/mmwr.mm7006e1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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12
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Impact of environmental cleaning on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii in patients within the intensive care unit in a tertiary hospital. Antimicrob Resist Infect Control 2021; 10:4. [PMID: 33407899 PMCID: PMC7789151 DOI: 10.1186/s13756-020-00870-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To continuously evaluate the effect of environmental cleaning and hand hygiene compliance on the colonization and infection rates of multidrug-resistant Acinetobacter baumannii (MDR-AB) in the patients within an intensive care unit (ICU).
Methods Environmental cleaning on the high-touch clinical surfaces (HTCS) within a comprehensive ICU was evaluated through monitoring fluorescent marks when the overall compliance with hand hygiene during 2013–2014 was monitored. Meanwhile, samples from the HTCS and inpatients were collected and sent for bacterial culture and identification. The drug susceptibility testing was further implemented to monitor the prevalence of MDR-AB. The genetic relatedness of MDR-AB collected either from the HTCS or inpatients was analyzed by pulsed field gel electrophoresis (PFGE) when an outbreak was doubted. Results The overall compliance with hand hygiene remained relatively stable during 2013–2014. Under this circumstance, the clearance rate of fluorescence marks on the environmental surfaces within ICUs significantly increased from 21.9 to 85.7%, and accordingly the colonization and infection rates of MDR-AB decreased from 16.5 to 6.6‰ and from 7.4 to 2.8‰, respectively, from the beginning to the end of 2013. However, during 2014, because of frequent change and movement of environmental services staff, the clearance rate of fluorescence marks decreased below 50.0%, and the overall colonization and infection rates of MDR-AB correspondingly increased from 9.1 to 11.1‰ and from 1.5 to 3.9‰, respectively. PFGE displayed a high genetic relatedness between the MDR-AB strains analyzed, indicating a dissemination of MDR-AB during the surveillance period. Conclusion For the easily disseminated MDR-AB within ICUs, the clearance rate of fluorescence labeling on HTCS is negatively correlated with the hospital infection rate of MDR-AB. Such an invisible fluorescence labelling is an effective and convenient method to continuously monitor cleanness of medical environment within hospitals.
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Derksen C, Keller FM, Lippke S. Obstetric Healthcare Workers' Adherence to Hand Hygiene Recommendations during the COVID-19 Pandemic: Observations and Social-Cognitive Determinants. Appl Psychol Health Well Being 2020; 12:1286-1305. [PMID: 33016518 PMCID: PMC7675238 DOI: 10.1111/aphw.12240] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023]
Abstract
Background Hand hygiene is crucial to avoid healthcare‐associated infections and the transmission of COVID‐19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social‐cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers’ adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID‐19 pandemic. Methods In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods (pre‐COVID‐19 pandemic, heightened awareness, and strict precautions). In addition, 115 healthcare workers answered questionnaires regarding social‐cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations. Results Adherence to hand hygiene recommendations increased from 47 per cent pre‐COVID‐19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self‐efficacy was associated with the intention to sanitise hands (β = .397, p < .001). Coping self‐efficacy mediated the association of intention with hand hygiene adherence. Conclusions Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID‐19 pandemic. To further improve interventions, social‐cognitive determinants should be considered, especially intention and (coping) self‐efficacy.
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Chaudhury A, Korompili G, Mitra M, Chronis N. A 3D-printed, touch-activated, sanitizer dispensing device for reducing healthcare-acquired infections. JOURNAL OF 3D PRINTING IN MEDICINE 2020; 4:91-104. [DOI: 10.2217/3dp-2020-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
Aim: We present a touch-activated, sanitizer dispensing (TSD) device, intended to be mounted on high-touch surfaces, that aims to reduce nosocomial infections. It disinfects the person’s hand touching its surface while being self-sterilizing. Materials & methods: The TSD device consists of an array of 3D-printed, passive, miniaturized, mechanical valves that dispense a small amount of liquid sanitizer when touched. Its mechanical performance and disinfecting efficiency were quantified using simulations and experimental tests. Results & conclusion: The TSD device has a disinfecting efficiency comparable to the standard hand sanitizing approach, reducing the microbiological load by approximately 30-times. It can be easily mounted on high-touch surfaces in a healthcare setting and it is expected to greatly reduce the spread of nosocomial infections.
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Affiliation(s)
- Amrita Ray Chaudhury
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Georgia Korompili
- Institute of Nanotechnology & Nanoscience, National Centre for Scientific Research Demokritos, Patriarchou Gregoriou & Neapoleos, Aghia Paraskevi, 15341 Athens, Greece
| | - Mainak Mitra
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nikolaos Chronis
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Institute of Nanotechnology & Nanoscience, National Centre for Scientific Research Demokritos, Patriarchou Gregoriou & Neapoleos, Aghia Paraskevi, 15341 Athens, Greece
- Department of Materials Science and Technology, University of Crete, Vassilika Voutes GR-70013 Heraklion, Greece
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Mckay KJ, Shaban RZ, Ferguson P. Hand hygiene compliance monitoring: Do video-based technologies offer opportunities for the future? Infect Dis Health 2020; 25:92-100. [PMID: 31932242 DOI: 10.1016/j.idh.2019.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022]
Abstract
Hand hygiene is universally recognised as the primary measure to reduce healthcare-associated infections. Studies have convincingly demonstrated a link between increased hand hygiene compliance and reductions in rates of healthcare-associated infections. Direct observation is considered the gold standard method for monitoring hand hygiene compliance. Despite the acknowledged benefits of this approach, recent literature has highlighted a range of issues impacting on the reliability and validity of this data collection technique. The rise of technology in healthcare provides opportunity for alternative methods that promise advantages over direct human observation. There have been no published examples of systems that are able to capture data consistent with all the WHO '5 Moments for Hand Hygiene'. In this paper we explore current human-based auditing practises for monitoring hand hygiene compliance and raise for discussion and debate video-based technologies to monitor hand hygiene compliance. We raise questions regarding hybrid approaches that incorporate both direct human observation and indirect video-based surveillance, and the possible advantages and disadvantages therein for monitoring hand hygiene compliance. We suggest that such methods have the potential to ameliorate, or minimise, the inherent biases associated with direct observation, notably the Hawthorne Effect. Future research into the utility of a hybrid approach to auditing, including the technical specifications, efficacy, cost effectiveness and acceptability of such a model is warranted.
