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Iversen AM, Hansen MB, Münster M, Kristensen B, Ellermann-Eriksen S. Hand hygiene compliance in nursing home wards: the effect of increased accessibility of alcohol-based hand rub. J Hosp Infect 2024; 147:206-212. [PMID: 38521416 DOI: 10.1016/j.jhin.2024.02.027] [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: 12/21/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission. AIM To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs). METHODS An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period. FINDINGS A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30-32). A significant +18% absolute immediate effect (first five months) (95% CI: 17-19; P < 0.0001) and +13 percentage points (95% CI: 11-14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (P < 0.0001). CONCLUSION Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential.
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Affiliation(s)
- A-M Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Denmark.
| | - M B Hansen
- Konduto ApS, Sani Nudge, Copenhagen, Denmark
| | | | - B Kristensen
- National Centre of Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - S Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Denmark
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Iversen AM, Hansen MB, Ellermann-Eriksen S. Effects of data-driven feedback on nurses' and physicians' hand hygiene in hospitals - a non-resource-intensive intervention in real-life clinical practice. Infect Prev Pract 2023; 5:100321. [PMID: 38028363 PMCID: PMC10679856 DOI: 10.1016/j.infpip.2023.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hand hygiene (HH) by healthcare workers (HCWs) is one of the most important measures to prevent hospital-acquired infections. However, HCWs struggle to adhere to HH guidelines. We aimed to investigate the effect of a non-resource intensive intervention with group and individual feedback on HCWs HH in a real-life clinical practice during the COVID-19 pandemic. Methods In 2021, an 11-month prospective, interventional study was conducted in two inpatient departments at a Danish university hospital. An automated hand hygiene monitoring system (Sani Nudge™) was used to collect data. HH opportunities and alcohol-based hand rub events were measured. Data were provided as HH compliance (HHC) rates. We compared HHC across 1) a baseline period, 2) an intervention period with weekly feedback in groups, followed by 3) an intervention period with weekly individual feedback on emails, and 4) a follow-up period. Results We analyzed data from physicians (N=65) and nurses (N=109). In total, 231,022 hygiene opportunities were analyzed. Overall, we observed no significant effect of feedback, regardless of whether it was provided to the group or individuals. We found a trend toward a higher HHC in staff restrooms than in medication rooms and patient rooms. The lowest HHC was found in patient rooms. Conclusions The automated hand hygiene monitoring system enabled assessment of the interventions. We found no significant effect of group or individual feedback at the two departments. However, other factors may have influenced the results during the pandemic, such as time constraints, workplace culture, and the degree of leadership support.
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Affiliation(s)
- Anne-Mette Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Denmark
| | | | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Denmark
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Terho K, Rintala E, Engblom J, Salanterä S. Action research on promoting hand hygiene practices in an intensive care unit. Nurs Open 2023; 10:3367-3377. [PMID: 36594651 PMCID: PMC10077419 DOI: 10.1002/nop2.1591] [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: 03/25/2022] [Revised: 12/06/2022] [Accepted: 12/18/2022] [Indexed: 01/04/2023] Open
Abstract
AIM Evaluate the intensive care acquired infections incidence and the change over time in infection practices in one intensive care unit. DESIGN We used an action research approach with cyclical activities. METHODS Our study included two cycles with hand hygiene observation based on the WHO's five-moments observation tool, observing hand hygiene practices, analysing the observations, and giving feedback on observations, intensive care acquired infection rates, and alcohol-based hand rub consumption. The Revised Standards for Quality Improvement Reporting Excellence is the basis for this research report describing research aimed at improving patient safety and quality of care. RESULTS During the study, annual alcohol-based hand rub consumption increased by 6.7 litres per 1000 patient days and observed hand hygiene compliance improved. In the first cycle of the study, there was a decrease in critical care acquired infection rates, but the improvement was not sustainable.
