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Kibira J, Kihungi L, Ndinda M, Wesangula E, Mwangi C, Muthoni F, Augusto O, Owiso G, Ndegwa L, Luvsansharav UO, Bancroft E, Rabinowitz P, Lynch J, Njoroge A. Improving hand hygiene practices in two regional hospitals in Kenya using a continuous quality improvement (CQI) approach. Antimicrob Resist Infect Control 2022; 11:56. [PMID: 35379327 PMCID: PMC8981833 DOI: 10.1186/s13756-022-01093-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Hand hygiene (HH) is central in prevention of health care-associated infections. In low resource settings, models to improve HH compliance are needed. We implemented a continuous quality improvement (CQI) program targeting HH in two hospitals in Kenya.
Objective To determine the impact of the HH CQI program and identify factors associated with HH compliance between 2018 and 2019. Methods A CQI project targeting the improvement of hand hygiene was implemented, including training and mentorship. Data were collected monthly between April 2018 and December 2019 in Thika and Kitale Hospitals. Healthcare workers trained on Infection Prevention and Control (IPC) observed and recorded HH opportunities and subsequent compliance among staff, including nurses, clinicians, and auxiliary staff, using the World Health Organization’s “My Five Moments for Hand Hygiene” tool. Covariates were explored using mixed-effects logistic regression with random department-level intercepts. Results Hand hygiene compliance improved from 27% at baseline to 44% after 21 months. Indication/moment for HH was significantly associated with compliance. Adjusting for site, professional category and department, compliance was higher after a moment of body fluid exposure (aOR 1.43, 95% CI 1.17–1.74, p value < 0.001) and lower before an aseptic procedure (aOR 0.12, 95% CI 0.08–0.17, p value < 0.001) compared to after patient contact. Wearing of gloves often replaced proper HH in surgical departments, which although not significant, had lower compliance compared to departments for internal medicine (aOR 0.93, 95% CI 0.85–1.02). Adjusted HH compliance from all quarters improved from baseline, but comparing each quarter to the previous quarter, the improvement fluctuated over time. Conclusion Training and mentorship on the importance of HH for all moments is needed to improve overall HH compliance. CQI with regular monitoring and feedback of HH performance can be an effective approach in improving HH compliance in public hospitals in Kenya.
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Affiliation(s)
- Jemima Kibira
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Loyce Kihungi
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Mary Ndinda
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Evelyn Wesangula
- Department of Patient and Healthcare Worker Safety, Ministry of Health, Nairobi, Kenya
| | - Catherine Mwangi
- Infection Prevention and Control Department, Thika Level 5 Hospital, Kiambu, Kenya
| | - Faith Muthoni
- Infection Prevention and Control Department, Kitale County Referral Hospital, Trans-Nzoia, Kenya
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, USA
| | - George Owiso
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya
| | - Linus Ndegwa
- Division of Global Health Protection (DGHP), Center for Global Health (CGH), US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Ulzii-Orshikh Luvsansharav
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Elizabeth Bancroft
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - John Lynch
- Department of Medicine, University of Washington, Seattle, USA
| | - Anne Njoroge
- International Training and Education Center for Health, P.O. Box 2614-00202, Nairobi, Kenya. .,Department of Global Health, University of Washington, Seattle, USA.