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Affiliation(s)
- Katherine J Mckay
- Infection Prevention and Control, Eastern Health, Box Hill, Victoria, Australia; Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia.
| | - Patricia Ferguson
- School of Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia.
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Tartari E, Fankhauser C, Masson-Roy S, Márquez-Villarreal H, Fernández Moreno I, Rodriguez Navas ML, Sarabia O, Bellissimo-Rodrigues F, Hernández-de Mezerville M, Lee YF, Aelami MH, Mehtar S, Agostinho A, Camilleri L, Allegranzi B, Pires D, Pittet D. Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control. Antimicrob Resist Infect Control 2019; 8:206. [PMID: 32005230 PMCID: PMC6937710 DOI: 10.1186/s13756-019-0666-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
Background Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a “Train-the-Trainers” (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries. Methods We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training. Results Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively. Conclusions The TTT in hand hygiene model proved to be effective in enhancing participant’s knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.
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Affiliation(s)
- Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Carolina Fankhauser
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Sarah Masson-Roy
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Hotel-Dieu de Lévis, Lévis, Canada
| | | | | | | | - Odet Sarabia
- Universidad Anáhuac, Naucalpan de Juárez, Mexico
| | | | | | - Yew Fong Lee
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Ministry of Health, Putrajaya, Malaysia
| | - Mohammad Hassan Aelami
- Department of Pediatrics and Hand Hygiene and Infection Control Research Center, Imam Reza Hospital ,Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shaheen Mehtar
- Infection Control Africa Network, Unit of IPC, Tygerberg Hospital, Cape Town, South Africa
| | - Américo Agostinho
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | - Daniela Pires
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.,Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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Hand hygiene compliance surveillance with time series anomaly detection. Am J Infect Control 2019; 47:1449-1452. [PMID: 31326263 DOI: 10.1016/j.ajic.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hand hygiene is the most important intervention to reduce the risk of transmission of pathogens in health care. Assurance of effective hand hygiene improvement campaigns includes adequate data analytics for reporting compliance. Traditional analytical approaches for monitoring hand hygiene compliance suffer from several limitations, including autocorrelation. The objective of this study was to use a novel time series anomaly detection algorithm to analyze routine hand hygiene compliance data. METHODS Hand hygiene compliance data were collected daily by trained observers in a large academic medical center. Statistical process control p-charts were used as a comparison method of analysis per facility protocol. Time series anomaly detection was carried out using the seasonal and trend decomposition using LOESS (STL) algorithm. RESULTS A total of 34 months of hand hygiene compliance data were analyzed. Traditional statistical process control p-charts identified over 76% of rates as special-cause variation, whereas STL identified 18% of rates as anomalous. CONCLUSIONS This study supports the use of time series anomaly detection for the routine surveillance of hand hygiene compliance data. This method will facilitate specific and accurate feedback, helping to improve this critical approach for improving patient safety.
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An in-room observation study of hand hygiene and contact precaution compliance for Clostridioides difficile patients. Am J Infect Control 2019; 47:1273-1276. [PMID: 31060870 DOI: 10.1016/j.ajic.2019.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/26/2022]
Abstract
Using an innovative, covert, in-room observer method to evaluate infection control practices for patients with Clostridioides difficile infection, we found no difference between physician and nursing hand hygiene compliance and contact precaution usage. There was also no diurnal variation in hand hygiene practices, but decreased contact precaution usage at night. Conversely, hospital-wide data from overt observations collected over the same time period showed significantly higher hand hygiene compliance among nurses than physicians.
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19
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Baccolini V, D'Egidio V, de Soccio P, Migliara G, Massimi A, Alessandri F, Tellan G, Marzuillo C, De Vito C, Ranieri MV, Villari P. Effectiveness over time of a multimodal intervention to improve compliance with standard hygiene precautions in an intensive care unit of a large teaching hospital. Antimicrob Resist Infect Control 2019; 8:92. [PMID: 31164981 PMCID: PMC6544958 DOI: 10.1186/s13756-019-0544-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Standard hygiene precautions are an effective way of controlling healthcare-associated infections. Nevertheless, compliance with hand hygiene (HH) guidelines among healthcare workers (HCWs) is often poor, and evidence regarding appropriate use of gloves and gowns is limited and not encouraging. In this study, we evaluated the ability over time of a multimodal intervention to improve HCWs compliance with standard hygiene precautions. Methods Trend analysis of direct observations of compliance with HH guidelines and proper glove or gown use was conducted in the medical/surgical intensive care unit (ICU) of Umberto I Teaching Hospital of Sapienza University of Rome. The study consisted of two phases: a six-month baseline phase and a 12-month post-intervention phase. The multimodal intervention was based on the World Health Organization strategy and included education and training of HCWs, together with performance feedback. Results A total of 12,853 observations were collected from November 2016 to April 2018. Overall compliance significantly improved from 41.9% at baseline to 62.1% (p < 0.001) after the intervention and this improvement was sustained over the following trimesters. Despite variability across job categories and over the study period, a similar trend was observed for most investigations. The main determinants of compliance were job category (with nurses having the highest compliance rates), being a member of ICU staff and whether delivering routine, as opposed to emergency, care. HH compliance was modified by glove use; unnecessary gloving negatively affected HH behaviour while appropriate gloving positively influenced it. Conclusions The multimodal intervention resulted in a significant improvement in compliance with standard hygiene precautions. However, regular educational reinforcement and feedback is essential to maintain a high and uniform level of compliance.
