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Bailey P, Cooper K, Stevens MP, Bearman G, Doll M. Contact precautions as a barrier to hand hygiene: The Plan-Do-Study-Act (PDSA) framework to improve compliance with gloved hand hygiene. Infect Control Hosp Epidemiol 2024; 45:788-789. [PMID: 38419431 DOI: 10.1017/ice.2024.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In an identified quality improvement effort, nurses were observed regarding their workflow while in contact precaution rooms. Multiple opportunities for hand hygiene were missed while nurses were in gloves, predominantly while moving between "dirty" and "clean" tasks. An education initiative afterward did not show improvement in hand hygiene rates.
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Affiliation(s)
| | - Kaila Cooper
- Virginia Commonwealth University Healthcare System, Richmond, Virginia
| | - Michael P Stevens
- West Virginia University Healthcare System, Morgantown, West Virginia
| | - Gonzalo Bearman
- Virginia Commonwealth University Healthcare System, Richmond, Virginia
| | - Michelle Doll
- Virginia Commonwealth University Healthcare System, Richmond, Virginia
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Abstract
BACKGROUND Skin antiseptics are used for several purposes before surgical procedures, for bathing high-risk patients as a means of reducing central line-associated infections and other health care associated infections. METHODS A PubMed search was performed to update the evidence on skin antiseptic products and practices. RESULTS Current guidelines for prevention of surgical site infections (SSIs) recommend preoperative baths or showers with a plain or antimicrobial soap prior to surgery, but do not make recommendations on the timing of baths, the total number of baths needed, or about the use of chlorhexidine gluconate (CGH)-impregnated cloths. Randomized controlled trials have demonstrated that pre-operative surgical hand antisepsis using an antimicrobial soap or alcohol-based hand rub yields similar SSI rates. Other studies have reported that using an alcohol-based hand rub caused less skin irritation, was easier to use, and required shorter scrub times than using antimicrobial soap. Current SSI prevention guidelines recommend using an alcohol-containing antiseptic for surgical site infection. Commonly used products contain isopropanol combined with either CHG or with povidone-iodine. Surgical site preparation protocols for shoulder surgery in men may need to include coverage for anaerobes. Several studies suggest the need to monitor and improve surgical site preparation techniques. Daily bathing of intensive care unit (ICU) patients with a CHG-containing soap reduces the incidence of central line-associated bloodstream infections (CLABSIs). Evidence for a similar effect in non-ICU patients is mixed. Despite widespread CHG bathing of ICU patients, numerous barriers to its effective implementation exist. Measuring CHG levels on the skin is useful for identifying gaps in coverage and suboptimal skin concentrations. Using alcohol-based products with at least 2% CHG for skin preparation prior to central line insertion reduces CLABSIs. CONCLUSIONS Progress has been made on skin antisepsis products and protocols, but improvements in technique are still needed.
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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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Siju J, Anagboso U, Vernet E, Moss M, Javaid W, Cassano K. Implementation of a quality improvement project using the patient as the observer to improve hand hygiene compliance in ambulatory care practices. J Hosp Infect 2023; 140:34-39. [PMID: 37562594 DOI: 10.1016/j.jhin.2023.08.001] [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: 03/17/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Monitoring hand hygiene compliance in the ambulatory setting remains a challenge because a healthcare trained observer loses line of sight once the examination room door closes. This quality improvement project focused on the implementation of a hand hygiene compliance improvement programme that is amenable to the routines and work flows of the ambulatory setting. METHODS After a review of the literature, nursing leadership and infection prevention implemented the 'patient as the observer' hand hygiene programme across 32 ambulatory practices. RESULTS Patients completed 281,000 observations with an overall compliance rate of ≥90%. The average overall compliance rate by role was 91% for providers, 89% for nurses, and 91% for medical assistants/technicians/others. A 92% compliance average was noted 'before caring for you' and 89% 'after caring for you' for providers, 90% and 87% for nurses, and 92% and 89% for medical assistants/technicians/others. DISCUSSION This study demonstrated that the implementation of a hand hygiene compliance improvement programme using the patient as the observer can be adopted successfully in the ambulatory setting. CONCLUSION Hand hygiene compliance can be monitored effectively in the ambulatory setting with the involvement of the patient as the observer.
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Affiliation(s)
- J Siju
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA.
| | - U Anagboso
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
| | - E Vernet
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
| | - M Moss
- Infection Prevention and Control, Mount Sinai Health System, New York, USA
| | - W Javaid
- Infection Prevention and Control, Mount Sinai Health System, New York, USA
| | - K Cassano
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
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Bilgin H, Sili U, Pazar N, Kucuker I, Kepenekli E, Yanar MA, Memisoglu A, Ozek E, Adhikari NK, Pinto R, Korten V. Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study. Am J Infect Control 2023; 51:1028-1033. [PMID: 36603809 DOI: 10.1016/j.ajic.2022.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). METHODS AND MATERIALS This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. RESULTS We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). CONCLUSION In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.
