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Reinoso Schiller N, Bludau A, Mathes T, König A, von Landesberger T, Scheithauer S. Unpacking nudge sensu lato: insights from a scoping review. J Hosp Infect 2024; 143:168-177. [PMID: 37949370 DOI: 10.1016/j.jhin.2023.11.001] [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: 09/13/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Nudges may play an important role in improving infection prevention and control (IPC) in hospitals. However, despite the novelty of the framework, their objectives, strategies and implementation approaches are not new. This review aims to provide an overview of the methods typically used by nudge interventions in IPC in hospitals targeting healthcare workers (HCWs). The initial search in PubMed yielded nine hits. Consequently, the search criteria were broadened and a second search was conducted, introducing 'nudge sensu lato' which incorporates insights from sources beyond the traditional nudge framework while maintaining the same objectives, strategies and approaches. During the second search, PubMed, Epistemonikos, Web of Science and PsycInfo were searched in accordance with the PRISMA guidelines. Abstracts were screened, and reviewers from an interdisciplinary team read the full text of selected papers. In total, 5706 unique primary studies were identified. Of these, 67 were included in the review, and only four were listed as nudge sensu stricto, focusing on changing HCWs' hand hygiene. All articles reported positive intervention outcomes. Of the 56 articles focused on improving hand hygiene compliance, 71.4% had positive outcomes. For healthcare equipment disinfection, 50% of studies showed significant results. Guideline adherence interventions had a 66.7% significant outcome rate. The concept of nudge sensu lato was introduced, encompassing interventions that employ strategies, methods and implementation approaches found in the nudge framework. The findings demonstrate that this concept can enhance the scientific development of more impactful nudges. This may help clinicians, researchers and policy makers to develop and implement effective nudging interventions.
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Affiliation(s)
- N Reinoso Schiller
- Department for Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany.
| | - A Bludau
- Department for Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - T Mathes
- Department of Medical Statistics, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - A König
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
| | - T von Landesberger
- Chair for Visualization and Visual Analytics, University of Cologne, Cologne, Germany
| | - S Scheithauer
- Department for Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University Göttingen, Göttingen, Germany
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Yehouenou CL, Abedinzadeh A, Houngnihin R, Baxerres C, Dossou FM, Simon A, Dalleur O. Understanding Hand Hygiene Behavior in a Public Hospital in Benin Using the Theoretical Domain Frameworks: The First Step for Designing Appropriate Interventions. Healthcare (Basel) 2022; 10:healthcare10101924. [PMID: 36292370 PMCID: PMC9602033 DOI: 10.3390/healthcare10101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/15/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2022] Open
Abstract
Background: Hand Hygiene (HH) is widely recognized to be one of the most successful and cost-effective measures for reducing the incidence of healthcare-associated infections (HAIs). The hand hygiene behavior of hospital healthcare workers (HCWs) is not well-documented in Benin. Therefore, Theoretical Domains Framework (TDF) was used to identify the behavioral determinants that may impact HCWs’ hand-hygiene compliance in a public hospital. Methods: A qualitative design comprising face-to-face semi-structured interviews with nine HCWs. The interviews included questions on transmission of infections, hand-hygiene practices, problems with their implementation; and ways to improve hand hygiene compliance. Two pharmacists independently coded interviews into behavioral domains using the TDF and then subdivided them into several themes. Interview transcripts were analyzed following 3-steps approach: coding, generation of specific beliefs, and identification of relevant domains. Results: Almost all interviewees have cited the environmental context and resources (such as lack of water) as a barrier to HH practice. They also believed that role models had a significant impact on the good practices of others HCWs. Fortunately, they were confident of their capabilities to perform appropriate HH behaviors. The majority (7/9) reported having the necessary knowledge and skills and believed they could carry out appropriate HH behavior. In all cases, the participants were motivated to carry out HH behavior, and it was recognized that HH remains the cornerstone to reduce health care associated infections. Conclusion: This study identified several behavioral constructs aligned with the TDF that can be targeted and help for the development of new hand-hygiene interventions. These may increase the likelihood of a successful intervention, thereby improving HH compliance and patient safety, especially in hospitals.
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Affiliation(s)
- Carine Laurence Yehouenou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, 1200 Brussels, Belgium
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou BP 817, Benin
- Faculté des Sciences de la Santé (FSS), Université d’Abomey Calavi (UAC), Cotonou 01 BP 526, Benin
- Correspondence: or
| | - Aynaz Abedinzadeh
- Service de Pharmacie Clinique, Clinique Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium
| | - Roch Houngnihin
- Laboratoire d’Anthropologie Médicale Appliquée (LAMA), Université d’Abomey-Calavi, Cotonou 01 BP 188, Benin
| | - Carine Baxerres
- UMR261-MERIT, French National Research Institute for Sustainable Development (IRD), University of Paris, 75006 Paris, France
- UMR151-LPED, IRD, Aix Marseille Université, 13005 Marseille, France
| | - Francis M. Dossou
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, Campus Universitaire, Champs de Foire, Cotonou 01 BP 118, Benin
| | - Anne Simon
- Centres Hospitaliers Jolimont, Prévention et Contrôle des Infections, Groupe Jolimont Asbl, Rue Ferrer, 7100 Haine-Saint-Paul, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, 1200 Brussels, Belgium
- Service de Pharmacie Clinique, Clinique Universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium
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Bredin D, O'Doherty D, Hannigan A, Kingston L. Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis. J Hosp Infect 2022; 130:20-33. [PMID: 36089071 DOI: 10.1016/j.jhin.2022.08.013] [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: 05/26/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct observation of hand hygiene compliance is the "gold standard" despite limitations and potential for bias. Previous literature highlights poorer hand hygiene compliance amongst physicians than nurses and suggests that covert monitoring may give better compliance estimates than overt monitoring. AIM This review aimed to explore differences in compliance between physicians and nurses further, and to analyse if compliance estimates differed when observations were covert rather than overt. METHODS A systematic search of databases PubMed, EMBASE, CENTRAL and CINAHL was performed. Experimental or observational studies in hospital settings in high-income countries published in English from 2010 onwards were included if estimates for both physicians and nurses using direct observation were reported. The search yielded 4814 studies, of which 105 were included. FINDINGS The weighted pooled compliance rate for nurses was 52% (95% CI 47% to 57%) and for doctors was 45% (95% CI 40% to 49%). Heterogeneity was considerable (I2=99%). The majority of studies were at moderate or high risk of bias. Random-effects meta-analysis of low risk of bias studies suggests higher compliance for nurses than physicians for both overt (difference of 7%, 95% CI for the difference 0.8% to 13.5%, p=0.027) and covert (difference of 7%, 95% CI 3% to 11%, p=0.0002) observation. Considerable heterogeneity was found in all analyses. CONCLUSION Wide variability in compliance estimates and differences in the methodological quality of hand hygiene studies were identified. Further research with meta-regression should explore sources of heterogeneity and improve the conduct and reporting of hand hygiene studies.
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Affiliation(s)
- D Bredin
- School of Medicine, University of Limerick, Ireland
| | - D O'Doherty
- School of Medicine, University of Limerick, Ireland
| | - A Hannigan
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - L Kingston
- Department of Nursing and Midwifery, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
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Amrein MA, Ruschetti GG, Baeder C, Bamert M, Inauen J. Mobile intervention to promote correct hand hygiene at key times to prevent COVID-19 in the Swiss adult general population: study protocol of a multiphase optimisation strategy. BMJ Open 2022; 12:e055971. [PMID: 35351716 PMCID: PMC8960462 DOI: 10.1136/bmjopen-2021-055971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Behaviour change is key to the public health measures that have been issued in many countries worldwide to contain COVID-19. Public health measures will only take preventive effect if people adhere to them. Interventions taking health psychology approaches may promote adherence to public health measures. However, evidence from randomised controlled behaviour change trials is scarce during an ongoing pandemic. We aim to use the example of hand washing with soap to optimise and test a digital, theory-based and evidence-based behaviour change intervention to prevent the spread of COVID-19. METHODS AND ANALYSIS This protocol describes the multiphase optimisation strategy for the preparation, optimisation and evaluation of a theory-based and evidence-based intervention delivered via app. The app aims to promote correct hand hygiene at key times in the adult general population. The study will be conducted in German-speaking Switzerland. The preparation phase has identified relevant behavioural determinants of hand hygiene during a pandemic from health behaviour theories and formative research with focus groups (n=8). The optimisation phase will identify the most effective and acceptable combination and sequence of three intervention modules in a parallel randomised trial (n=387) with analysis of variance (ANOVA) and regression analysis. Additionally, thematic analysis of qualitative interview data (n=15) will be used to gain insights on the feasibility, usability and satisfaction of the intervention. The evaluation phase will test the optimised intervention against an active control group in a randomised controlled trial (n=205), analysing pre-post differences and 6-month follow-up effects with ANOVA and regression analysis. ETHICS AND DISSEMINATION The trial was approved by the Cantonal Ethics Commission Bern of the Swiss Association of Research Ethics Committees (protocol ID: 2021-00164). Final results will be presented in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER NCT04830761.