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Affiliation(s)
- Valentina Baccolini
- 1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Valeria D'Egidio
- 1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Pasquale de Soccio
- 1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Giuseppe Migliara
- 1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Azzurra Massimi
- 1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Francesco Alessandri
- 2Department of Anesthesiology and Critical Care, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Guglielmo Tellan
- 2Department of Anesthesiology and Critical Care, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- 1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Corrado De Vito
- 1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Marco Vito Ranieri
- 3Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Paolo Villari
- 1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
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Suen LKP, Wong JWS, Lo KYK, Lai TKH. The use of hand scanner to enhance hand hygiene practice among nursing students: A single-blinded feasibility study. NURSE EDUCATION TODAY 2019; 76:137-147. [PMID: 30784842 DOI: 10.1016/j.nedt.2019.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/29/2019] [Indexed: 05/25/2023]
Affiliation(s)
- Lorna K P Suen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; Hospital Authority, Hong Kong, China.
| | - Joy W S Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; Hospital Authority, Hong Kong, China
| | - Kiki Y K Lo
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; Hospital Authority, Hong Kong, China.
| | - Timothy K H Lai
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China; Hospital Authority, Hong Kong, China.
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21
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Jeanes A, Coen PG, Gould DJ, Drey NS. Validity of hand hygiene compliance measurement by observation: A systematic review. Am J Infect Control 2019; 47:313-322. [PMID: 30322815 DOI: 10.1016/j.ajic.2018.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hand hygiene is monitored by direct observation to improve practice, but this approach can potentially cause information, selection, and confounding bias, threatening the validity of findings. The aim of this study was to identify and describe the potential biases in hand hygiene compliance monitoring by direct observation; develop a typology of biases and propose improvements to reduce bias; and increase the validity of compliance measurements. METHODS This systematic review of hospital-based intervention studies used direct observation to monitor health care workers' hand hygiene compliance. RESULTS Seventy-one publications were eligible for review. None was free of bias. Selection bias was present in all studies through lack of data collection on the weekends (n = 61, 86%) and at night (n = 46, 65%) and observations undertaken in single-specialty settings (n = 35, 49%). We observed inconsistency of terminology, definitions of hand hygiene opportunity, criteria, tools, and descriptions of the data collection. Frequency of observation, duration, or both were not described or were unclear in 58 (82%) publications. Observers were trained in 56 (79%) studies. Inter-rater reliability was measured in 26 (37%) studies. CONCLUSIONS Published research of hand hygiene compliance measured by direct observation lacks validity. Hand hygiene should be measured using methods that produce a valid indication of performance and quality. Standardization of methodology would expedite comparison of hand hygiene compliance between clinical settings and organizations.
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Affiliation(s)
- Annette Jeanes
- Infection Control Department, University College London Hospitals, London, United Kingdom.
| | - Pietro G Coen
- Infection Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Nicolas S Drey
- School of Health Sciences, Cardiff, University of London, London, United Kingdom
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22
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El-Saed A, Noushad S, Tannous E, Abdirizak F, Arabi Y, Al Azzam S, Albanyan E, Al Jahdalil H, Al Sudairy R, Balkhy HH. Quantifying the Hawthorne effect using overt and covert observation of hand hygiene at a tertiary care hospital in Saudi Arabia. Am J Infect Control 2018; 46:930-935. [PMID: 30072161 DOI: 10.1016/j.ajic.2018.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/24/2018] [Accepted: 02/24/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Although direct human observation of hand hygiene (HH) is considered the gold standard for measuring HH compliance, its accuracy is challenged by the Hawthorne effect. OBJECTIVES To compare HH compliance using both overt and covert methods of direct observation in different professional categories, hospital settings, and HH indications. METHODS A cross-sectional study was conducted in 28 units at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and July 2013. Compliance was defined as performing handrubbing or handwashing during 1 of the World Health Organization 5 Moments for HH indications (ie, opportunities). Overt observation was done by infection preventionists (IPs) who were doing their routine HH observation. Covert observation was done by unrecognized temporarily hired professionally trained observers. RESULTS A total of 15,883 opportunities were observed using overt observation and 7,040 opportunities were observed using covert observation. Overall HH compliance was 87.1% versus 44.9% using overt/covert observations, respectively (risk ratio, 1.94; P < .001). The significant overestimation was seen across all professional categories, hospital settings, and HH indications. CONCLUSION There is a considerable difference in HH compliance being observed overtly and covertly in all categories. More work is required to improve the methodology of direct observation to minimize the influence of the Hawthorne effect.
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Laskar AM, R D, Bhat P, Pottakkat B, Narayan S, Sastry AS, Sneha R. A multimodal intervention to improve hand hygiene compliance in a tertiary care center. Am J Infect Control 2018; 46:775-780. [PMID: 29753498 DOI: 10.1016/j.ajic.2017.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a major threat to patient safety worldwide. HAIs are mainly transmitted via the hands of healthcare workers (HCWs), and HCW compliance with hand hygiene (HH) practices is reportedly low. Therefore, multimodal interventions are needed to develop effective HH improvement strategies. In this study, we assessed the effect of multimodal interventions on improvement of HH compliance. METHODS This study was conducted in 2 intensive care units from August 2016 to October 2016. It encompassed 3 phases: pre-intervention (20 days), intervention (1 month), and post-intervention (20 days). A total of 53 HCWs, including physicians, nurses, and housekeeping staff, were included in the HH audit. The audit was analyzed by direct observation and by a completed knowledge, attitude, and practice (KAP) questionnaire. RESULTS A total of 6350 HH opportunities were recorded; the results were 34.7%, 35%, and 69.7% for hand hygiene complete adherence rate (HHCAR), hand hygiene partial adherence rate (HHPAR), and hand hygiene adherence rate (HHAR), respectively. The HHCAR in the pre-intervention and post-intervention phases were 3% and 70.1%, respectively. HHCAR was highest among nurses (3.6% in the pre-intervention phase and 80.7% in the post-intervention phase). Other findings were that senior physicians had better HH compliance than junior physicians; in the pre-intervention phase, the HHCAR was better in the evening (4.8%); in the post-intervention phase, the HHCAR was better in the morning (72.1%); women had a higher HHCAR than men; and in the pre-intervention phase, good compliance was seen with Moments 2 and 3 of the World Health Organization's (WHO) Five Moments for Hand Hygiene, whereas in the post-intervention phase, good compliance was seen with Moments 3, 4, and 5. Questionnaire-based data were also analyzed to assess KAP of HH. We found that only 55%-82% of HCWs were aware of the WHO's Five Moments for Hand Hygiene. In the post-intervention phase, we observed a significant improvement in KAP of the study group. CONCLUSION Significant improvement in HH compliance can be achieved through a systematic, multidimensional intervention involving all types of HCWs.