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Kim E, Jeong IS. [Level of Complete Knowledge on Five Moments of Hand Hygiene among Nurses Working at Integrated Nursing Care Service Wards]. J Korean Acad Nurs 2021; 51:454-464. [PMID: 34497254 DOI: 10.4040/jkan.21030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to identify the level of complete knowledge about hand hygiene indications among nurses working at integrated nursing care service wards. METHODS A total of 127 nurses in eight integrated nursing care service wards completed structured sheets while observing a video based on six scenarios developed by the research team. Complete knowledge level was calculated as the percentage (%) of participants who responded correctly to all questions among participants. Complete knowledge levels according to the scenarios were calculated and compared according to general characteristics using the chi-squared test or Wilcoxon rank-sum test. RESULTS The complete knowledge level for each scenario ranged from 7.9% (scenario 6) to 42.5% (scenarios 4 and 5), and no one had complete knowledge of all scenarios. Only 3.1% of participants demonstrated complete knowledge in more than four scenarios, and 26.0% had complete knowledge of four or more hand hygiene moments. Complete knowledge level per scenario did not differ depending on work experience at hospitals and study wards, or prior hand hygiene training in the last year. CONCLUSION As the complete knowledge level regarding hand hygiene moment is very low, it is suggested that regular hand hygiene training should be provided to nurses using video media that reflect real nursing tasks. Thus, they can acquire complete knowledge of when hand hygiene is needed or not during complex nursing work situations.
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Affiliation(s)
- Eunhee Kim
- Infection Control Team, Ulsan University Hospital, Ulsan, Korea
| | - Ihn Sook Jeong
- College of Nursing, Pusan National University, Yangsan, Korea.
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Bale TL, Ramukumba TS, Mudau LS. Evaluation of compliance to the World Health Organization’s five moments of hand hygiene: Cross-sectional observation of healthcare professionals. S Afr J Infect Dis 2021. [DOI: 10.4102/sajid.v36i1.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Bounou L, Katelani S, Panagiotopoulou KI, Skouloudaki AI, Spyrou V, Orfanos P, Lagiou P. Hand hygiene education of Greek medical and nursing students: A cross-sectional study. Nurse Educ Pract 2021; 54:103130. [PMID: 34246184 DOI: 10.1016/j.nepr.2021.103130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/09/2021] [Accepted: 06/23/2021] [Indexed: 11/19/2022]
Abstract
AIM To investigate medical and nursing students' education on hand hygiene, their attitude on hand hygiene education and how this education influences their hand hygiene knowledge and practices. BACKGROUND Hospital-acquired infections are associated with prolonged hospitalisation and mortality. The most effective measure for their control is healthcare workers' hand hygiene compliance. Since medical and nursing students constitute the future healthcare workers, our study focuses on them. DESIGN Cross-sectional study METHODS: This study was conducted during the academic year 2016-2017, using a modified World Health Organisation questionnaire. Our sample consisted of 132 medical and 111 nursing students from National and Kapodistrian University of Athens, Greece. In data analysis, the Mann-Whitney and Fisher's exact tests were applied to compare differences in continuous variables and proportions in categorical variables, respectively. Knowledge and practices overall scores were calculated per student group. Multiple linear regression analyses were performed to assess the influence of potential confounders on these scores. RESULTS We found that 73.1% of medical and 98.2% of nursing students had received relevant education, which was reported as "only theoretical" by 77.4% of the former and as "hands-on and theoretical" by 88.1% of the latter group. Besides the risk of infection, knowledge acquired in lectures and trainer's behaviour were also considered very influential factors shaping hand hygiene attitude in both groups. Overall, medical students reported better hand hygiene practices than nursing ones (69.9% and 59.7%, respectively; p < 0.001). The opposite finding was observed regarding their overall knowledge on hand hygiene (57.2% of medical versus 60.4% of nursing students, p = 0.04). The majority of students (86.6% of all participants; p < 0.001) supported the inclusion of compulsory hand hygiene education in their curriculum. Compulsory education and seminars were assessed as the most effective measures to increase hand hygiene compliance (71.4% of all students). CONCLUSION In our study, medical students scored better in practices questions than nursing students; this did not apply for the knowledge score. The majority of students supported the inclusion of compulsory education on hand hygiene principles in their Departments' curricula, highlighting compulsory education and seminars as the most effective measures to increase compliance with hand hygiene.
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Affiliation(s)
- Lamprini Bounou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens GR-115 27, Greece.
| | - Stamatia Katelani
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens GR-115 27, Greece.
| | - Konstantina-Ioanna Panagiotopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens GR-115 27, Greece.
| | - Agapi-Iliana Skouloudaki
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens GR-115 27, Greece.
| | - Vasiliki Spyrou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens GR-115 27, Greece.