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Affiliation(s)
| | | | - Carole Baeder
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Melanie Bamert
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Jennifer Inauen
- Institute of Psychology, University of Bern, Bern, Switzerland
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Ferren MD, Von Ah D, Stolldorf DP, Newhouse RP. Seeking to Understand: Qualitative Research on Sustainability of Evidence-Based Practice in Acute Care. J Nurs Adm 2022; 52:138-145. [PMID: 35179141 DOI: 10.1097/nna.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to describe cultural characteristics, values, and beliefs that influence sustainability of an evidence-based practice (EBP) intervention in the acute care clinical setting. BACKGROUND There is an urgent need to identify best practices to sustain EBP to gain efficiencies in nursing care delivery and improve patient outcomes. METHODS A focused ethnographic qualitative study was conducted in a community hospital with nurses that used Screening, Brief Intervention, and Referral to Treatment (SBIRT). RESULTS Customizing the intervention to the unit culture evolved and was crucial for sustainability. Overlap in responsibilities, time, clinician confidence, and impact to workflow were noted as negative influences. The intervention was primarily viewed as a task to be checked off a list instead of a tool that informs the patient's plan of care. CONCLUSIONS Assessing clinician experiences, beliefs, and values of an EBP should be incorporated into a strategic sustainability plan. Clinician understanding of how an EBP can advance the patient plan of care could promote ownership of professional practice and sustainment.
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Affiliation(s)
- Melora D Ferren
- Author Affiliations : Vice President/Associate Chief Nurse Executive (Dr Ferren), Indiana University Health, Indianapolis; Distinguished Professor of Cancer Research, College of Nursing, and Director of Cancer Research (Dr Von Ah), The Ohio State University, Columbus; Assistant Professor (Dr Stolldorf), Vanderbilt University School of Nursing, Nashville, Tennessee; and Distinguished Professor and Dean (Dr Newhouse), Indiana University School of Nursing, Indianapolis
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Chong CY, Catahan MA, Lim SH, Jais T, Kaur G, Yin S, de Korne D, Thoon KC, Ng KC. Patient, staff empowerment and hand hygiene bundle improved and sustained hand hygiene in hospital wards. J Paediatr Child Health 2021; 57:1460-1466. [PMID: 33908109 DOI: 10.1111/jpc.15526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/29/2022]
Abstract
AIM We piloted a hand hygiene (HH) project in a ward, focusing on World Health Organization moments 1 and 4. Our aim was to design highly reliable interventions to achieve >90% compliance. METHODS Baseline HH compliance was 57 and 67% for moments 1, 4, respectively, in 2015. After the pilot ward showed sustained improvement, we launched the 'HH bundle' throughout the hospital. This included: (i) appointment of HH champions; (ii) verbal/visual bedside reminders; (iii) patient empowerment; (iv) hand moisturisers; (v) tagging near-empty handrub (HR) bottles. Other hospital-wide initiatives included: (vi) Smartphone application for auditing; (vii) 'Speak up for Patient Safety' Campaign in 2017 for staff empowerment; (viii) making HH a key performance indicator. RESULTS Overall HH compliance increased from a baseline median of 79.6-92.6% in end-2019. Moments 1 and 4 improved from 71 to 92.7% and from 77.6 to 93.2%, respectively. Combined HR and hand wash consumption increased from a baseline median of 82.6 ml/patient day (PD) to 109.2 mL/PD. Health-care-associated rotavirus infections decreased from a baseline median of 4.5 per 10 000 PDs to 1.5 per 10 000 PDs over time. CONCLUSIONS The 'HH Bundle' of appointing HH champions, active reminders and feedback, patient education and empowerment, availability of hand moisturisers, tagging near-empty hand rub bottles together with hospital-wide initiatives including financial incentives and the 'Speak Up for Patient Safety' campaign successfully improved the overall HH compliance to >90%. These interventions were highly reliable, sustained over 4 years and also reduced health-care-associated rotavirus infection rates.
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Affiliation(s)
- Chia Yin Chong
- Infectious Diseases, Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Siok Hong Lim
- Infection Control, Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Thuraiya Jais
- Ward 55, Urgent Obstetric and Gynecology Centre, Division of Nursing, KK Women's and Children's Hospital, Singapore
| | - Gian Kaur
- Specialty and Ambulatory Services, KK Women's and Children's Hospital, Singapore
| | - Shanqing Yin
- Chairman Medical Board Office, KK Women's and Children's Hospital, Singapore
| | - Dirk de Korne
- Medical Innovation & Care Transformation, KK Women's & Children's Hospital, Singapore.,Department of Care and Welfare, SVRZ Cares in Zeeland, Middelburg, Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Koh Cheng Thoon
- Infectious Diseases, Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kee Chong Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Paediatrics, Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Chairman Medical Board Office, KK Women's and Children's Hospital, Singapore
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Mishra A, Dutta S, Basu M. Hand hygiene in housekeeping staffs: An assessment of their perceptions and practices in a tertiary care hospital of Kolkata. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_415_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Barker AK, Scaria E, Safdar N, Alagoz O. Evaluation of the Cost-effectiveness of Infection Control Strategies to Reduce Hospital-Onset Clostridioides difficile Infection. JAMA Netw Open 2020; 3:e2012522. [PMID: 32789514 PMCID: PMC7426752 DOI: 10.1001/jamanetworkopen.2020.12522] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/25/2020] [Indexed: 12/14/2022] Open
Abstract
Importance Clostridioides difficile infection is the most common hospital-acquired infection in the United States, yet few studies have evaluated the cost-effectiveness of infection control initiatives targeting C difficile. Objective To compare the cost-effectiveness of 9 C difficile single intervention strategies and 8 multi-intervention bundles. Design, Setting, and Participants This economic evaluation was conducted in a simulated 200-bed tertiary, acute care, adult hospital. The study relied on clinical outcomes from a published agent-based simulation model of C difficile transmission. The model included 4 agent types (ie, patients, nurses, physicians, and visitors). Cost and utility estimates were derived from the literature. Interventions Daily sporicidal cleaning, terminal sporicidal cleaning, health care worker hand hygiene, patient hand hygiene, visitor hand hygiene, health care worker contact precautions, visitor contact precautions, C difficile screening at admission, and reduced intrahospital patient transfers. Main Outcomes and Measures Cost-effectiveness was evaluated from the hospital perspective and defined by 2 measures: cost per hospital-onset C difficile infection averted and cost per quality-adjusted life-year (QALY). Results In this agent-based model of a simulated 200-bed tertiary, acute care, adult hospital, 5 of 9 single intervention strategies were dominant, reducing cost, increasing QALYs, and averting hospital-onset C difficile infection compared with baseline standard hospital practices. They were daily cleaning (most cost-effective, saving $358 268 and 36.8 QALYs annually), health care worker hand hygiene, patient hand hygiene, terminal cleaning, and reducing intrahospital patient transfers. Screening at admission cost $1283/QALY, while health care worker contact precautions and visitor hand hygiene interventions cost $123 264/QALY and $5 730 987/QALY, respectively. Visitor contact precautions was dominated, with increased cost and decreased QALYs. Adding screening, health care worker hand hygiene, and patient hand hygiene sequentially to the daily cleaning intervention formed 2-pronged, 3-pronged, and 4-pronged multi-intervention bundles that cost an additional $29 616/QALY, $50 196/QALY, and $146 792/QALY, respectively. Conclusions and Relevance The findings of this study suggest that institutions should seek to streamline their infection control initiatives and prioritize a smaller number of highly cost-effective interventions. Daily sporicidal cleaning was among several cost-saving strategies that could be prioritized over minimally effective, costly strategies, such as visitor contact precautions.
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Affiliation(s)
- Anna K. Barker
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Elizabeth Scaria
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin–Madison
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Oguzhan Alagoz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin–Madison
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Multifaceted interventions for healthcare-associated infections and rational use of antibiotics in a low-to-middle-income country: Can they be sustained? PLoS One 2020; 15:e0234233. [PMID: 32544154 PMCID: PMC7297356 DOI: 10.1371/journal.pone.0234233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transmission of infection between patients by health workers, and the irrational use of antibiotics are preventable causes for healthcare-associated infections (HAI) and multi-resistant organisms. A previous study implementing a hand hygiene campaign and antibiotic stewardship program significantly reduced these infections. Sustaining such interventions can be challenging. AIMS To evaluate whether there was a sustained effect of a multifaceted infection control and antibiotic stewardship program on HAI and antibiotic use 5 years after it began. METHODS A prospective evaluation study was conducted over 26 months (from February 2016 to April 2018) in a teaching hospital in Indonesia, 5 years after the implementation of an antibiotic stewardship and infection control program, which was successful when initially evaluated. All children admitted to the pediatric ICU and pediatric wards were observed daily. Assessment of HAI was made based on the criteria from the Centers for Disease Control and Prevention. Assessment of rational antibiotic use was based on the WHO Pocket Book of Hospital Care for Children. Multivariable logistic regression analysis was used to quantify the relationship between the HAI and the multifaceted intervention. RESULTS We observed an increase in HAIs, from 8.6% (123/1419 patients) in the initial post-intervention period in 2011-2013 to 16.9% (314/1855) in the evaluation study (relative risk (RR) (95% CI) 1.95 (1.60 to 2.37)). After adjusting for potential confounders, we found that an increase in HAI in the evaluation period with adjusted OR 1.94 (95% CI 1.53 to 2.45). Inappropriate antibiotic use also increased, from 20.6% (182 of 882 patients who were prescribed antibiotics) to 48.6% (545/1855) (RR 2.35 (2.04 to 2.71)). Hand hygiene compliance also declined from 62.9% (1125/1789) observed moments requiring hand hygiene to 51% (1526/2993) (RR 3.33 (2.99 to 3.70)). CONCLUSIONS Healthcare-associated infections and irrational use of antibiotics remain significant even after the implementation of a multifaceted infection control intervention and antibiotic stewardship program. There is a need for continuous input, ongoing surveillance and long-term monitoring of these interventions to sustain compliance and effectiveness and address problems as they emerge.