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Affiliation(s)
- Kirsi Terho
- Department of Nursing Science, University of Turku, Turku, Finland.,Department of Hospital Hygiene and Infection control, Turku University Hospital, Turku, Finland
| | - Esa Rintala
- Department of Hospital Hygiene and Infection control, Turku University Hospital, Turku, Finland
| | | | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Administration, Nursing, Turku, Finland
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4
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Erichsen Andersson A, Gillespie BM, Karlsson M, Malchau H, Nellgård B, Wikström E, Rogmark C, Tillander J. Reduction of early surgical site and other care related infections in 3553 hip fracture patients: lessons learned from the 5-year Safe Hands project. Antimicrob Resist Infect Control 2022; 11:113. [PMID: 36064457 PMCID: PMC9444111 DOI: 10.1186/s13756-022-01153-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Surgical site infection (SSI) after acute hip fracture surgery is a devastating complication associated with increased suffering and mortality. The aim of the study was to investigate early SSI, sepsis, pneumonia and urinary tract infections over five years, before and after the implementation of the Safe Hands project. Methods This was a single-centre observational study with a 5-year longitudinal design, investigating the effects of an infection-prevention intervention targeting the clinical care pathway of individuals with acute hip fracture. Statistical analyses were based on routinely collected patient outcome data comprising 3553 patients. The study conforms to the criteria of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Results The incidence of early SSIs decreased from 2.5% in years 1–2 to 1.1% in years 4–5. Similar results were observed for sepsis (2.7% to 1.3%) and urinary tract infections (14.2% to 4.2%). The multivariable regression results suggest that, for every observed year, the odds of early SSIs decreased. Male gender, procedure time, sepsis and preoperative skin damage increased the odds significantly.
Conclusions Our preventive bundle, based on partnership between researchers, managers and clinicians and a strong commitment to change from the involved professions, appear to be effective in reducing the frequency of potentially devastating SSIs and other hospital acquired infections after hip fracture surgery. The use of external and internal facilitators was crucial to enable individual and organisational learning and overcoming barriers to improvements.
Trial registration: Clinical Trials.gov ID: NCT02983136 Registered 6 December 2016—Retrospectively registered.
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Hammerschmidt J, Heier L, Ernstmann N. Enablement of nursing home residents in infection prevention during general practitioner visits: A qualitative study. PLoS One 2022; 17:e0266502. [PMID: 35390089 PMCID: PMC8989284 DOI: 10.1371/journal.pone.0266502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Hand hygiene measures are essential to protect nursing home residents against nosocomial infections. Evidence on the prevention of nosocomial infections for nursing home residents by general practitioners during their medical visits in nursing homes or how they enable nursing home residents to perform hand hygiene measures is lacking. This study aimed to explore hand hygiene behaviors of general practitioners in nursing homes, their attitudes toward infection prevention measures, and the enablement of nursing home residents in performing hand hygiene measures. Materials and methods Semi-structured interviews were conducted with general practitioners and nursing home residents in Germany. Interviews were audio-recorded and transcribed. Data were analyzed using thematic content analysis. Results Overall, 12 general practitioners and 12 nursing home residents participated in the study. The general practitioners expressed the fact that the possibilities for practicing hand hygiene differ in individual nursing homes. For nursing home residents, the availability of hand rub solutions was limited. Instructions for residents on hand disinfection from general practitioners was not described. Due to the lack of enablement, the residents’ knowledge on how to correctly perform hand hygiene was low, although some of the nursing home residents have experience with multidrug-resistant organisms. The nursing home residents varied in their needs for active participation and enablement during the general practitioners visit. Conclusion Nursing home residents require continuous enablement by their general practitioners to maintain adequate hand hygiene. Therefore, general practitioners should consider the different needs of nursing home residents to ensure adequate individual hand hygiene and safety for the residents. Existing guidelines for infection prevention and control do not adequately cover the nursing home care setting for the enablement of residents to enquire about hand hygiene.