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Correlation of Hand Hygiene Compliance Measured by Direct Observation with Estimates Obtained from Product Usage. Infect Control Hosp Epidemiol 2018; 39:746-749. [PMID: 29606156 DOI: 10.1017/ice.2018.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improving compliance with hand hygiene is a cornerstone of infection prevention. However, data regarding practical methods for monitoring compliance are limited. We found that product use metrics have a moderate correlation with direct observation in ward settings and limited correlation in intensive care units.Infect Control Hosp Epidemiol 2018;39:746-749.
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Larson EL, Murray MT, Cohen B, Simpser E, Pavia M, Jackson O, Jia H, Hutcheon RG, Mosiello L, Neu N, Saiman L. Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial. Behav Med 2018; 44. [PMID: 28632004 PMCID: PMC5732083 DOI: 10.1080/08964289.2017.1288607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children in pediatric long-term care facilities (pLTCF) represent a highly vulnerable population and infectious outbreaks occur frequently, resulting in significant morbidity, mortality, and resource use. The purpose of this quasi-experimental trial using time series analysis was to assess the impact of a 4-year theoretically based behavioral intervention on infection prevention practices and clinical outcomes in three pLTCF (288 beds) in New York metropolitan area including 720 residents, ages 1 day to 26 years with mean lengths of stay: 7.9-33.6 months. The 5-pronged behavioral intervention included explicit leadership commitment, active staff participation, work flow assessments, training staff in the World Health Organization "'five moments of hand hygiene (HH)," and electronic monitoring and feedback of HH frequency. Major outcomes were HH frequency, rates of infections, number of hospitalizations associated with infections, and outbreaks. Mean infection rates/1000 patient days ranged from 4.1-10.4 pre-intervention and 2.9-10.0 post-intervention. Mean hospitalizations/1000 patient days ranged from 2.3-9.7 before and 6.4-9.8 after intervention. Number of outbreaks/1000 patient days per study site ranged from 9-24 pre- and 9-18 post-intervention (total = 95); number of cases/outbreak ranged from 97-324 (total cases pre-intervention = 591 and post-intervention = 401). Post-intervention, statistically significant increases in HH trends occurred in one of three sites, reductions in infections in two sites, fewer hospitalizations in all sites, and significant but varied changes in the numbers of outbreaks and cases/outbreak. Modest but inconsistent improvements occurred in clinically relevant outcomes. Sustainable improvements in infection prevention in pLTCF will require culture change; increased staff involvement; explicit administrative support; and meaningful, timely behavioral feedback.
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Shortening the Application Time of Alcohol-Based Hand Rubs to 15 Seconds May Improve the Frequency of Hand Antisepsis Actions in a Neonatal Intensive Care Unit. Infect Control Hosp Epidemiol 2017; 38:1430-1434. [PMID: 29081301 DOI: 10.1017/ice.2017.217] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND For alcohol-based hand rubs, the currently recommended application time of 30 seconds is longer than the actual time spent in clinical practice. We investigated whether a shorter application time of 15 seconds is microbiologically safe in neonatal intensive care and may positively influence compliance with the frequency of hand antisepsis actions. METHODS We conducted in vitro experiments to determine the antimicrobial efficacy of hand rubs within 15 seconds, followed by clinical observations to assess the effect of a shortened hand antisepsis procedure under clinical conditions in a neonatal intensive care unit (NICU). An independent observer monitored the frequency of hand antisepsis actions during shifts. RESULTS All tested hand rubs fulfilled the requirement of equal or even significantly higher efficacy within 15 seconds when compared to a reference alcohol propan-2-ol 60% (v/v) within 30 seconds. Microbiologically, reducing the application time to 15 seconds had a similar effect when compared to 30-second hand rubbing, but it resulted in significantly increased frequency of hand antisepsis actions (7.9±4.3 per hour vs 5.8±2.9 per hour; P=.05). CONCLUSION Time pressure and workload are recognized barriers to compliance. Therefore, reducing the recommended time for hand antisepsis actions, using tested and well-evaluated hand rub formulations, may improve hand hygiene compliance in clinical practice. Infect Control Hosp Epidemiol 2017;38:1430-1434.
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Clack L, Scotoni M, Wolfensberger A, Sax H. "First-person view" of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool. Antimicrob Resist Infect Control 2017; 6:108. [PMID: 29093812 PMCID: PMC5661930 DOI: 10.1186/s13756-017-0267-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/17/2017] [Indexed: 01/29/2023] Open
Abstract
Background Healthcare workers' hands are the foremost means of pathogen transmission in healthcare, but detailed hand trajectories have been insufficiently researched so far. We developed and applied a new method to systematically document hand-to-surface exposures (HSE) to delineate true hand transmission pathways in real-life healthcare settings. Methods A head-mounted camera and commercial coding software were used to capture ten active care episodes by eight nurses and two physicians and code HSE type and duration using a hierarchical coding scheme. We identified HSE sequences of particular relevance to infectious risks for patients based on the WHO 'Five Moments for Hand Hygiene'. The study took place in a trauma intensive care unit in a 900-bed university hospital in Switzerland. Results Overall, the ten videos totaled 296.5 min and featured eight nurses and two physicians. A total of 4222 HSE were identified (1 HSE every 4.2 s), which concerned bare (79%) and gloved (21%) hands. The HSE inside the patient zone (n = 1775; 42%) included mobile objects (33%), immobile surfaces (5%), and patient intact skin (4%), while HSE outside the patient zone (n = 1953; 46%) included HCW's own body (10%), mobile objects (28%), and immobile surfaces (8%). A further 494 (12%) events involved patient critical sites. Sequential analysis revealed 291 HSE transitions from outside to inside patient zone, i.e. "colonization events", and 217 from any surface to critical sites, i.e. "infection events". Hand hygiene occurred 97 times, 14 (5% adherence) times at colonization events and three (1% adherence) times at infection events. On average, hand rubbing lasted 13 ± 9 s. Conclusions The abundance of HSE underscores the central role of hands in the spread of potential pathogens while hand hygiene occurred rarely at potential colonization and infection events. Our approach produced a valid video and coding instrument for in-depth analysis of hand trajectories during active patient care that may help to design more efficient prevention schemes.
