1
|
Kanaujia R, Biswal M, Kaur K, Kaur H, Kaur R, Kaur H, Kaur M, Arora P, Dhaliwal N. Hand hygiene compliance of respiratory physiotherapists: An analysis of trends over eight years including the COVID-19 pandemic period. Indian J Med Microbiol 2024; 50:100646. [PMID: 38879161 DOI: 10.1016/j.ijmmb.2024.100646] [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: 08/06/2023] [Revised: 03/15/2024] [Accepted: 06/08/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Respiratory physiotherapists (RPs) are an integral part of healthcare workers delivering care to intubated patients. Our study aimed to evaluate the effect of awareness campaigns on hand hygiene (HH) compliance among RPs. METHOD An observational single-center study was conducted between 2015 and 2022 in different ICU types in both adult and paediatric settings. The hand hygiene compliance rates were monitored prospectively and the quality improvement interventions included various hand hygiene campaigns and awareness sessions with RPs. Compliance was calculated as a percentage of events over total opportunities observed. RESULTS There was a significant increase in compliance rates for all five moments of HH (p-value: <0.05). Overall, mean compliance rate in ICUs was significantly higher than wards for Moment 1 (p-value: 0.0045), Moment 4 (p-value: 0.0372) and Moment 5 (p-value: 0.0036) by 24.2%, 22.7% and 21.5% respectively. Also, paediatric ICUs had higher HH compliance than adult ICUs for Moment 1 (87.5% vs 61.1%; p-value: 0.0459) and Moment 4 (93.7% vs 79.3%; p-value: 0.0255). A significant increase in HH compliance was observed in post-COVID-19 period compared to pre-COVID-19 period with respect to Moment 1, 2 and 5. CONCLUSION This study adds to the almost non-existent literature on this important category of healthcare workers working in respiratory ICUs. Our results project an increase compliance after the HH awareness programmes over the years among RP which is critical to prevent spread infection by multidrug resistant organisms among the hospitals.
Collapse
Affiliation(s)
- Rimjhim Kanaujia
- Department of Medical Microbiology, PGIMER, Chandigarh, India; Department of Microbiology, Punjab Institute of Liver and Biliary Sciences, Mohali, Punjab, India.
| | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Kulbeer Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Harpreet Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Rupinder Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Harinder Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Manjinder Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | - Pankaj Arora
- Department of Hospital Administration, PGIMER, Chandigarh, India.
| | - Navneet Dhaliwal
- Department of Hospital Administration, PGIMER, Chandigarh, India.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Frödin M, Rogmark C, Nellgård B, Gillespie BM, Wikström E, Andersson AE. Interactive Interventions Can Improve Hand Hygiene and Aseptic Techniques During Perioperative Care-Experience From the "Safe Hands" Project. J Perianesth Nurs 2023; 38:284-290. [PMID: 36319520 DOI: 10.1016/j.jopan.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation. DESIGN This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention. METHODS The primary outcome was differences in HH practices "Before aseptic/clean procedure" (WHO moment 2), "After body fluid exposure risk" (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017. FINDINGS The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P = .014), WHO 3; from 22.2% to 42.3%, (P = .002), and aseptic techniques; from 17.5% to 31.6%, (P = .003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department. CONCLUSIONS This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care.
Collapse
Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden.
| | - Cecilia Rogmark
- Department of Orthopedics Malmö, Lund University, Skane University Hospital, Lund, Skane, Sweden; The Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Västra Götalandregionen, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden
| | - Brigid M Gillespie
- NMHRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Griffith, Queensland, Australia; Health Service, Gold Coast University Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
| | - Annette E Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
| |
Collapse
|
4
|
Wilson KB, Satchell L, Smathers SA, Goff LFL, Sammons JS, Coffin SE. The power of feedback: Implementing a comprehensive hand hygiene observer program. Am J Infect Control 2023; 51:142-148. [PMID: 35691447 DOI: 10.1016/j.ajic.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hand hygiene (HH) is a fundamental component of infection prevention within all healthcare settings. We implemented a hospital-wide program built on overt HH observation, real-time feedback, and thematic analysis of HH misses. METHODS A robust observer training program was established to include foundational training in the WHO's My Five Moments of HH. Observational data from 2011 to 2019 were analyzed by unit, provider type, and thematic analyses of misses. RESULTS During the study period, we conducted 160,917 hospital-wide observations on 29 units (monthly average of 1,490 observations). Institutional compliance remained above 95% from 2013 to 2019. Thematic analysis revealed "touching self" and "touching phone" as common, institution-wide reasons for HH misses. DISCUSSION Overt observations facilitated communication between HH program and healthcare staff to better understand workflow and educate staff on HH opportunities. This program is an integral part of the Infection Prevention team and has been deployed to collect supplemental data during clusters and outbreaks investigations. CONCLUSIONS In addition to having rich HH data, successes of this program, include increased awareness of IPC practices, enhanced communication about patient safety, enriched dialog and feedback around HH misses, and relationship building among program observers, unit staff and leaders.
Collapse
Affiliation(s)
- Kimberly B Wilson
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Lauren Satchell
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah A Smathers
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lauren F Le Goff
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julia S Sammons
- The Office of Preparedness and Response, Children's Hospital of Philadelphia, Philadelphia, PA; The Division of Infectious Disease, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Susan E Coffin
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, PA; The Division of Infectious Disease, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
5
|
Marang-van de Mheen PJ, Woodcock T. Grand rounds in methodology: four critical decision points in statistical process control evaluations of quality improvement initiatives. BMJ Qual Saf 2023; 32:47-54. [PMID: 36109158 DOI: 10.1136/bmjqs-2022-014870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/02/2022] [Indexed: 12/27/2022]
Abstract
Quality improvement (QI) projects often employ statistical process control (SPC) charts to monitor process or outcome measures as part of ongoing feedback, to inform successive Plan-Do-Study-Act cycles and refine the intervention (formative evaluation). SPC charts can also be used to draw inferences on effectiveness and generalisability of improvement efforts (summative evaluation), but only if appropriately designed and meeting specific methodological requirements for generalisability. Inadequate design decreases the validity of results, which not only reduces the chance of publication but could also result in patient harm and wasted resources if incorrect conclusions are drawn. This paper aims to bring together much of what has been written in various tutorials, to suggest a process for using SPC in QI projects. We highlight four critical decision points that are often missed, how these are inter-related and how they affect the inferences that can be drawn regarding effectiveness of the intervention: (1) the need for a stable baseline to enable drawing inferences on effectiveness; (2) choice of outcome measures to assess effectiveness, safety and intervention fidelity; (3) design features to improve the quality of QI projects; (4) choice of SPC analysis aligned with the type of outcome, and reporting on the potential influence of other interventions or secular trends.These decision points should be explicitly reported for readers to interpret and judge the results, and can be seen as supplementing the Standards for Quality Improvement Reporting Excellence guidelines. Thinking in advance about both formative and summative evaluation will inform more deliberate choices and strengthen the evidence produced by QI projects.
Collapse
Affiliation(s)
- Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, J10-S, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas Woodcock
- National Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, London, UK
| |
Collapse
|
6
|
Slaughter J, Ayra E, Bell E, Ayres A, Martin EM, Snyder GM. Utilizing an interview method to estimate potential bias in silent observer hand hygiene observations. Am J Infect Control 2022:S0196-6553(22)00844-6. [PMID: 36463975 DOI: 10.1016/j.ajic.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
Interviewed health care workers to determine whether they had noticed a silent hand hygiene observer, thereby determining the legitimacy of the silent observers. Data supported the observers were typically unseen, and potential observer bias had a negligible role in hand hygiene compliance.
Collapse
|
7
|
Elia F, Calzavarini F, Bianco P, Vecchietti RG, Macor AF, D'Orazio A, Dragonetti A, D'Alfonso A, Belletrutti L, Floris M, Bert F, Crupi V, Aprà F. A nudge intervention to improve hand hygiene compliance in the hospital. Intern Emerg Med 2022; 17:1899-1905. [PMID: 35852676 PMCID: PMC9294805 DOI: 10.1007/s11739-022-03024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022]
Abstract
Hand hygiene among professionals plays a crucial role in preventing healthcare-associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.