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Affiliation(s)
| | - Lina Heier
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany
| | - Nicole Ernstmann
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany
- * E-mail:
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Chen W, Tseng CL. What are healthcare workers' preferences for hand hygiene interventions? A discrete choice experiment. BMJ Open 2021; 11:e052195. [PMID: 34732487 PMCID: PMC8572395 DOI: 10.1136/bmjopen-2021-052195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To understand the key attributes in designing effective interventions for improving healthcare workers' (HCWs') hand hygiene compliance and HCWs' preference for these attributes. DESIGN A discrete choice experiment (DCE) was conducted with five attributes extracted from the framework of Total Quality Management that can be applied in the design of hand hygiene interventions. They were hand hygiene monitoring, open discussion, message framing, resources accessibility and top management involvement. An addition attribute, peer hand hygiene performance, was considered as a contextual factor. Data were analysed by a conditional logit model to evaluate how these attributes impact HCWs' hand hygiene compliance. SETTING The DCE was conducted with participants from a university hospital in Taichung. PARTICIPANTS HCWs involved in daily patient-care activities (N=387). RESULTS To enhance their compliance, HCWs had strong and consistent preferences in having open discussion of hand hygiene problems ([Formula: see text], [Formula: see text]), easy access to hand hygiene resources ([Formula: see text], [Formula: see text]) and top management involvement ([Formula: see text], [Formula: see text]). For hand hygiene monitoring ([Formula: see text], [Formula: see text]), HCWs preferred to be monitored by infection control staff over their department head if their peer hand hygiene performance was low. On the other hand, when the peer performance was high, monitoring by their department head could improve their hand hygiene compliance. Similarly, how educational messages were framed impacted compliance and also depended on the peer hand hygiene performance. When the peer performance was low, HCWs were more likely to increase their compliance in reaction to loss-framed educational messages ([Formula: see text],[Formula: see text]). When the peer performance was high, gain-framed messages that focus on the benefit of compliance were more effective in inducing compliance. CONCLUSIONS Each intervention design has its unique impact on HCWs' hand hygiene compliant behaviour. The proposed approach can be used to evaluate HCWs' preference and compliance of an intervention before it is implemented.
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Affiliation(s)
- Wenlin Chen
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chung-Li Tseng
- Business School, University of New South Wales, Sydney, New South Wales, Australia
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7
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Banks M, Phillips AB. Evaluating the effect of automated hand hygiene technology on compliance and C. difficile rates in a long-term acute care hospital. Am J Infect Control 2021; 49:727-732. [PMID: 33186681 DOI: 10.1016/j.ajic.2020.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Compliance with hand hygiene (HH) standards is a critical component to reducing the prevalence of Health Care Acquired Infections (HAIs). The use of HH technologies is increasing and studies examining the success of these technologies on HH compliance and HAIs are important to inform standards of care. COVID-19 has emphasized compliance HH standards. METHODS This study evaluated HH compliance and Clostridium difficile (C difficile) rates following implementation of an HH technology at a long-term acute care hospital. The HH technology required nursing and other staff with direct patient contact to wear a "badge" that measured alcohol concentration on a health care worker's hands or time washing hands at designated sinks upon exit/entry of patient rooms. No changes were made to environmental cleaning or antibiotic stewardship standards. Compliance and infection rates were compared 12 months pre-post implementation during 2017-2019. RESULTS There was an increase in HH compliance (89.82%-97.10%, P< .001)) and a reduction in the incidence of C. difficile (9.541-3.720, P= .0032). CONCLUSION The HH technology significantly and quickly increased HH compliance and reduced rates of C difficile. The technology provided ancillary benefits, including data tracing of all patient and staff contacts and cross-contamination events.
