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Ghorbanmovahhed S, Shahbazi S, Gilani N, Ostadi A, Shabanloei R, Gholizadeh L. Effectiveness of implementing of an infection control link nurse program to improve compliance with standard precautions and hand hygiene among nurses: a quasi-experimental study. BMC MEDICAL EDUCATION 2023; 23:265. [PMID: 37076871 PMCID: PMC10116755 DOI: 10.1186/s12909-023-04208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Standard precautions (SPs) including hand hygiene are considered fundamental protective measures to manage health care-associated infections (HCAIs) and to reduce occupational health hazards. The purpose of this research was to examine the effectiveness of an infection control link nurse (ICLN) program on compliance with SPs and hand hygiene among nurses. METHODS A quasi-experimental study with a pretest-post-test design was conducted with participating of 154 clinical nurses who worked in different wards of a tertiary referral teaching hospital in Iran. The intervention group (n = 77) had 16 infection control link nurses nominated. The control group (n = 77) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of compliance with standard precautions and hand hygiene compliance was performed via the Compliance with Standard Precautions Scale (CSPS) and the World Health Organization observational hand hygiene form. Two independent sample t-tests were used to examine differences between Compliance with Standard Precautions and hand hygiene Compliance among nurses in intervention and control group. Multiple linear regression analysis was used to assess the effect size. RESULTS After developing and implementing the infection control link nurse program, no statistically significant improvement was found in the Compliance with Standard Precautions (β = 5.18; 95% CI= -0.3-10.65, p = 0.064). An improvement in hand hygiene compliance was observed among nurses in the intervention group that improved statistically significant from 18.80% before the program to 37.32% 6 months after the program (β = 20.82; 95% CI 16.40-25.25, p < 0.001). CONCLUSIONS Given the continuing level of interest that exists in improving health care workers' hand hygiene practices, the findings of this study provide significant practical implications for hospitals seeking to improve compliance with hand hygiene among nurses, showing the effectiveness of using infection control link nurse program. Further research is needed to assess effectiveness of using infection control link nurse program to improve compliance with standard precautions.
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Affiliation(s)
- Shamsi Ghorbanmovahhed
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Shahbazi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, PO Box 5138947-977, Tabriz, Iran
- Clinical Research Development Unit, Sina Educational, Research and Treatment Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Ostadi
- Department of Internal Medicine, Sina Educational, Research and Treatment Center, faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Shabanloei
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Using video-based surveillance for monitoring hand hygiene compliance according to the World Health Organization (WHO) Five Moments framework: A pragmatic trial. Infect Control Hosp Epidemiol 2022; 44:721-727. [DOI: 10.1017/ice.2021.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective:
To examine the utility of video-based monitoring systems (VMSs) for auditing hand hygiene compliance according to the World Health Organization (WHO) Five Moments.
Design:
Pragmatic quasi-experimental observation trial.
Setting:
The New South Wales Biocontainment Centre, Westmead, New South Wales, Australia.
Participants:
Volunteer healthcare workers (HCWs).
Method:
Six high-fidelity simulations were recorded and subsequently assessed for their ability to audit hand hygiene compliance according to the WHO Five Moments for hand hygiene criteria using tools provided by the National Hand Hygiene Initiative (NHHI).
Results:
In total, 206 minutes of recorded footage were reviewed in 120 minutes, yielding 111 moments. Overall HCW hand hygiene compliance was 88% according to the WHO Five Moments framework. The cost per moment was $0.91 AUD ($0.66 USD) and the time required per moment was 64 seconds.
Conclusions:
Auditing of hand hygiene compliance according to all 5 of the WHO Five Moments from recorded footage is not only possible but provides cost and time savings. In addition, the process may produce output that is less subject to the biases inherent in direct human observational auditing.
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Madden C, Lydon S, Walsh C, O'Dowd E, Fox S, Vellinga A, Lambe K, Tujjar O, Greally C, Power M, Bates J, O'Connor P. What are the predictors of hand hygiene compliance in the intensive care unit? A cross-sectional observational study. J Infect Prev 2021; 22:252-258. [PMID: 34880947 PMCID: PMC8647638 DOI: 10.1177/17571774211033351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Although appropriate hand hygiene (HH) practices are recognised as the most
effective preventative strategy for infection, adherence is suboptimal.