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Suzuki Y, Morino M, Morita I, Yamamoto S. The effect of a 5-year hand hygiene initiative based on the WHO multimodal hand hygiene improvement strategy: an interrupted time-series study. Antimicrob Resist Infect Control 2020; 9:75. [PMID: 32460892 PMCID: PMC7251720 DOI: 10.1186/s13756-020-00732-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/08/2020] [Indexed: 01/09/2023] Open
Abstract
Background A World Health Organization (WHO) guideline-based multimodal hand hygiene (HH) initiative was introduced hospital-wide to a nonteaching Japanese hospital for 5 years. The objective of this study was to assess the effect of this initiative in terms of changes in alcohol-based hand rub (ABHR) consumption and the Hand Hygiene Self-Assessment Framework (HHSAF) score. Methods The consumption of monthly hospital-wide ABHR was calculated in L per 1000 patient days (PDs). The change in ABHR consumption was analysed by an interrupted time series analysis with a pre-implementation period of 36 months and an implementation period of 60 months. The correlation between annual ABHR consumption and the HHSAF score was estimated using Pearson’s correlation coefficients. Results The annual ABHR consumption was 4.0 (L/1000 PDs) to 4.4 in the pre-implementation period and 10.4 to 34.4 in the implementation period. The HHSAF score was 117.5 (out of 500) in the pre-implementation period and 267.5 to 445 in the implementation period. A statistically significant increase in the monthly ABHR consumption (change in slope: + 0.479 L/1000 PDs, p < 0.01) was observed with the implementation of the initiative. Annual ABHR consumption was strongly correlated with the annual HHSAF score (r = 0.971, p < 0.01). Conclusions A 5-year WHO-based HH initiative significantly increased ABHR consumption. Our study suggested that the HHSAF assessment can be a good process measure to improve HH in a single facility, as ABHR consumption increased with the HHSAF score.
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Affiliation(s)
- Yumi Suzuki
- Department of Pediatrics, National Hospital Organization (NHO) Shimoshizu National Hospital, 934-5 Shikawatashi, Yotsukaido, 284-0003, Chiba, Japan. .,Division of Infection Control, NHO Shimoshizu National Hospital, Yotsukaidou, Japan.
| | - Motoko Morino
- Division of Infection Control, NHO Shimoshizu National Hospital, Yotsukaidou, Japan.,Department of Nursing, NHO Shimoshizu National Hospital, Yotsukaidou, Japan
| | - Ichizo Morita
- Japanese Red Cross Toyota College of Nursing, 12-33 Nanamagari Hakusancho, Toyota, 471-8565, Aichi, Japan
| | - Shigenori Yamamoto
- Department of Pediatrics, National Hospital Organization (NHO) Shimoshizu National Hospital, 934-5 Shikawatashi, Yotsukaido, 284-0003, Chiba, Japan
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11
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[Factors that influence compliance with hand hygiene in healthcare professionals: A concept mapping study]. J Healthc Qual Res 2020; 35:103-112. [PMID: 32179017 DOI: 10.1016/j.jhqr.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify factors that may influence hand hygiene compliance by professional category and clinical department. MATERIALS AND METHODS Use was made of concept mapping methodology, a tool that combines a qualitative analysis with a quantitative statistical analysis, in order to identify the most influential and important factors for the fulfilment of hand hygiene in 2 clinical departments (Infectious and General Surgery) of the Hospital del Mar. RESULTS The study included a total of 42 volunteer professionals from General Surgery (6 doctors and 10 nurses) and from Infectious Diseases (11 doctors and 10 nurses) clinical departments, as well as 5 hospital porters. High correlations of influential and important factors for hand hygiene compliance were observed between nurses and doctors in the Infectious Diseases Department (r=0.93 vs. r=0.69, respectively). In contrast, the correlation was lower among surgical professionals (r=-0.17 for influence and r=0.51 for importance). Professionals identified the most influential factors in compliance as training and adequate resources, taking into account professional category and clinical department. CONCLUSION The design of interventions to improve compliance with hand hygiene should take into account the perceptions of different professionals in order to adapt actions to each professional group.
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12
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Oliveira AC, Gama CS, Paula AO. Multimodal strategy to improve the adherence to hand hygiene and self-assessment of the institution for the promotion and practice of hand hygiene. J Public Health (Oxf) 2019; 40:163-168. [PMID: 28369595 DOI: 10.1093/pubmed/fdx035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Indexed: 11/14/2022] Open
Abstract
Background Hand hygiene (HH) has a low rate of adherence worldwide. This study aimed to estimate the HH adherence rate before and after the implementation of the multimodal strategy and to perform a self-assessment of an institution for promotion and practice of HH. Methods Before and after study, conducted in a university hospital. Professionals of the medical and nursing staff were included. Data collection was from October 2013 to July 2015, through observations of the HH opportunities and application of the HH self-assessment instrument for the institution. Descriptive and univariate analysis were performed. Results A total of 9500 HH opportunities were observed. The rate of adherence to HH in pre-intervention period was 20.8%, compared to 16.2% and 15.7% in post-intervention. Regarding the evaluation of the institution, it did not have an established ongoing program of training of professionals, no feedback of HH rates to professionals. Conclusion The low rate of HH adherence reflected the evaluation of the institution in relation to its investment in the practice and promotion of HH, showing that the investment policy for HH adherence needs to be reviewed, considering that before the study the hospital has not been trained in the 'My Five Moments for HH'.
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Affiliation(s)
- A C Oliveira
- Post Doctorate from the University of New York. Associate Professor of the Federal University of Minas Gerais (UFMG) School of Nursing, Basic Nursing Department, 190 Av. Prof. Alfredo Balena - Santa Efigênia, 30130-100, Belo Horizonte, Minas Gerais, Brazil
| | - C S Gama
- Doctoral student in Federal University of Minas Gerais (UFMG) School of Nursing, Belo Horizonte, Brazil
| | - A O Paula
- PhD in Nursing from the Federal University of Minas Gerais (UFMG) School of Nursing, Technical consultant of GJO, Belo Horizonte, Brazil
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13
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Fehling P, Hasenkamp J, Unkel S, Thalmann I, Hornig S, Trümper L, Scheithauer S. Effect of gloved hand disinfection on hand hygiene before infection-prone procedures on a stem cell ward. J Hosp Infect 2019; 103:321-327. [PMID: 31226271 DOI: 10.1016/j.jhin.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hand hygiene compliance even before infection-prone procedures (indication 2, 'before aseptic tasks', according to the World Health Organization (WHO)) remains disappointing. AIM To improve hand hygiene compliance by implementing gloved hand disinfection as a resource-neutral process optimization strategy. METHODS We performed a three-phase intervention study on a stem cell transplant ward. After baseline evaluation of hand hygiene compliance (phase 1) gloved hand disinfection was allowed (phase 2) and restricted (phase 3) to evaluate and differentiate intervention derived from learning and time effects. The incidence of severe infections as well as of hospital-acquired multidrug-resistant bacteria was recorded by active surveillance. FINDINGS Hand hygiene compliance improved significantly from 50% to 76% (P < 0.001) when gloved hand disinfection was allowed. The biggest increase was for infection-prone procedures (WHO 2) from 31% to 65%; P < 0.001. Severe infections decreased by trend (from 6.0 to 2.5 per 1000 patient-days) whereas transmission of multidrug-resistant organisms was not affected. CONCLUSION Gloved hand disinfection significantly improved compliance with the hand hygiene, especially in activities relevant to infections and infection prevention. Thus, this process optimization may be an additional, easy implementable, resource-neutral tool for a highly vulnerable patient cohort.