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens GR-115 27, Greece.
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Athens GR-115 27, Greece.
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CAMBIL-MARTIN J, FERNANDEZ-PRADA M, GONZALEZ-CABRERA J, RODRIGUEZ-LOPEZ C, ALMARAZ-GOMEZ A, LANA-PEREZ A, BUENO-CAVANILLAS A. Comparison of knowledge, attitudes and hand hygiene behavioral intention in medical and nursing students. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E9-E14. [PMID: 32490263 PMCID: PMC7225645 DOI: 10.15167/2421-4248/jpmh2020.61.1.741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 10/22/2019] [Indexed: 11/16/2022]
Abstract
Introduction Hand hygiene is crucial to prevent cross infection. Healthcare students are in a prime position to learn hand hygiene skills. The aim of this study was to analyze hand hygiene behavioral intentions of healthcare students before and after contact with the patient and to compare the knowledge of and attitude towards hand hygiene between medical and nursing students. Methods In a descriptive survey research design, convenience selection of a sample of medical students (n=657) and nursing students (n=303) was done from modules taught by the Department of Preventive Medicine and Public Health in both Medicine and Nursing undergraduate degrees in four Spanish universities. The hand hygiene Questionnaire, a validated instrument to evaluate behavior, knowledge, and attitudes, was used. Results A significantly lower percentage of students reported always or almost always carrying out hand hygiene before contact with the patient or invasive procedures in comparison to the percentage complying after contact with secretions or with the patient. Although hand hygiene knowledge appears acceptable, its importance is not sufficiently valued. Conclusions There are deficiencies in behavioral intention, knowledge, and attitudes related to hand hygiene in medical and nursing students. Better results are observed among nursing students, especially those who have received specific training.
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Affiliation(s)
| | - M. FERNANDEZ-PRADA
- Department of Preventive Medicine and Public Health, University of Granada, Spain, Preventive Medicine Unit, San Cecilio Universitary Hospital of Granada, Spain
| | - J. GONZALEZ-CABRERA
- Department of Social Psychology and Methodology of Science Human Behavior, University of Granada, Spain
| | - C. RODRIGUEZ-LOPEZ
- Department of Obstetrics and Gynecology, Pediatrics, Preventive Medicine and Public Health, Toxicology and Forensic Medicine, University of La Laguna, Spain
| | - A. ALMARAZ-GOMEZ
- Department of Pathology, Microbiology, Preventive Medicine and Public Health, Forensic Medicine, University of Valladolid, Spain
| | | | - A. BUENO-CAVANILLAS
- Department of Preventive Medicine and Public Health, University of Granada, Spain, Preventive Medicine Unit, San Cecilio Universitary Hospital of Granada, Spain
- Correspondence: Aurora Bueno-Cavanillas, Departament of Preventive Medicine and Public Health. University of Granada. (Spain). Preventive Medicine Unit. San Cecilio Universitary Hospital of Granada, Spain, Ciber of Epidemiology and Public Health (CIBERESP), Faculty of Medicine, 11, La Investigación Avenue, 18016 Granada, Spain - Tel. 0034 958248855 - E-mail:
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A family empowerment strategy is associated with increased healthcare worker hand hygiene in a resource-limited setting. Infect Control Hosp Epidemiol 2019; 41:202-208. [PMID: 31822321 DOI: 10.1017/ice.2019.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Guidelines recommend empowering patients and families to remind healthcare workers (HCWs) to perform hand hygiene (HH). The effectiveness of empowerment tools for patients and their families in Southeast Asia is unknown. METHODS We performed a prospective study in a pediatric intensive care unit (PICU) of a Vietnamese pediatric referral hospital. With family and HCW input, we developed a visual tool for families to prompt HCW HH. We used direct observation to collect baseline HH data. We then enrolled families to receive the visual tool and education on its use while continuing prospective collection of HH data. Multivariable logistic regression was used to identify independent predictors of HH in baseline and implementation periods. RESULTS In total, 2,014 baseline and 2,498 implementation-period HH opportunities were observed. During the implementation period, 73 families were enrolled. Overall, HCW HH was 46% preimplementation, which increased to 73% in the implementation period (P < .001). The lowest HH adherence in both periods occurred after HCW contact with patient surroundings: 16% at baseline increased to 24% after implementation. In multivariable analyses, the odds of HCW HH during the implementation period were significantly higher than baseline (adjusted odds ratio [aOR], 2.94; 95% confidence interval [CI], 2.54-3.41; P < .001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs evening or weekend), and HH moment. CONCLUSIONS The introduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese PICU. Future research should explore acceptability and barriers to use of similar tools in low- and middle-income settings.