Previous studies in intensive care units (ICUs) have found differences in HH
compliance between those moments that protect the patient, and those that
protect the healthcare provider. However, such studies did not control for
other variables known to impact HH compliance. Aim: To examine HH among healthcare workers (HCWs) in ICU settings, and identify
whether there is a statistical difference in HH compliance between
patient-protective and self-protective moments, while controlling for other
variables known to influence HH compliance (i.e. professional role, unit and
shift time). Methods: A cross-sectional observational study was conducted in four ICUs across three
Irish hospitals. Compliance was assessed according to the WHO’s ‘five
moments for hand hygiene’. HCW professional role, total number of
‘opportunities’ for HH and whether compliance was achieved were
recorded. Results: A total of 712 HH opportunities were recorded, with an overall compliance
rate of 56.9%. Logistic regression analysis revealed that physicians, allied
healthcare professionals and auxiliary staff were less likely than nurses to
engage in HH. HCWs were more likely to comply during night shifts compared
to morning shifts, and with self-protective as compared to
patient-protective HH moments. Conclusion: The information provided in this study provides a data-driven approach that
ICUs can use to tailor HH interventions to where, when and for whom they are
most required.
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Affiliation(s)
- Caoimhe Madden
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation.,School of Medicine, National University of Ireland, Galway
| | - Chloe Walsh
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation
| | - Emily O'Dowd
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation
| | - Susan Fox
- Health Services Executive, Dublin, Ireland
| | - Akke Vellinga
- School of Medicine, National University of Ireland, Galway
| | - Kathryn Lambe
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation
| | | | | | - Michael Power
- Critical Care Programme, National Clinical Programmes, Health Services Executive, Dublin, Ireland
| | - John Bates
- Galway University Hospital, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation
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Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. THE LANCET. INFECTIOUS DISEASES 2021; 21:e209-e221. [PMID: 34331890 DOI: 10.1016/s1473-3099(21)00383-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022]
Abstract
Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.
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Affiliation(s)
- Nasim Lotfinejad
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alexandra Peters
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ermira Tartari
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Faculty of Health Sciences, University of Malta, Malta
| | | | - Daniela Pires
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Mohd Rani MD, Mohamed NA, Jamaluddin TZMT, Ismail Z, Ramli S, Faroque H, Samad FNA, Ariffien AR, Farid AARCA, Isahak I. Electronic Hand Hygiene Quality and Duration Monitoring in Pre-School Children: A Feasibility Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021:272684X211033448. [PMID: 34256634 DOI: 10.1177/0272684x211033448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hand hygiene is regarded as the most important measure to prevent spread of infectious diseases. The aim of this study was to assess the feasibility of a prototype application in an electronic device in educating, stimulating and monitoring hand hygiene quality in young children. METHOD A pre-school was provided with an interactive hand hygiene application for two months. The device features an online administrator dashboard for data collection and for monitoring the children's hand washing steps and duration. A good hand washing is defined as hand washing which comprise all of the steps outlined in the World Health Organization (WHO) guidelines. RESULTS The prototype managed to capture 6882 hand wash performed with an average of 20.85 seconds per hand wash. Washing hands palm to palm was the most frequent (79.9%) step performed, whereas scrubbing fingernails and wrists were the least (56%) steps performed. CONCLUSIONS The device is a good prototype to educate, stimulate and monitor good hand hygiene practices. However, other measures should be undertaken to ensure sustainability of the practices.