Collapse
Affiliation(s)
- Fabrizio Elia
- Emergency Medicine, San Giovanni Bosco Hospital, Turin, Italy.
| | - Fabrizio Calzavarini
- Department of Letters, Philosophy and Communication, University of Bergamo, Bergamo, Italy
| | - Paola Bianco
- Hospital Infection Prevention and Control Unit, San Giovanni Bosco Hospital, Turin, Italy
| | | | - Antonio Franco Macor
- Hospital Infection Prevention and Control Unit, ASL Città di Torino, Turin, Italy
| | | | | | | | | | - Mara Floris
- Department of Philosophy and Education Sciences, University of Turin, Turin, Italy
| | - Fabrizio Bert
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Vincenzo Crupi
- Department of Philosophy and Education Sciences, University of Turin, Turin, Italy
| | - Franco Aprà
- Emergency Medicine, San Giovanni Bosco Hospital, Turin, Italy
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Lakoh S, Firima E, Williams CEE, Conteh SK, Jalloh MB, Sheku MG, Adekanmbi O, Sevalie S, Kamara SA, Kamara MAS, Barrie U, Kamara GN, Yi L, Guo X, Haffner C, Kamara MN, Jiba DF, Namanaga ES, Maruta A, Kallon C, Kanu JS, Deen GF, Samai M, Okeibunor JC, Russell JBW. An Intra-COVID-19 Assessment of Hand Hygiene Facility, Policy and Staff Compliance in Two Hospitals in Sierra Leone: Is There a Difference between Regional and Capital City Hospitals? Trop Med Infect Dis 2021; 6:tropicalmed6040204. [PMID: 34941660 PMCID: PMC8705290 DOI: 10.3390/tropicalmed6040204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Although hand hygiene (HH) is the most effective intervention to reduce the spread of infections, there are limited data on HH facilities, policy, and compliance in sub-Saharan Africa. This cross-sectional study is aimed at assessing HH using the WHO HH self-assessment framework, HH technical reference manual, and a modified infection control self-assessment tool in two hospitals in Sierra Leone. Only 10% and 9% of regional and capital city hospitals had running tap water, respectively. Veronica buckets were the resources for HH in 89% of units in the regional hospital and 92% of units in capital city hospital. Constant supply of soap and alcohol-based hand rub was available in 82% and 68%; and 74% and 79% of units in the capital city and regional hospitals, respectively. Only 10% of the units in both hospitals had hand-drying facilities and functional sinks. Overall HH compliance for the two hospitals was 18.6% and was higher in the regional (20.8%) than the capital city (17.0%) hospitals. The HH levels for the capital city and regional hospitals were 277.5 and 262.5 respectively. Despite the COVID-19 pandemic, there are still challenges with HH compliance in Sierra Leone. It is, therefore, necessary to strengthen the HH multi-modal strategy.
Collapse
Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
- Correspondence: (S.L.); (E.F.)
| | - Emmanuel Firima
- Clinical Research Unit, Department of Medicine, Swiss Tropical and Public Health Institute, CH-4051 Basel, Switzerland
- University of Basel, CH-4001 Basel, Switzerland
- SolidarMed, Christie House 3rd Floor, Orpen Road, Old Europa, P.O. Box 0254, Maseru West 105, Lesotho
- Correspondence: (S.L.); (E.F.)
| | - Christine Ellen Elleanor Williams
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Sarah K. Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Mohamed Boie Jalloh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- 34 Military Hospital, Freetown, Sierra Leone; (S.A.K.); (M.A.S.K.); (G.N.K.)
| | - Mohamed Gbeshay Sheku
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan 200005, Nigeria;
- Department of Medicine, University College Hospital, Ibadan 200005, Nigeria
| | - Stephen Sevalie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- 34 Military Hospital, Freetown, Sierra Leone; (S.A.K.); (M.A.S.K.); (G.N.K.)
| | - Sylvia Adama Kamara
- 34 Military Hospital, Freetown, Sierra Leone; (S.A.K.); (M.A.S.K.); (G.N.K.)
| | | | - Umu Barrie
- Infectious Disease Research Network, Freetown, Sierra Leone;
| | | | - Le Yi
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130122, China; (L.Y.); (X.G.)
| | - Xuejun Guo
- Changchun Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Changchun 130122, China; (L.Y.); (X.G.)
| | - Chukwuemeka Haffner
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Matilda N. Kamara
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
| | - Darlinda F. Jiba
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Enanga Sonia Namanaga
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Anna Maruta
- World Health Organization Country Office, Freetown, Sierra Leone;
| | - Christiana Kallon
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Joseph Sam Kanu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| | | | - James B. W. Russell
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; (M.B.J.); (S.S.); (M.N.K.); (J.S.K.); (G.F.D.); (M.S.); (J.B.W.R.)
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone; (C.E.E.W.); (S.K.C.); (M.G.S.); (C.H.); (D.F.J.); (E.S.N.); (C.K.)
| |
Collapse
|
11
|
Mouajou V, Adams K, DeLisle G, Quach C. HAND HYGIENE COMPLIANCE IN THE PREVENTION OF HOSPITAL ACQUIRED INFECTIONS: A SYSTEMATIC REVIEW. J Hosp Infect 2021; 119:33-48. [PMID: 34582962 DOI: 10.1016/j.jhin.2021.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Healthcare worker's (HCW) hands are known to be a primary source of transmission of hospital-acquired infections (HAIs). Thus, practicing hand hygiene (HH) and adhering to HH guidelines are both expected to decrease the risk of transmission but there is no consensus on the optimal hand hygiene compliance (HHC) rate that HCWs should aim for. AIM The objective of this study was to systematically review the published literature to determine an optimal threshold of HCW HHC rate associated with the lowest incidence rate of HAIs. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We searched online databases using a comprehensive search criterion for randomized controlled trials and non-randomized controlled studies, investigating the impact of HCW's HHC rate on HAI rates in patients of all ages, within healthcare facilities in high income countries. FINDINGS Of the 8,093 articles citations and abstracts screened, 35 articles were included in the review. Most studies reported overall HAIs per 1000 patient-days and device-associated HAIs per 1000 device-days. Most studies reported HHC rates between 60%-70%. Lower incidence HAI rates seemed to be achieved with HHC rates of approximately 60%. Studies included were not originally designed to assess the impact of HHC on HAI rates but risk of bias was assessed as per our predetermined exposure and outcome criterion. 11 (31%) of studies were deemed at low risk of bias. CONCLUSIONS Although HHC is part of HCW's code of conduct, very high HHC rates were difficult to reach. In observational studies, HHC and HAI followed a negative relationship up to about 60%. Due to flaws in study design, causality could not be inferred; only general trends could be discussed. Given the limitations, there is a need for high-quality evidence to support the implementation of specified targets of HHC rates.
Collapse
Affiliation(s)
- V Mouajou
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada
| | - K Adams
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - G DeLisle
- Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - C Quach
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada; Infection Prevention and Control, CHU Sainte-Justine, Montreal, QC, Canada.
| |
Collapse
|
12
|
Calcagni N, Venier AG, Nasso R, Broc G, Ardichen E, Jarrige B, Parneix P, Quintard B. Barriers and facilitators on hand hygiene and hydro-alcoholic solutions' use: representations of health professionals and prevention perspectives. Infect Prev Pract 2021; 3:100169. [PMID: 34522880 PMCID: PMC8426555 DOI: 10.1016/j.infpip.2021.100169] [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: 03/31/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Healthcare-associated infections pose a serious problem in terms of health and mortality. Their prevention is a necessity, and healthcare professionals are one of their main vectors. Thus, they must be at the centre of preventative strategies. As hydro-alcoholic solutions (alcohol-based hand rub) represent the most effective means of preventing these infections, it is necessary to identify the representations, barriers, and facilitators of their use. Method Forty-six healthcare professionals from two areas in France, New Aquitaine and Guadeloupe, were questioned about their practices through semi-structured registered interviews and four focus groups. Each interview and focus group were transcribed then analysed through lexicometric and thematic content analyses. Results The interviewed identified several barriers and facilitators related to the composition and characteristics of hydro-alcoholic solutions (unpleasantness, harmfulness, personal preferences for other hand hygiene products), personal factors (work habits, cognitive bias, lack of knowledge and communication) and organizational (professional constraints, product accessibility, financial resources). Conclusion Strategies to prevent healthcare-associated infections should be constructed with consideration of psychosocial facilitators and barriers for healthcare professionals in using hydro-alcoholic solutions. These strategies should also ensure that they are well informed about the effectiveness of alcohol-based solutions, through prevention campaigns and scientific articles. This awareness should equally be conveyed with educational tools that involve healthcare professionals and use the social dynamics of their work environment.
Collapse
Affiliation(s)
- Nicolas Calcagni
- INSERM U1219 équipe Handicap, Activité, Cognition, Santé, Université de Bordeaux, Bordeaux, F-33000, France
| | - Anne-Gaëlle Venier
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Nouvelle-Aquitaine, CHU de Bordeaux, Bordeaux, F-33000, France
| | - Raymond Nasso
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Iles de Guadeloupe, Pointe à Pitre, F-97100, France
| | - Guillaume Broc
- Unité Dynamique des capacités humaines et des conduites de santé, Université Paul-Valéry Montpellier 3, Montpellier, F-34000, France
| | - Eva Ardichen
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Nouvelle-Aquitaine, CHU de Bordeaux, Bordeaux, F-33000, France
| | - Bruno Jarrige
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Iles de Guadeloupe, Pointe à Pitre, F-97100, France
| | - Pierre Parneix
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Nouvelle-Aquitaine, CHU de Bordeaux, Bordeaux, F-33000, France
| | - Bruno Quintard
- INSERM U1219 équipe Handicap, Activité, Cognition, Santé, Université de Bordeaux, Bordeaux, F-33000, France
| |
Collapse
|
13
|
Effects of a 4-year intervention on hand hygiene compliance and incidence of healthcare associated infections: a longitudinal study. Infection 2021; 49:977-981. [PMID: 33988829 PMCID: PMC8120257 DOI: 10.1007/s15010-021-01626-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/06/2021] [Indexed: 01/02/2023]
Abstract
Purpose Studies have demonstrated improvements in hand hygiene (HH) compliance through interventions, noting the negative association of HH and healthcare associated infections (HAIs), but how to sustain long-term improvement is still unknown in the Chinese population. This study sought to determine the extent of change in HH compliance after multimodal HH interventions, and to evaluate the relationship between that change and HAI incidence. Methods We conducted a longitudinal study in a general teaching hospital in China from 2017 to 2020. Trained investigators observed HH practices based on the World Health Organization’s 5 moments for HH. We identified the incidence of HAIs using semi-automated constant surveillance software. We used the Cochran–Mantel–Haenszel test to assess the secular trend of HH compliance and HAIs. The Spearman correlation coefficient (rs) was used to evaluate the relationship between the incidence of HAIs and compliance with HH. Results The study made 480,943 observations, where HH was occurring between 2017 and 2020. HH compliance increased from 68.90 to 91.76% during that period (Ptrend < 0.01), while the incidence of HAIs decreased from 1.10 to 0.91%. Compliance also increased for each moment type and for each healthcare worker (Ptrend < 0.01). Lower HH compliance was observed in before-patient contact and after contact with patient surroundings, and among interns and cleaners. We also observed a weak but statistically significant negative correlation between the monthly HH compliance and incidence of HAIs (rs = − 0.27; P = 0.037). Conclusions The multimodal HH implementation delivered sustained improvement in HH compliance, and this change was associated with a decline in the incidence of HAIs. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01626-5.