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Sundal JS, Aune AG, Storvig E, Aasland JK, Fjeldsaeter KL, Torjuul K. The hand hygiene compliance of student nurses during clinical placements. J Clin Nurs 2017; 26:4646-4653. [DOI: 10.1111/jocn.13811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Jorun Saetre Sundal
- Department of Public Health and Nursing; Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Anne Grethe Aune
- Department of Public Health and Nursing; Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Eline Storvig
- Department of Infection Control; St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - Jenny Kristin Aasland
- Department of Infection Control; St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - Kaja Linn Fjeldsaeter
- Department of Infection Control; St. Olavs Hospital; Trondheim University Hospital; Trondheim Norway
| | - Kirsti Torjuul
- Department of Public Health and Nursing; Faculty of Medicine and Health Sciences; Norwegian University of Science and Technology (NTNU); Trondheim Norway
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Chen P, Yuan T, Sun Q, Jiang L, Jiang H, Zhu Z, Tao Z, Wang H, Xu A. Role of quality control circle in sustained improvement of hand hygiene compliance: an observational study in a stomatology hospital in Shandong, China. Antimicrob Resist Infect Control 2016. [PMID: 27980731 DOI: 10.1186/s13756-016-0160-1.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Hand hygiene is an important element of the WHO multimodal strategy for healthcare-associated infection control, whereas compliance of hand hygiene among healthcare workers (HCWs) remains a challenge to sustain. In order to increase the hand hygiene compliance of HCWs, a quality control circle (QCC) program was carried out in our hospital, and the plan-do-check-act (PDCA) method was applied for 12 months. FINDINGS Hand hygiene compliance rates improved over time, with significant improvement between preintervention (60.1%) and postintervention (97.2%) periods (P < 0.001). Nurses (88.3%) exhibited higher compliance than dentists (87.3%), and female (88.4%) HCWs were more likely to perform hand hygiene than males (85.6%), both P < 0.001. Overall hand hygiene compliance and observance of the five indications exhibited significant linear increases over time (P < 0.005). CONCLUSION This study highlights the success of a multifaceted intervention, conducted by QCC program and PDCA method, which led to a significant improvement of hand hygiene compliance. Though training is the most basic intervention element, surveillance, evaluation and feedback should be explored as additional interventions to ensure that hand hygiene compliance is achieved and sustained at high levels.