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Affiliation(s)
| | | | | | - Zarini Ismail
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Shalinawati Ramli
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Habibah Faroque
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | | | - Abdul Rasyid Ariffien
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | | | - Ilina Isahak
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
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Kashyap B, Jhamb R, Saha R, Prasad P, Singh NP. Feasibility of direct observation and consumption method for hand hygiene compliance in an intensive care unit of a Tertiary Care Hospital. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2021. [DOI: 10.4103/injms.injms_165_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]
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Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections. Infect Control Hosp Epidemiol 2020; 41:931-937. [PMID: 32460928 DOI: 10.1017/ice.2020.182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Hand hygiene adherence has been associated with reductions in nosocomial infection. We assessed the effect of improvements in electronically measured hand hygiene adherence on the incidence of hospital-acquired infections. METHODS This quasi-experimental study was conducted in a 555-bed urban safety-net level I trauma center. The preintervention period was January 2015 through June 2016. Baseline electronic hand hygiene data collection took place from April through June 2016. The intervention period was July 2016 through December 2017. An electronic hand hygiene system was installed in 4 locations in our hospital. Performance improvement strategies were implemented that included education, troubleshooting, data dissemination, and feedback. Adherence rates were tracked over time. Rates of hospital-acquired infections were evaluated in the intervention units and in control units selected for comparison. The intervention period was subdivided into the initial and subsequent 9-month periods and were compared to the baseline period. RESULTS Electronically measured hand hygiene rates improved significantly from baseline to intervention, from 47% 77% adherence. Rates >70% continued to be measured 18 months after the intervention. Interrupted time series analysis indicated a significant effect of hand hygiene on healthcare facility-onset Clostridioides difficile infection rates during the first 9 months of the intervention. This trend continued during the final 9 months of the intervention but was nonsignificant. No effects were observed for other hospital-acquired infection rates. CONCLUSIONS Implementation of electronic hand hygiene monitoring and performance improvement interventions resulted in reductions in hospital-onset Clostridioides difficile infection rates.
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Kashyap B, Gupta K, Gomber S, Gupta N, Bhardwaj A, Singh NP, Kumar A. Hand hygiene compliance among health care workers in pediatric oncology ward of a tertiary care hospital: A cross sectional observational study. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Pires D, Pittet D. Hand hygiene electronic monitoring: Are we there yet? Am J Infect Control 2017; 45:464-465. [PMID: 28456319 DOI: 10.1016/j.ajic.2016.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 12/28/2016] [Indexed: 10/19/2022]
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10
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Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance. Am J Infect Control 2017; 45:528-535. [PMID: 28456322 DOI: 10.1016/j.ajic.2016.11.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 01/16/2023]
Abstract
Monitoring hand hygiene compliance among health care personnel (HCP) is an essential element of hand hygiene promotion programs. Observation by trained auditors is considered the gold standard method for establishing hand hygiene compliance rates. Advantages of observational surveys include the unique ability to establish compliance with all of the World Health Organization "My 5 Moments for Hand Hygiene" initiative Moments and to provide just-in-time coaching. Disadvantages include the resources required for observational surveys, insufficient sample sizes, and nonstandardized methods of conducting observations. Electronic and camera-based systems can monitor hand hygiene performance on all work shifts without a Hawthorne effect and provide significantly more data regarding hand hygiene performance. Disadvantages include the cost of installation, variable accuracy in estimating compliance rates, issues related to acceptance by HCP, insufficient data regarding their cost-effectiveness and influence on health care-related infection rates, and the ability of most systems to monitor only surrogates for Moments 1, 4, and 5. Increasing evidence suggests that monitoring only Moments 1, 4, and 5 provides reasonable estimates of compliance with all 5 Moments. With continued improvement of electronic monitoring systems, combining electronic monitoring with observational methods may provide the best information as part of a multimodal strategy to improve and sustain hand hygiene compliance rates among HCP.