Collapse
|
14
|
Leis JA, Powis JE, McGeer A, Ricciuto DR, Agnihotri T, Coyle N, Williams V, Moore C, Salt N, Wong L, McCreight L, Sivaramakrishna S, Junaid S, Cao X, Muller M. Introduction of Group Electronic Monitoring of Hand Hygiene on Inpatient Units: A Multicenter Cluster Randomized Quality Improvement Study. Clin Infect Dis 2021; 71:e680-e685. [PMID: 32270865 DOI: 10.1093/cid/ciaa412] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/08/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The current approach to measuring hand hygiene (HH) relies on human auditors who capture <1% of HH opportunities and rapidly become recognized by staff, resulting in inflation in performance. Group electronic monitoring is a validated method of measuring HH adherence, but data demonstrating the clinical impact of this technology are lacking. METHODS A stepped-wedge cluster randomized quality improvement study was performed on 26 inpatient medical and surgical units across 5 acute care hospitals in Ontario, Canada. The intervention involved daily HH reporting as measured by group electronic monitoring to guide unit-led improvement strategies. The primary outcome was monthly HH adherence (percentage) between baseline and intervention. Secondary outcomes included transmission of antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and other healthcare-associated infections. RESULTS After adjusting for the correlation within inpatient units and hospitals, there was a significant overall improvement in HH adherence associated with the intervention (incidence rate ratio [IRR], 1.73 [95% confidence interval {CI}, 1.47-1.99]; P < .0001). Monthly HH adherence relative to the intervention increased from 29% (1 395 450/4 544 144) to 37% (598 035/1 536 643) within 1 month, followed by consecutive incremental increases up to 53% (804 108/1 515 537) by 10 months (P < .0001). There was a trend toward reduced healthcare-associated transmission of MRSA (IRR, 0.74 [95% CI, .53-1.04]; P = .08). CONCLUSIONS The introduction of a system for group electronic monitoring led to rapid, significant improvements in HH performance within a 2-year period. This method offers significant advantages over direct observation for measurement and improvement of HH.
Collapse
Affiliation(s)
- Jerome A Leis
- Sunnybrook Health Sciences Centre, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada
| | - Jeff E Powis
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada.,Michael Garron Hospital, Toronto, Canada
| | - Allison McGeer
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Sinai Health Systems, Toronto, Canada
| | | | | | | | | | | | - Natasha Salt
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | | | | | - Xinghan Cao
- Sunnybrook Research Institute, Toronto, Canada
| | - Matthew Muller
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| |
Collapse
|
15
|
Watterson TL, Stone JA, Brown R, Xiong KZ, Schiefelbein A, Ramly E, Kleinschmidt P, Semanik M, Craddock L, Pitts S, Woodroof T, Chui MA. CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting. J Am Med Inform Assoc 2021; 28:1526-1533. [PMID: 33835183 DOI: 10.1093/jamia/ocab038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/19/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic's electronic health record (EHR) to the outpatient pharmacy's software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software. MATERIALS AND METHODS CancelRx was implemented in October 2017 at an academic health system. For 12 months prior, and 12 months after CancelRx implementation, data were collected on discontinued medications in the health system's EHR and whether those prescriptions were successfully discontinued in the pharmacy's dispensing software. An interrupted time series analysis was conducted to model the occurrence of prescriptions successfully discontinued over time. RESULTS There was an immediate (lag = 0), significant (P < 0.001), and sustained (post-implementation slope 0.02) increase in the proportion of successful medication discontinuations after CancelRx implementation (from 34% to 93%). CancelRx had variable impact based on whether the clinic was primary care (71.4% change prepost) or specialty care (53.9% change prepost). CancelRx reduced the time between when a medication was discontinued in the clinic EHR and pharmacy dispensing software. CONCLUSION CancelRx automated a manual process and illustrated the role for health IT in communicating medication discontinuations between clinics and pharmacies. Overall, CancelRx had a marked benefit on medication list discrepancies and illustrated how health IT can be used across different settings to improve patient care.
Collapse
Affiliation(s)
| | - Jamie A Stone
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Roger Brown
- School of Nursing University of Wisconsin-Madison, Madison, WI, USA.,School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ka Z Xiong
- Wisconsin Department of Health Services, Madison, WI, USA
| | | | - Edmond Ramly
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.,College of Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Peter Kleinschmidt
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael Semanik
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | | | | | - Michelle A Chui
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
16
|
Sreeramoju P, Voy-Hatter K, White C, Ruggiero R, Girod C, Minei J, Garvey K, Herrington J, Minhajuddin A, Madden C, Haley R, Cerise F. Results and lessons from a hospital-wide initiative incentivised by delivery system reform to improve infection prevention and sepsis care. BMJ Open Qual 2021; 10:bmjoq-2020-001189. [PMID: 33547154 PMCID: PMC7871234 DOI: 10.1136/bmjoq-2020-001189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/18/2020] [Accepted: 01/13/2021] [Indexed: 12/29/2022] Open
Abstract
Background An academic safety-net hospital leveraged the federally funded state Delivery System Reform Incentive Payment programme to implement a hospital-wide initiative to reduce healthcare-associated infections (HAIs) and improve sepsis care. Methods The study period was from 2013 to 2017. The setting is a 770-bed urban hospital with six intensive care units and a large emergency department. Key interventions implemented were (1) awareness campaign and clinician engagement, (2) implementation of HAI and sepsis bundles, (3) education of clinical personnel using standardised curriculum on bundles, (4) training of key managers, leaders and personnel in quality improvement methods, and (5) electronic medical record-based clinical decision support. Throughout the 5-year period, staff received frequent, clear, visible and consistent messages from leadership regarding the importance of their participation in this initiative, performing hand hygiene and preventing potential regulatory failures. Several process measures including bundle compliance, hand hygiene and culture of safety were monitored. The primary outcomes were rates of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI) and sepsis mortality. Results From 2013 to 2017, the hospital-wide rates of HAI reduced: CLABSI from 1.6 to 0.8 per 1000 catheter-days (Poisson regression estimate: −0.19; 95% CI −0.29 to −0.09; p=0.0002), CAUTI from 4.7 to 1.3 per 1000 catheter-days (−0.34; −0.43 to −0.26; p<0.0001) and SSI after 18 types of procedures from 3.4% to 1.3% (−0.29; −0.34 to −0.24; p<0.0001). Mortality of patients presenting to emergency department with sepsis reduced from 9.4% to 2.9% (−0.42; −0.49 to −0.36; p<0.0001). Adherence to bundles of care and hand hygiene and the hospital culture of patient safety improved. Results were sustained through 2019. Conclusion A hospital-wide initiative incentivised by the Delivery System Reform Incentive Payment programme succeeded in reducing HAI and sepsis mortality over 5 years in a sustainable manner.
