Patients' hand hygiene at home predicts their hand hygiene practices in the hospital

Hand hygiene determinants of informal caregivers in hospitals under Pender's perspective

OBJECTIVES

to analyze hand hygiene determinants of informal caregivers in a hospital environment.

METHODS

qualitative study conducted with 55 caregivers at a university hospital in the Northeast of Brazil. A semi-structured instrument was used, adapted from Nola Pender's Health Promotion Model, from which the deductive categories were derived.

RESULTS

the general behavior included hand hygiene before meals and after using the bathroom. Sensitivity to the requirements for hand hygiene was observed, but the barriers and self-efficacy consisted of the availability of soap or alcohol-based hand sanitizers, the lack of knowledge on the importance of and forgetfulness of the practice. The reinforcement on the importance of the practice and being in a contaminated environment were influencers, and commitment, warnings, and training were indispensable.

CONCLUSIONS

benefits related to protection from infections were seen as positive determinants for hand hygiene adherence. For non-adherence, factors such as lack of sanitizing supplies, ignorance towards the importance of the activity, and forgetfulness stood out.

Increasing patient participation in hand hygiene practices in adult surgical wards in a tertiary institution: a best practice implementation project

INTRODUCTION

The WHO states that hospital-acquired infections may be transmitted through contaminated hands. Practicing hand hygiene using alcohol-based handrub or soap and water reduces harmful organisms. The Joanna Briggs Institute (JBI) best practice recommends empowering patients with hand hygiene knowledge and engaging their involvement to strengthen hand hygiene practices.

AIMS

The aim of this project was to improve hand hygiene among surgical inpatients.

METHODS

This evidence-based quality improvement project was conducted in three phases: the baseline audit, implementing best practice, and the postimplementation audit. Participants were patients hospitalized in three surgical wards of a 1200-bed acute care tertiary hospital. This project utilized the online JBI Practical Application of Clinical Evidence System and The Getting Research into Practice program to identify barriers and strategies. Nurses provided patients with an education pamphlet and regularly reminded them to improve their hand hygiene practices.

RESULTS

Ninety-four patients were audited between April and June 2018. Patients' hand hygiene practices improved from 19.1% at baseline audit to 61.7% (P < 0.01) at first follow-up audit. Patients' hand hygiene improved from 48.9 to 72.3% (P = 0.03) before meals, and from 92.6 to 98.9% (P = 0.65) after toileting. The proportion of patients who received a hand hygiene information leaflet in an appropriate language increased from 64.9 to 89.4% (P < 0.01).

CONCLUSION

Patients' involvement in the hand hygiene program has significantly improved their hand hygiene practices. Patient education and patient information leaflet continue to be an effective strategy to improve knowledge and practices.

Patient education on infection control: A systematic review

BACKGROUND

Lately, suggestions have been emphasizing the importance of engaging patients and family members in infection control (IC) through participation and education after showing that patients and family members can aid in preventing the transmission of health care-associated infections. However, assessing patient education on IC measures in hospitals is poorly investigated.

PURPOSE

To identify all available studies in the literature that assessed hospitalized patients' education on IC measures.

METHODS

PubMed, Embase, and CINAHL were searched from inception till May 6, 2020 without restrictions. We used Strengthening the Reporting of Observational Studies in Epidemiology tool for assessing the reporting quality of each eligible study.

MAIN FINDINGS

Of the 6,740 identified papers, 25 were eligible for inclusion. Education on health care-associated infections was investigated in 8 studies, education on central line-associated bloodstream infections in 1, education on surgical site infections in 2, education on hand hygiene in 12, education on isolation rationale, precautions, usage of personal protective equipment in 3, and education on respiratory hygiene in 1. In general, a low percentage of patient education on IC was found in most of the included papers.

CONCLUSIONS

The low percentage of patient education on IC in hospitals highlights the need for additional emphasis on patient involvement in IC. Further studies are needed to assess patient education on several IC measures and to explore the education of family members as well.