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Affiliation(s)
- Huseyin Bilgin
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nazli Pazar
- Infection Prevention and Control, Marmara University Hospital, Istanbul, Turkey
| | - Isil Kucuker
- Infection Prevention and Control, Marmara University Hospital, Istanbul, Turkey
| | - Eda Kepenekli
- Department of Pediatric Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Meral Agirman Yanar
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Asli Memisoglu
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Eren Ozek
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Neill Kj Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Volkan Korten
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
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Krause JS, Jarnecke M. Perceived impact of the COVID-19 pandemic among people with spinal cord injury: A descriptive study. Arch Rehabil Res Clin Transl 2023; 5:100271. [PMID: 37363128 PMCID: PMC10238114 DOI: 10.1016/j.arrct.2023.100271] [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] [Indexed: 06/28/2023] Open
Abstract
Objective To describe the self-reported impact of the COVID-19 pandemic on the lives of persons with spinal cord injury (SCI). Design Cross sectional study. Participants There were a total of 382 adult participants with traumatic SCI of at least one-year duration, all of whom were identified through a state-based surveillance registry in the Southeastern United States. The majority of participants were male (68.4%) and 72% were ambulatory. The average age at the time of the study was 57.7. Main Outcome Measures Participants completed a self-report assessment (SRA) online or by mail on the impact of COVID-19 on quality-of-life, ability to get daily necessities, and access to healthcare. Results Over half of the participants (58.9%) reported a negative impact of the pandemic in at least one of five life areas, with community participation being the primary area affected (51.4%). A small portion of individuals had trouble obtaining necessities, with approximately 12% reporting difficulties getting enough or quality food and 8.2% reporting difficulty getting prescription medications. However, 25% reported delaying healthcare procedures because of fear of catching COVID-19. Among those requiring personal assistance, 32% reported a decrease in quality of care and 51.9% relied more on family to assist with their care. Conclusions The COVID-19 pandemic had multiple negative impacts. Of particular importance were reduced access to healthcare and declines in quality and stability of attendant care, with greater reliance on family. Fear of contracting COVID-19 when accessing routine medical procedures needs to be addressed in future outbreaks.
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Affiliation(s)
- James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Melinda Jarnecke
- College of Health Professions, Medical University of South Carolina, Charleston, SC
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Frödin M, Rogmark C, Nellgård B, Gillespie BM, Wikström E, Andersson AE. Interactive Interventions Can Improve Hand Hygiene and Aseptic Techniques During Perioperative Care-Experience From the "Safe Hands" Project. J Perianesth Nurs 2023; 38:284-290. [PMID: 36319520 DOI: 10.1016/j.jopan.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation. DESIGN This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention. METHODS The primary outcome was differences in HH practices "Before aseptic/clean procedure" (WHO moment 2), "After body fluid exposure risk" (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017. FINDINGS The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P = .014), WHO 3; from 22.2% to 42.3%, (P = .002), and aseptic techniques; from 17.5% to 31.6%, (P = .003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department. CONCLUSIONS This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care.
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Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden.
| | - Cecilia Rogmark
- Department of Orthopedics Malmö, Lund University, Skane University Hospital, Lund, Skane, Sweden; The Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Västra Götalandregionen, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden
| | - Brigid M Gillespie
- NMHRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Griffith, Queensland, Australia; Health Service, Gold Coast University Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
| | - Annette E Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
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SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:355-376. [PMID: 36751708 PMCID: PMC10015275 DOI: 10.1017/ice.2022.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Szczesny G, Leszczynski P, Sokol-Leszczynska B, Maldyk P. Identification of human-dependent routes of pathogen's transmission in a tertiary care hospital. Jt Dis Relat Surg 2022; 33:330-337. [PMID: 35852191 PMCID: PMC9361096 DOI: 10.52312/jdrs.2022.556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
The purpose of the study was to validate the risk of patients' exposure to pathogenic flora carried on hands of students, visitors, and patients themselves, analyzing its density and genera and to compare them with the microflora of healthcare workers (HCWs). Patients and methods
Between May and June 2018, five groups of participants were included. Each group consisted of eight individuals. Palmar skin imprints were obtained from dominant hands of doctors, nurses, students, visitors, and patients in orthopedics ward. Imprints were incubated at 37°C under aerobic conditions, and colony-forming units (CFU) on each plate were counted after 24, 48, and 72 h. Microorganisms were identified. Results
Hands of doctors were colonized more often by Gram - positive non-spore-forming rods bacteria than hands of nurses (p<0.05). A higher number of Staphylococcus epidermidis CFUs was observed on doctors’ than on nurses’ hands (p<0.05), whereas Staphylococcus hominis was isolated from doctor’s and patients’ imprints, but was not from nurses’ and students’ imprints (p<0.05). Micrococcus luteus colonized patients’ hands more often than students’ (p<0.05), visitors’ hands than doctors’ (p<0.05), students’ than nurses’ (p<0.05), visitors’ than nurses’ (p<0.05) and patients’ hands (p<0.05). Staphylococcus aureus (S. aureus) was isolated only from one doctor and one nurse (203 and 10 CFUs/25 cm2 ). Imprints taken from the hands of patients, students and visitors were S. aureus-free. No methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci, nor expanded spectrum betalactamase-positive or carbapenemase-positive rods were isolated. The number of Gram-negative rods was the highest on visitors' hands, significantly differing from the number on patient’s, doctor’s, nurse’s, and student’s hands. Spore-forming rods from genus of Bacillus were isolated from representatives of all tested groups. Bacillus cereus occurred more commonly on visitors’ hands than doctors’ hands (p<0.05). Conclusion
Patients, students, and visitors may play the causal role in the spread of pathogenic bacteria, particularly spore-forming rods. Our study results confirm the effectiveness of educational activities, that is the hospital's hand hygiene program among HCWs, patients, and visitors. Hand hygiene procedures should be reviewed to put much more effort into reducing the impact of all studied groups on the transmission of infectious diseases.