Collapse
Affiliation(s)
- Pranavi Sreeramoju
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA .,Department of Infection Prevention, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Karla Voy-Hatter
- Department of Infection Prevention, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Calvin White
- Department of Infection Prevention, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Rosechelle Ruggiero
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Carlos Girod
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph Minei
- Department of Surgery, Burn and Critical Care, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Karen Garvey
- Department of Patient Safety and Risk, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Judith Herrington
- Division of Nursing, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Abu Minhajuddin
- Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Christopher Madden
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Robert Haley
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Fred Cerise
- Health System Administration, Parkland Health and Hospital System, Dallas, Texas, USA
| |
Collapse
|
17
|
Aghdassi SJS, Schröder C, Lemke E, Behnke M, Fliss PM, Plotzki C, Wenk J, Gastmeier P, Kramer TS. A multimodal intervention to improve hand hygiene compliance in peripheral wards of a tertiary care university centre: a cluster randomised controlled trial. Antimicrob Resist Infect Control 2020; 9:113. [PMID: 32682429 PMCID: PMC7368705 DOI: 10.1186/s13756-020-00776-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 07/09/2020] [Indexed: 11/18/2022] Open
Abstract
Background Interventions to improve hand hygiene (HH) compliance are a key element in the practice infection prevention and control. It was our objective to assess the effect of a multimodal intervention on HH compliance at a tertiary care university hospital. As a secondary objective, we investigated the effect of the intervention on the occurrence of device-associated bloodstream infections. Methods We performed a single centre cluster randomised controlled trial at a university hospital in Germany. Twenty peripheral wards were invited to participate and randomly assigned to either the intervention (n = 10) or control group (n = 10). Quarterly, specifically trained student employees conducted direct compliance observations in all twenty wards. The intervention entailed dissemination of teaching materials on aseptic procedures, equipment with flexibly mountable alcoholic hand rub dispensers, and quarterly feedback on HH compliance. Results In total, 21,424 HH opportunities were observed. Overall, compliance did not change significantly in either group (intervention group: 59% vs. 61% (1482 HH actions for 2494 HH opportunities vs. 5033 HH actions for 8215 HH opportunities), odds ratio (OR) 1.08 (95% confidence interval (CI95) 0.88, 1.33)); control group: 59% vs. 60% (1457 HH actions for 2484 HH opportunities vs. 4948 HH actions for 8231 HH opportunities), OR 1.06 (CI95 0.84, 1.35)). Compliance prior to aseptic procedures improved significantly in the intervention group from 44% (168 HH actions for 380 HH opportunities) to 53% (764 HH actions for 1452 HH opportunities) (OR 1.40 (CI95 1.04, 1.89), p = 0.03), while no significant increase was noted in the control group. In the intervention group, significantly fewer device-associated bloodstream infections per 1000 patient-days occurred than in the control group (84 vs. 123, incidence rate ratio 0.61 (CI95 0.46, 0.81), p < 0.01). Conclusions The lack of a significant overall improvement of HH compliance demonstrated that comprehensive implementation of HH interventions in multiple wards simultaneously is difficult. However, through targeted intervention measures, we were able to significantly increase HH compliance before aseptic procedures.
Collapse
Affiliation(s)
- Seven Johannes Sam Aghdassi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany. .,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.
| | - Christin Schröder
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Elke Lemke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Michael Behnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | | | | | - Janina Wenk
- BODE SCIENCE CENTER, BODE Chemie GmbH, Hamburg, Germany
| | - Petra Gastmeier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - Tobias Siegfried Kramer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.,Aktion Saubere Hände, Berlin, Germany
| |
Collapse
|
18
|
Tschudin-Sutter S, Sepulcri D, Dangel M, Ulrich A, Frei R, Widmer AF. Simplifying the World Health Organization Protocol: 3 Steps Versus 6 Steps for Performance of Hand Hygiene in a Cluster-randomized Trial. Clin Infect Dis 2020; 69:614-620. [PMID: 30395180 DOI: 10.1093/cid/ciy948] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/01/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In an experimental setting, a simplified, 3-step hand hygiene technique for applying alcohol-based hand rub was non inferior in terms of reduction of bacterial counts, as compared to the conventional World Health Organization 6-step technique. We therefore compared compliance and microbiological efficacy between both hand hygiene techniques in routine clinical practice. METHODS We performed a cluster-randomized trial from October-November 2015 at the University Hospital Basel, Switzerland: a tertiary, academic care center (ISRCTN45923734). We randomly assigned 12 wards to either the 3-step technique or the conventional 6-step technique of hand rubbing. The primary endpoints were compliance with the assigned technique and reduction of bacterial counts on the hands of health-care workers. RESULTS Overall, 2923 hand hygiene indications were observed, and compliance was 70.7% (2066/2923). Compliance with technique and indications was 51.7% (595/1151) and 75.9% (1151/1516) on wards assigned to the 3-step technique, respectively, as compared to 12.7% (116/915) and 65.0% (915/1407) on wards assigned to the 6-step technique (P < .001). The reduction factor (RF) of bacterial colony counts did not differ between techniques (median RF 0.97 log10 colony-forming units [CFU] [interquartile range 0.39-1.59] for the 3-step technique vs median RF 1.04 log10 CFU [interquartile range 0.49-1.52] for the 6-step technique; P = .629). CONCLUSIONS In a clinical setting, the simpler hand hygiene technique, consisting of 3 steps, resulted in higher compliance with both hand hygiene indications and technique, as compared to the 6 steps. As the results of the microbiological analyses exclude inferiority, the conventional 6 steps could be safely replaced by a simpler hand hygiene technique. CLINICAL TRIALS REGISTRATION ISRCTN45923734.
Collapse
Affiliation(s)
- Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Daniel Sepulcri
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Marc Dangel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Anja Ulrich
- Department of Internal Medicine, University Hospital Basel, Switzerland
| | - Reno Frei
- Division of Clinical Microbiology, University Hospital Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| |
Collapse
|
19
|
Ojanperä H, Kanste OI, Syrjala H. Hand-hygiene compliance by hospital staff and incidence of health-care-associated infections, Finland. Bull World Health Organ 2020; 98:475-483. [PMID: 32742033 PMCID: PMC7375219 DOI: 10.2471/blt.19.247494] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
Objective To determine changes in hand-hygiene compliance after the introduction of direct observation of hand-hygiene practice for doctors and nurses, and evaluate the relationship between the changes and the incidence of health-care-associated infections. Methods We conducted an internal audit survey in a tertiary-care hospital in Finland from 2013 to 2018. Infection-control link nurses observed hand-hygiene practices based on the World Health Organization's strategy for hand hygiene. We calculated hand-hygiene compliance as the number of observations where necessary hand-hygiene was practised divided by the total number of observations where hand hygiene was needed. We determined the incidence of health-care-associated infections using a semi-automated electronic incidence surveillance programme. We calculated the Pearson correlation coefficient (r) to evaluate the relationship between the incidence of health-care-associated infections and compliance with hand hygiene. Findings The link nurses made 52 115 hand-hygiene observations between 2013 and 2018. Annual hand-hygiene compliance increased significantly from 76.4% (2762/3617) in 2013 to 88.5% (9034/10 211) in 2018 (P < 0.0001). Over the same time, the number of health-care-associated infections decreased from 2012 to 1831, and their incidence per 1000 patient-days fell from 14.0 to 11.7 (P < 0.0001). We found a weak but statistically significant negative correlation between the monthly incidence of health-care-associated infections and hand-hygiene compliance (r = -0.48; P < 0.001). Conclusion The compliance of doctors and nurses with hand-hygiene practices improved with direct observation and feedback, and this change was associated with a decrease in the incidence of health-care-associated infections. Further studies are needed to evaluate the contribution of hand hygiene to reducing health-care-associated infections.
Collapse
Affiliation(s)
- Helena Ojanperä
- Research Unit of Nursing Science and Health Management, University of Oulu, Aapistie 5A, 2 krs 90220 Oulu, Finland
| | - Outi I Kanste
- Research Unit of Nursing Science and Health Management, University of Oulu, Aapistie 5A, 2 krs 90220 Oulu, Finland
| | - Hannu Syrjala
- Department of Infection Control, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
20
|
Kenters N, Eikelenboom-Boskamp A, Hines J, McGeer A, Huijskens E, Voss A. Product dose considerations for real-world hand sanitiser efficacy. Am J Infect Control 2020; 48:503-506. [PMID: 31924389 DOI: 10.1016/j.ajic.2019.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alcohol based hand rubs (ABHR) are extremely effective at reducing microbial contamination and have an essential role in best practice hand hygiene described by the World Health Organization. METHODS We determined ABHR drying time when performing hand hygiene in a laboratory setting. Which was followed by identifying the amount of ABHR needed for complete hand coverage. When the aforementioned was analyzed real-time data were gathered to examine the amount used for hand hygiene in a hospital setting. In parallel hands of healthcare workers (HCWs) were monitored for drying time and perception on ABHR use. RESULTS In 86% (24,446,397/28,280,383) of the events a single dose of ABHR was used on clinical wards. Twenty-four HCWs expected hand hygiene to take 7.5 seconds (median; range 3-30 seconds). Forty-three HCWs show that 1.5 mL ABHR dose achieves the desired drying time according to World Health Organization guidelines (av. median 26 seconds), but is consistently perceived to have a longer drying time than expected (av. median 18 seconds). In-vivo results (n = 10) indicate that 2.25 mL ABHR is required for adequate coverage (82%-90%) of both sides of the hand. CONCLUSIONS Results indicate that set standards for the use of ABHR do not match "in-vivo" behaviour of HCWs. Perceived drying times are shorter than actual drying time. The needed drying time to reach acceptable antimicrobial efficacy of ABHRs should be revisited.