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Affiliation(s)
- Peng Chen
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong People's Republic of China.,Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Ting Yuan
- Department of General Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong People's Republic of China
| | - Qinfeng Sun
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Lili Jiang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Hongmin Jiang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Zhenkun Zhu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Zexin Tao
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, Shandong People's Republic of China.,Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan, 250014 Shandong People's Republic of China
| | - Haiyan Wang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, Shandong People's Republic of China.,Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan, 250014 Shandong People's Republic of China
| | - Aiqiang Xu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong People's Republic of China.,Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, Shandong People's Republic of China.,Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan, 250014 Shandong People's Republic of China
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Chen P, Yuan T, Sun Q, Jiang L, Jiang H, Zhu Z, Tao Z, Wang H, Xu A. Role of quality control circle in sustained improvement of hand hygiene compliance: an observational study in a stomatology hospital in Shandong, China. Antimicrob Resist Infect Control 2016; 5:54. [PMID: 27980731 PMCID: PMC5146823 DOI: 10.1186/s13756-016-0160-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Hand hygiene is an important element of the WHO multimodal strategy for healthcare-associated infection control, whereas compliance of hand hygiene among healthcare workers (HCWs) remains a challenge to sustain. In order to increase the hand hygiene compliance of HCWs, a quality control circle (QCC) program was carried out in our hospital, and the plan-do-check-act (PDCA) method was applied for 12 months. Findings Hand hygiene compliance rates improved over time, with significant improvement between preintervention (60.1%) and postintervention (97.2%) periods (P < 0.001). Nurses (88.3%) exhibited higher compliance than dentists (87.3%), and female (88.4%) HCWs were more likely to perform hand hygiene than males (85.6%), both P < 0.001. Overall hand hygiene compliance and observance of the five indications exhibited significant linear increases over time (P < 0.005). Conclusion This study highlights the success of a multifaceted intervention, conducted by QCC program and PDCA method, which led to a significant improvement of hand hygiene compliance. Though training is the most basic intervention element, surveillance, evaluation and feedback should be explored as additional interventions to ensure that hand hygiene compliance is achieved and sustained at high levels. Electronic supplementary material The online version of this article (doi:10.1186/s13756-016-0160-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peng Chen
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong People's Republic of China.,Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Ting Yuan
- Department of General Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong People's Republic of China
| | - Qinfeng Sun
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Lili Jiang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Hongmin Jiang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Zhenkun Zhu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Zexin Tao
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, Shandong People's Republic of China.,Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan, 250014 Shandong People's Republic of China
| | - Haiyan Wang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, Shandong People's Republic of China.,Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan, 250014 Shandong People's Republic of China
| | - Aiqiang Xu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong People's Republic of China.,Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, Shandong People's Republic of China.,Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan, 250014 Shandong People's Republic of China
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Interindividual Contacts and Carriage of Methicillin-Resistant Staphylococcus aureus: A Nested Case-Control Study. Infect Control Hosp Epidemiol 2015; 36:922-9. [PMID: 25892162 DOI: 10.1017/ice.2015.89] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reducing the spread of multidrug-resistant bacteria in hospitals remains a challenge. Current methods are screening of patients, isolation, and adherence to hygiene measures among healthcare workers (HCWs). More specific measures could rely on a better characterization of the contacts at risk of dissemination. OBJECTIVE To quantify how close-proximity interactions (CPIs) affected Staphylococcus aureus dissemination. DESIGN Nested case-control study. SETTING French long-term care facility in 2009. PARTICIPANTS Patients (n=329) and HCWs (n=261). METHODS We recorded CPIs using electronic devices together with S. aureus nasal carriage during 4 months in all participants. Cases consisted of patients showing incident S. aureus colonization and were paired to 8 control patients who did not exhibit incident colonization at the same date. Conditional logistic regression was used to quantify associations between incidence and exposure to demographic, network, and carriage covariables. RESULTS The local structure of contacts informed on methicillin-resistant S. aureus (MRSA) carriage acquisition: CPIs with more HCWs were associated with incident MRSA colonization in patients (odds ratio [OR], 1.10 [95% CI, 1.04-1.17] for 1 more HCW), as well as longer CPI durations (1.03 [1.01-1.06] for a 1-hour increase). Joint analysis of carriage and contacts showed increased carriage acquisition in case of CPI with another colonized individual (OR, 1.55 [1.14-2.11] for 1 more HCW). Global network measurements did not capture associations between contacts and carriage. CONCLUSIONS Electronically recorded CPIs inform on the risk of MRSA carriage, warranting more study of in-hospital contact networks to design targeted intervention strategies.
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