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Affiliation(s)
- Lauren Clack
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Manuela Scotoni
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Aline Wolfensberger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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Edmisten C, Hall C, Kernizan L, Korwek K, Preston A, Rhoades E, Shah S, Spight L, Stradi S, Wellman S, Zygadlo S. Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals. Am J Infect Control 2017; 45:860-865. [PMID: 28526308 DOI: 10.1016/j.ajic.2017.03.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. METHODS An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. RESULTS The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. DISCUSSION Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. CONCLUSIONS Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff.
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Affiliation(s)
| | | | | | | | | | - Evan Rhoades
- Hospital Corporation of America West Florida Division, Tampa, FL
| | - Shalin Shah
- Regional Medical Center Bayonet Point, Hudson, FL
| | - Lori Spight
- Regional Medical Center Bayonet Point, Hudson, FL
| | | | | | - Scott Zygadlo
- Hospital Corporation of America West Florida Division, Tampa, FL
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Abstract
The medical field has long recognized the importance of hand hygiene in preventing health care-associated infections, yet studies indicate that this important task is performed only 40% of the time. Health care workers cite several barriers to optimal performance of hand hygiene, but the time required to perform this task is foremost among them. Introduction of alcohol-based hand rubs, bundled interventions, and incorporation of technologies designed to monitor and promote hand hygiene all represent promising advances in this field.
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Seyed Nematian SS, Palenik CJ, Mirmasoudi SK, Hatam N, Askarian M. Comparing knowledge and self-reported hand hygiene practices with direct observation among Iranian hospital nurses. Am J Infect Control 2017; 45:e65-e67. [PMID: 28427787 DOI: 10.1016/j.ajic.2017.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
Abstract
We compared knowledge and self-reported hand hygiene practices with direct observations among Shiraz Nemazee Hospital nurses. Overall hand hygiene compliance was low (39.6%). Use and appreciation for alcohol-based handrubs were suboptimal. Some reluctance was due to religious concerns. Most nurses self-reported performing proper hand hygiene more than 75% of the time, whereas direct observation indicated much lower levels of compliance. It appears that additional training and improved monitoring are needed.
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Construct validity-Current issues and recommendations for future hand hygiene research. Am J Infect Control 2017; 45:521-527. [PMID: 28285726 DOI: 10.1016/j.ajic.2017.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/20/2022]
Abstract
Health care-associated infection is a leading cause of morbidity and mortality. Hand hygiene is widely regarded as an effective prevention strategy. Often, hand hygiene research is designed and conducted by health care practitioners who may lack formal training in research methods, particularly in the area of social science. In a research context, a construct is a concept that can be measured or observed in some way. A construct can be directly or indirectly measured. For example, height can be directly measured by centimeters, whereas depression can be indirectly measured by a scale of 20 items. Every construct needs to be operationalized by measure(s) to make it a variable. Hence, construct validity refers to the degree of fit between the construct of interest and its operational measure. However, issues with construct validity often weaken the translation from construct to measure(s). This article will (1) describe the common threats to construct validity pertaining to hand hygiene research, (2) identify practical limitations in current research design, and (3) provide recommendations to improve construct validity in future hand hygiene research. By understanding how construct validity may affect hand hygiene research design, there is great potential to improve the validity of future hand hygiene research findings.
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Assessment of an Aggregate-Level Hand Hygiene Monitoring Technology for Measuring Hand Hygiene Performance Among Healthcare Personnel. Infect Control Hosp Epidemiol 2016; 38:348-352. [DOI: 10.1017/ice.2016.298] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUNDDespite significant advances in technological methods for hand hygiene surveillance, a lack of evidence prohibits comparison of systems to one another or against the current gold standard of direct observation.OBJECTIVETo validate a hand hygiene monitoring technology (HHMT) designed to capture hand hygiene behaviors aggregated at the hospital-unit level (GOJO Industries, Akron, OH).METHODSOur team followed a rigorous validation approach to assess the sensitivity and positive predictive value (PPV) of an HHMT. A planned path was first used to measure the accuracy of the system when purposefully activated by investigators. Next, behavioral validation was used to quantify accuracy of the system in capturing real-world behaviors.RESULTSDuring the planned path phase, investigators performed 4,872 unique events across 3 distinct hospital buildings varying in size and age since construction. Overall sensitivity across the medical center was 88.7% with a PPV of 99.2%. During the behavioral validation phase, trained direct observers recorded 5,539 unique events across 3 distinct hospital buildings. Overall sensitivity across the medical center was 92.7% and PPV was 84.4%.CONCLUSIONObjective measures of sensitivity and PPV indicate the promise of the benefit of this and other HHMTs to capture basic behaviors associated with hand hygiene.Infect Control Hosp Epidemiol 2017;38:348–352
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O’Donoghue M, Ng SH, Suen LKP, Boost M. A quasi-experimental study to determine the effects of a multifaceted educational intervention on hand hygiene compliance in a radiography unit. Antimicrob Resist Infect Control 2016; 5:36. [PMID: 27777757 PMCID: PMC5070356 DOI: 10.1186/s13756-016-0133-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst numerous studies have investigated nurses' compliance with hand hygiene and use of alcohol-based hand rub (ABHR), limited attention has been paid to these issues in allied health staff. Reports have linked infections to breaches in infection control in the radiography unit (RU). With advances in medical imaging, a higher proportion of patients come into contact with RU staff increasing the need for good hand hygiene compliance. This study aimed to evaluate effectiveness on compliance of an intervention to improve awareness of hand hygiene in the RU of a district hospital. METHODS A quasi-experimental study design including questionnaires assessing knowledge and attitudes of hand hygiene and direct observation of participants was used to evaluate an educational programme on hand hygiene of the RU of a large district hospital. All healthcare workers (HCW), comprising 76 radiographers, 17 nurses, and nine healthcare assistants (HCA), agreed to participate in the study. Of these, 85 completed the initial and 76 the post-test anonymous questionnaire. The hand hygiene compliance of all 102 HCW was observed over a 3-week period prior to and after the intervention. The 2-month intervention consisted of talks on hand hygiene and benefits of ABHR, provision of visual aids, wall-mounted ABHR dispensers, and personal bottles of ABHR. RESULTS Before the intervention, overall hand hygiene compliance was low (28.9 %). Post-intervention, compliance with hand hygiene increased to 51.4 %. This improvement was significant for radiographers and HCA. Additionally, knowledge and attitudes improved in particular, understanding that ABHR can largely replace handwashing and there is a need to perform hand hygiene after environmental contact. The increased use of ABHR allowed HCW to feel they had enough time to perform hand hygiene. CONCLUSIONS The educational intervention led to increased awareness of hand hygiene opportunities and better acceptance of ABHR use. The reduced time needed to perform hand rubbing and improved access to dispensers resulted in fewer missed opportunities. Although radiographers and other allied HCW make frequent contact with patients, these may be mistakenly construed as irrelevant with respect to healthcare associated infections. Stronger emphasis on hand hygiene compliance of these staff may help reduce infection risk.