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Affiliation(s)
- Grzegorz Szczesny
- Department of Orthopedic Surgery and Traumatology, Medical University of Warsaw, 02-091 Warsaw, Poland.
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Abstract
Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 62 Sonoma Lane, Middletown, CT 06457, USA.
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Baye AM, Ababu A, Bayisa R, Abdella M, Diriba E, Wale M, Selam MN. Perspectives of compounding pharmacists on alcohol-based hand sanitizer production and utilization for COVID-19 prevention in Addis Ababa, Ethiopia: A descriptive phenomenology study. PLoS One 2021; 16:e0250020. [PMID: 33914768 PMCID: PMC8084187 DOI: 10.1371/journal.pone.0250020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, the safety of patients and healthcare providers is at risk due to health care-associated infections (HCAIs). World Health Organization and the Centers for Disease Control and Prevention recommend using alcohol-based hand rub (ABHR) for hand hygiene in healthcare settings to prevent HCAIs. Irrational use of ABHR will have undesirable consequences including wastage of products, exposure of healthcare providers to infections and emergence of microbial resistance to the alcohol in hand sanitizers. This study aimed to explore the perspective and experiences of compounding pharmacists on production and utilization of ABHR solution for coronavirus disease in 2019 (COVID-19) prevention in public hospitals of Addis Ababa, Ethiopia. METHODS A descriptive qualitative study using in-depth interview of 13 key-informants serving as compounding pharmacists in public hospitals of Addis Ababa, Ethiopia, was conducted. The study participants were identified and selected by purposive sampling. All transcribed interviews were subjected to thematic analysis and transcripts were analyzed manually. FINDINGS The compounding pharmacists in this study had a mean age of 30.6 (±3.1) years and nine of the thirteen participants were men. Ten participants believed that the compounding practice in their respective sites followed the principles of good compounding practice. More than half of the participants did not believe that ABHR products were used rationally in health facilities. They argued that users did not have enough awareness when and how to use sanitizers. Most of the interviewees reported that compounding personnel had no formal training on ABHR solution production. Study participants suggested incentive mechanisms and reimbursements for experts involved in the compounding of ABHR solutions. CONCLUSION Three of the compounding pharmacists indicated that ABHR production in their setting lack compliance to good compounding practice due to inadequate compounding room, quality control tests, manpower and equipment. Despite this, most study participants preferred the in-house ABHR products than the commercially available ones. Thus, training, regular monitoring and follow-up of the hospital compounding services can further build staff confidence.
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Affiliation(s)
- Assefa Mulu Baye
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Andualem Ababu
- Pharmaceutical and Medical Equipment Directorate (PMED), Ministry of Health, Addis Ababa, Ethiopia
| | - Regasa Bayisa
- Pharmaceutical and Medical Equipment Directorate (PMED), Ministry of Health, Addis Ababa, Ethiopia
| | - Mahdi Abdella
- Pharmaceutical and Medical Equipment Directorate (PMED), Ministry of Health, Addis Ababa, Ethiopia
| | - Edessa Diriba
- Pharmaceutical and Medical Equipment Directorate (PMED), Ministry of Health, Addis Ababa, Ethiopia
| | - Minyechel Wale
- All African Leprosy, Tuberculosis Rehabilitation and Training Center (ALERT), Addis Ababa, Ethiopia
| | - Muluken Nigatu Selam
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
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Jia Q, Wang X, Yu X, Li Z, Che X, Shen J. Hand Hygiene Compliance and Influencing Factors Among Nursing Assistants in Nursing Homes. J Gerontol Nurs 2021; 47:45-52. [PMID: 34038250 DOI: 10.3928/00989134-20210310-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study explored compliance with hand hygiene and related influencing factors among nursing assistants (NAs) in nursing homes. A descriptive observational research design was used. Seven nursing homes in Chongqing, China, including hospital-affiliated, public, and private, were selected. A hand hygiene observation tool was used to assess NAs' (N = 237) hand hygiene practice (N = 2,370 opportunities). NAs' overall compliance rate was 3.6%: 6.8%, 3.1%, and 1.9% at hospital-affiliated, public, and private nursing homes, respectively. Compliance rate between two opportunities, after contact with residents and after contact with residents' surroundings, differed significantly (p = 0.002 and 0.038, respectively). The highest and lowest compliance rates occurred after bodily fluid exposure (8.3%; odds ratio [OR] = 0.37, 95% confidence interval [CI] [0.218, 0.627], p < 0.001) and before resident contact (1.2%; OR = 3.142, 95% CI [1.265, 7.805], p = 0.014), respectively. Working experience and educational background were the two major influencing factors for hand hygiene. It is urgent to improve NAs' hand hygiene accordingly. [Journal of Gerontological Nursing, 47(4), 45-52.].
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Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect 2021; 111:6-26. [PMID: 33744382 PMCID: PMC9585124 DOI: 10.1016/j.jhin.2021.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Background There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers. Aim This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene. Methods CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria. Findings Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the ‘Five Moments’. However, recording of hand hygiene technique was not common. Conclusion Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.