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Affiliation(s)
- P Fehling
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany.
| | - J Hasenkamp
- Department of Hematology and Oncology, University Medical Center, Georg August University Goettingen, Germany
| | - S Unkel
- Department of Medical Statistics, University Medical Center, Georg August University Goettingen, Germany
| | - I Thalmann
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany
| | - S Hornig
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany
| | - L Trümper
- Department of Hematology and Oncology, University Medical Center, Georg August University Goettingen, Germany
| | - S Scheithauer
- Institute of Infection Control and Infectious Diseases, University Medical Center, Georg August University Goettingen, Germany
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14
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Yoo E, Ursua L, Clark R, Seok J, Jeon J, Kim HB. The effect of incorporating covert observation into established overt observation-based hand hygiene promotion programs. Am J Infect Control 2019; 47:482-486. [PMID: 30558992 DOI: 10.1016/j.ajic.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Covert observation (CO) is reliable for measuring hand hygiene compliance (HHC). However, the benefit of adding CO to overt observation (OO) is uncertain. We evaluated whether incorporating CO into an OO-based hand hygiene (HH) promotion program improves HH rate. METHODS Health care worker's HH activities were observed through 5 monitoring sessions (2 in phases 1 and 2 and 1 in phase 3) of simultaneous CO and OO. An intervention was applied-barrier identification interview-only in phase 2. RESULTS Overall HHC was 91.0% for OO, and 49.3% for CO. HHC in phase 1 was not changed by repeated CO (34.7% and 34.0%, P = .70). HHC based on CO increased to 66.9% in phase 2 after the application of an intervention (P < .01), but decreased to 57.5% in phase 3 (P < .01). HHC based on OO increased significantly between only the first and second sessions in phase 2 (90.8% and 94.5%, respectively, P = .01). DISCUSSION Although CO did not significantly change behavior, HHC with CO responded promptly to the application and cessation of a new intervention. CONCLUSIONS CO reflects HHC change more reliably than does OO. However, it is uncertain whether CO will improve HHC.
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15
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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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16
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Bowman LG, Hardesty SL, Sigurdsson SO, McIvor M, Orchowitz PM, Wagner LL, Hagopian LP. Utilizing Group-Based Contingencies to Increase Hand Washing in a Large Human Service Setting. Behav Anal Pract 2019; 12:600-611. [PMID: 31976267 DOI: 10.1007/s40617-018-00328-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Hand washing is the most important preventative measure for the reduction of contagious disease. Although hand washing is easy to perform, non-adherence is a ubiquitous problem. Several studies have demonstrated the effectiveness of multi-component intervention packages to improve hand washing among employees; however, interventions are limited to acute settings, are often implemented for a short period of time, and rarely, if ever, include information on long-term effectiveness. The purpose of the current study was to utilize a behavior analytic approach to determine the stimulus conditions under which hand washing should occur, and to assess and then implement a long-term monitoring system among direct care workers in a large, non-acute inpatient unit. A single-case repeated measures reversal design was used to evaluate the effectiveness of two interventions aimed at improving hand washing adherence. A lottery was found to be effective in increasing hand hygiene for 2-years with 170 staff.
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Affiliation(s)
- Lynn G Bowman
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA.,2Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Samantha L Hardesty
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA.,3University of Maryland, Baltimore County, Baltimore, MD USA
| | | | - Melissa McIvor
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA
| | - Phillip M Orchowitz
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA
| | - Leaora L Wagner
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA
| | - Louis P Hagopian
- 1Neurobehavioral Unit, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD 21205 USA.,2Johns Hopkins University School of Medicine, Baltimore, MD USA
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17
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Smith JD, Corace KM, MacDonald TK, Fabrigar LR, Saedi A, Chaplin A, MacFarlane S, Valickis D, Garber GE. Application of the Theoretical Domains Framework to identify factors that influence hand hygiene compliance in long-term care. J Hosp Infect 2018; 101:393-398. [PMID: 30594611 DOI: 10.1016/j.jhin.2018.12.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Healthcare worker (HCW) hand hygiene compliance is key to patient safety; however, compliance is suboptimal. Nevertheless hand hygiene compliance is not well studied in the long-term care setting. AIM To apply a behaviour change framework, the Theoretical Domains Framework (TDF), to identify modifiable facilitators and barriers for HCW hand hygiene compliance in long-term care settings. METHODS HCW hand hygiene compliance facilitators and barriers were examined using a questionnaire for HCWs from long-term care homes in Ontario, Canada. The questionnaire was informed by the TDF, which is based on a synthesis of constructs from a number of relevant psychological theories of behaviour change. FINDINGS Barriers identified from the questionnaire aligned with the TDF domain environmental context and resources (time pressure, workload, and environmental controls). Facilitators identified from questionnaire results aligned with the TDF domains social/professional role and identity (it is what is expected of HCWs), and beliefs about consequences (risk of transmission of micro-organisms to self or others). CONCLUSION There are several barriers to hand hygiene compliance that persist in long-term care. A behaviour change theory-informed framework such as the TDF can be helpful to identify those barriers. This study identified several key behavioural constructs aligned with the TDF that can be targeted when developing novel hand hygiene interventions.
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Affiliation(s)
- J D Smith
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - K M Corace
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - T K MacDonald
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - L R Fabrigar
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - A Saedi
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - A Chaplin
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - S MacFarlane
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - D Valickis
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - G E Garber
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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West G, Resendiz M, Lustik M. Assessing hand hygiene attitudes of inpatient nursing personnel in a US military hospital. J Hosp Infect 2018; 100:214-217. [DOI: 10.1016/j.jhin.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/15/2018] [Indexed: 10/16/2022]
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Barker AK, Alagoz O, Safdar N. Interventions to Reduce the Incidence of Hospital-Onset Clostridium difficile Infection: An Agent-Based Modeling Approach to Evaluate Clinical Effectiveness in Adult Acute Care Hospitals. Clin Infect Dis 2018; 66:1192-1203. [PMID: 29112710 PMCID: PMC5888988 DOI: 10.1093/cid/cix962] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022] Open
Abstract
Background Despite intensified efforts to reduce hospital-onset Clostridium difficile infection (HO-CDI), its clinical and economic impacts continue to worsen. Many institutions have adopted bundled interventions that vary considerably in composition, strength of evidence, and effectiveness. Considerable gaps remain in our knowledge of intervention effectiveness and disease transmission, which hinders HO-CDI prevention. Methods We developed an agent-based model of C. difficile transmission in a 200-bed adult hospital using studies from the literature, supplemented with primary data collection. The model includes an environmental component and 4 distinct agent types: patients, visitors, nurses, and physicians. We used the model to evaluate the comparative clinical effectiveness of 9 single interventions and 8 multiple-intervention bundles at reducing HO-CDI and asymptomatic C. difficile colonization. Results Daily cleaning with sporicidal disinfectant and C. difficile screening at admission were the most effective single-intervention strategies, reducing HO-CDI by 68.9% and 35.7%, respectively (both P < .001). Combining these interventions into a 2-intervention bundle reduced HO-CDI by 82.3% and asymptomatic hospital-onset colonization by 90.6% (both, P < .001). Adding patient hand hygiene to healthcare worker hand hygiene reduced HO-CDI rates an additional 7.9%. Visitor hand hygiene and contact precaution interventions did not reduce HO-CDI, compared with baseline. Excluding those strategies, healthcare worker contact precautions were the least effective intervention at reducing hospital-onset colonization and infection. Conclusions Identifying and managing the vast hospital reservoir of asymptomatic C. difficile by screening and daily cleaning with sporicidal disinfectant are high-yield strategies. These findings provide much-needed data regarding which interventions to prioritize for optimal C. difficile control.
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Affiliation(s)
- Anna K Barker
- Department of Population Health Sciences, School of Medicine and Public Health, Madison, Wisconsin
| | - Oguzhan Alagoz
- Department of Population Health Sciences, School of Medicine and Public Health, Madison, Wisconsin
- Department of Industrial and Systems Engineering, College of Engineering, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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20
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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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Esfandiari A, Salari H, Rashidian A, Masoumi Asl H, Rahimi Foroushani A, Akbari Sari A. Eliminating Healthcare-Associated Infections in Iran: A Qualitative Study to Explore Stakeholders' Views. Int J Health Policy Manag 2018; 7:27-34. [PMID: 29325400 PMCID: PMC5745865 DOI: 10.15171/ijhpm.2017.34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 03/13/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although preventable, healthcare-associated infections (HAIs) continue to pose huge health and economic burdens on countries worldwide. Some studies have indicated the numerous causes of HAIs, but only a tiny literature exists on the multifaceted measures that can be used to address the problem. This paper presents stakeholders' opinions on measures for controlling HAIs in Iran. METHODS We used the qualitative research method in studying the phenomenon. Through a purposive sampling approach, we conducted 24 face-to-face interviews using a semi-structured interview guide. Participants were mainly key informants, including policy-makers, health professionals, and technical officers across the national and subnational levels, including the Ministry of Health (MoH), medical universities, and hospitals in Iran. We performed thematic framework analysis using the software MAXQDA10. RESULTS Four main interdisciplinary themes emerged from our study of measures of controlling HAIs: strengthening governance and stewardship; strengthening human resources policies; appropriate prescription and usage of antibiotics; and environmental sanitation and personal hygiene. CONCLUSION According to our findings, elimination of HAIs demands multifactorial interventions. While the ultimate recommendation of policy-makers is to have HAIs among the priorities of the national agenda, financial commitment and the creation of an enabling work environment in which both patients and healthcare workers can practice personal hygiene could lead to a significant reduction in HAIs in Iran.