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Affiliation(s)
- Margaret O’Donoghue
- The Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Suk-Hing Ng
- The Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Lorna KP Suen
- The Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Maureen Boost
- The Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Adler A, Friedman ND, Marchaim D. Multidrug-Resistant Gram-Negative Bacilli: Infection Control Implications. Infect Dis Clin North Am 2016; 30:967-997. [PMID: 27660090 DOI: 10.1016/j.idc.2016.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Antimicrobial resistance is a common iatrogenic complication of both modern life and medical care. Certain multidrug resistant and extensively drug resistant Gram-negative organisms pose the biggest challenges to health care today, predominantly owing to a lack of therapeutic options. Containing the spread of these organisms is challenging, and in reality, the application of multiple control measures during an evolving outbreak makes it difficult to measure the relative impact of each measure. This article reviews the usefulness of various infection control measures in containing the spread of multidrug-resistant Gram-negative bacilli.
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Affiliation(s)
- Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Dror Marchaim
- Department of Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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Hines J, Wilkinson SM, John SM, Diepgen TL, English J, Rustemeyer T, Wassilew S, Kezic S, Maibach HI. The three moments of skin cream application: an evidence-based proposal for use of skin creams in the prevention of irritant contact dermatitis in the workplace. J Eur Acad Dermatol Venereol 2016; 31:53-64. [PMID: 27545662 PMCID: PMC5434821 DOI: 10.1111/jdv.13851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
Contact dermatitis is one of the most common occupational diseases, with serious impact on quality of life, lost days at work and a condition that may be chronically relapsing. Regular prophylactic skin cream application is widely acknowledged to be an effective prevention strategy against occupational contact dermatitis; however, compliance rates remain low. To present a simple programme for skin cream application in the workplace with focus on implementation to drive down the rate of occupational irritant contact dermatitis, an expert panel of eight international dermatologists combined personal experience with extensive literature review. The recommendations are based on clinical experience as supported by evidence-based data from interventional studies. The authors identified three moments for skin cream application in the work place: (i) before starting a work period; (ii) after washing hands; and (iii) after work. Affecting behaviour change requires systematic communications, monitoring and reporting, which is proposed through Kotter's principles of organizational change management. Measurement tools are provided in the appendix. Interventional data based on application of this proposal is required to demonstrate its effectiveness.
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Affiliation(s)
- J Hines
- Deb Group Ltd., Research & Development, Denby, Derbyshire, UK
| | | | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabrueck, Germany
| | - T L Diepgen
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J English
- Nottingham NHS Treatment Center, Nottingham, UK
| | - T Rustemeyer
- Department of Dermatology and Allergology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - S Wassilew
- Hautarztzentrum Krefeld, Krefeld, Germany
| | - S Kezic
- Coronel Institute of Occupational Health, Academic Medical Centre, Amsterdam, The Netherlands
| | - H I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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Abstract
Hand hygiene (HH) is the single most important procedure health care workers (HCWs) can follow to reduce the risk of spreading health care–associated infections, yet compliance with this simple task remains at less than 50%. One of the reasons often cited for noncompliance is irritant contact dermatitis (ICD) resulting from repeated exposure to HH products and procedure. This literature review used the World Health Organization’s components of empowerment as a guideline for the search and development of a clinical model to address HCW HH and ICD.
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What Drives Healthcare Worker Actions to Treat Irritant Contact Dermatitis on Hands? Infect Control Hosp Epidemiol 2016; 37:877-8. [PMID: 27174158 DOI: 10.1017/ice.2016.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S155-78. [DOI: 10.1017/s0899823x00193900] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Aseptic technique for accessing central venous catheters: applying a standardised tool to audit 'scrub the hub' practices. J Vasc Access 2016; 17:269-72. [PMID: 26868480 DOI: 10.5301/jva.5000509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To reduce the risk of infections associated with indwelling central venous catheters (CVCs), practices for hub disinfection have been widely promoted. The objective of this study was to design and implement a standardised tool to monitor compliance with 'scrub the hub' practices at an Australian centre. METHODS Review of existing literature and recommendations regarding scrub the hub practices was performed to identify nine key components that could be audited by direct observation of staff in clinical areas. The tool was reviewed by stakeholders in infection prevention, infectious diseases and senior nursing roles prior to pilot evaluation. RESULTS Twenty attempts to access a CVC were audited. In all instances, scrub the hub practices were commenced. However, a 15-second scrub was performed in only 60% of cases, and the hub was permitted to dry in only 65% of instances. With respect to maintaining an aseptic field, the overall compliance was 40%, and compliance was lowest for maintenance of a non-touch technique for key parts and sites, and hand hygiene practices following CVC access. CONCLUSIONS A standardised clinical audit tool for monitoring aseptic access of CVCs enabled identification of practices amendable to targeted intervention and education, such as duration of hub disinfection. This tool would be readily utilised to facilitate quality improvement initiatives in a range of healthcare contexts, including high-risk inpatient and ambulatory care settings.