Questionnaire based evaluation of the motivation of surgically treated patients to participate in preventative hygiene measures

Background: Nosocomial infections caused by antibiotic-resistant pathogens demonstrate the continued need for preventive hygiene management strategies. Information and training of patients in their personal hygiene is a current requirement of the German Society for Hospital Hygiene, and is recommended by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention beim Robert-Koch Institut, KRINKO) at the Robert Koch Institute.

Aim: The aim of this study was to evaluate patients’ existing knowledge of hygiene and their motivation to actively participate in preventive hygiene measures.

Methods: This study included 445 inpatients at the Polyclinic for Surgery of University Hospital Bonn. Subjects were interviewed over a 6-month period using a questionnaire comprising 21 questions on the topic of hygiene.

Results: The majority of patients rated their subjective level of knowledge as intermediate (41%), 25% as poor and 35% as high. The respondents rated the active inclusion of patients in hygiene practices as highly relevant, and were willing to actively contribute to infection prevention, whereby the patients considered hand washing and hand disinfection in particular as important starting points. 78% of the respondents wanted more information on hygiene, particularly on wound and food hygiene. Targeted hygiene education provided by hospital staff had a positive effect on the patients’ subjective level of information, as well as on their confidence in physicians and nursing staff. Previous information via television or radio had a negative impact on the patients’ subjective information level and on their confidence in hospital staff.

Conclusion: Most surgically treated patients are motivated to actively contribute to preventive hygiene measures. This represents an additional and important option for applying hospital hygiene more effectively and, above all, closer to the patient. Information and education should preferably be performed by healthcare professionals.

Patients' capability, opportunity, motivation, and perception of inpatient hand hygiene

BACKGROUND

Studies that examine the perceptions and behaviors of patients regarding patient hand hygiene rarely examine the viewpoint of patients about their hand hygiene behavior relative to current resources provided in the hospital.

METHODS

Voluntary interviews that employed a 16-item survey tool were used among patients (N = 107) in outpatient clinics at post-admission visits. The survey was created using the Behavior Change Wheel, Capability, Opportunity, Motivation Behavior model. Patients were asked whether they brought hand sanitizer to the hospital, used hospital resources to clean their hands, and their perspective on patient hand hygiene importance compared with hospital staff, as well as their satisfaction or lack of satisfaction with hand hygiene independence.

RESULTS

Most of the participants (65, 60.7%) reported that prior to being admitted to the hospital, they were able to maintain cleaning their hands with little or no difficulty. During their admission, only 21 (19.6%) of the participants reported needing little or no assistance. More than one-half of the participants, 34 (31.8%) and 23 (21.5%), respectively, reported, mostly or completely agreeing that the hand hygiene of the health care staff was more important than their own. Close to one-half of the participants (50, 46.7%) reported not being satisfied at all with their ability to maintain their hand hygiene in the hospital, whereas only 10 (9.3%) were very satisfied with their ability to maintain hand hygiene.

CONCLUSIONS

Findings from this study will enhance our understanding of how to incorporate inpatient hand hygiene into existing infection control programs in inpatient settings.

Intensive Patient Treatment

Intensive care units (ICUs) are treating hospital’s poorest patients that need medical assistance during the most extreme period of their life. Intensive patients are treated with extensive invasive procedures, which may cause a risk of hospital infections in 10–30% of the cases. More than half of these infections can be prevented. The patients are often admitted directly from outside the hospital or from abroad with trauma after accidents, serious heart and lung conditions, sepsis and other life-threatening diseases. Infection or carrier state of microbes is often unknown on arrival and poses a risk of transmission to other patients, personnel and the environment. Patients that are transferred between different healthcare levels and institutions with unknown infection may be a particular risk for other patients. In spite of the serious state of the patients, many ICUs have few resources and are overcrowded and understaffed, with a lack of competent personnel. ICU should have a large enough area and be designed, furnished and staffed for a good, safe and effective infection control. The following chapter is focused on practical measures to reduce the incidence of infections among ICU patients.