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Affiliation(s)
| | | | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Masoumi Asl
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran.,Research Center of Pediatric Infectious Diseases, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Vincent C, Carthey J, Macrae C, Amalberti R. Safety analysis over time: seven major changes to adverse event investigation. Implement Sci 2017; 12:151. [PMID: 29282080 PMCID: PMC5745912 DOI: 10.1186/s13012-017-0695-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Every safety-critical industry devotes considerable time and resource to investigating and analysing accidents, incidents and near misses. The systematic analysis of incidents has greatly expanded our understanding of both the causes and prevention of harm. These methods have been widely employed in healthcare over the last 20 years but are now subject to critique and reassessment. In this paper, we reconsider the purpose and value of incident analysis and methods appropriate to the healthcare of today. MAIN TEXT The primary need for a revised vision of incident analysis is that healthcare itself is changing dramatically. People are living longer, often with multiple co-morbidities which are managed over very long timescales. Our vision of safety analysis needs to expand concomitantly to embrace much longer timescales. Rather than think only in terms of the prevention of specific incidents, we need to consider the balance of benefit, harm and risks over long time periods encompassing the social and psychological impact of healthcare as well as physical effects. We argued for major changes in our approach to the analysis of safety events: assume that patients and families will be partners in investigation and where possible engage them fully from the beginning, examine much longer time periods and assess contributory factors at different time points in the patient journey, be more proportionate and strategic in analysing safety issues, seek to understand success and recovery as well as failure, consider the workability of clinical processes as well as deviations from them and develop a much more structured and wide-ranging approach to recommendations. CONCLUSIONS Previous methods of incident analysis were simply adopted and disseminated with little research into the concepts, methods, reliability and outcomes of such analyses. There is a need for significant research and investment in the development of new methods. These changes are profound and will require major adjustments in both practical and cultural terms and research to explore and evaluate the most effective approaches.
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Affiliation(s)
- Charles Vincent
- Department of Experimental Psychology, University of Oxford, 15 Parks Road, Oxford, OX1 3PW, UK.
| | | | - Carl Macrae
- Department of Experimental Psychology, University of Oxford, 15 Parks Road, Oxford, OX1 3PW, UK
| | - Rene Amalberti
- Haute Autorité de Santé, Paris, 5 Avenue du Stade de France, Saint-Denis, 93210, Paris, France
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23
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Construct validity-Current issues and recommendations for future hand hygiene research. Am J Infect Control 2017; 45:521-527. [PMID: 28285726 DOI: 10.1016/j.ajic.2017.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/20/2022]
Abstract
Health care-associated infection is a leading cause of morbidity and mortality. Hand hygiene is widely regarded as an effective prevention strategy. Often, hand hygiene research is designed and conducted by health care practitioners who may lack formal training in research methods, particularly in the area of social science. In a research context, a construct is a concept that can be measured or observed in some way. A construct can be directly or indirectly measured. For example, height can be directly measured by centimeters, whereas depression can be indirectly measured by a scale of 20 items. Every construct needs to be operationalized by measure(s) to make it a variable. Hence, construct validity refers to the degree of fit between the construct of interest and its operational measure. However, issues with construct validity often weaken the translation from construct to measure(s). This article will (1) describe the common threats to construct validity pertaining to hand hygiene research, (2) identify practical limitations in current research design, and (3) provide recommendations to improve construct validity in future hand hygiene research. By understanding how construct validity may affect hand hygiene research design, there is great potential to improve the validity of future hand hygiene research findings.
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Gould D, Creedon S, Jeanes A, Drey N, Chudleigh J, Moralejo D. Impact of observing hand hygiene in practice and research: a methodological reconsideration. J Hosp Infect 2017; 95:169-174. [DOI: 10.1016/j.jhin.2016.08.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/03/2016] [Indexed: 11/25/2022]
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25
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Storr J, Twyman A, Zingg W, Damani N, Kilpatrick C, Reilly J, Price L, Egger M, Grayson ML, Kelley E, Allegranzi B. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resist Infect Control 2017; 6:6. [PMID: 28078082 PMCID: PMC5223492 DOI: 10.1186/s13756-016-0149-9] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.
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Affiliation(s)
- Julie Storr
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Anthony Twyman
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Walter Zingg
- Infection Control Programme, and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Nizam Damani
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Claire Kilpatrick
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Jacqui Reilly
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Lesley Price
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA UK
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland
| | - M Lindsay Grayson
- Austin Health and University of Melbourne, 145 Studley Road, PO Box 5555, Heidelberg, VIC Australia
| | - Edward Kelley
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, HIS, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
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Neo JRJ, Sagha-Zadeh R, Vielemeyer O, Franklin E. Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review. Am J Infect Control 2016; 44:691-704. [PMID: 27240800 DOI: 10.1016/j.ajic.2015.11.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/28/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission and nosocomial infections. However, most HH interventions (HHI) have not been sustainable. AIMS This review aims to provide a comprehensive summary of recently published evidence-based HHI designed to improve HH compliance (HHC) that will enable health care providers to make informed choices when allocating limited resources to improve HHC and patient safety. METHODS The Medline electronic database (using PubMed) was used to identify relevant studies. English language articles that included hand hygiene interventions and related terms combined with health care environments or related terms were included. RESULTS Seventy-three studies that met the inclusion criteria were summarized. Interventions were categorized as improving awareness with education, facility design, and planning, unit-level protocols and procedures, hospital-wide programs, and multimodal interventions. Past successful HHIs may not be as effective when applied to other health care environments. HH education should be interactive and engaging. Electronic monitoring and reminders should be implemented in phases to ensure cost-effectiveness. To create hospitalwide programs that engage end users, policy makers should draw expertise from interdisciplinary fields. Before implementing the various components of multimodal interventions, health care practitioners should identify and examine HH difficulties unique to their organizations. CONCLUSIONS Future research should seek to achieve the following: replicate successful HHI in other health care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions, examine ways (eg, hospital leadership, financial support, and strategies from public health and infection prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs.
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Affiliation(s)
- Jun Rong Jeffrey Neo
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY.
| | - Rana Sagha-Zadeh
- Department of Design and Environmental Analysis, Cornell University, Ithaca, NY
| | - Ole Vielemeyer
- Division of Infectious Disease, Weill Cornell Medical College, New York, NY
| | - Ella Franklin
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC
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Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL. An organizational perspective on the long-term sustainability of a nursing best practice guidelines program: a case study. BMC Health Serv Res 2015; 15:535. [PMID: 26634343 PMCID: PMC4669651 DOI: 10.1186/s12913-015-1192-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many healthcare innovations are not sustained over the long term, wasting costly implementation efforts and often desperately-needed initial improvements. Although there have been advances in knowledge about innovation implementation, there has been considerably less attention focused on understanding what happens following the early stages of change. Research is needed to determine how to improve the 'staying power' of healthcare innovations. As almost no empirical knowledge exists about innovation sustainability in nursing, the purpose of our study was to understand how a nursing best practice guidelines (BPG) program was sustained over a long-term period in an acute healthcare centre. METHODS We conducted a qualitative descriptive case study to examine the program's sustainability at the nursing department level of the organization. The organization was a large, urban, multi-site acute care centre in Canada. The patient safety-oriented BPG program, initiated in 2004, consisted of an organization-wide implementation of three BPGs: falls prevention, pressure ulcer prevention, and pain management. Data were collected eight years following program initiation through 14 key informant interviews, document reviews, and observations. We developed a framework for the sustainability of healthcare innovations to guide data collection and content analysis. RESULTS Program sustainability entailed a combination of three essential characteristics: benefits, institutionalization, and development. A constellation of 11 factors most influenced the long-term sustainability of the program. These factors were innovation-, context-, leadership-, and process-related. Three key interactions between factors influencing program sustainability and characteristics of program sustainability accounted for how the program had been sustained. These interactions were between: leadership commitment and benefits; complementarity of leadership actions and both institutionalization and development; and a reflection-and-course-correction strategy and development. CONCLUSIONS Study findings indicate that the successful initial implementation of an organizational program does not automatically lead to longer-term program sustainability. The persistent, complementary, and aligned actions of committed leaders, in a variety of roles across a health centre department, seem necessary. Organizational leaders should consider a broad conceptualization of sustainability that extends beyond program institutionalization and/or program benefits. The development of an organizational program may be necessary for its long-term survival.
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Affiliation(s)
| | - Sonia E Semenic
- Ingram School of Nursing, McGill University, Montreal, Canada.
- McGill University Health Centre (MUHC), Montreal, Canada.
| | | | - Marie-Claire Richer
- Ingram School of Nursing, McGill University, Montreal, Canada.
- McGill University Health Centre (MUHC), Montreal, Canada.
| | - Jean-Louis Denis
- École nationale d'administration publique (ENAP), Montreal, Canada.