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Huang H, Tao L, Liu F, Ji L, Hu Y, Cheng MMC, Chen PY, Akinwande D. Chemical-sensitive graphene modulator with a memory effect for internet-of-things applications. MICROSYSTEMS & NANOENGINEERING 2016; 2:16018. [PMID: 31057821 PMCID: PMC6444719 DOI: 10.1038/micronano.2016.18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/11/2016] [Accepted: 03/04/2016] [Indexed: 05/05/2023]
Abstract
Modern internet of things (IoTs) and ubiquitous sensor networks could potentially take advantage of chemically sensitive nanomaterials and nanostructures. However, their heterogeneous integration with other electronic modules on a networked sensor node, such as silicon-based modulators and memories, is inherently challenging because of compatibility and integration issues. Here we report a novel paradigm for sensing modulators: a graphene field-effect transistor device that directly modulates a radio frequency (RF) electrical carrier signal when exposed to chemical agents, with a memory effect in its electrochemical history. We demonstrated the concept and implementation of this graphene-based sensing modulator through a frequency-modulation (FM) experiment conducted in a modulation cycle consisting of alternating phases of air exposure and ethanol or water treatment. In addition, we observed an analog memory effect in terms of the charge neutrality point of the graphene, V cnp, which strongly influences the FM results, and developed a calibration method using electrochemical gate-voltage pulse sequences. This graphene-based multifunctional device shows great potential for use in a simple, low-cost, and ultracompact nanomaterial-based nodal architecture to enable continuous, real-time event-based monitoring in pervasive healthcare IoTs, ubiquitous security systems, and other chemical/molecular/gas monitoring applications.
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Affiliation(s)
- Haiyu Huang
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX 78712, USA
- Maxim Integrated Inc., Dallas, TX 75240, USA
- ()
| | - Li Tao
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX 78712, USA
| | - Fei Liu
- School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Li Ji
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX 78712, USA
| | - Ye Hu
- Houston Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Mark Ming-Cheng Cheng
- Department of Electrical and Computer Engineering, Wayne State University, Detroit, MI 48202, USA
| | - Pai-Yen Chen
- Department of Electrical and Computer Engineering, Wayne State University, Detroit, MI 48202, USA
- ()
| | - Deji Akinwande
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX 78712, USA
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Chen J, Cremer JF, Zarei K, Segre AM, Polgreen PM. Using Computer Vision and Depth Sensing to Measure Healthcare Worker-Patient Contacts and Personal Protective Equipment Adherence Within Hospital Rooms. Open Forum Infect Dis 2015; 3:ofv200. [PMID: 26949712 PMCID: PMC4757761 DOI: 10.1093/ofid/ofv200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/15/2015] [Indexed: 11/16/2022] Open
Abstract
This prospective study of cellulitis identified β-hemolytic streptococci as the dominating cause in all investigated subgroups. Group C/G streptococci were more frequently detected than group A streptococci. No single clinical feature substantially increased the probability of confirmed streptococcal etiology. Background. We determined the feasibility of using computer vision and depth sensing to detect healthcare worker (HCW)-patient contacts to estimate both hand hygiene (HH) opportunities and personal protective equipment (PPE) adherence. Methods. We used multiple Microsoft Kinects to track the 3-dimensional movement of HCWs and their hands within hospital rooms. We applied computer vision techniques to recognize and determine the position of fiducial markers attached to the patient's bed to determine the location of the HCW's hands with respect to the bed. To measure our system's ability to detect HCW-patient contacts, we counted each time a HCW's hands entered a virtual rectangular box aligned with a patient bed. To measure PPE adherence, we identified the hands, torso, and face of each HCW on room entry, determined the color of each body area, and compared it with the color of gloves, gowns, and face masks. We independently examined a ground truth video recording and compared it with our system's results. Results. Overall, for touch detection, the sensitivity was 99.7%, with a positive predictive value of 98.7%. For gowned entrances, sensitivity was 100.0% and specificity was 98.15%. For masked entrances, sensitivity was 100.0% and specificity was 98.75%; for gloved entrances, the sensitivity was 86.21% and specificity was 98.28%. Conclusions. Using computer vision and depth sensing, we can estimate potential HH opportunities at the bedside and also estimate adherence to PPE. Our fine-grained estimates of how and how often HCWs interact directly with patients can inform a wide range of patient-safety research.
