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Boyce JM. Current issues in hand hygiene. Am J Infect Control 2023; 51:A35-A43. [PMID: 37890952 DOI: 10.1016/j.ajic.2023.02.003] [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: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Multiple aspects of hand hygiene have changed in recent years. METHODS A PubMed search was conducted to identify recent articles about hand hygiene. RESULTS The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. CONCLUSIONS Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, CT, USA.
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Rüfenacht S, Kohler P, Kuhn R, Flury D, Widmer AF, Schlegel M. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the adherence to hand hygiene practice in hospitals-Data from a Swiss national surveillance system. Infect Control Hosp Epidemiol 2023; 44:1522-1525. [PMID: 36624690 PMCID: PMC10507510 DOI: 10.1017/ice.2022.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 01/11/2023]
Abstract
In >100,000 observations across Swiss acute-care hospitals, hand hygiene (HH) adherence significantly increased during the first coronavirus disease 2019 (COVID-19) wave. However, despite persisting COVID-19 activity, HH adherence returned to prepandemic levels over a 2-year observation period. These results indicate that training and support remains challenging.
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Affiliation(s)
- Susanne Rüfenacht
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Philipp Kohler
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Rolf Kuhn
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Domenica Flury
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | | | - Matthias Schlegel
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
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Schinas G, Polyzou E, Spernovasilis N, Gogos C, Dimopoulos G, Akinosoglou K. Preventing Multidrug-Resistant Bacterial Transmission in the Intensive Care Unit with a Comprehensive Approach: A Policymaking Manual. Antibiotics (Basel) 2023; 12:1255. [PMID: 37627675 PMCID: PMC10451180 DOI: 10.3390/antibiotics12081255] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Patients referred to intensive care units (ICU) commonly contract infections caused by multidrug-resistant (MDR) bacteria, which are typically linked to complications and high mortality. There are numerous independent factors that are associated with the transmission of these pathogens in the ICU. Preventive multilevel measures that target these factors are of great importance in order to break the chain of transmission. In this review, we aim to provide essential guidance for the development of robust prevention strategies, ultimately ensuring the safety and well-being of patients and healthcare workers in the ICU. We discuss the role of ICU personnel in cross-contamination, existing preventative measures, novel technologies, and strategies employed, along with antimicrobial surveillance and stewardship (AMSS) programs, to construct effective and thoroughly described policy recommendations. By adopting a multifaceted approach that combines targeted interventions with broader preventive strategies, healthcare facilities can create a more coherent line of defense against the spread of MDR pathogens. These recommendations are evidence-based, practical, and aligned with the needs and realities of the ICU setting. In conclusion, this comprehensive review offers a blueprint for mitigating the risk of MDR bacterial transmission in the ICU, advocating for an evidence-based, multifaceted approach.
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Affiliation(s)
- Georgios Schinas
- Department of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (E.P.); (C.G.); (K.A.)
| | - Elena Polyzou
- Department of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (E.P.); (C.G.); (K.A.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
| | | | - Charalambos Gogos
- Department of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (E.P.); (C.G.); (K.A.)
| | - George Dimopoulos
- 3rd Department of Critical Care, Evgenidio Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Karolina Akinosoglou
- Department of Medicine, University of Patras, 26504 Patras, Greece; (G.S.); (E.P.); (C.G.); (K.A.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Patras, Greece
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Armstrong-Novak J, Juan HY, Cooper K, Bailey P. Healthcare Personnel Hand Hygiene Compliance: Are We There Yet? Curr Infect Dis Rep 2023; 25:1-7. [PMID: 37361491 PMCID: PMC10213575 DOI: 10.1007/s11908-023-00806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review Poor hand hygiene is well documented as a factor in healthcare-associated infections and excellent rates of hand hygiene remains elusive. Recent Findings There is increased use of universal or increased gloving to minimize hand contamination, but its use does not replace hand hygiene opportunities. There is significant interest in electronic hand hygiene monitoring systems, but they are not without their unique issues. Behavioral psychology remains a significant factor in motivating hand hygiene behaviors; even in COVID-19, hand hygiene rates initially improved but trended down back to baseline while still dealing with the pandemic. Summary More emphasis should be placed on the how to properly perform hand hygiene and why it is so important, as well as the role of gloves, is needed. Continued investment and awareness of their status as role models from both system leadership and senior healthcare providers are needed.