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Cure L, Van Enk R. Effect of hand sanitizer location on hand hygiene compliance. Am J Infect Control 2015; 43:917-21. [PMID: 26088769 DOI: 10.1016/j.ajic.2015.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hand hygiene is the most important intervention to prevent infection in hospitals. Health care workers should clean their hands at least before and after contact with patients. Hand sanitizer dispensers are important to support hand hygiene because they can be made available throughout hospital units. The aim of this study was to determine whether the usability of sanitizer dispensers correlates with compliance of staff in using the sanitizer in a hospital. This study took place in a Midwest, 404-bed, private, nonprofit community hospital with 15 inpatient care units in addition to several ambulatory units. METHODS The usability and standardization of sanitizers in 12 participating inpatient units were evaluated. The hospital measured compliance of staff with hand hygiene as part of their quality improvement program. Data from 2010-2012 were analyzed to measure the relationship between compliance and usability using mixed-effects logistic regression models. RESULTS The total usability score (P = .0046), visibility (P = .003), and accessibility of the sanitizer on entrance to the patient room (P = .00055) were statistically associated with higher observed compliance rates. Standardization alone showed no significant impact on observed compliance (P = .37). CONCLUSION Hand hygiene compliance can be influenced by visibility and accessibility of dispensers. The sanitizer location should be part of multifaceted interventions to improve hand hygiene.
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Srigley JA, Corace K, Hargadon DP, Yu D, MacDonald T, Fabrigar L, Garber G. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. J Hosp Infect 2015; 91:202-10. [PMID: 26321675 DOI: 10.1016/j.jhin.2015.06.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite the importance of hand hygiene in preventing transmission of healthcare-associated infections, compliance rates are suboptimal. Hand hygiene is a complex behaviour and psychological frameworks are promising tools to influence healthcare worker (HCW) behaviour. AIM (i) To review the effectiveness of interventions based on psychological theories of behaviour change to improve HCW hand hygiene compliance; (ii) to determine which frameworks have been used to predict HCW hand hygiene compliance. METHODS Multiple databases and reference lists of included studies were searched for studies that applied psychological theories to improve and/or predict HCW hand hygiene. All steps in selection, data extraction, and quality assessment were performed independently by two reviewers. FINDINGS The search yielded 918 citations; seven met eligibility criteria. Four studies evaluated hand hygiene interventions based on psychological frameworks. Interventions were informed by goal setting, control theory, operant learning, positive reinforcement, change theory, the theory of planned behaviour, and the transtheoretical model. Three predictive studies employed the theory of planned behaviour, the transtheoretical model, and the theoretical domains framework. Interventions to improve hand hygiene adherence demonstrated efficacy but studies were at moderate to high risk of bias. For many studies, it was unclear how theories of behaviour change were used to inform the interventions. Predictive studies had mixed results. CONCLUSION Behaviour change theory is a promising tool for improving hand hygiene; however, these theories have not been extensively examined. Our review reveals a significant gap in the literature and indicates possible avenues for novel research.
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Affiliation(s)
- J A Srigley
- Public Health Ontario, Toronto, Ontario, Canada.
| | - K Corace
- University of Ottawa, University of Ottawa Institute of Mental Health Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - D Yu
- Public Health Ontario, Toronto, Ontario, Canada
| | - T MacDonald
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - L Fabrigar
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - G Garber
- Public Health Ontario, Toronto, Ontario, Canada
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Luangasanatip N, Hongsuwan M, Limmathurotsakul D, Lubell Y, Lee AS, Harbarth S, Day NPJ, Graves N, Cooper BS. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ 2015; 351:h3728. [PMID: 26220070 PMCID: PMC4517539 DOI: 10.1136/bmj.h3728] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the relative efficacy of the World Health Organization 2005 campaign (WHO-5) and other interventions to promote hand hygiene among healthcare workers in hospital settings and to summarize associated information on use of resources. DESIGN Systematic review and network meta-analysis. DATA SOURCES Medline, Embase, CINAHL, NHS Economic Evaluation Database, NHS Centre for Reviews and Dissemination, Cochrane Library, and the EPOC register (December 2009 to February 2014); studies selected by the same search terms in previous systematic reviews (1980-2009). REVIEW METHODS Included studies were randomised controlled trials, non-randomised trials, controlled before-after trials, and interrupted time series studies implementing an intervention to improve compliance with hand hygiene among healthcare workers in hospital settings and measuring compliance or appropriate proxies that met predefined quality inclusion criteria. When studies had not used appropriate analytical methods, primary data were re-analysed. Random effects and network meta-analyses were performed on studies reporting directly observed compliance with hand hygiene when they were considered sufficiently homogeneous with regard to interventions and participants. Information on resources required for interventions was extracted and graded into three levels. RESULTS Of 3639 studies retrieved, 41 met the inclusion criteria (six randomised controlled trials, 32 interrupted time series, one non-randomised trial, and two controlled before-after studies). Meta-analysis of two randomised controlled trials showed the addition of goal setting to WHO-5 was associated with improved compliance (pooled odds ratio 1.35, 95% confidence interval 1.04 to 1.76; I(2)=81%). Of 22 pairwise comparisons from interrupted time series, 18 showed stepwise increases in compliance with hand hygiene, and all but four showed a trend for increasing compliance after the intervention. Network meta-analysis indicated considerable uncertainty in the relative effectiveness of interventions, but nonetheless provided evidence that WHO-5 is effective and that compliance can be further improved by adding interventions including goal setting, reward incentives, and accountability. Nineteen studies reported clinical outcomes; data from these were consistent with clinically important reductions in rates of infection resulting from improved hand hygiene for some but not all important hospital pathogens. Reported costs of interventions ranged from $225 to $4669 (£146-£3035; €204-€4229) per 1000 bed days. CONCLUSION Promotion of hand hygiene with WHO-5 is effective at increasing compliance in healthcare workers. Addition of goal setting, reward incentives, and accountability strategies can lead to further improvements. Reporting of resources required for such interventions remains inadequate.
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Affiliation(s)
- Nantasit Luangasanatip
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand School of Public Health, Queensland University of Technology, Brisbane, Australia
| | - Maliwan Hongsuwan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Andie S Lee
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva 1211, Switzerland Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney 2050, Australia
| | - Stephan Harbarth
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva 1211, Switzerland
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicholas Graves
- School of Public Health, Queensland University of Technology, Brisbane, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Ben S Cooper
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Proctor E, Luke D, Calhoun A, McMillen C, Brownson R, McCrary S, Padek M. Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support. Implement Sci 2015; 10:88. [PMID: 26062907 PMCID: PMC4494699 DOI: 10.1186/s13012-015-0274-5] [Citation(s) in RCA: 222] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 05/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about how well or under what conditions health innovations are sustained and their gains maintained once they are put into practice. Implementation science typically focuses on uptake by early adopters of one healthcare innovation at a time. The later-stage challenges of scaling up and sustaining evidence-supported interventions receive too little attention. This project identifies the challenges associated with sustainability research and generates recommendations for accelerating and strengthening this work. METHODS A multi-method, multi-stage approach, was used: (1) identifying and recruiting experts in sustainability as participants, (2) conducting research on sustainability using concept mapping, (3) action planning during an intensive working conference of sustainability experts to expand the concept mapping quantitative results, and (4) consolidating results into a set of recommendations for research, methodological advances, and infrastructure building to advance understanding of sustainability. Participants comprised researchers, funders, and leaders in health, mental health, and public health with shared interest in the sustainability of evidence-based health care. RESULTS Prompted to identify important issues for sustainability research, participants generated 91 distinct statements, for which a concept mapping process produced 11 conceptually distinct clusters. During the conference, participants built upon the concept mapping clusters to generate recommendations for sustainability research. The recommendations fell into three domains: (1) pursue high priority research questions as a unified agenda on sustainability; (2) advance methods for sustainability research; (3) advance infrastructure to support sustainability research. CONCLUSIONS Implementation science needs to pursue later-stage translation research questions required for population impact. Priorities include conceptual consistency and operational clarity for measuring sustainability, developing evidence about the value of sustaining interventions over time, identifying correlates of sustainability along with strategies for sustaining evidence-supported interventions, advancing the theoretical base and research designs for sustainability research, and advancing the workforce capacity, research culture, and funding mechanisms for this important work.
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Affiliation(s)
- Enola Proctor
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
| | - Douglas Luke
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
| | | | - Curtis McMillen
- School of Social Service Administration, The University of Chicago, 969 E. 60th Street, Chicago, IL, USA.
| | - Ross Brownson
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
| | - Stacey McCrary
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
| | - Margaret Padek
- George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA.