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Affiliation(s)
| | | | | | | | - Philip M Polgreen
- Departments of Internal Medicine and Epidemiology , University of Iowa , Iowa City
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A Review of Electronic Hand Hygiene Monitoring: Considerations for Hospital Management in Data Collection, Healthcare Worker Supervision, and Patient Perception. J Healthc Manag 2015. [DOI: 10.1097/00115514-201509000-00009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ellingson K, Haas JP, Aiello AE, Kusek L, Maragakis LL, Olmsted RN, Perencevich E, Polgreen PM, Schweizer ML, Trexler P, VanAmringe M, Yokoe DS. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol 2015; 35:937-60. [PMID: 25026608 DOI: 10.1086/677145] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Ellingson K, Haas JP, Aiello AE, Kusek L, Maragakis LL, Olmsted RN, Perencevich E, Polgreen PM, Schweizer ML, Trexler P, VanAmringe M, Yokoe DS. Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infect Control Hosp Epidemiol 2015. [DOI: 10.1086/651677] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Boyce JM. Measuring Healthcare Worker Hand Hygiene Activity: Current Practices and Emerging Technologies. Infect Control Hosp Epidemiol 2015; 32:1016-28. [DOI: 10.1086/662015] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of multidisciplinary hand hygiene improvement programs. Observational surveys conducted by trained personnel are currently considered the “gold standard” method for establishing compliance rates, but they are time-consuming and have a number of shortcomings. Monitoring hand hygiene product consumption is less time-consuming and can provide useful information regarding the frequency of hand hygiene that can be used to give caregivers feedback. Electronic counting devices placed in hand hygiene product dispensers provide detailed information about hand hygiene frequency over time, by unit and during interventions. Electronic hand hygiene monitoring systems that utilize wireless systems to monitor room entry and exit of healthcare workers and their use of hand hygiene product dispensers can provide individual and unit-based data on compliance with the most common hand hygiene indications. Some systems include badges (tags) that can provide healthcare workers with real-time reminders to clean their hands upon entering and exiting patient rooms. Preliminary studies suggest that use of electronic monitoring systems is associated with increased hand hygiene compliance rates and that such systems may be acceptable to care givers. Although there are many questions remaining about the practicality, accuracy, cost, and long-term impact of electronic monitoring systems on compliance rates, they appear to have considerable promise for improving our efforts to monitor and improve hand hygiene practices among healthcare workers.
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McGuckin M, Govednik J. Hand Hygiene Product Volume Measurement: An Integral Part of a Multiple-Method Program. Infect Control Hosp Epidemiol 2015; 31:980-1; author reply 981. [DOI: 10.1086/656208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alhenn AS, Yousef A, Mhawsh M, Alqudah N. Hand Hygiene Championship: A Direct Observational Study. Infect Control Hosp Epidemiol 2015; 34:1126-7. [DOI: 10.1086/673159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Walker JL, Sistrunk WW, Higginbotham MA, Burks K, Halford L, Goddard L, Thombs LA, Austin C, Finley PJ. Hospital hand hygiene compliance improves with increased monitoring and immediate feedback. Am J Infect Control 2014; 42:1074-8. [PMID: 25278396 DOI: 10.1016/j.ajic.2014.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/20/2014] [Accepted: 06/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Health care-associated infections are serious complications impacting 2 million patients and accounting for approximately 100,000 deaths per year. In the present study, we evaluated the effectiveness of a new hand hygiene monitoring program (HHMP) and measured the sustainability of this effectiveness over a 1-year period. METHODS The HHMP consisted of 4 key components: extensive education, conspicuous and visible monitors, immediate feedback concerning compliance to health care workers, and real-time data dissemination to leadership. The HHMP was implemented in 2 hospital care units. Two different, but similar, departments served as controls, and hand hygiene compliance was monitored via the "secret shopper" technique. All 4 departments were followed for 12 months. RESULTS Both experimental departments showed statistically significant increases in hand hygiene compliance. Experimental department 1 increased compliance from 49% to an average of 90%, and experimental department 2 increased compliance from 60% to an average of 96%. Both experimental departments were able to sustain these results for at least 6 months. Compliance rates were significantly higher in the experimental departments compared with the control departments. No significant changes were seen in the control departments. CONCLUSIONS These finding suggest that continuous monitoring by salient observers and immediate feedback are critical to the success of hand hygiene programs.
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Jayaraman SP, Klompas M, Bascom M, Liu X, Piszcz R, Rogers SO, Askari R. Hand-hygiene compliance does not predict rates of resistant infections in critically ill surgical patients. Surg Infect (Larchmt) 2014; 15:533-9. [PMID: 25215463 DOI: 10.1089/sur.2013.128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Our institution had a major outbreak of multi-drug-resistant Acinetobacter (MDRA) in its general surgical and trauma intensive care units (ICUs) in 2011, requiring implementation of an aggressive infection-control response. We hypothesized that poor hand-hygiene compliance (HHC) may have contributed to the outbreak of MDRA. A response to the outbreak including aggressive environmental cleaning, cohorting, and increased hand hygiene compliance monitoring may have led to an increase in HHC after the outbreak and to a consequent decrease in the rates of infection by the nosocomial pathogens methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile. METHODS Hand-hygiene compliance, tracked in monthly audits by trained and anonymous observers, was abstracted from an infection control database. The incidences of nosocomial MRSA, VRE, and C. difficile were calculated from a separate prospectively collected data base for 6 mo before and 12 mo after the 2011 outbreak of MDRA in the institution's general surgical and trauma ICUs, and data collected prospectively from two unaffected ICUs (the thoracic surgical ICU and medical intensive care unit [MICU]). We created a composite endpoint of "any resistant pathogen," defined as MRSA, VRE, or C. difficile, and compared incidence rates over time, using the Wilcoxon signed rank test and Pearson product-moment correlation coefficient to measure the correlations among these rates. RESULTS Rates of HHC before and after the outbreak of MDRA were consistently high in both the general surgical (median rates: 100% before and 97.6% after the outbreak, p=0.93) and trauma ICUs (median rates: 90% before and 96.75% after the outbreak, p=0.14). In none of the ICUs included in the study did the rates of HHC increase in response to the outbreak of MDRA. The incidence of "any resistant pathogen" decreased in the general surgical ICU after the outbreak (from 6.7/1,000 patient-days before the outbreak to 2.7/1,000 patient-days after the outbreak, p=0.04), but this decrease did not correlate with HHC (trauma ICU: Pearson correlation [ρ]=-0.34, p=0.28; general surgical ICU: ρ=0.52, p=0.08). CONCLUSIONS The 2011 outbreak of MDRA at our institution occurred despite high rates of HHC. Notwithstanding stable rates of HHC, the rates of infection with MRSA, VRE and C. difficile decreased in the general surgical ICU after the outbreak. This suggests that infection control tactics other than HHC play a crucial role in preventing the transmission of nosocomial pathogens, especially when rates of HHC have been maximized.
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Affiliation(s)
- Sudha P Jayaraman
- 1 Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts
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