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Affiliation(s)
- Maureen Banks
- Spaulding Rehabilitation Network, Chief Operating Officer and Chief Nursing Officer, Charlestown, MA.
| | - Andrew B Phillips
- MGH Institute of Health Professions, Spaulding Rehabilitation Network, Charlestown, MA
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Guzmán Herrador BR, Romero Muñoz MJ, Ruiz Montero R, de la Fuente Martos C, Salcedo Leal I, Barranco Quintana JL, Amor Díaz I, González Priego ML, Díaz Molina C. [Discussion groups as an approach to assess knowledge, attitudes and practices of hand hygiene among the adult intensive care unit professionals from a referral hospital]. J Healthc Qual Res 2020; 35:297-304. [PMID: 32972904 DOI: 10.1016/j.jhqr.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The adherence to hand hygiene practices among the adult Intensive Care Unit (ICU) professionals in this hospital has not improved substantially in the last years, regardless of the theoretical training sessions conducted. A study was made of the knowledge, attitudes, and practices of the ICU personnel in this field. METHODS Several small discussion groups with ICU staff organised by preventive medicine professionals were scheduled in March 2018. Semi-structured questions on hand hygiene and use of gloves were included. The points discussed were listed into strengths and weaknesses. Knowledge was then assessed using an anonymous questionnaire, after the sessions. RESULTS Thirteen 60-minute sessions were carried out with 157 participants from all professional categories (82% from ICU, median=11 participants / session). The majority perceived hand hygiene as a priority issue of personal responsibility for patient safety. They identified factors that limit their ability to improve their adherence. Certain habits have more to do with personal preferences than with theoretical knowledge or technical indications. CONCLUSIONS The discussion groups have helped to make a diagnosis of the situation that will be useful to strengthen those areas of improvement that have been identified. If we aim for a cultural change, and eliminate incorrect habits, it seems more useful to carry out adequate continuing education as part of the daily routine of professionals.
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Affiliation(s)
- B R Guzmán Herrador
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España.
| | - M J Romero Muñoz
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
| | - R Ruiz Montero
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
| | - C de la Fuente Martos
- Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España; Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España
| | - I Salcedo Leal
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
| | - J L Barranco Quintana
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
| | - I Amor Díaz
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España
| | - M L González Priego
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España
| | - C Díaz Molina
- Unidad de Gestión Clínica Interniveles de Prevención, Promoción y Vigilancia de la Salud, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (Imibic), Córdoba, España
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Arianpoor A, Zarifian A, Askari E, Akhavan-Rezayat A, Dayyani M, Rahimian A, Amini E, Amel R, Ziaeemehr A, Zingg W, Aelami MH, Pittet D. "Infection prevention and control idea challenge" contest: a fresh view on medical education and problem solving. Antimicrob Resist Infect Control 2020; 9:26. [PMID: 32033592 PMCID: PMC7006168 DOI: 10.1186/s13756-020-0688-y] [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: 09/03/2019] [Accepted: 01/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background Healthcare-associated infections (HAIs) challenge modern medicine. Considering their high prevalence in Iran, we aimed to provide knowledge on the subject, and to teach about the importance of infection prevention and control (IPC) to a broad audience of pre-graduate healthcare professionals, focusing on education as the cornerstone of IPC. Main body We invited Iranian medical students to present ideas on “how to reduce HAIs.” Projects were eligible if being original and addressing the call. Accepted projects were quality assessed using a scoring system. Forty-nine projects were submitted, of which 37 met the inclusion criteria. They had a mean score of 69.4 ± 18.3 out of the maximum possible score of 115. Four reviewers assessed the 37 projects for clinical applicability, impact on patient safety, and innovation, and selected the best 12 to compete at the 2nd International Congress on Prevention Strategies for Healthcare-associated Infections, Mashhad, Iran, 2018. The competition took place in three rounds. The selected teams presented their projects in the first round and debated one by one in a knockout manner, while the jury reviewed their scientific content and presentation skills. In the second round, the top 5 projects competed for reaching the final stage, in which the teams presented their ideas in front of a panel of international IPC experts to determine the first three ranks. At the end of the contest, the participants gained valuable criticisms on how to improve their ideas. Moreover, by its motivating atmosphere, the contest created an excellent opportunity to promote IPC in medical schools. Conclusions Using innovation contests in pre-graduates is an innovative education strategy. It sensitizes medical students to the challenges of IPC and antimicrobial resistance and drives them to think about solutions. By presenting and defending their innovations, they deepen their understanding on the topic and generate knowledge transfer in both ways, from students to teachers and vice versa.