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Zivich PN, Huang W, Walsh A, Dutta P, Eisenberg M, Aiello AE. Measuring office workplace interactions and hand hygiene behaviors through electronic sensors: A feasibility study. PLoS One 2021; 16:e0243358. [PMID: 33465139 PMCID: PMC7815125 DOI: 10.1371/journal.pone.0243358] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 11/19/2020] [Indexed: 01/06/2023] Open
Abstract
Office-based workplaces are an important but understudied context for infectious disease transmission. We examined the feasibility of two different sensors (Opos and Bluetooth beacons) for collecting person-to-person contacts and hand hygiene in office-based workplaces. Opo is an interaction sensor that captures sensor-to-sensor interactions through ultrasonic frequencies, which correspond to face-to-face contacts between study participants. Opos were additionally used to measure hand hygiene events by affixing sensors to soap and alcohol-based hand sanitizer dispensers. Bluetooth beacons were used in conjunction with a smartphone application and recorded proximity contacts between study participants. Participants in two office sites were followed for one-week in their workplace in March 2018. Contact patterns varied by time of day and day of the week. Face-to-face contacts were of shorter mean duration than proximity contacts. Supervisors had fewer proximity contacts but more face-to-face contacts than non-supervisors. Self-reported hand hygiene was substantively higher than sensor-collected hand hygiene events and duration of hand washing events was short (median: 9 seconds, range: 2.5-33 seconds). Given that office settings are key environments in which working age populations spend a large proportion of their time and interactions, a better characterization of empirical social networks and hand hygiene behaviors for workplace interactions are needed to mitigate outbreaks and prepare for pandemics. Our study demonstrates that implementing sensor technologies for tracking interactions and behaviors in offices is feasible and can provide new insights into real-world social networks and hygiene practices. We identified key social interactions, variability in hand hygiene, and differences in interactions by workplace roles. High-resolution network data will be essential for identifying the most effective ways to mitigate infectious disease transmission and develop pandemic preparedness plans for the workplace setting.
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Affiliation(s)
- Paul N. Zivich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
| | - Will Huang
- College of Engineering, University of California, Berkley, California, United States of America
| | - Ali Walsh
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, United States of America
| | - Prabal Dutta
- College of Engineering, University of California, Berkley, California, United States of America
| | - Marisa Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Allison E. Aiello
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, Chapel Hill, North Carolina, United States of America
- * E-mail:
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Efficacy of compressed sodium chloride (CSC) against E. coli and Candida auris in minutes and methods improvement for testing. Sci Rep 2021; 11:149. [PMID: 33420125 PMCID: PMC7794526 DOI: 10.1038/s41598-020-79212-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Controlling infections has become one of the biggest problems in the world, whether measured in lives lost or money spent. This is worsening as pathogens continue becoming resistant to therapeutics. Antimicrobial surfaces are one strategy being investigated in an attempt to decrease the spread of infections through the most common route of transmission: surfaces, including hands. Regulators have chosen two hours as the time point at which efficacy should be measured. The objectives of this study were to characterize the new antimicrobial surface compressed sodium chloride (CSC) so that its action may be understood at timepoints more relevant to real-time infection control, under two minutes; to develop a sensitive method to test efficacy at short time points; and to investigate antifungal properties for the first time. E. coli and Candida auris are added to surfaces, and the surfaces are monitored by contact plate, or by washing into collection vats. An improved method of testing antimicrobial efficacy is reported. Antimicrobial CSC achieves at least 99.9% reduction of E. coli in the first two minutes of contact, and at least 99% reduction of C. auris in one minute.
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16
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Wu W, Wang W, Yuan Y, Lin L, Tan Y, Yang J, Dai L, Wang Y. Knowledge, attitude and practice concerning healthcare-associated infections among healthcare workers in Wuhan, China: cross-sectional study. BMJ Open 2021; 11:e042333. [PMID: 33402407 PMCID: PMC7786794 DOI: 10.1136/bmjopen-2020-042333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To assess the knowledge, attitude and practice (KAP) concerning healthcare-associated infections (HAIs) among healthcare givers and to identify the factors influencing KAP. DESIGN This was a hospital-based, cross-sectional study. SETTING Two public hospitals in Wuhan, central China. PARTICIPANTS Participants were recruited among healthcare workers (HCWs) of one general hospital and one children's hospital in Wuhan city between 1 June and 30 September 2019. PRIMARY AND SECONDARY OUTCOME MEASURES The outcomes were KAPs concerning HAIs. RESULTS Data from 455 HCWs were included in the final data analysis. The mean scores of KAP and total KAP were 15.67±3.32, 25.00±2.75, 43.44±5.15 and 84.76±6.72, respectively. The following factors were significantly associated with the total KAP score concerning HAIs, explaining 61% of the variance (p<0.001): gender (β=2.36, 95% CI 1.11 to 4.40), age (β=6.65, 95% CI 5.07 to 7.74), position (β=7.02, 95% CI 3.88 to 8.45), type of employment (β=-1.08, 95% CI -2.08 to -0.07), with HAI education within last year (β=-2.98, 95% CI -4.23 to -1.72), with invasive operation authority (β=-4.22, 95% CI -5.46 to -2.99), antibacterial drug training (β=-4.38, 95% CI -5.45 to -3.31) and with antibacterial drug training and clinical consultation (β=-4.35, 95% CI -5.38 to -3.32). CONCLUSION The controllable factors identified in this study can be used by hospital managers to implement measures that improve KAP among HCWs. Moreover, these measures should be customised, based on uncontrollable factors to suit the specific characteristics of medical staff and to improve KAP. Training programmes should be designed for medical workers to increase their awareness of HAIs and to foster positive attitudes and practices.