Collapse
|
21
|
Crable EL, Biancarelli D, Walkey AJ, Drainoni ML. Barriers and facilitators to implementing priority inpatient initiatives in the safety net setting. Implement Sci Commun 2020; 1:35. [PMID: 32885192 PMCID: PMC7427845 DOI: 10.1186/s43058-020-00024-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/28/2020] [Indexed: 02/03/2023] Open
Abstract
Background Safety net hospitals, which serve vulnerable and underserved populations and often operate on smaller budgets than non-safety net hospitals, may experience unique implementation challenges. We sought to describe common barriers and facilitators that affect the implementation of improvement initiatives in a safety net hospital, and identify potentially transferable lessons to enhance implementation efforts in similar settings. Methods We interviewed leaders within five inpatient departments and asked them to identify the priority inpatient improvement initiative from the last year. We then conducted individual, semi-structured interviews with 25 stakeholders across the five settings. Interviewees included individuals serving in implementation oversight, champion, and frontline implementer roles. The Consolidated Framework for Implementation Research informed the discussion guide and a priori codes for directed content analysis. Results Despite pursuing diverse initiatives in different clinical departments, safety net hospital improvement stakeholders described common barriers and facilitators related to inner and outer setting dynamics, characteristics of individuals involved, and implementation processes. Implementation barriers included (1) limited staffing resources, (2) organizational recognition without financial investment, and (3) the use of implementation strategies that did not adequately address patients’ biopsychosocial complexities. Facilitators included (1) implementation approaches that combined passive and active communication styles, (2) knowledge of patient needs and competitive pressure to perform well against non-SNHs, (3) stakeholders’ personal commitment to reduce health inequities, and (4) the use of multidisciplinary task forces to drive implementation activities. Conclusion Inner and outer setting dynamics, individual’s characteristics, and process factors served as implementation barriers and facilitators within the safety net. Future work should seek to leverage findings from this study toward efforts to enact positive change within safety net hospitals.
Collapse
Affiliation(s)
- Erika L Crable
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2030, Boston, 02118 MA USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA USA
| | - Dea Biancarelli
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2030, Boston, 02118 MA USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA USA
| | - Allan J Walkey
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2030, Boston, 02118 MA USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA USA.,The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Mari-Lynn Drainoni
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2030, Boston, 02118 MA USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA USA.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA USA
| |
Collapse
|
22
|
Contact isolation versus standard precautions to decrease acquisition of extended-spectrum β-lactamase-producing Enterobacterales in non-critical care wards: a cluster-randomised crossover trial. THE LANCET. INFECTIOUS DISEASES 2020; 20:575-584. [PMID: 32087113 DOI: 10.1016/s1473-3099(19)30626-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/02/2019] [Accepted: 10/25/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effectiveness of contact isolation for decreasing the spread of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) has been questioned. The aim of this study was to establish the benefits of contact isolation over standard precautions for reducing the incidence density of ESBL-E colonisation and infection in adult medical and surgical wards with an active surveillance culture programme. METHODS We did a cluster-randomised crossover trial in adult wards in four European university hospitals. Medical, surgical, or combined medical-surgical wards without critical care were randomised to continue standard precautions alone or implement contact isolation alongside standard precautions for 12 months, followed by a 1 month washout period and 12 months of the alternate strategy. Randomisation was done via a computer-generated sequence, with a block size of two consecutive wards. Only laboratory technicians and data analysts were masked to allocation. Patients were screened for ESBL-E carriage within 3 days of admission, once a week thereafter, and on discharge. The primary outcome was the incidence density of ESBL-E, defined as the acquisition rate per 1000 patient-days at risk at the ward level and assessed in the per-protocol population, which included all patients screened at least twice with a length of stay of more than 1 week for each intervention period. No specific safety measures were assessed given the minimal risk of adverse events. The trial is registered, ISRCTN57648070. FINDINGS We enrolled 20 wards from four hospitals in Germany (eight wards), the Netherlands (four wards), Spain (four wards), and Switzerland (four wards). Between Jan 6, 2014, and Aug 31, 2016, 38 357 patients were admitted to these wards. Among 15 184 patients with a length of stay of more than 1 week, 11 368 patients (75%) were screened at least twice. The incidence density of ward-acquired ESBL-E was 6·0 events per 1000 patient-days at risk (95% CI 5·4-6·7) during periods of contact isolation and 6·1 (5·5-6·7) during periods of standard precautions (p=0·9710). Multivariable analysis adjusted for length of stay, percentage of patients screened, and prevalence in first screening cultures yielded an incidence rate ratio of 0·99 (95% CI 0·80-1·22; p=0·9177) for care under contact isolation compared with standard precautions. INTERPRETATION Contact isolation showed no benefit when added to standard precautions for controlling the spread of ESBL-E on non-critical care wards with extensive surveillance screening. FUNDING European Commission.
Collapse
|
23
|
Williams V, Leis JA. Applying rigour to the interpretation of surgical site infection rates. BMJ Qual Saf 2019; 29:446-448. [PMID: 31836626 DOI: 10.1136/bmjqs-2019-009964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Victoria Williams
- Infection Prevention & Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jerome A Leis
- Infection Prevention & Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine and Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Pada SMSK, Chee PL, Rathenam S, Ng KS, Alenton LS, Poh L, Tambyah PA. Effectiveness of a Ward level target accountability strategy for hand hygiene. Antimicrob Resist Infect Control 2019; 8:177. [PMID: 31788234 PMCID: PMC6858769 DOI: 10.1186/s13756-019-0641-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background Hand hygiene is a simple and effective solution in prevention of Multi Drug Resistant Organisms. Hand Hygiene campaigns have mostly taken the form of a generalised hospital approach with visual reminders and rewards for improvement in compliance. We describe a hand hygiene programme that sets an individualised ward target to increase accountability and drive improvement. Methods We undertook to develop a "Hand Hygiene Accountability" model, where the mean compliance rate, using the WHO hand hygiene assessment tool, for each ward over the past 6 months plus 10% was used as a target for that particular ward.Rewards were given to wards with the most percentage improvement over the year. A graded escalation was used for wards that did not meet targets based on 1,2 or 3 months of non-compliance. The most extreme action, setting up a task force directed by the Chairman of our Medical Board, would be required if 3 continuous months of non-compliance was observed. Hand Hygiene audits were performed by staff trained using the WHO audit tools. The same strategy was repeated at our community hospital.Active surveillance testing for Methicillin Resistant Staphylococcus aureus (MRSA) using nasal, groin and axilla swabs established before the project continued to be in operation, as did surveillance for hospital acquired MRSA bacteraemia (using NHSN criteria), hospital-onset Clostridioides difficile (HO-CD), and multi-resistant gram-negative bacilli. Results Data from July 2015 to December 2017 was analysed. In the acute and community hospitals, 21,582 and 5770 hand hygiene (HH) observations were undertaken respectively.In the acute care hospital, HH compliance rates went from 65 to 78% (p-value < 0.00001). There was a reduction in MRSA bacteraemia from 5 episodes at the start of the study to 0 in 2017.In the community hospital, HH compliance improved from a mean of 64 to 75% (p-value 0.00005). MRSA transmission rate decreased from 5.72 per 1000 patient days, to 2.79 per 1000 patient days (p-value 0.00035) with an admission prevalence of 13.1% for 2016 and 20.6% in 2017. Conclusions Using a ward level accountability for hand hygiene is possible and can be successful in improving hand hygiene rates, possibly reducing transmission of MDROs. Realistic targets need to be set and adequate rewards and incentives provided to ensure continuous improvement.
Collapse
Affiliation(s)
- Surinder M. S. Kaur Pada
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Poh Ling Chee
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Sarathemani Rathenam
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Kim Sim Ng
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Lilibeth Silagan Alenton
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Lishi Poh
- Ng Teng Fong General Hospital and Jurong Community Hospital, Jurong Health Campus, National University Health Services, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Paul Anatharajah Tambyah
- National University Hospital, National University Health Services, 5 Lower Kent Ridge Rd, Singapore, 119074 Singapore
| |
Collapse
|
25
|
Romero DMP, Reboredo MM, Gomes EP, Coelho CM, Paula MASD, Souza LCD, Colugnati FAB, Pinheiro BV. Effects of the implementation of a hand hygiene education program among ICU professionals: an interrupted time-series analysis. J Bras Pneumol 2019; 45:e20180152. [PMID: 31188977 PMCID: PMC6715164 DOI: 10.1590/1806-3713/e20180152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/23/2018] [Indexed: 11/22/2022] Open
Abstract
Objective: To evaluate the effects that a hand hygiene education program has on the compliance of health professionals in an ICU. Methods: This was a quasi-experimental study with an interrupted time-series design, conducted over a 12-month period: the 5 months preceding the implementation of a hand hygiene education program (baseline period); the 2 months of the intensive (intervention) phase of the program; and the first 5 months thereafter (post-intervention phase). Hand hygiene compliance was monitored by one of the researchers, unbeknownst to the ICU team. The primary outcome measure was the variation in the rate of hand hygiene compliance. We also evaluated the duration of mechanical ventilation (MV), as well as the incidence of ventilator-associated pneumonia (VAP) at 28 days and 60 days, together with mortality at 28 days and 60 days. Results: On the basis of 959 observations, we found a significant increase in hand hygiene compliance rates-from 31.5% at baseline to 65.8% during the intervention phase and 83.8% during the post-intervention phase, corresponding to prevalence ratios of 2.09 and 2.66, respectively, in comparison with the baseline rate (p < 0.001). Despite that improvement, there were no significant changes in duration of MV, VAP incidence (at 28 or 60 days), or mortality (at 28 or 60 days). Conclusions: Our findings indicate that a hand hygiene education program can increase hand hygiene compliance among ICU professionals, although it appears to have no impact on VAP incidence, duration of MV, or mortality.