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Affiliation(s)
- Arash Arianpoor
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Mashhad Medical Microbiology Student Research Group, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmadreza Zarifian
- Mashhad Medical Microbiology Student Research Group, Mashhad University of Medical Sciences, Mashhad, Iran.,Orthopaedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Emran Askari
- Mashhad Medical Microbiology Student Research Group, Mashhad University of Medical Sciences, Mashhad, Iran.,Nuclear Medicine Resident, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arash Akhavan-Rezayat
- Mashhad Medical Microbiology Student Research Group, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Dayyani
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Amin Rahimian
- Mashhad Medical Microbiology Student Research Group, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elahe Amini
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roya Amel
- Mashhad Medical Microbiology Student Research Group, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aghigh Ziaeemehr
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Walter Zingg
- Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland
| | - Mohammad Hasan Aelami
- Infection Control and Hand Hygiene Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Shariati Square, Mashhad, Iran.
| | - Didier Pittet
- Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
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Soh KL, Davidson PM, Leslie G, DiGiacomo M, Soh KG. Nurses' perceptions of the sustainability of a standardised assessment for preventing complications in a ICU: a qualitative study. Contemp Nurse 2020; 55:221-236. [PMID: 31403398 DOI: 10.1080/10376178.2019.1643751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Quality improvement projects have been widely adopted to prevent complications in the ICU. Objective: This paper describes nurses' perceptions of implementation strategies and the potential sustainability of a practice change intervention to prevent complications in a Malaysian ICU. Design: A participatory action research using five focus group discussions were undertaken with 19 nurses in a single ICU in regional Malaysia. Focus group transcripts were analysed using thematic analysis. Results: The main themes derived from the interviews were: [1] Empowering staff to embrace evidence-based practices; [2] Staff knowledge, attitudes, and beliefs that impact on behaviour; and [3] management support and leadership are influential in staff behaviours (acceptance & perseverance of change process). Discussion: Resistance to change was recognized as a barrier to adopting evidence based recommendations. There is a need to improve nurses' knowledge, attitude and awareness of the importance of assessment for VAP, CRBSI and PIs in the ICU.
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Affiliation(s)
- Kim Lam Soh
- a Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia , Malaysia
| | - Patricia M Davidson
- b John Hopkins School of Nursing , Baltimore , MD , USA.,c University of Technology Sydney , Sydney , Australia
| | - Gavin Leslie
- d Curtin Health Innovation Research Institute, Curtin University , Perth , Australia
| | | | - Kim Geok Soh
- e Department of Sport Studies, Faculty of Educational Studies / Sport Academy, Universiti Putra Malaysia , Malaysia
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Unexpected categories at risk of S. aureus nasal carriage among hospital workers. Int J Hyg Environ Health 2019; 222:1093-1097. [PMID: 31422009 DOI: 10.1016/j.ijheh.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Thirty percent of the general population are Staphylococcus aureus nasal carriers. It has been shown that this increases with repeated contact with patients, but it is not known whether all categories of healthcare workers are at equal risk of carriage. We aimed to explore S. aureus nasal carriage among healthcare professionals. METHODS Prospective study conducted in two French university hospitals in 2014 and 2016. Volunteers were screened for S. aureus nasal carriage. Profession and hygiene habits were collected. Based on the results of this initial study, a second study focused on semi-skilled workers and biomedical equipment technicians (BETs) only; participants were given education on the basic rules of hygiene, then re-screened three months later. RESULTS In the initial study, 38.8% of the 436 participants were detected as nasal carriers. There was a significant difference in nasal carriage according to professional category (p < 0.0001); the lowest was found among administrative agents (17.3%), followed by healthcare providers (37.4%), laboratory technicians (37.6%). The greatest proportion was found among semi-skilled workers and BETs (52.9%). Spa-typing ruled out the hypothesis of a single clone dissemination among colleagues. After the three-month hygiene awareness campaign, all re-screened individuals remained positive, and with their respective initial strain. CONCLUSIONS To the best of our knowledge we report here for the first time that semi-skilled workers and BETs are specifically more at risk of S. aureus nasal colonisation. This striking finding urges hospital hygiene departments to evaluate this specific professional category and implement strategies to improve hygiene awareness.