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Michaelsen K, Sanders JL, Zimmer SM, Bump GM. Overcoming Patient Barriers to Discussing Physician Hand Hygiene: Do Patients Prefer Electronic Reminders to Other Methods? Infect Control Hosp Epidemiol 2015; 34:929-34. [DOI: 10.1086/671727] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Despite agreement that handwashing decreases hospital-acquired infections (HAIs), physician hand hygiene remains suboptimal. Interventions to empower patients to discuss handwashing have had variable success.Objective.To understand patient perceived barriers to discussing physician hand hygiene and to determine whether patients prefer electronic alerts over printed information as an intervention to discuss physician handwashing.Design.Cross-sectional study of 250 medical/surgical patients at an academic medical center.Results.Ninety-six percent of patients had heard of HAIs. Ninety-six percent of patients thought it was important for physicians to clean their hands before touching anything in a patient's room. The majority of patients (78%) believed patients should remind physicians to clean their hands. Thirty-two percent of patients observed physician hand hygiene noncompliance. In multivariate analysis, predictors of not speaking up regarding physician hand hygiene included never having worked in health care (odds ratio [OR], 2.8 [95% confidence interval (CI), 1.5-5.1]), not observing a physician clean hands before touching the patient (OR, 2.4 [95% CI, 1.3-4.4]), and not thinking patients should have to remind physicians to clean hands (OR, 5.5 [95% CI, 2.4-12.7]). Ninety-three percent of patients favored electronic device reminders over printed information as an intervention to encourage patients to discuss hand hygiene with their doctors.Conclusions.The strongest predictor of not challenging a doctor to clean their hands was not believing it was the patient's role to do so. Patients prefer electronic device reminders to printed information as an aid in overcoming barriers to discussing hand hygiene with physicians.
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12
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Chavali S, Menon V, Shukla U. Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian J Crit Care Med 2014; 18:689-93. [PMID: 25316980 PMCID: PMC4195200 DOI: 10.4103/0972-5229.142179] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: We are using multimodal technique to improve hand hygiene (HH) compliance among all health care staff for the past 1-year. This cross-sectional observational study was conducted in the surgical ICU to assess adherence to HH among nurses and allied healthcare workers, at the end of the training year. Materials and Methods: This was a cross-sectional observational study using direct observation technique. A single observer collected all HH data. During this analysis, 1500 HH opportunities were observed. HH compliance was tested for all 5 moments as per WHO guidelines. Results: Overall compliance as per WHO Guidelines was 78%. Nurses had an adherence rate of 63%; allied staff adherence was 86.5%. Compliance was 93% after patient contact versus 63% before patient contact. Nurses'compliance before aseptic procedures was lowest at 39%. 92% staff was aware of the facts viz. Diseases prevented by hand washing, ideal duration of HH, reduction of health care associated infections, etc. Conclusion: After 1-year of aggressive multimodal intervention in improving HH compliance, we have an overall compliance of 78%. It implies that sustained performance and compliance to HH can be ensured by ongoing training. Direct observation remains a widely used, easily reproducible method for monitoring compliance.
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Affiliation(s)
- Siddharth Chavali
- Department of Anesthesia and Critical Care, MKCG Medical College, Berhampur, Odisha, India
| | - Varun Menon
- Department of Critical Care, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Urvi Shukla
- Department of Critical Care, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
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13
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Diller T, Kelly JW, Blackhurst D, Steed C, Boeker S, McElveen DC. Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: validation of the HOW2 Benchmark Study. Am J Infect Control 2014; 42:602-7. [PMID: 24837110 DOI: 10.1016/j.ajic.2014.02.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 02/24/2014] [Accepted: 02/24/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously published a formula to estimate the number of hand hygiene opportunities (HHOs) per patient-day using the World Health Organization's "Five Moments for Hand Hygiene" methodology (HOW2 Benchmark Study). HHOs can be used as a denominator for calculating hand hygiene compliance rates when product utilization data are available. This study validates the previously derived HHO estimate using 24-hour video surveillance of health care worker hand hygiene activity. METHODS The validation study utilized 24-hour video surveillance recordings of 26 patients' hospital stays to measure the actual number of HHOs per patient-day on a medicine ward in a large teaching hospital. Statistical methods were used to compare these results to those obtained by episodic observation of patient activity in the original derivation study. RESULTS Total hours of data collection were 81.3 and 1,510.8, resulting in 1,740 and 4,522 HHOs in the derivation and validation studies, respectively. Comparisons of the mean and median HHOs per 24-hour period did not differ significantly. HHOs were 71.6 (95% confidence interval: 64.9-78.3) and 73.9 (95% confidence interval: 69.1-84.1), respectively. CONCLUSION This study validates the HOW2 Benchmark Study and confirms that expected numbers of HHOs can be estimated from the unit's patient census and patient-to-nurse ratio. These data can be used as denominators in calculations of hand hygiene compliance rates from electronic monitoring using the "Five Moments for Hand Hygiene" methodology.