Infection control perception and behavior: a question of sex and gender? Results of the AHOI feasibility study

Purpose

Infections, in particular with multidrug-resistant organisms, are a burden for inpatient and outpatient care and the whole community. The pathogens “roam” with patients and their relatives, forming an epidemiological bridge between different care facilities. Patients could play an important role in infection control, given that they are properly involved. The AHOI project stands for the Activation of patients, people in need of care, and care-providers for a Hygiene-conscious participatiOn in Infection prevention. To this end, a multimodal intervention bundle was developed and subjected to a feasibility study at a university hospital. Our goal was to clarify whether sex- and gender-specific characteristics are relevant in the field of infection prevention.

Materials and methods

AHOI was tested with a cross-sectional design and a cross-media communication strategy at two surgical wards of a university hospital. Interventions included patient information brochures and motivational materials, reminders, and two video presentations. A welcome box with information material and two questionnaires was given to every inpatient. The patients were instructed to complete the questionnaires at the beginning and at the end of their stay.

Results

A sample size of 133 inpatients who completed questionnaires at the beginning and end of hospitalization was analyzable. The analysis produced a differentiated picture of the perception and reaction behavior of the sexes. Women had a more negative expectation of the response of doctors. In addition, there were differences in the perception of the positioning of disinfectant dispensers and cleaning processes as well as in satisfaction with the general cleanliness. For all subjects mentioned above, the differences were significant at least at the P-value 0.05.

Conclusion

The AHOI study shows sex differences in hygiene perception and behavior. Measures to improve patient safety by involving patients in infection control must take these differences into account.

Use of a verbal electronic audio reminder with a patient hand hygiene bundle to increase independent patient hand hygiene practices of older adults in an acute care setting

BACKGROUND

We hypothesized that the addition of a novel verbal electronic audio reminder to an educational patient hand hygiene bundle would increase performance of self-managed patient hand hygiene.

METHODS

We conducted a 2-group comparative effectiveness study randomly assigning participants to patient hand hygiene bundle 1 (n = 41), which included a video, a handout, and a personalized verbal electronic audio reminder (EAR) that prompted hand cleansing at 3 meal times, or patient hand hygiene bundle 2 (n = 34), which included the identical video and handout, but not the EAR. The primary outcome was alcohol-based hand sanitizer use based on weighing bottles of hand sanitizer.

RESULTS

Participants that received the EAR averaged significantly more use of hand sanitizer product over the 3 days of the study (mean ± SD, 29.97 ± 17.13 g) than participants with no EAR (mean ± SD, 10.88 ± 9.27 g; t₇₃ = 5.822; P ≤ .001).

CONCLUSIONS

The addition of a novel verbal EAR to a patient hand hygiene bundle resulted in a significant increase in patient hand hygiene performance. Our results suggest that simple audio technology can be used to improve patient self-management of hand hygiene. Future research is needed to determine if the technology can be used to promote other healthy behaviors, reduce infections, and improve patient-centered care without increasing the workload of health care workers.

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

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.

On the hands of patients with Clostridium difficile: A study of spore prevalence and the effect of hand hygiene on C difficile removal

The prevalence of Clostridium difficile spores was assessed in 48 observations of infected inpatients. Participants were randomized to hand hygiene with either alcohol-based handrub or soap and water. C difficile was recovered in 14.6% of pre-hand hygiene observations. It was still present on 5 of these 7 participants after hand hygiene (3/3 using alcohol-based handrub; 2/4 using soap and water).

The influence of spatial configuration on the frequency of use of hand sanitizing stations in health care environments

BACKGROUND

The lack of user-friendly, accessible, and visible hand sanitizing stations (HSSs) in health care environments are significant factors affecting low hand hygiene compliance rates among caregivers.