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12
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Hammerschmidt J, Manser T. Nurses' knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC Health Serv Res 2019; 19:547. [PMID: 31382968 PMCID: PMC6683349 DOI: 10.1186/s12913-019-4347-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Infections with multi-resistant bacteria’s, associated with healthcare, is a known problem. The nursing home setting differs from other healthcare environments in individual and organisational factors such as knowledge, behaviour, and attitude to improve hand hygiene and it is therefore difficult to research the influential factors to improve hand hygiene. Studies have shown that increasing knowledge, behaviour and attitudes could enhance hand hygiene compliance in nursing homes. Therefore, it may be important to examine individual and organisational factors that foster improvement of these factors in hand hygiene. We aim to explore these influences of individual and organisational factors of hand hygiene in nursing home staff, with a particular focus on the function of role modelling by nursing managers. Methods We conducted a mixed-methods study surveying 165 nurses and interviewing 27 nursing managers from nursing homes in Germany. Results Most nurses and nursing managers held the knowledge of effective hand hygiene procedures. Hygiene standards and equipment were all generally available but compliance to standards also depended upon availability in the immediate work area and role modelling. Despite a general awareness of the impact of leadership on staff behaviour, not all nursing managers fully appreciated the impact of their own consistent role modelling regarding hand hygiene behaviours. Conclusion These results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.
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Affiliation(s)
- Judith Hammerschmidt
- Institute for Patient Safety, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Tanja Manser
- University of Applied Sciences and Arts Northwestern Switzerland, FHNW School of Applied Psychology, Olten, Switzerland
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Smiddy MP, Murphy OM, Savage E, Fitzgerald AP, O' Sullivan B, Murphy C, Bernard M, Browne JP. Efficacy of observational hand hygiene audit with targeted feedback on doctors' hand hygiene compliance: A retrospective time series analysis. J Infect Prev 2019; 20:164-170. [PMID: 31428196 DOI: 10.1177/1757177419833165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/30/2018] [Indexed: 11/16/2022] Open
Abstract
Background Healthcare-associated infection compromises patient safety. Compliance with hand hygiene (HH) guidelines has been shown to be an effective method of reducing infection; however, it remains suboptimal and poorer among doctors compared to other healthcare workers. The aim of this study is to determine the relationship between an individualised observational hand hygiene audit (OHHA) and feedback intervention with observed HH compliance. Methods We used a retrospective interrupted time series design using OHHA data from a five-year period, 2011-2015. OHHA indicated poorer HH compliance among doctors than other healthcare workers in a 345-bed acute private hospital. An increase in orthopaedic surgical site infection prompted additional auditing of the orthopaedic unit further identifying substandard HH compliance among orthopaedic surgeons. In addition to ongoing HH interventions, an individualised hand hygiene audit and feedback intervention focusing on consultant orthopaedic surgeons was implemented. Observed HH compliance improved. The intervention was then extended to include all consultant doctors at the study site. Audit was implemented by trained clinical nurse managers during clinical rounds. Written audit feedback was provided by the infection prevention and control team. Results HH compliance increased significantly among both orthopaedic surgeons and other consultant doctors, P < 0.05. Conclusion An individualised audit and feedback intervention was effective in improving compliance. Incorporation of OHHA with individualised feedback into routine daily practice needs to be considered as a quality improvement opportunity. This study has the potential to inform other audit and feedback interventions to maximise effectiveness and ensure implementation.
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Affiliation(s)
- Maura P Smiddy
- University College Cork National University of Ireland, Western Gateway Building, Cork, Ireland
| | | | - Eileen Savage
- University College Cork National University of Ireland, Western Gateway Building, Cork, Ireland
| | - Anthony P Fitzgerald
- University College Cork National University of Ireland, Western Gateway Building, Cork, Ireland
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