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Seto WH, Li KH, Cheung CWY, Ching PTY, Cowling BJ. Breaking a Guinness World Record on Hand Sanitizing Relay, initiating a call for vital research in overcoming campaign fatigue for hand hygiene. F1000Res 2015; 3:234. [PMID: 25717366 PMCID: PMC4329673 DOI: 10.12688/f1000research.5403.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/20/2022] Open
Abstract
Hand hygiene has been shown to be effective in significantly reducing hospital acquired infections for many years. However it is difficult to maintain and enhance compliance with hand hygiene guidelines. In Hong Kong, we previously reported a strategy to counter campaign fatigue from 50%-55% in 2009-11 to 83% in 2012. Here we report a creative activity that we used to sustain and enhance hand hygiene compliance. In May 2014 we broke the first Guinness World Record for a Hand Sanitizing Relay. A total of 277 participants performed hand hygiene before two official and approved witnesses. Following this team-directed strategy, an increase in hand hygiene compliance was identified in June 2014 in two clinical areas with previously poor compliance. The longer term impact of this strategy remains to be determined. More broadly, further research is urgently needed on meeting the challenge of campaign fatigue, and maintaining and enhancing compliance with hand hygiene guidelines.
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Affiliation(s)
- Wing Hong Seto
- Department of Pathology, Hong Kong Baptist Hospital, Kowloon Tong, Hong Kong
| | - Kwok-Hung Li
- Department of Pathology, Hong Kong Baptist Hospital, Kowloon Tong, Hong Kong
| | | | | | - Benjamin J Cowling
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
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Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, Allegranzi B, Magiorakos AP, Pittet D. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. THE LANCET. INFECTIOUS DISEASES 2015; 15:212-24. [DOI: 10.1016/s1473-3099(14)70854-0] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Comparison of hand hygiene monitoring using the 5 Moments for Hand Hygiene method versus a wash in-wash out method. Am J Infect Control 2015; 43:16-9. [PMID: 25564119 DOI: 10.1016/j.ajic.2014.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/07/2014] [Accepted: 10/09/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND One strategy to promote improved hand hygiene is to monitor health care workers' adherence to recommended practices and give feedback. For feasibility of monitoring, many health care facilities assess hand hygiene practices on room entry and exit (wash in-wash out). It is not known if the wash in-wash out method is comparable with a more comprehensive approach, such as the World Health Organization's My 5 Moments for Hand Hygiene method. METHODS During a 1-month period, a surreptitious observer monitored hand hygiene compliance simultaneously using the wash in-wash out and My 5 Moments for Hand Hygiene methods. RESULTS For 283 health care worker room entries, the methods resulted in similar rates of hand hygiene compliance (70% vs 72%, respectively). The wash in-wash out method required 148 hand hygiene events not required by the My 5 Moments for Hand Hygiene method (ie, before and after room entry with no patient or environmental contact) while not providing monitoring for 89 hand hygiene opportunities in patient rooms. CONCLUSION The monitoring methods resulted in similar overall rates of hand hygiene compliance. Use of the wash in-wash out method should include ongoing education and intermittent assessment of hand hygiene before clean procedures and after body fluid exposure in patient rooms.
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Rhodes D, Kennon J, Aitchison S, Watson K, Hornby L, Land G, Bass P, McLellan S, Karki S, Cheng AC, Worth LJ. Improvements in process with a multimodal campaign to reduce urinary tract infections in hospitalised Australian patients. ACTA ACUST UNITED AC 2014. [DOI: 10.1071/hi14024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Allegranzi B, Conway L, Larson E, Pittet D. Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities. Am J Infect Control 2014; 42:224-30. [PMID: 24581011 DOI: 10.1016/j.ajic.2013.11.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/05/2013] [Accepted: 11/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. METHODS From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. RESULTS Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). CONCLUSION Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign.
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Affiliation(s)
- Benedetta Allegranzi
- First Global Patient Safety Challenge, World Health Organization Patient Safety Program, World Health Organization, Geneva, Switzerland
| | - Laurie Conway
- Columbia University School of Nursing, Columbia University, New York, NY
| | - Elaine Larson
- Columbia University School of Nursing, Columbia University, New York, NY
| | - Didier Pittet
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Cure L, Van Enk R, Tiong E. A systematic approach for the location of hand sanitizer dispensers in hospitals. Health Care Manag Sci 2013; 17:245-58. [PMID: 24194381 DOI: 10.1007/s10729-013-9254-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 10/16/2013] [Indexed: 10/26/2022]
Abstract
Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.
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Affiliation(s)
- Laila Cure
- Department of Industrial and Manufacturing Engineering, Western Michigan University, Kalamazoo, MI, 49008, USA,
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Scheithauer S, Rosarius A, Rex S, Post P, Heisel H, Krizanovic V, Schulze-Röbbecke R, Rossaint R, Lemmen SW. Improving hand hygiene compliance in the anesthesia working room work area: More than just more hand rubs. Am J Infect Control 2013; 41:1001-6. [PMID: 23669298 DOI: 10.1016/j.ajic.2013.02.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The anesthesia working area represents an environment with a high density of invasive and, thus, infection-prone procedures. The 2 primary goals of this study were (1) to perform a precise analysis of anesthesia-related hand hygiene (HH) procedures and (2) to optimize HH compliance. METHODS We conducted a prospective, triphase before/after study to determine opportunities for and compliance with hand disinfection (World Health Organization definition) in an anesthesia working area. Standard operating procedures were optimized for invasive procedures during 2 predefined intervention periods to improve work flow practices. RESULTS Seven hundred fifty anesthesia procedures were evaluated with 12,142 indications for HH. Compliance significantly increased from 10% (465/4,636) to 30% (1,202/4,029) and finally to 55% (1,881/3,477; all P < .001) in phases I, II, and III, respectively. We identified a significant increase in the number of hand rubs performed during 1 anesthesia procedure (2 to 8, respectively; P < .001) in parallel with a significant decrease in number of opportunities needing a hand rub (24 to 14, respectively; P < .0001) because of improved work flow practices. Notably, the greatest improvement was seen before aseptic tasks (8% to 55%, respectively). CONCLUSION Our study provides the first detailed data on anesthesia-related and indication-specific HH. Importantly, HH compliance improved significantly without a noticeable increasing workload.
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Crews JD, Whaley E, Syblik D, Starke J. Sustained improvement in hand hygiene at a children's hospital. Infect Control Hosp Epidemiol 2013; 34:751-3. [PMID: 23739082 DOI: 10.1086/671002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A quality improvement project was conducted to improve hand hygiene at a children's hospital. Interventions included education, performance feedback, an incentive program, and a marketing campaign. There were 9,322 observations performed over a 5-year period. Hospital-wide adherence increased from 39.9% to 97.9%. Adherence of 95% or greater was sustained for over 3 years.
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Affiliation(s)
- Jonathan D Crews
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, 1102 Bates Street, Suite 1150, Houston, TX 77030, USA.
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Larson E. Monitoring hand hygiene: meaningless, harmful, or helpful? Am J Infect Control 2013; 41:S42-5. [PMID: 23622747 DOI: 10.1016/j.ajic.2012.09.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/29/2012] [Accepted: 09/04/2012] [Indexed: 11/15/2022]
Abstract
Whereas monitoring adherence to hand hygiene (HH) guidelines is standard practice in most acute care facilities, practice improvement has been slow. In hospitals primarily concerned with reputation, incentives to report high HH rates may create negative consequences. Practice change will require increased staff engagement and more sustainable methods to monitor HH and provide feedback.
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Affiliation(s)
- Elaine Larson
- School of Nursing, and Professor of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Scheithauer S, Eitner F, Häfner H, Floege J, Lemmen SW. Long-term sustainability of hand hygiene improvements in the hemodialysis setting. Infection 2013; 41:675-80. [DOI: 10.1007/s15010-013-0424-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 02/05/2013] [Indexed: 11/24/2022]
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Hand hygiene and healthcare system change within multi-modal promotion: a narrative review. J Hosp Infect 2013; 83 Suppl 1:S3-10. [DOI: 10.1016/s0195-6701(13)60003-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Al-Tawfiq JA, Pittet D. Improving hand hygiene compliance in healthcare settings using behavior change theories: reflections. TEACHING AND LEARNING IN MEDICINE 2013; 25:374-382. [PMID: 24112209 DOI: 10.1080/10401334.2013.827575] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although hand hygiene is the most effective method for preventing healthcare-associated infections, hand hygiene practice falls short in many healthcare facilities. The compliance rate is mostly linked to system design and easily accessible hand hygiene products. System change, healthcare worker motivation, and complex behavioral considerations seem to play a significant role. SUMMARY This article discusses the application of behavioral theories in hand hygiene promotion in a theoretical manner. The program relies on the transtheoretical model (TTM) of health behavior change, John Keller's (ARCS) Model of Motivational Design, and the theory of planned behavior (TPB). Thus, the program links attitudes and behavior to hand hygiene promotion. CONCLUSIONS The TTM of health behavior change helps to tailor interventions to predict and motivate individual movement across the pathway to change. A program could be based on this theory with multiple intercalations with John Keller's ARCS and the TPB. Such a program could be strengthened by linking attitudes and behavior to promote hand hygiene. The program could utilize different strategies such as organization cultural change that may increase the attention as well as fostering the movement in the ARCS stages. In addition, modeling TPB by creating peer pressure, ability to overcome obstacles, and increasing knowledge of the role of hand hygiene may lead to the desired outcome. The understanding and application of behavior change theories may result in an effective program to improve awareness and raise intention and thus may increase the potential for success of hand hygiene promotion programs.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- a Specialty Internal Medicine Unit , Saudi Aramco Medica Services Organization , Saudi Aramco , Dharan , Saudi Arabia
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Hautemanière A, Cunat L, Ahmed-Lecheheb D, Hajjard F, Gerardin F, Morele Y, Hartemann P. Assessment of exposure to ethanol vapors released during use of Alcohol-Based Hand Rubs by healthcare workers. J Infect Public Health 2012; 6:16-26. [PMID: 23290089 DOI: 10.1016/j.jiph.2012.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 09/11/2012] [Accepted: 09/22/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite the increasing use of Alcohol-Based Hand Rub solutions, few studies have quantified the concentrations of inhaled ethanol. OBJECTIVE The aim of this study was to assess ethanol exposure during hygienic and surgical hand disinfection practices. METHOD Ethanol concentrations were measured at the nose level of a wooden dummy and human volunteers. Two systems were used in parallel to determine short-term ethanol vapor exposures: activated charcoal tubes followed by gas chromatography analysis and direct reading on a photoionization detector (PID). Exposure was assessed for 4 different sequences (N=10) reproducing hand rubs for simple surgery, nursing care, intensive care and surgical scrub. RESULTS The ethanol concentrations measured were of a similar order between the dummy and volunteers. The concentrations obtained by PID were higher than the gas chromatography values for the simple care (45%) and nursing care (27%) sequences and reflected specific exposure peaks of ethanol, whereas ethanol concentrations were continuously high for intensive care (440 mg m(-3)) or surgical scrub (650 mg m(-3)). CONCLUSION Ethanol concentrations were similar for these two exposure assessment methods and demonstrated a relationship between handled doses and inhaled doses. However, the ethanol vapors released during hand disinfection were safe for the healthcare workers.