Collapse
Affiliation(s)
- Diana Marcela Prieto Romero
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Maycon Moura Reboredo
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil.,. Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Edimar Pedrosa Gomes
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil.,. Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | - Cristina Martins Coelho
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | | | - Luciene Carnevale de Souza
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| | | | - Bruno Valle Pinheiro
- . Núcleo de Pesquisa em Pneumologia e Terapia Intensiva, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil.,. Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora (MG) Brasil
| |
Collapse
|
26
|
Mondoux S, Shojania KG. Evidence-based medicine: A cornerstone for clinical care but not for quality improvement. J Eval Clin Pract 2019; 25:363-368. [PMID: 30977249 DOI: 10.1111/jep.13135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 11/28/2022]
Abstract
Quality improvement (QI) as a clinical improvement science has been criticized for failing to deliver broad patient outcome improvement and for being a top-down regulatory and compliance construct. These critics have argued that the focus of QI should be on increasing adherence to clinical practice guidelines (CPGs) and, as a result, should be consolidated into research structures with the science of evidence-based medicine (EBM) at the helm. We argue that EBM often overestimates the role of knowledge as the root cause of quality problems and focuses almost exclusively on the effectiveness of care while often neglecting the domains of safety, efficiency, patient-centredness, and equity. Successfully addressing quality problems requires a much broader, systems-based view of health-care delivery. Although essential to clinical decision-making and practice, EBM cannot act as the cornerstone of health system improvement.
Collapse
Affiliation(s)
- Shawn Mondoux
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada
| | - Kaveh G Shojania
- Centre for Quality Improvement and Patient Safety and the Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
27
|
Diefenbacher S, Fliss P, Tatzel J, Wenk J, Keller J. A quasi-randomized controlled before–after study using performance feedback and goal setting as elements of hand hygiene promotion. J Hosp Infect 2019; 101:399-407. [DOI: 10.1016/j.jhin.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022]
|
28
|
Implementation of a national quality improvement program to enhance hand hygiene in nursing homes in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:345-351. [PMID: 30316727 DOI: 10.1016/j.jmii.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE This study investigated the cause of hand hygiene deficit, and further implemented a quality improvement program using WHO's hand-hygiene strategy to enhance the compliance of hand hygiene in the nursing home in Taiwan. METHODS This prospective study was conducted in eleven nursing homes in Taiwan from January 2015 to December 2016. After intervention, we monitor the compliance, and accuracy of hand hygiene. In addition, we also calculated the number of episodes of infection per 1000 resident-days in each nursing home in the intervention period (July-December 2015) and post-intervention period (January-October 2016). RESULTS Overall, the consumption of alcohol-based handrubs increased from 10.1 ml per resident-day in intervention period to 12.2 ml per resident-day in post intervention period. The compliance of hand hygiene increased from 74% in intervention period to 79% in post-intervention period and the rate of correct hand hygiene increased from 81% in intervention period to 87% in post-intervention period. Most importantly, the infection density decreased from 2.39 per 1000 resident-day in intervention period to 1.89 per 1000 resident-day. CONCLUSIONS A national quality-improvement program using WHO's hand-hygiene strategy to enhance hand hygiene and reduce healthcare associated infection is effective in nursing homes in Taiwan.
Collapse
|
29
|
Caris M, Labuschagne H, Dekker M, Kramer M, van Agtmael M, Vandenbroucke-Grauls C. Nudging to improve hand hygiene. J Hosp Infect 2018; 98:352-358. [DOI: 10.1016/j.jhin.2017.09.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/24/2017] [Indexed: 12/11/2022]
|
30
|
Clostridium Difficile Infection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention. Infect Control Hosp Epidemiol 2018; 38:476-482. [PMID: 28300019 DOI: 10.1017/ice.2016.324] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Prevention of Clostridium difficile infection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009. DESIGN We searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015. SETTING We included studies performed in acute-care hospitals. PATIENTS OR PARTICIPANTS We included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates. INTERVENTIONS We used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible. RESULTS Of 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates. CONCLUSIONS Daily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates. Infect Control Hosp Epidemiol 2017;38:476-482.
Collapse
|
31
|
Abstract
OBJECTIVES To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. DATA SOURCES Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened. STUDY SELECTION English language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included. DATA EXTRACTION Data were extracted on the setting, participant characteristics, experimental design, hand hygiene measurement, intervention characteristics, and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist. DATA SYNTHESIS Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 of 24 (SD= 2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were education (78.9%), enablement (71.1%), training (68.4%), environmental restructuring (65.8%), and persuasion (65.8%). Intervention outcomes were variable, with a mean relative percentage change of 94.7% (SD= 195.7; range, 4.3-1155.4%) from pre to post intervention. CONCLUSIONS This review demonstrates that best practice for improving hand hygiene in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.
Collapse
|
32
|
Patient Safety Culture and the Ability to Improve: A Proof of Concept Study on Hand Hygiene. Infect Control Hosp Epidemiol 2017; 38:1277-1283. [PMID: 28967350 DOI: 10.1017/ice.2017.209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate whether the safety culture of a hospital unit is associated with the ability to improve. DESIGN Qualitative investigation of safety culture on hospital units following a before-and-after trial on hand hygiene. SETTING VU University Medical Center, a tertiary-care hospital in the Netherlands. METHODS With support from hospital management, we implemented a hospital-wide program to improve compliance. Over 2 years, compliance was measured through direct observation, twice before, and 4 times after interventions. We analyzed changes in compliance from baseline, and selected units to evaluate safety culture using a positive deviance approach: the hospital unit with the highest hand hygiene compliance and 2 units that showed significant improvement (21% and 16%, respectively) were selected as high performing. Another 2 units showed no improvement and were selected as low performing. A blinded, independent observer conducted interviews with unit management, physicians, and nurses, based on the Hospital Survey on Patient Safety Culture. Safety culture was categorized as pathological (lowest level), reactive, bureaucratic, proactive, or generative (highest level). RESULTS Overall, 3 units showed a proactive or generative safety culture and 2 units had bureaucratic or pathological safety cultures. When comparing compliance and interview results, high-performing units showed high levels of safety culture, while low-performing units showed low levels of safety culture. CONCLUSIONS Safety culture is associated with the ability to improve hand hygiene. Interventions may not be effective when applied in units with low levels of safety culture. Although additional research is needed to corroborate our findings, the safety culture on a unit can benefit from enhancement strategies such as team-building exercises. Strengthening the safety culture before implementing interventions could aid improvement and prevent nonproductive interventions. Infect Control Hosp Epidemiol 2017;38:1277-1283.
Collapse
|
33
|
Al Kuwaiti A. Impact of a multicomponent hand hygiene intervention strategy in reducing infection rates at a university hospital in Saudi Arabia. Interv Med Appl Sci 2017; 9:137-143. [PMID: 29201437 PMCID: PMC5700699 DOI: 10.1556/1646.9.2017.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Few studies have reported the correlation between hand hygiene (HH) practices and infection rates in Saudi Arabia. This work was aimed to study the effect of a multicomponent HH intervention strategy in improving HH compliance and reducing infection rates at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia between January 2014 and December 2016. METHODS A yearlong multicomponent HH intervention, which included various strategies recommended by the World Health Organization, was introduced. HH compliance among staff and infection rates observed in the inpatient wards were assessed and compared at pre- and post-interventional phases. RESULTS There was a significant increase in mean HH compliance from 50.17% to 71.75% after the intervention (P < 0.05). Hospital-acquired infection (HAI) and catheter-associated urinary tract infection (CAUTI) rates decreased from 3.37 to 2.59 and from 3.73 to 1.75, respectively (P < 0.05). HH compliance was found to be negatively correlated with HAI (r = -0.278) and CAUTI (r = -0.523) rates. CONCLUSIONS Results show that multicomponent intervention is effective in improving HH compliance, and that an increase in HH compliance among hospital staff decreases infection rates. Further studies on cost-effectiveness of such a model could augment to these findings.
Collapse
Affiliation(s)
- Ahmed Al Kuwaiti
- Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University (Formerly University of Dammam), Al-Khobar, Kingdom of Saudi Arabia
| |
Collapse
|
34
|
Impact of a Successful Speaking Up Program on Health-Care Worker Hand Hygiene Behavior. Pediatr Qual Saf 2017; 2:e035. [PMID: 30229171 PMCID: PMC6132482 DOI: 10.1097/pq9.0000000000000035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/01/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Health-care worker (HCW) hand hygiene (HH) is the cornerstone of efforts to reduce hospital infections but remains low. Real-time mitigation of failures can increase process reliability to > 95% but has been challenging to implement for HH. Objective: To sustainably improve HCW HH to > 95%. Methods: A hospital-wide quality improvement initiative to improve HH was initiated in February 2012. HCW HH behavior was measured by covert direct observation utilizing multiple-trained HCW volunteers. HH compliance was defined as correct HH performed before and after contact with the patient or the patient’s care area. Interventions focusing on leadership support, HCW knowledge, supply availability, and culture change were implemented using quality improvement science methodology. In February 2014, the hospital began the Speaking Up for Safety Program, which trained all HCWs to identify and mitigate HH failures at the moment of occurrence and addressed known barriers to speaking up. Results: Between January 1, 2012, and January 31, 2016, there were 30,514 HH observations, averaging 627 observations per month (9% attending physicians, 12% resident physicians, 46% nurses, 33% other HCW types). HCW HH gradually increased from 75% to > 90% by December 2014. After the Speaking Up for Safety Program, HCW HH has been > 95% for 20 months. Physician HH compliance has been above 90% for over a year. Conclusion: Creating a specific process for staff to speak up and prevent HH failures, as part of a multimodal improvement effort, can sustainably increase HCW HH above 95%.