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Affiliation(s)
- Thomas Diller
- Institute for the Advancement of Healthcare, Greenville, SC; Department of Quality Management, Greenville Health System, Greenville, SC; University of South Carolina School of Medicine-Greenville, Greenville, SC; Clemson University Department of Industrial Engineering, Clemson, SC.
| | - J William Kelly
- University of South Carolina School of Medicine-Greenville, Greenville, SC; Department of Internal Medicine, Greenville Health System, Greenville, SC; Department of Infection Prevention and Control, Greenville Health System, Greenville, SC
| | - Dawn Blackhurst
- Institute for the Advancement of Healthcare, Greenville, SC; Department of Quality Management, Greenville Health System, Greenville, SC; University of South Carolina School of Medicine-Greenville, Greenville, SC
| | - Connie Steed
- Department of Infection Prevention and Control, Greenville Health System, Greenville, SC
| | - Sue Boeker
- Department of Infection Prevention and Control, Greenville Health System, Greenville, SC
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Ward MA, Schweizer ML, Polgreen PM, Gupta K, Reisinger HS, Perencevich EN. Automated and electronically assisted hand hygiene monitoring systems: a systematic review. Am J Infect Control 2014; 42:472-8. [PMID: 24773785 DOI: 10.1016/j.ajic.2014.01.002] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hand hygiene is one of the most effective ways to prevent transmission of health care-associated infections. Electronic systems and tools are being developed to enhance hand hygiene compliance monitoring. Our systematic review assesses the existing evidence surrounding the adoption and accuracy of automated systems or electronically enhanced direct observations and also reviews the effectiveness of such systems in health care settings. METHODS We systematically reviewed PubMed for articles published between January 1, 2000, and March 31, 2013, containing the terms hand AND hygiene or hand AND disinfection or handwashing. Resulting articles were reviewed to determine if an electronic system was used. RESULTS We identified 42 articles for inclusion. Four types of systems were identified: electronically assisted/enhanced direct observation, video-monitored direct observation systems, electronic dispenser counters, and automated hand hygiene monitoring networks. Fewer than 20% of articles identified included calculations for efficiency or accuracy. CONCLUSIONS Limited data are currently available to recommend adoption of specific automatic or electronically assisted hand hygiene surveillance systems. Future studies should be undertaken that assess the accuracy, effectiveness, and cost-effectiveness of such systems. Given the restricted clinical and infection prevention budgets of most facilities, cost-effectiveness analysis of specific systems will be required before these systems are widely adopted.
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Affiliation(s)
- Melissa A Ward
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Marin L Schweizer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Iowa City VA Health Care System, Iowa City, IA
| | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Kalpana Gupta
- VA Boston Health Care System, West Roxbury, MA; Boston University School of Medicine, Jamaica Plain, MA
| | - Heather S Reisinger
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Iowa City VA Health Care System, Iowa City, IA
| | - Eli N Perencevich
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Iowa City VA Health Care System, Iowa City, IA.