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Affiliation(s)
- Wenwen Wu
- School of Public Health and Management, Hubei University of Medicine, Shiyan, Hubei, China
| | - Wenru Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yufeng Yuan
- Department of Nosocomial Infection Management, Wuhan University Zhongnan Hospital, Wuhan, Hubei, China
| | - Likai Lin
- Institute of Hospital Management, Wuhan University, Wuhan, Hubei, China
| | - Yibin Tan
- Department of Nosocomial Infection Management, Wuhan University Zhongnan Hospital, Wuhan, Hubei, China
| | - Jinru Yang
- School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, China
| | - Li Dai
- Department of Cardiovascular Medicine, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Ying Wang
- Department of Nosocomial Infection Management, Wuhan University Zhongnan Hospital, Wuhan, Hubei, China
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Fordyce CB, Katz JN, Alviar CL, Arslanian-Engoren C, Bohula EA, Geller BJ, Hollenberg SM, Jentzer JC, Sims DB, Washam JB, van Diepen S. Prevention of Complications in the Cardiac Intensive Care Unit: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e379-e406. [DOI: 10.1161/cir.0000000000000909] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contemporary cardiac intensive care units (CICUs) have an increasing prevalence of noncardiovascular comorbidities and multisystem organ dysfunction. However, little guidance exists to support the development of best-practice principles specific to the CICU. This scientific statement evaluates strategies to avoid the potentially preventable complications encountered within contemporary CICUs, focusing on those that are most applicable to the CICU environment. This scientific statement reviews evidence-based practices derived in non–CICU populations, assesses their relevance to CICU practice, and highlights key knowledge gaps warranting further investigation to attenuate patient risk.
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Sakihama T, Kayauchi N, Kamiya T, Saint S, Fowler KE, Ratz D, Sato Y, Iuchi R, Honda H, Tokuda Y. Assessing sustainability of hand hygiene adherence 5 years after a contest-based intervention in 3 Japanese hospitals. Am J Infect Control 2020; 48:77-81. [PMID: 31345615 DOI: 10.1016/j.ajic.2019.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Our goal was to evaluate the 5-year sustainability of a multimodal intervention that included a prize to the hospital with the highest overall hand hygiene adherence rates among health care workers. METHODS We conducted an observational study in 3 Japanese tertiary care hospitals using unobtrusive direct observation of physician and nurse hand hygiene adherence. Observations were performed by a trained observer on inpatient medical, surgical, intensive care, and emergency units. The primary outcome was hand hygiene adherence rates before patient contact. Secondary outcomes were health care worker survey responses to a World Health Organization (WHO) questionnaire on hand hygiene practices. RESULTS Hand hygiene adherence rates had improved significantly after the introduction of a multimodal intervention (based on principles recommend by the WHO) in 2012 and 2013 (from 18.0% pre-intervention to 32.7% 6 months post-intervention; P < .001). No significant changes were found in hand hygiene adherence in these hospitals 5 years after the original intervention (31.9% 5 years after intervention; P = .53); however, substantial variability in hand hygiene adherence by unit and health care worker type was noted. CONCLUSIONS A multimodal hand hygiene initiative achieved sustained improvement in hand hygiene adherence in 3 Japanese hospitals 5 years after the original intervention.
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Karabay M, Kaya G, Hafizoglu T, Karabay O. Effect of camera monitoring and feedback along with training on hospital infection rate in a neonatal intensive care unit. Ann Clin Microbiol Antimicrob 2019; 18:35. [PMID: 31722715 PMCID: PMC6852772 DOI: 10.1186/s12941-019-0332-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/23/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In terms of pediatric healthcare-associated infections (HAI), neonatal intensive care units (NICU) constitute the greatest risk. Contacting a health care personnel, either directly or indirectly, elevates NICU occurrence rate and risks other infants in the same unit. In this study, it is aimed to retrospectively analyze the effect of the training along with camera monitoring and feedback (CMAF) to control the infection following a small outbreak. METHODS ESBL producing Klebsiella pneumoniae was detected on three infants in May 2014 at the isolation room of Sakarya University Hospital NICU. Precautions were taken to prevent further spread of the infection. The infected infants were isolated and the decolonization process was initiated. For this aspect, health care workers (HCWs) in NICU were trained for infection control measures. An infection control committee has monitored the HCWs. Before monitoring, an approval was obtained from the hospital management and HCWs were informed about the CMAF, who were then periodically updated. On a weekly basis, NICU workers were provided with the feedbacks. Epidemic period and post-epidemic control period (June-July-August 2014) were evaluated and p value < 0.05 was considered statistically significant. RESULTS Healthcare-associated infection (HAI) density was 9.59% before the onset of the CMAF, whereas it was detected as 2.24% during the CMAF period (p < 0.05). Following the precautions, HAI and HAI density rates have reduced to 76.6% and 74.85%, respectively. Moreover, hand hygiene compliance of health care workers was found 49.0% before the outbreak, whereas this rate has elevated to 62.7% after CMAF. CONCLUSIONS Healthcare workers should be monitored in order to increase their compliance for infection control measures. Here, we emphasized that that CMAF of health workers may contribute reducing the HAI rate in the NICU.