Collapse
|
35
|
Abstract
The medical field has long recognized the importance of hand hygiene in preventing health care-associated infections, yet studies indicate that this important task is performed only 40% of the time. Health care workers cite several barriers to optimal performance of hand hygiene, but the time required to perform this task is foremost among them. Introduction of alcohol-based hand rubs, bundled interventions, and incorporation of technologies designed to monitor and promote hand hygiene all represent promising advances in this field.
Collapse
|
36
|
Leis JA. Advancing infection prevention and antimicrobial stewardship through improvement science. BMJ Qual Saf 2017; 27:163-165. [PMID: 28615344 DOI: 10.1136/bmjqs-2017-006793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Jerome A Leis
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
37
|
Acute care nurses' responses and recommendations for improvement of hand hygiene compliance: A cross-sectional factorial survey research study. Am J Infect Control 2017; 45:620-625. [PMID: 28233570 DOI: 10.1016/j.ajic.2016.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hand hygiene is promoted as an effective practice to counter health care-acquired infections; however, compliance is less than optimal. Nurses have many patient contact opportunities and therefore are frequent participants in intervention research. The optimal combination of efficient and effective intervention components has not been conclusively identified. METHODS A factorial survey research design offers an efficient method to assess multiple factors simultaneously by combining elements into vignettes. This article describes a process, grounded in the framework of Bandura's social cognitive theory, that explored environmental and individual factors that potentially influence nurses' hand hygiene behavior in acute care settings. Survey respondents consisted of nurses employed in patient care; respondents also could address an open response item. RESULTS A total of 466 participants scored a total of 3,685 vignettes. Statistically significant parameters included goal, supervisor priority, electronic monitoring, and rewards. The most frequently mentioned open response item was the need to keep hand hygiene product dispensers refilled. Participants also suggested that culture and intrinsic motivation influenced hand hygiene behavior. CONCLUSIONS Researchers might consider assessing promising factors, especially use of goal setting, as an intervention rather than as components of an intervention. Further research is indicated to better understand how nurses define and view hand hygiene culture.
Collapse
|
38
|
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.
Collapse
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
| | | |
Collapse
|
39
|
Chun JY, Seo HK, Kim MK, Shin MJ, Kim SY, Kim M, Kim CJ, Song KH, Kim ES, Lee H, Kim HB. Impact of a hand hygiene campaign in a tertiary hospital in South Korea on the rate of hospital-onset methicillin-resistant Staphylococcus aureus bacteremia and economic evaluation of the campaign. Am J Infect Control 2016; 44:1486-1491. [PMID: 27658769 DOI: 10.1016/j.ajic.2016.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hand hygiene (HH) is the most important factor affecting health care-associated infections. METHODS We introduced a World Health Organization HH campaign in October 2010. The monthly procurement of hand sanitizers per 1,000 patient days was calculated, and the monthly incidence of methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), classified into community- and hospital-onset (HO), was measured from a microbiologic laboratory database. Trends of MRSAB incidence were assessed using Bayesian structural time series models. A cost-benefit analysis was also performed based on the economic burden of HO MRSAB in Korea. RESULTS Procurement of hand sanitizers increased 134% after the intervention (95% confidence interval [CI], 120%-149%), compared with the preintervention period (January 2008-September 2010). In the same manner, HH compliance improved from 33.2% in September 2010 to 92.2% after the intervention. The incidence of HO MRSAB per 100,000 patient days decreased 33% (95% CI, -57% to -7.8%) after the intervention. Because there was a calculated reduction of 65 HO MRSAB cases during the intervention period, the benefit outweighed the cost (total benefit [$851,565]/total cost [$167,495] = 5.08). CONCLUSIONS Implementation of the HH campaign led to increased compliance and significantly reduced HO MRSAB incidence; it was also cost saving.
Collapse
Affiliation(s)
- June Young Chun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hye Kyung Seo
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Min-Kyung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Myoung Jin Shin
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Su Young Kim
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Moonsuk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chung-Jong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Heeyoung Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| |
Collapse
|
40
|
Barneck MD, Rhodes NL, de la Presa M, Allen JP, Poursaid AE, Nourian MM, Firpo MA, Langell JT. Violet 405-nm light: a novel therapeutic agent against common pathogenic bacteria. J Surg Res 2016; 206:316-324. [DOI: 10.1016/j.jss.2016.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 06/27/2016] [Accepted: 08/02/2016] [Indexed: 01/12/2023]
|
41
|
Impact of WHO Hand Hygiene Improvement Program Implementation: A Quasi-Experimental Trial. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7026169. [PMID: 27999811 PMCID: PMC5141532 DOI: 10.1155/2016/7026169] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/06/2016] [Indexed: 11/17/2022]
Abstract
Objectives. As affirmed by the World Health Organization (WHO), hand hygiene is the most powerful preventive measure against healthcare-associated infections (HCAIs) and, thus, it has become one of the five key elements of patient safety program. The aim is to assess the effect of implementation of the WHO's Multimodal Hand Hygiene Improvement Strategy among healthcare workers of a tertiary teaching hospital in a developing country. Methods. Hand hygiene compliance was assessed among healthcare workers, according to five defined moments for hand hygiene of the WHO, before and after implementation of the WHO's Multimodal Hand Hygiene Improvement Strategy in fourteen wards of a tertiary teaching hospital in Shiraz, Iran. We used direct observation method and documented the results in WHO hand hygiene observation forms. Results. There was a significant change in compliance before and after implementation of WHO's Multimodal HH Improvement Strategy (29.8% and 70.98%, resp.). Conclusions. Implementing WHO hand hygiene program can significantly improve hand hygiene compliance among nurses.
Collapse
|
42
|
Fonguh S, Uwineza A, Catry B, Simon A. Belgian hand hygiene campaigns in ICU, 2005-2015. Arch Public Health 2016; 74:47. [PMID: 27826443 PMCID: PMC5098279 DOI: 10.1186/s13690-016-0159-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/10/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Healthcare-associated infections (HCAI) are still a major problem especially in most intensive care units (ICU). Incompliance by clinical staff with hand hygiene (HH) increases rates of preventable infections. We report the outcome of the Belgian national hand hygiene campaign from 2005 to 2015 with focus on intensive care units. METHODS Using the World Health organisation (WHO) standardised observation roster, trained infection control teams measured adherence to HH guidelines by direct observation. HH opportunities were counted and the actual episodes of HH were scored as no HH, HH with water and soap, or HH with alcohol-based hand rub. Measurements were repeatedly done before and after a one month awareness campaign every second year. Compliance was stratified by indication and by type of healthcare worker, and computed as a percentage of the number of HH episodes with water and soap or with alcohol-based hand rub, divided by the number of opportunities. RESULTS A total of 108,050 hand hygiene opportunities were observed in ICU during this period. HH compliance increased significantly from 49.6 % before campaign in 2005 to 72.0 % before campaign in 2015. Over the same time frame, post campaign compliance increased from 67.0 to 80.2 %. The number of opportunities observed substantially increased when automated feedback was installed. CONCLUSIONS In Belgian intensive care units, hand hygiene compliance is getting improved overtime, though consecutive campaigns with immediate feedback are required to achieve and sustain a high compliance rate.
Collapse
Affiliation(s)
- Sylvanus Fonguh
- Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, Healthcare Associated Infections and Antimicrobial Resistance Unit, Brussels, Belgium
| | - Annie Uwineza
- Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, Healthcare Associated Infections and Antimicrobial Resistance Unit, Brussels, Belgium
| | - Boudewijn Catry
- Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, Healthcare Associated Infections and Antimicrobial Resistance Unit, Brussels, Belgium
| | - Anne Simon
- Cliniques Universitaires Saint-Luc UCL, Laboratory of Microbiology, Brussels, Belgium
- Pôle de Microbiologie, Institut de Recherche Expérimentale et Clinique, UC Louvain, Brussels, Belgium
| |
Collapse
|
43
|
Azim S, Juergens C, McLaws ML. An average hand hygiene day for nurses and physicians: The burden is not equal. Am J Infect Control 2016; 44:777-81. [PMID: 27040570 DOI: 10.1016/j.ajic.2016.02.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND To understand whether the burden of hand hygiene contributes to poor compliance we measured the daily number of hand hygiene opportunities (HHOs) by shift for nurses and physicians in 2 wards in a 850-bed university teaching hospital. METHODS On each ward 4 trained auditors collected the number of HHOs and compliance events for 24 hours over 7 days. Twenty-one thousand four hundred fifty HHOs were collected from a medical and a surgical ward. The proportion of alcohol-based handrub used daily, the burden of hand hygiene, and compliance rates were calculated separately for nurses and physicians. RESULTS The average indication for alcohol-based handrub cleansing represented 68% of all HHOs. Nurses had an average burden of 55 HHOs per 24 hours or 27 HHOs per shift, 3 times higher than the burden for physicians, who had 16 HHOs per 24 hours or 8 HHOs per shift. Overt observations of the weekly compliance identified nurses had 1.5 times higher compliance than physicians: 76% and 52% (P < .01), respectively. CONCLUSIONS Nurses have 3 times more HHOs than physicians, yet nurses have 1.5 times higher compliance than physicians. Hand hygiene compliance in physicians cannot be explained by burden of HHOs.