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Affiliation(s)
| | - Hui Yu Juan
- Virginia Commonwealth University Health System, Richmond, VA USA
| | - Kaila Cooper
- Virginia Commonwealth University Health System, Richmond, VA USA
| | - Pamela Bailey
- Prisma Health Midlands, Columbia, SC USA
- University of South Carolina School of Medicine, 2 Medial Park, Suite 205, Columbia, SC 29203 USA
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Casaroto E, Generoso JR, Serpa Neto A, Prado M, Gagliardi GM, de Menezes FG, Gonçalves P, Hohmann FB, Olivato GB, Gonçalves GP, Xavier N, Fernandes Miguel M, Edmond MB, Marra AR. Comparing human to electronic observers to monitor hand hygiene compliance in an intensive care unit. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e161. [PMID: 36483392 PMCID: PMC9726540 DOI: 10.1017/ash.2022.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We sought to determine whether an electronic hand hygiene (HH) system could monitor HH compliance at similar rates to direct human observation. METHODS This 4-year proof-of-concept study was conducted in an intensive care unit (ICU) of a private tertiary-care hospital in São Paulo, Brazil, where electronic HH systems were installed in 2 rooms. HH compliance was reported respectively using direct observation and electronic counter devices with an infrared system for detecting HH opportunities. RESULTS In phase 1, HH compliance by human observers was 56.3% (564 of 1,001 opportunities), while HH compliance detected by the electronic observer was 51.0% (515 of 1,010 opportunities). In phase 2, human observers registered 484 HH opportunities with a HH compliance rate of 64.7% (313 of 484) versus 70.6% (346 of 490) simultaneously detected by the electronic system. In addition, an enhanced HH electronic system monitored activity 24 hours per day and HH compliance without the presence of a human observer was 40.3% (10,642 of 26,421 opportunities), providing evidence for the Hawthorne effect. CONCLUSIONS The electronic HH monitoring system had good correlation with human HH observation, but compliance was remarkably lower when human observers were not present due to the Hawthorne effect (25%-30% absolute difference). Electronic monitoring systems can replace direct observation and can markedly reduce the Hawthorne effect.
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Affiliation(s)
- Eduardo Casaroto
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Jose R. Generoso
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Ary Serpa Neto
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, ANZIC-RC, Melbourne, Victoria, Australia
| | - Marcelo Prado
- Universidade de São Paulo, São Carlos, São Paulo, Brazil
| | | | | | | | | | | | | | - Nathalia Xavier
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | | | - Michael B. Edmond
- West Virginia University School of Medicine, Morgantown, West Virginia, United States
| | - Alexandre R. Marra
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs Health Care System, Iowa City, Iowa, United States
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
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Advani SD, Sickbert-Bennett E, Moehring R, Cromer A, Lokhnygina Y, Dodds-Ashley E, Kalu IC, DiBiase L, Weber DJ, Anderson DJ. The Disproportionate Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Healthcare-Associated Infections in Community Hospitals: Need for Expanding the Infectious Disease Workforce. Clin Infect Dis 2022; 76:e34-e41. [PMID: 35997795 PMCID: PMC9452131 DOI: 10.1093/cid/ciac684] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic had a considerable impact on US healthcare systems, straining hospital resources, staff, and operations. However, a comprehensive assessment of the impact on healthcare-associated infections (HAIs) across different hospitals with varying level of infectious disease (ID) physician expertise, resources, and infrastructure is lacking. METHODS This retrospective longitudinal multicenter cohort study included central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and ventilator-associated events (VAEs) from 53 hospitals (academic and community) in Southeastern United States from 1 January 2018 to 31 March 2021. Segmented negative binomial regression generalized estimating equations models estimated changes in monthly incidence rates in the baseline (01/2018-02/2020) compared to the pandemic period (03/2020-03/2021, further divided into three pandemic phases). RESULTS CLABSIs and VAEs increased by 24% and 34%, respectively, during the pandemic period. VAEs increased in all phases of the pandemic, while CLABSIs increased in later phases of the pandemic. CDI trend increased by 4.2% per month in the pandemic period. On stratifying the analysis by hospital characteristics, the impact of the pandemic on healthcare-associated infections was more significant in smaller sized and community hospitals. CAUTIs did not change significantly during the pandemic across all hospital types. CONCLUSIONS CLABSIs, VAEs, and CDIs increased significantly during the pandemic, especially in smaller community hospitals, most of which lack ID physician expertise. Future efforts should focus on better understanding challenges faced by community hospitals, strengthening the infection prevention infrastructure, and expanding the ID workforce, particularly to community hospitals.