OBJECTIVE

To determine whether the simulated parameters of visibility and global traffic flow score for an HSS can influence the frequency of use of that HSS.

METHODS

Space syntax was used to measure virtual simulation of spatial layouts of 3 units to provide quantitative visibility and global traffic flow scores for each HSS. The frequency of use of HSSs was measured for 2 weeks in 3 units in a community hospital through electronic tracking with self-developed motion sensors. Behavioral observations were also conducted during the same period to validate hand hygiene data obtained through electronic tracking. Linear models were used to tests how much variance in use is accounted for when visibility and/or global traffic flow are included in the model.

RESULTS

When the visibility score for an HSS increases (decrease), frequency of use of the HSS will increase (decrease) (F [5, 65] = 13.877; P < .001). When the global traffic flow score for an HSS increases (decrease), frequency of use of the HSS will increase (decrease) (F [5, 65] = 13.877; P < .001).

CONCLUSIONS

This study proposed and validated a novel approach of using space syntax simulations to predict and optimize hand hygiene behavior.

Feasibility: An important but neglected issue in patient hand hygiene

BACKGROUND

Patient hand hygiene may be a useful strategy to prevent acquisition of pathogens and to reduce the risk for transmission by colonized patients. Several studies demonstrate that patients and long-term-care facility (LTCF) residents may have difficulty using hand hygiene products that are provided; however, none of them measure feasibility for patients to use different hand hygiene products.

METHODS

A convenience sample of 42 hospitalized patients and 46 LTCF residents was assessed for their ability to use 3 hand sanitizer products (8-oz pushdown pump bottle, 2-oz pocket-sized bottle with a reclosable lid, and alcohol-impregnated hand wipes). The time (seconds) required for accessing each product was compared among acute-care patients and LTCF residents. Participants provided feedback on which product they preferred and found easiest to use.

RESULTS

Of 88 participants, 86 (97.7%) preferred the pushdown pump, 2 (2.3%) preferred the bottle with the reclosable lid, and none preferred the hand wipes. For both hospitalized patients and LTCF residents, the average time required to access the pushdown pump was significantly less than the time required to access the other products (pushdown pump, 0.45 seconds; bottle with reclosable lid, 3.86 seconds; and wipes, 5.66 seconds; P < .001).

CONCLUSIONS

Feasibility and ease of use should be considered in the selection of hand hygiene products for patients and LTCF residents.

Hand hygiene in health care settings: the citizens' point of view

BACKGROUND AND AIM

The infection risk prevention is one of the main objectives of all health and sanitary systems, since the reduction of the healthcare associated infections is attainable goals through appropriate prevention strategies. Among these, proper hand hygiene of health care professionals and citizens (visitors/outpatients/caregivers, volunteers) is fundamental to reduce the spreading of micro organisms and prevent infections. The purpose of the study is indeed to explore the self-reported hand washing behavior of citizens who access to health facilities and the variables involved in it, using in particular the Theory of Planned Behaviour.

METHOD

A quantitative research was lead using an anonymous questionnaire, filled out online by 195 citizens (53.6% Female). In the survey were included all the associations of volunteers, relatives and caregivers who cooperate in health care settings of Emilia Romagna Region (Italy).

RESULTS

This study has shown that hand hygiene is influenced by different socio-demographic (e.g. gender, age, education) and socio-cognitive variables (intention, attitude, subjective norms, control beliefs). In particular, citizens have a favorable attitude toward hands hygiene in healthcare settings, but they wash their hands more frequently in other contexts or in case of global infectious diseases.

CONCLUSION

The study confirms that the Theory of Planned Behavior adequately explains the hand hygiene behavior in health care settings. Furthermore the threat of infection has a significant impact both on the intention and on the behavior. The results mostly interested those are involved in infectious risk giving the opportunity to intervene with targeted programs for the citizenship.

Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review

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.