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Affiliation(s)
- Meltem Karabay
- Department of Pediatrics, Newborn Unit, Sakarya University Faculty of Medicine, Sakarya, 54100, Türkiye.
| | - Gulsum Kaya
- Member of Infection Control Committee, Sakarya University Faculty of Medicine, Adnan Menderes Bulvari, Sakarya, Turkey
| | - Taner Hafizoglu
- Department of Pediatrics, Newborn Unit, Sakarya University Faculty of Medicine, Sakarya, 54100, Türkiye
| | - Oguz Karabay
- Member of Infection Control Committee, Sakarya University Faculty of Medicine, Adnan Menderes Bulvari, Sakarya, Turkey
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Patel PK, Popovich KJ, Collier S, Lassiter S, Mody L, Ameling JM, Meddings J. Foundational Elements of Infection Prevention in the STRIVE Curriculum. Ann Intern Med 2019; 171:S10-S15. [PMID: 31569229 DOI: 10.7326/m18-3531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Payal K Patel
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
| | | | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., S.L.)
| | - Shelby Lassiter
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., S.L.)
| | - Lona Mody
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
| | | | - Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., L.M., J.M.)
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Impact of an automated hand hygiene monitoring system and additional promotional activities on hand hygiene performance rates and healthcare-associated infections. Infect Control Hosp Epidemiol 2019; 40:741-747. [PMID: 31106714 DOI: 10.1017/ice.2019.77] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Determine the impact of an automated hand hygiene monitoring system (AHHMS) plus complementary strategies on hand hygiene performance rates and healthcare-associated infections (HAIs). DESIGN Retrospective, nonrandomized, observational, quasi-experimental study. SETTING Single, 93-bed nonprofit hospital. METHODS Hand hygiene compliance rates were estimated using direct observations. An AHHMS, installed on 4 nursing units in a sequential manner, determined hand hygiene performance rates, expressed as the number of hand hygiene events performed upon entering and exiting patient rooms divided by the number of room entries and exits. Additional strategies implemented to improve hand hygiene included goal setting, hospital leadership support, feeding AHHMS data back to healthcare personnel, and use of Toyota Kata performance improvement methods. HAIs were defined using National Healthcare Safety Network criteria. RESULTS Hand hygiene compliance rates generated by direct observation were substantially higher than performance rates generated by the AHHMS. Installation of the AHHMS without supplementary activities did not yield sustained improvement in hand hygiene performance rates. Implementing several supplementary strategies resulted in a statistically significant 85% increase in hand hygiene performance rates (P < .0001). The incidence density of non-Clostridioies difficile HAIs decreased by 56% (P = .0841), while C. difficile infections increased by 60% (P = .0533) driven by 2 of the 4 study units. CONCLUSION Implementation of an AHHMS, when combined with several supplementary strategies as part of a multimodal program, resulted in significantly improved hand hygiene performance rates. Reductions in non-C. difficile HAIs occurred but were not statistically significant.
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Wilmont S, Hessels AJ, Kelly AM, Larson EL. Family Experiences and Perspectives on Infection Prevention in Pediatric Long-Term Care. Rehabil Nurs 2019; 43:307-314. [PMID: 30395556 PMCID: PMC6221461 DOI: 10.1097/rnj.0000000000000013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Residents of pediatric long-term care facilities (pLTCF) are particularly vulnerable to healthcare-associated infections. The aims of this qualitative study were to (a) explore perspectives on infection prevention among families visiting children in pLTCF and (b) identify facilitators of and barriers to optimal hand hygiene. DESIGN AND METHODS Semistructured, in-depth interviews with 10 family members visiting two New York City metropolitan area facilities were analyzed to identify themes. FINDINGS "Everyone follows the rules" and "infections are inevitable" were primary themes. Participants reported "common sense" as a facilitator and "distraction" as a major barrier to prevention practices. CONCLUSION Current education for visitors may be inadequate to improve infection prevention behaviors. CLINICAL RELEVANCE Nurse-led education strategies for infection prevention should be tested and modified for families visiting pLTCF.
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Affiliation(s)
- Sibyl Wilmont
- The Center for Interdisciplinary Research to Prevent Infections, Columbia University School of Nursing, New York
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23
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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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Ndegwa L, Hatfield KM, Sinkowitz-Cochran R, D’Iorio E, Gupta N, Kimotho J, Woodard T, Chaves SS, Ellingson K. Evaluation of a program to improve hand hygiene in Kenyan hospitals through production and promotion of alcohol-based Handrub - 2012-2014. Antimicrob Resist Infect Control 2019; 8:2. [PMID: 30622703 PMCID: PMC6318974 DOI: 10.1186/s13756-018-0450-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022] Open
Abstract
Although critical to prevent healthcare-associated infections, hand hygiene (HH) compliance is poor in resource-limited settings. In 2012, three Kenyan hospitals began onsite production of alcohol-based handrub (ABHR) and HH promotion. Our aim is to determine the impact of local production of ABHR on HH compliance and perceptions of ABHR. We observed 25,738 HH compliance opportunities and conducted 15 baseline and post-intervention focus group discussions. Hand Hygiene compliance increased from 28% (baseline) to 38% (post-intervention, p = 0.0003). Healthcare workers liked the increased accessibility of ABHR, but disliked its smell, feel, and sporadic availability. Onsite production and promotion of ABHR resulted in modest HH improvement. Enhancing the quality of ABHR and addressing logistical barriers could improve program impact.