Collapse
|
44
|
Sakihama T, Honda H, Saint S, Fowler KE, Kamiya T, Sato Y, Iuchi R, Tokuda Y. Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers. J Hosp Med 2016; 11:199-205. [PMID: 26427035 DOI: 10.1002/jhm.2491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 07/15/2015] [Accepted: 08/05/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Though hand hygiene is an important method of preventing healthcare-associated infection, we found suboptimal hand hygiene adherence among healthcare workers in 4 diverse Japanese hospitals (adherence rates of 11%-25%). OBJECTIVE Our goal was to assess multimodal hand hygiene intervention coupled with a contest to improve hand hygiene adherence. SETTING A total of 3 to 4 inpatient wards in 3 Japanese hospitals. DESIGN Pre-post intervention study. INTERVENTION The intervention was a multimodal hand hygiene intervention recommended by the World Health Organization that was tailored to each facility. The hospital with the highest adherence after the intervention was given $5000 US dollars and a trophy, provided by an American coinvestigator unaffiliated with any of the Japanese hospitals. MEASUREMENT We tracked hand hygiene adherence rates before patient contact for each unit and hospital and compared these to pre-intervention adherence rates. RESULTS We observed 2982 postintervention provider-patient encounters in 10 units across 3 hospitals. Hand hygiene adherence rates were improved overall after the intervention (18% pre- to 33% postintervention; P < 0.001), but postintervention adherence rates varied considerably: hospital A + 29%, B + 5%, C + 8%. Hospital A won the contest with 40% adherence after the intervention. CONCLUSIONS Using a novel contest coupled with a multimodal intervention successfully improved hand hygiene rates among Japanese healthcare workers. Given the overall low rates, however, further improvement is necessary.
Collapse
Affiliation(s)
- Tomoko Sakihama
- Department of Nursing, International University of Health and Welfare Graduate School, Minato-ku, Tokyo, Japan
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Sanjay Saint
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Toru Kamiya
- Division of General Internal Medicine & Infectious Diseases, Rakuwakai Otowa Hospital, Yamashina, Kyoto, Japan
| | - Yumiko Sato
- Division of Infection Control, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan
| | - Ritsuko Iuchi
- Division of Infection Control, Rakuwakai Otowa Hospital, Yamashina, Kyoto, Japan
| | - Yasuharu Tokuda
- Japan Community Healthcare Organization, Minato-ku, Tokyo, Japan
| |
Collapse
|
45
|
Wetzker W, Bunte-Schönberger K, Walter J, Pilarski G, Gastmeier P, Reichardt C. Compliance with hand hygiene: reference data from the national hand hygiene campaign in Germany. J Hosp Infect 2016; 92:328-31. [PMID: 26984282 DOI: 10.1016/j.jhin.2016.01.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 01/31/2016] [Indexed: 01/03/2023]
Abstract
Hand hygiene is a key measure to prevent healthcare-associated infection. To promote hand hygiene nationally the German campaign 'Aktion Saubere Hände' was launched in January 2008, based on the World Health Organization's 'Clean Care is Safer Care' initiative. We report the first results from a full year of data collection on hand hygiene compliance recorded with the help of a renewed observation tool. Data were based on submissions from 109 participating hospitals collected from 576 wards between January 1st and December 31st, 2014. The overall median compliance was 73%, ranging from 55% (10th percentile) to 89% (90th percentile). The results demonstrated only small differences between adult and non-adult intensive care units (ICUs) with neonatal ICUs and paediatric non-ICUs maintaining higher compliance than adult care units. Performance among nurses was better than physicians, and overall rates of hand hygiene performance were significantly higher after patient contact than before.
Collapse
Affiliation(s)
- W Wetzker
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | - K Bunte-Schönberger
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | - J Walter
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | - G Pilarski
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany.
| | - Ch Reichardt
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany
| |
Collapse
|
46
|
Abstract
Purpose of review Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions. Recent findings Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission. Summary Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation.
Collapse
|
47
|
Branch-Elliman W, Savor Price C, Bessesen MT, Perl TM. Using the Pillars of Infection Prevention to Build an Effective Program for Reducing the Transmission of Emerging and Reemerging Infections. Curr Environ Health Rep 2015; 2:226-35. [PMID: 26231500 PMCID: PMC7099308 DOI: 10.1007/s40572-015-0059-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Preventing transmission of emerging infectious diseases remains a challenge for infection prevention and occupational safety programs. The recent Ebola and measles outbreaks highlight the need for pre-epidemic planning, early identification, and appropriate isolation of infected individuals and health care personnel protection. To optimally allocate limited infection control resources, careful consideration of major modes of transmission, the relative infectiousness of the agent, and severity of the pathogen-specific disease are considered. A framework to strategically approach pathogens proposed for health care settings includes generic principles (1) elimination of potential exposure, (2) implementation of administrative controls, (3) facilitation of engineering and environmental controls, and (4) protection of the health care worker and patient using hand hygiene and personal protective equipment. Additional considerations are pre-epidemic vaccination and incremental costs and benefits of infection prevention interventions. Here, major strategies for preventing health-care-associated transmissions are reviewed, including reducing exposure; vaccination; administrative, engineering, and environmental controls; and personal protective equipment. Examples from recent outbreaks are used to highlight key infection prevention aspects and controversies.
Collapse
Affiliation(s)
- Westyn Branch-Elliman
- Department of Medicine, Division of Infectious Diseases, Eastern Colorado VA Healthcare System, Denver, CO, USA,
| | | | | | | |
Collapse
|
48
|
Reich JA, Goodstein ME, Callahan SE, Callahan KM, Crossley LW, Doron SI, Snydman DR, Nasraway SA. Physician report cards and rankings yield long-lasting hand hygiene compliance exceeding 90%. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:292. [PMID: 26271619 PMCID: PMC4536705 DOI: 10.1186/s13054-015-1008-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/23/2015] [Indexed: 11/19/2022]
Abstract
Introduction Hand hygiene is an effective, low-cost intervention that prevents the spread of multidrug-resistant bacteria. Despite mandatory education and reminders, compliance by physicians in our hospital remained stubbornly low. Our objective was to study whether surveillance by our unit coordinator (secretary) paired with regular feedback to chiefs of service would increase physician hand hygiene compliance in the ICU. Method The ICU unit coordinator was trained to observe and measure hand hygiene compliance. Data were collected on hand hygiene compliance at room entry and exit for 9 months. Percentage compliance for each medical and surgical subspecialty was reported to chiefs of service at the end of each month. Comparative rankings by service were widely distributed throughout the physician organization and the medical center. Results The hand hygiene compliance rate among physicians increased from 65.1 % to 91.6 % during the study period (p <0.0001). More importantly in the succeeding 24 months after study completion, physician hand hygiene compliance remained >90 % in every month. Conclusions Physician hand hygiene compliance increased as a consequence of the surveillance conducted by a full-time ICU team member, leading to a highly significant increase in the number of observations. In turn, this allowed for specific comparative monthly feedback to individual chiefs of service. Over the next 2 years after the study ended, these gains were sustained, suggesting an enduring culture change in physician behavior.
Collapse
Affiliation(s)
- John Adam Reich
- Department of Anesthesiology, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
| | - Monica E Goodstein
- Department of Surgery, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
| | - Susan E Callahan
- Department of Anesthesiology, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
| | - Kathleen M Callahan
- Department of Anesthesiology, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
| | - Lindsay W Crossley
- Department of Nursing, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
| | - Shira I Doron
- Division of Infectious Diseases, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
| | - David R Snydman
- Division of Infectious Diseases, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
| | - Stanley A Nasraway
- Department of Surgery, Tufts Medical Center and the Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA.
| |
Collapse
|
49
|
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.
Collapse
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
| |
Collapse
|
50
|
Fätkenheuer G, Hirschel B, Harbarth S. Screening and isolation to control meticillin-resistant Staphylococcus aureus: sense, nonsense, and evidence. Lancet 2015; 385:1146-9. [PMID: 25150745 DOI: 10.1016/s0140-6736(14)60660-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Gerd Fätkenheuer
- Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany; German Centre for Infection Research (DZIF)-partner site Bonn-Cologne, Germany.
| | - Bernard Hirschel
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| |
Collapse
|