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Talbot TR, Johnson JG, Fergus C, Domenico JH, Schaffner W, Daniels TL, Wilson G, Slayton J, Feistritzer N, Hickson GB. Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives. Infect Control Hosp Epidemiol 2013; 34:1129-36. [PMID: 24113595 DOI: 10.1086/673445] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the impact of an institutional hand hygiene accountability program on healthcare personnel hand hygiene adherence. DESIGN Time-series design with correlation analysis. SETTING Tertiary care academic medical center, including outpatient clinics and procedural areas. PARTICIPANTS Medical center healthcare personnel. METHODS A comprehensive hand hygiene initiative was implemented in 2 major phases starting in July 2009. Key facets of the initiative included extensive project planning, leadership buy-in and goal setting, financial incentives linked to performance, and use of a system-wide shared accountability model. Adherence was measured by designated hand hygiene observers. Adherence rates were compared between baseline and implementation phases, and monthly hand hygiene adherence rates were correlated with monthly rates of device-associated infection. RESULTS A total of 109,988 observations were completed during the study period, with a sustained increase in hand hygiene adherence throughout each implementation phase (P < .001) as well as from one phase to the next (P < .001), such that adherence greater than 85% has been achieved since January 2011. Medical center departments were able to reclaim some rebate dollars allocated through a self-insurance trust, but during the study period, departments did not achieve full reimbursement. Hand hygiene adherence rates were inversely correlated with device-associated standardized infection ratios (R(@) = 0.70). CONCLUSIONS Implementation of this multifaceted, observational hand hygiene program was associated with sustained improvement in hand hygiene adherence. The principles of this program could be applied to other medical centers pursuing improved hand hygiene adherence among healthcare personnel.
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Affiliation(s)
- Thomas R Talbot
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
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16
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Boyce JM. Update on hand hygiene. Am J Infect Control 2013; 41:S94-6. [PMID: 23622758 DOI: 10.1016/j.ajic.2012.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/11/2012] [Accepted: 11/12/2012] [Indexed: 12/17/2022]
Abstract
Recent developments related to hand hygiene include new test methods for evaluating hand hygiene products, improvements in alcohol-based hand rubs, novel methods of hand antisepsis, and new strategies and technologies for monitoring hand hygiene practices among health care personnel.
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Affiliation(s)
- John M Boyce
- Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, and Yale University School of Medicine, New Haven, CT, USA.
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Mestre G, Berbel C, Tortajada P, Alarcia M, Coca R, Gallemi G, Garcia I, Fernández MM, Aguilar MC, Martínez JA, Rodríguez-Baño J. "The 3/3 strategy": a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology. PLoS One 2012; 7:e47200. [PMID: 23110061 PMCID: PMC3478274 DOI: 10.1371/journal.pone.0047200] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 09/10/2012] [Indexed: 11/18/2022] Open
Abstract
Background Only multifaceted hospital wide interventions have been successful in achieving sustained improvements in hand hygiene (HH) compliance. Methodology/Principal Findings Pre-post intervention study of HH performance at baseline (October 2007– December 2009) and during intervention, which included two phases. Phase 1 (2010) included multimodal WHO approach. Phase 2 (2011) added Continuous Quality Improvement (CQI) tools and was based on: a) Increase of alcohol hand rub (AHR) solution placement (from 0.57 dispensers/bed to 1.56); b) Increase in frequency of audits (three days every three weeks: “3/3 strategy”); c) Implementation of a standardized register form of HH corrective actions; d) Statistical Process Control (SPC) as time series analysis methodology through appropriate control charts. During the intervention period we performed 819 scheduled direct observation audits which provided data from 11,714 HH opportunities. The most remarkable findings were: a) significant improvements in HH compliance with respect to baseline (25% mean increase); b) sustained high level (82%) of HH compliance during intervention; c) significant increase in AHRs consumption over time; c) significant decrease in the rate of healthcare-acquired MRSA; d) small but significant improvements in HH compliance when comparing phase 2 to phase 1 [79.5% (95% CI: 78.2–80.7) vs 84.6% (95% CI:83.8–85.4), p<0.05]; e) successful use of control charts to identify significant negative and positive deviations (special causes) related to the HH compliance process over time (“positive”: 90.1% as highest HH compliance coinciding with the “World hygiene day”; and “negative”:73.7% as lowest HH compliance coinciding with a statutory lay-off proceeding). Conclusions/Significance CQI tools may be a key addition to WHO strategy to maintain a good HH performance over time. In addition, SPC has shown to be a powerful methodology to detect special causes in HH performance (positive and negative) and to help establishing adequate feedback to healthcare workers.
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Affiliation(s)
- Gabriel Mestre
- Nosocomial Infection Control Unit, Delfos Medical Center, Barcelona, Catalonia, Spain.
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