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Affiliation(s)
- Linus Ndegwa
- Influenza Program, US Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - Kelly M. Hatfield
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Ronda Sinkowitz-Cochran
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Emily D’Iorio
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Neil Gupta
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - James Kimotho
- Production Unit, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Tiffanee Woodard
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Sandra S. Chaves
- Influenza Program, US Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
- Influenza Division, National Center for Immunization and Respiratory Disease, US Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Katherine Ellingson
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA USA
- Department of Epidemiology and Biostatistics, The University of Arizona College of Public Health, Tucson, Arizona USA
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Del Río-Carbajo L, Vidal-Cortés P. Types of antiseptics, presentations and rules of use. Med Intensiva 2018; 43 Suppl 1:7-12. [PMID: 30447857 DOI: 10.1016/j.medin.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/11/2018] [Accepted: 09/20/2018] [Indexed: 11/17/2022]
Abstract
Antiseptics are chemical substances that when applied topically onto intact skin, mucous membranes or wounds partially or completely reduces the population of living microorganisms in those tissues. Different types of antiseptics are available - those most commonly used in clinical practice being alcohols, iodinated compounds and chlorhexidine. When using an antiseptic, consideration is required of its spectrum of antimicrobial activity, latency, residual effects, possible interferences of the presence of organic material with the activity of the antiseptic, its side effects, compatibility with other antiseptics, and cost. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Affiliation(s)
- L Del Río-Carbajo
- Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - P Vidal-Cortés
- Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, España.
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Gilmartin H, Saint S, Rogers M, Winter S, Snyder A, Quinn M, Chopra V. Pilot randomised controlled trial to improve hand hygiene through mindful moments. BMJ Qual Saf 2018; 27:799-806. [PMID: 29463769 DOI: 10.1136/bmjqs-2017-007359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/25/2018] [Accepted: 01/29/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND To evaluate the effectiveness of a brief mindfulness intervention on hand hygiene performance and mindful attention for inpatient physician teams. DESIGN A pilot, pre-test/post-test randomised controlled mixed methods trial. SETTING One academic medical centre in the USA. PARTICIPANTS Four internal medicine physician teams consisting of one attending, one resident, two to three interns and up to four medical students. INTERVENTION A facilitated, group-based educational discussion on how mindfulness, as practised through mindful hand hygiene, may improve clinical care and practices in the hospital setting. MAIN OUTCOMES AND MEASURES The primary outcome was hand hygiene adherence (percentage) for each patient encounter. Other outcomes were observable mindful moments and mindful attention, measured using the Mindfulness Attention Awareness Scale, from baseline to post-intervention, and qualitative evaluation of the intervention. RESULTS For attending physicians, hand hygiene adherence increased 14.1% in the intervention group compared with a decrease of 5.7% in the controls (P=0.035). For residents, the comparable figures were 24.7% (intervention) versus 0.2% (control) (P=0.064). For interns, adherence increased 10.0% with the intervention versus 4.2% in the controls (P=0.007). For medical students, adherence improved more in the control group (4.7% intervention vs 7.7% controls; P=0.003). An increase in mindfulness behaviours was observed for the intervention group (3.7%) versus controls (0.9%) (P=0.021). Self-reported mindful attention did not change (P=0.865). CONCLUSIONS A brief, education-based mindfulness intervention improved hand hygiene in attending physicians and residents, but not in medical students. The intervention was well-received, increased mindfulness practice, and appears to be a feasible way to introduce mindfulness in the clinical setting. Future work instructing clinicians in mindfulness to improve hand hygiene may prove valuable. TRIAL REGISTRATION NUMBER NCT 03165799; Results.
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Affiliation(s)
- Heather Gilmartin
- Denver/Seattle Center of Innovation, Denver VA Medical Center, Denver, Colorado, USA
| | - Sanjay Saint
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Rogers
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Suzanne Winter
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashley Snyder
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Martha Quinn
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vineet Chopra
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev (Orlando) 2017; 32:36-57. [PMID: 28811074 DOI: 10.1016/j.trre.2017.07.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 12/17/2022]
Abstract
Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.
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Padgette P. Understanding and Improving Surgical Hand Hygiene Compliance. AORN J 2017; 105:614-618. [PMID: 28554358 DOI: 10.1016/j.aorn.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/18/2017] [Indexed: 11/17/2022]
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29
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Wu KS, Chen YS, Lin HS, Hsieh EL, Chen JK, Tsai HC, Chen YH, Lin CY, Hung CT, Sy CL, Tseng YT, Lee SSJ. A nationwide covert observation study using a novel method for hand hygiene compliance in health care. Am J Infect Control 2017; 45:240-244. [PMID: 27838163 DOI: 10.1016/j.ajic.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evaluation and feedback is a core hand hygiene (HH) improvement strategy. The covert observation method avoids observation bias inherent to the overt method. The aim of the study was to observe HH compliance by a novel covert method in a real-world setting. METHODS We conducted a 2-year, nationwide, prospective, observational study in teaching hospitals across Taiwan. Medical students and students who may have contact with patients in their careers were recruited as participants. A novel, shorthand notation method for covert observation was used. Observation results were reported through a study website. RESULTS There were a total of 25,379 HH opportunities covertly observed by 93 observers. Overall HH compliance was 32.0%. Health care workers had the highest HH compliance for indication 4 (42.6%), and the lowest for indication 5 (21.7%). Overall handrubbing percentage was high, reaching 83.6%. The HH compliance increased significantly with an increase in the number of indications within 1 HH opportunity (P < .001). CONCLUSIONS The overall HH compliance by the covert observation method was low. An innovative shorthand notation method facilitated covert observation, and website reporting was demonstrated to be feasible for large-scale observation.