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Affiliation(s)
- Sonali D Advani
- Corresponding Author: Sonali D. Advani MBBS, MPH, Assistant Professor of Medicine, Division of Infectious Diseases, Duke University School of Medicine, 315 Trent Drive, Hanes House, Room 154, Durham, NC, 27710, United States,
| | - Emily Sickbert-Bennett
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US
| | - Rebekah Moehring
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
| | - Andrea Cromer
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
| | - Yuliya Lokhnygina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, US
| | - Elizabeth Dodds-Ashley
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
| | - Ibukunoluwa C Kalu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, US
| | - Lauren DiBiase
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US
| | - David J Weber
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US
| | - Deverick J Anderson
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
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Davies R, Mowbray F, Martin AF, Smith LE, Rubin GJ. A systematic review of observational methods used to quantify personal protective behaviours among members of the public during the COVID-19 pandemic, and the concordance between observational and self-report measures in infectious disease health protection. BMC Public Health 2022; 22:1436. [PMID: 35902818 PMCID: PMC9330943 DOI: 10.1186/s12889-022-13819-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/11/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess the quantity and quality of studies using an observational measure of behaviour during the COVID-19 pandemic, and to narratively describe the association between self-report and observational data for behaviours relevant to controlling an infectious disease outbreak. DESIGN Systematic review and narrative synthesis of observational studies. DATA SOURCES We searched Medline, Embase, PsychInfo, Publons, Scopus and the UK Health Security Agency behavioural science LitRep database from inception to 17th September 2021 for relevant studies. STUDY SELECTION We included studies which collected observational data of at least one of three health protective behaviours (hand hygiene, face covering use and maintaining physical distance from others ('social distancing') during the COVID-19 pandemic. Studies where observational data were compared to self-report data in relation to any infectious disease were also included. DATA EXTRACTION AND SYNTHESIS We evaluated the quality of studies using the NIH quality assessment scale for observational studies, extracted data on sample size, setting and adherence to health protective behaviours, and synthesized results narratively. RESULTS Of 27,279 published papers on COVID-19 relevant health protective behaviours that included one or more terms relating to hand hygiene, face covering and social distancing, we identified 48 studies that included an objective observational measure. Of these, 35 assessed face covering use, 17 assessed hand hygiene behaviour and seven assessed physical distancing. The general quality of these studies was good. When expanding the search to all infectious diseases, we included 21 studies that compared observational versus self-report data. These almost exclusively studied hand hygiene. The difference in outcomes was striking, with self-report over-estimating observed adherence by up to a factor of five in some settings. In only four papers did self-report match observational data in any domains. CONCLUSIONS Despite their importance in controlling the pandemic, we found remarkably few studies assessing protective behaviours by observation, rather than self-report, though these studies tended to be of reasonably good quality. Observed adherence tends to be substantially lower than estimates obtained via self-report. Accurate assessment of levels of personal protective behaviour, and evaluation of interventions to increase this, would benefit from the use of observational methods.
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Affiliation(s)
- Rachel Davies
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK.
| | - Fiona Mowbray
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK
| | - Alex F Martin
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK
| | - Louise E Smith
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK
| | - G James Rubin
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK
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Stancill LB, Sickbert-Bennett EE, DiBiase LM. Sustainability of a well-established hand hygiene program during the coronavirus disease 2019 (COVID-19) pandemic. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e34. [PMID: 36310776 PMCID: PMC9614842 DOI: 10.1017/ash.2022.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 06/16/2023]
Abstract
Overall, engagement and compliance from the crowd-sourced hand hygiene observation program, Clean-In-Clean-Out (CICO), were similar between 2019 (96.6%) and 2020 (96.7%) despite fluctuations within 2020 that reflected our hospital's coronavirus disease 2019 (COVID-19) experience. Shared responsibility and just-in-time reminders can allow manual hand hygiene observation models to be sustainable.
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Affiliation(s)
- Lisa B. Stancill
- Department of Infection Prevention, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, North Carolina
| | - Emily E. Sickbert-Bennett
- Department of Infection Prevention, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, North Carolina
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
- UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren M. DiBiase
- Department of Infection Prevention, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, North Carolina
- UNC School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Nuckchady DC. Impact of a Multimodal Improvement Strategy to Promote Hand Hygiene at a Hospital in Mauritius. Cureus 2021; 13:e15812. [PMID: 34306879 PMCID: PMC8294769 DOI: 10.7759/cureus.15812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Limited data is available on which interventions are likely to improve compliance to hand hygiene, especially in underdeveloped countries. The objective of this study is to explore whether the introduction of a particular bundle of strategies to improve hand hygiene is effective. Material and methods In this pre-post study, a multimodal strategy comprised of educating healthcare staff, using reminders, providing feedback and increasing the availability of soap and alcohol, was implemented over a period of one year from 2019 to 2020. Trained observers assessed compliance to hand hygiene before and after the intervention. Results A total of 143 hand hygiene opportunities were observed. Hand hygiene compliance rate did not improve despite the introduction of multiple measures. Conclusions Other approaches should be considered to promote hand hygiene. The choice of which strategies to use should be adapted to the local setting. For instance, in some healthcare facilities, emphasis should be placed on leadership support and on the training of hand hygiene champions.
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