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Sahiner P. Is there a relationship between nurses' hand hygiene beliefs, practices and ethical sensitivity? Appl Nurs Res 2024; 78:151813. [PMID: 39053990 DOI: 10.1016/j.apnr.2024.151813] [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: 04/25/2023] [Revised: 08/03/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Hand hygiene is the most important way to prevent health care-associated infections. It is important for all nurses that come in physical contact with patients the most to follow hand hygiene rules. AIM This study aimed to determine the relationship between nurses' hand hygiene beliefs and practices and their ethical sensitivity. METHOD This descriptive and cross-sectional study was conducted with nurses working in internal medicine, surgery and intensive care clinics of a university hospital between June and August 2022. A total of 350 nurses participated in the study. A Personal Information Form, the Ethical Sensitivity Questionnaire (ESQ), the Hand Hygiene Practice Inventory (HHPI), and the Hand Hygiene Beliefs Scale (HHBS) were used for data collection. RESULTS Findings support that nurses have moderate ethical sensitivity (88.36 ± 26.33), good hand hygiene beliefs (85.60 ± 9.21) and practice (66.14 ± 5.90). Despite there being no statistical significance in evaluating the relationship between hand hygiene practice and ethical sensitivity (p = 0.253, r = -0.061), there was a statically significant inverse relationship between hand hygiene beliefs and ethical sensitivity (p = 0.001, r = -0.172). The hand hygiene compliance score of the nurses who received only ethics training after nursing school (p = 0.000); the hand hygiene belief (p = 0.011) and hand hygiene practice (p = 0.007) scores of those who received both ethics and hand hygiene training were higher. CONCLUSIONS It can be said that the ethical sensitivity of nurses does not affect their hand hygiene practices, and the hand hygiene and ethics education they receive after school education increases their hand hygiene beliefs and practices.
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Affiliation(s)
- Pervin Sahiner
- Kocaeli University Faculty of Health Sciences, Kocaeli, Turkey.
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2
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Chakma SK, Hossen S, Rakib TM, Hoque S, Islam R, Biswas T, Islam Z, Islam MM. Effectiveness of a hand hygiene training intervention in improving knowledge and compliance rate among healthcare workers in a respiratory disease hospital. Heliyon 2024; 10:e27286. [PMID: 38486731 PMCID: PMC10937679 DOI: 10.1016/j.heliyon.2024.e27286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 01/23/2024] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
Background Practicing hand hygiene (HH) is a crucial element of infection control, with healthcare workers (HCWs) playing a vital role in preventing the spread of infection. However, inadequate knowledge and non-compliance to HH protocols pose significant challenges in healthcare settings. This study aimed to evaluate the effectiveness of an HH training intervention in enhancing knowledge and staff compliance within a respiratory disease hospital. Method A pre-and post-training study was conducted among the healthcare workers in a respiratory disease treatment facility. The intervention comprised a series of 3-hour training sessions conducted over five days, focusing on the World Health Organization's (WHO) recommended guideline "Your Five Moments For Hand Hygiene." These sessions covered proper HH techniques and underscored the repercussions of inadequate compliance. Educational materials related to HH were displayed in prominent locations throughout the facility. The knowledge levels and compliance rate were assessed before and after the intervention. Result The intervention significantly improved HH knowledge levels and compliance rates among the participants. Marking a significant improvement, the compliance rate of HH protocols increased from 66.0% to 88.3% during the pre-to post-training period, with a concurrent increase in the mean knowledge score from 68.6% to 78.9%. Conclusion This study underscores the potential of training and education in elevating HH compliance and knowledge among healthcare workers. The findings advocate that healthcare facilities routinely incorporate such interventions into their infection control programs, ultimately improving patient and healthcare worker safety.
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Affiliation(s)
- Samar Kishor Chakma
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh
| | - Saheen Hossen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh
| | - Tareq Mahmud Rakib
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh
| | - Samsul Hoque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh
| | - Rashadul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh
| | - Tapos Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh
| | - Ziaul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh
| | - M Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka-1212, Bangladesh
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Chitamanni P, Allana A, Hand I. Quality Improvement Project to Improve Hand Hygiene Compliance in a Level III Neonatal Intensive Care Unit. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1484. [PMID: 37761445 PMCID: PMC10528076 DOI: 10.3390/children10091484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
This quality improvement project aimed to improve hand hygiene (HH) compliance in a Level III Neonatal Intensive Care Unit. The project was conducted over three Plan-Do-Study-Act (PDSA) cycles, with each cycle lasting two months. The interventions included healthcare worker (HCW) education on HH, repetition of education, and immediate feedback to HCWs. Compliance data were collected through covert observations of HCWs in the NICU. The overall compliance rate increased from 31.56% at baseline to 46.64% after the third PDSA cycle. The HH compliance was noted to be relatively low after touching patient care surroundings, at entry and exit from the NICU main unit, before wearing gloves and after removing gloves, at baseline and throughout the three PDSA cycles. HCW education alone did not result in significant improvements, highlighting the need for additional interventions. The study underscores the importance of involving NICU leadership and providing immediate feedback to promote HH compliance. Further efforts should focus on addressing the false sense of security associated with glove usage among HCWs, individual rewards and involving the healthcare staff in the shared goal of increasing HH compliance. Consideration of workload metrics and their impact on compliance could steer future interventions.