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New Strategies to Monitor Healthcare Workers’ Hand Hygiene Compliance. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017. [DOI: 10.1007/s40506-017-0111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Galiczewski JM, Shurpin KM. An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure. Intensive Crit Care Nurs 2017; 40:26-34. [PMID: 28237090 DOI: 10.1016/j.iccn.2016.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 12/06/2016] [Accepted: 12/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality. AIM The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates. METHODS This case control study was conducted in a medical intensive care unit. During phase I, a retrospective data review was conducted on utilsiation and urinary catheter infection rates when practitioners followed the institution's standard insertion algorithm. During phase II, an intervention of direct observation was added to the standard insertion procedure. RESULTS The results demonstrated no change in utilization rates, however, CAUTI rates decreased from 2.24 to 0 per 1000 catheter days. CONCLUSION The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes.
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Affiliation(s)
- Janet M Galiczewski
- Stony Brook University School of Nursing, United States; Long Island Jewish Medical Center, United States.
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Sustained High Level of Healthcare Worker Adherence With Hand Hygiene Practice Recommendations Using the Patient-as-Observer Approach in the Ambulatory Setting. Infect Control Hosp Epidemiol 2016; 37:1496-1498. [PMID: 27697087 DOI: 10.1017/ice.2016.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report on a quality improvement initiative for hand hygiene adherence using the patient-as-observer method in the ambulatory setting. There were 604,661 observations recorded with improvement of adherence from 88% to 95% or greater; alcohol-based hand sanitizer purchasing correlated with this increase. This sustainable method effectively ensures hand hygiene adherence. Infect Control Hosp Epidemiol 2016;1496-1498.
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Wood A. Clinical Issues—October 2016. AORN J 2016; 104:357-363. [DOI: 10.1016/j.aorn.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/08/2016] [Indexed: 10/20/2022]
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Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S108-32. [DOI: 10.1017/s0899823x00193882] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistantStaphylococcus aureus(MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals,” published in 2008. 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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Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review. Infect Control Hosp Epidemiol 2016; 37:567-75. [PMID: 26861117 DOI: 10.1017/ice.2015.341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3) quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation. DESIGN Systematic review METHODS A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and assessment of study quality was conducted for each study reviewed. RESULTS A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100 (20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most frequently reported measure. CONCLUSIONS Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To facilitate replication and effective implementation, reporting fidelity should be standard practice when describing results of complex behavioral interventions such as hand hygiene.
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O'Reilly K, Ruokis S, Russell K, Teves T, DiLibero J, Yassa D, Berry H, Howell MD. Standard work for room entry: Linking lean, hand hygiene, and patient-centeredness. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 4:45-51. [PMID: 27001098 DOI: 10.1016/j.hjdsi.2015.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/07/2015] [Accepted: 12/27/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Healthcare-associated infections are costly and fatal. Substantial front-line, administrative, regulatory, and research efforts have focused on improving hand hygiene. PROBLEM While broad agreement exists that hand hygiene is the most important single approach to infection prevention, compliance with hand hygiene is typically only about 40%(1). GOALS Our aim was to develop a standard process for room entry in the intensive care unit that improved compliance with hand hygiene and allowed for maximum efficiency. STRATEGY We recognized that hand hygiene is a single step in a substantially more complicated process of room entry. We applied Lean engineering techniques to develop a standard process that included both physical steps and also standard communication elements from provider to patients and families and created a physical environment to support this. RESULTS We observed meaningful improvement in the performance of the new standard as well as time savings for clinical providers with each room entry. We also observed an increase in room entries that included verbal communication and an explanation of what the clinician was entering the room to do. IMPLICATIONS The design and implementation of a standardized room entry process and the creation of an environment that supports that new process has resulted in measurable positive outcomes on the medical intensive care unit, including quality, patient experience, efficiency, and staff satisfaction. Designing a process, rather than viewing tasks that need to happen in close proximity in time (either serially or in parallel) as unrelated, simplifies work for staff and results in higher compliance to individual tasks.
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Affiliation(s)
- Kristin O'Reilly
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States.
| | - Samantha Ruokis
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Kristin Russell
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Tim Teves
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Justin DiLibero
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - David Yassa
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Hannah Berry
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
| | - Michael D Howell
- Critical Care Quality, Silverman Institute for Healthcare Quality, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston 02215, MA, United States
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Banach DB, Bearman GM, Morgan DJ, Munoz-Price LS. Infection control precautions for visitors to healthcare facilities. Expert Rev Anti Infect Ther 2015; 13:1047-50. [DOI: 10.1586/14787210.2015.1068119] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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