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Schleyer AM, Best JA, McIntyre LK, Ehrmantraut R, Calver P, Goss JR. Improving Resident Engagement in Quality Improvement and Patient Safety Initiatives at the Bedside. Am J Med Qual 2012; 28:243-9. [DOI: 10.1177/1062860612453850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Jennifer A. Best
- University of Washington, Seattle, WA
- Harborview Medical Center, Seattle, WA
| | - Lisa K. McIntyre
- University of Washington, Seattle, WA
- Harborview Medical Center, Seattle, WA
| | | | | | - J. Richard Goss
- University of Washington, Seattle, WA
- Harborview Medical Center, Seattle, WA
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Pincock T, Bernstein P, Warthman S, Holst E. Bundling hand hygiene interventions and measurement to decrease health care-associated infections. Am J Infect Control 2012; 40:S18-27. [PMID: 22546269 DOI: 10.1016/j.ajic.2012.02.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 02/28/2012] [Accepted: 02/28/2012] [Indexed: 11/30/2022]
Abstract
Proper performance of hand hygiene at key moments during patient care is the most important means of preventing health care-associated infections (HAIs). With increasing awareness of the cost and societal impact caused by HAIs has come the realization that hand hygiene improvement initiatives are crucial to reducing the burden of HAIs. Multimodal strategies have emerged as the best approach to improving hand hygiene compliance. These strategies use a variety of intervention components intended to address obstacles to complying with good hand hygiene practices, and to reinforce behavioral change. Although research has substantiated the effectiveness of the multimodal design, challenges remain in promoting widespread adoption and implementation of a coordinated approach. This article reviews elements of a multimodal approach to improve hand hygiene and advocates the use of a "bundled" strategy. Eight key components of this bundle are proposed as a cohesive program to enable the deployment of synergistic, coordinated efforts to promote good hand hygiene practice. A consistent, bundled methodology implemented at multiple study centers would standardize processes and allow comparison of outcomes, validation of the methodology, and benchmarking. Most important, a bundled approach can lead to sustained infection reduction.
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Affiliation(s)
- Ted Pincock
- Department of Infection Prevention and Control, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
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Wiltsey Stirman S, Kimberly J, Cook N, Calloway A, Castro F, Charns M. The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci 2012; 7:17. [PMID: 22417162 PMCID: PMC3317864 DOI: 10.1186/1748-5908-7-17] [Citation(s) in RCA: 727] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 03/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of evidence-based programs and practices into healthcare settings has been the subject of an increasing amount of research in recent years. While a number of studies have examined initial implementation efforts, less research has been conducted to determine what happens beyond that point. There is increasing recognition that the extent to which new programs are sustained is influenced by many different factors and that more needs to be known about just what these factors are and how they interact. To understand the current state of the research literature on sustainability, our team took stock of what is currently known in this area and identified areas in which further research would be particularly helpful. This paper reviews the methods that have been used, the types of outcomes that have been measured and reported, findings from studies that reported long-term implementation outcomes, and factors that have been identified as potential influences on the sustained use of new practices, programs, or interventions. We conclude with recommendations and considerations for future research. METHODS Two coders identified 125 studies on sustainability that met eligibility criteria. An initial coding scheme was developed based on constructs identified in previous literature on implementation. Additional codes were generated deductively. Related constructs among factors were identified by consensus and collapsed under the general categories. Studies that described the extent to which programs or innovations were sustained were also categorized and summarized. RESULTS Although "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves. CONCLUSIONS Clearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues such as fidelity, modification, and changes in implementation over time. While prospective and experimental designs are needed, there is also an important role for qualitative research in efforts to understand the phenomenon, refine hypotheses, and develop strategies to promote sustainment.
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Affiliation(s)
- Shannon Wiltsey Stirman
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - John Kimberly
- Department of Healthcare Management, The Wharton School of the University of Pennsylvania, Philadelphia, PA, USA
| | - Natasha Cook
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Amber Calloway
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - Frank Castro
- Women's Health Sciences Division, National Center for PTSD, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
| | - Martin Charns
- VA Boston Healthcare System, Boston, MA, USA
- VA Center for Organization, Leadership, and Management Research, Boston, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Bessonneau V, Thomas O. Assessment of exposure to alcohol vapor from alcohol-based hand rubs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:868-79. [PMID: 22690169 PMCID: PMC3367283 DOI: 10.3390/ijerph9030868] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/06/2012] [Accepted: 03/07/2012] [Indexed: 01/06/2023]
Abstract
This study assessed the inhaled dose of alcohol during hand disinfection. Experiments were conducted with two types of hand rub using two hand disinfection procedures. Air samples were collected every 10 s from the breathing zone, by bubbling through a mixture of K2Cr2O7 and H2SO4. The reduction of dichromate ions in the presence of alcohols was followed by UV-vis spectrophotometry. The difference in intensity of the dichromate absorption peak was used to quantify the alcohol concentration expressed in ethanol equivalent. During hygienic hand disinfection, the mean ethanol equivalent concentrations peaked at around 20–30 s for both hand rubs (14.3 ± 1.4 mg/L for hand rub 1 and 13.2 ± 0.7 mg/L for hand rub 2). During surgical hand disinfection, two peaks were found at the same time (40 and 80 s) for both hand rubs. The highest mean concentrations were 20.2 ± 0.9 mg/L for hand rub 1 and 18.1 ± 0.9 mg/L for hand rub 2. For hand rub 1, the total absorbed doses, calculated from ethanol with an inhalation flow of 24 L/min and an absorption rate of 62%, were 46.5 mg after one hygienic hand disinfection and 203.9 mg after one surgical hand disinfection. Although the use of ABHRs leads to the absorption of very low doses, sudden, repeated inhalation of high alcohol concentrations raises the question of possible adverse health effects.
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Affiliation(s)
- Vincent Bessonneau
- Environmental and Health Research Laboratory (LERES), U 1085 Institute of Research in Environmental and Occupational Health (IRSET), Advanced School of Public Health (EHESP), Avenue du Professeur Léon Bernard, 35043 Rennes, France.
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Qualitative study on perceptions of hand hygiene among hospital staff in a rural teaching hospital in India. J Hosp Infect 2012; 80:340-4. [PMID: 22321723 DOI: 10.1016/j.jhin.2011.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/11/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hand hygiene is a simple but underutilized measure to control healthcare-associated infections. AIM To explore staff perceptions of hand hygiene using focus group discussions (FGDs) in a teaching hospital in India. METHODS Qualitative study. The FGD guide included questions on transmission of infections, hand hygiene practices and problems with implementation, and ways to improve adherence to hand hygiene recommendations. The FGDs were recorded, transcribed verbatim, translated into English (when conducted in Hindi) and analysed using content analysis. FINDINGS Two themes emerged: 'inter-relationship of knowledge, beliefs, motivation, practices and needs' and 'roles and responsibilities for sustainable and efficient implementation of context-relevant approaches and interventions'. Staff were generally aware of the importance of hand hygiene for the prevention of healthcare-associated infections, but perceived practical problems with implementation. CONCLUSIONS The staff suggested various interventions and appeared to be prepared to follow hand hygiene guidelines if the hospital provided the necessary facilities.
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