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Affiliation(s)
- Pavani Chitamanni
- Department of Pediatrics, NYC Health & Hospitals/Kings County, Brooklyn, NY 11203, USA; (P.C.); (A.A.)
- Department of Pediatrics, SUNY-Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Ahreen Allana
- Department of Pediatrics, NYC Health & Hospitals/Kings County, Brooklyn, NY 11203, USA; (P.C.); (A.A.)
- Department of Pediatrics, SUNY-Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Ivan Hand
- Department of Pediatrics, NYC Health & Hospitals/Kings County, Brooklyn, NY 11203, USA; (P.C.); (A.A.)
- Department of Pediatrics, SUNY-Downstate Health Sciences University, Brooklyn, NY 11203, USA
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Arai M, Feniche M, Ouhadous M, Lajane H, Barrou L, Zerouali K. Hand Hygiene in the Intensive Care Unit: Knowledge, Compliance and Factors Influencing Nursing Adherence, a Descriptive Study. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2206290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Nosocomial infections are particularly common among hospitalized patients who undergo resuscitation compared with other types of care. Hand hygiene remains the simplest and most effective measure to prevent and control the risk of infection.
Objective:
The main objectives are to evaluate hand hygiene compliance among nursing staff in the different intensive care units and to identify the factors influencing the adherence of nursing staff to the practice.
Methods:
It was a quantitative descriptive study using a questionnaire and an observation grid with all the nursing staff working in all the intensive care units of our university hospital.
Results:
The study showed a hand contamination rate of (80%), a hand hygiene compliance rate of (21.3%), it also showed the different factors explaining non-adherence, these are not necessarily related to training, nor to the availability of material resources but related to hidden reasons, non-apparent factors, which are often more important. (Workload and work environment)
Conclusion:
This study examined hand hygiene in the ICU setting, obtained data on overall compliance, which remains poor, and the various factors influencing nurses' adherence to the practice.
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Tadesse M, Shimelash A, Tegegne E. Level of Hand Hygiene Compliance and Its Associated Factors Among Health Care Workers at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221113673. [PMID: 35873715 PMCID: PMC9305797 DOI: 10.1177/11786302221113673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Poor hand hygiene is an important source of infection, but maintaining hand hygiene is the most important measure to prevent infections. Hand hygiene compliance and its associated factors are not well recognized in Ethiopia. Therefore, this study was intended to determine hand hygiene compliance and its associated factors among health care workers in Eka Kotebe General Hospital. METHODS A cross-sectional study was conducted among health care workers at Eka Kotebe General Hospital. A self-administered questionnaire supplemented by a World Health Organization Hand Hygiene Technical Reference Manual was used to collect data. Data was entered using Epi Info 7.2.0.1 and exported to SPSS 23 for analysis. The data were analyzed using descriptive and inferential statistics. Statistical significance was determined using a P-value of ⩽.05 with a 95% confidence interval. RESULTS Hand hygiene compliance among healthcare workers was 22.2%. Hand hygiene training (AOR = 2.9, 95% CI: 1.13-7.52), presence of hand hygiene indication poster (AOR = 3.38, 95% CI: 1.18-9.66), hand hygiene promotion by IPC team (AOR = 4.2, 95% CI: 2.53-8.58)), working experience ⩾5 years of a health care providers (AOR = 3.96, 95% CI: 1.12-13.9), being midwife (AOR = 17.1, 95% CI: 2.8-10), being nurse (AOR = 5.3, 95% CI: 2.09-7.8) by profession, and presence of water (AOR = 2.50, 95% CI: 2.20-11.78) were significantly associated factors to hand hygiene compliance. CONCLUSION The level of hand hygiene compliance among health care providers was found to be low. Training about hand hygiene, the presence of hand hygiene indication posters, hand hygiene promotion by the IPC team, working experience of health care providers, being a nurse and midwife, and the presence of water were independent predictors of hand hygiene compliance. Health care workers need to be given training on hand hygiene as well as hand hygiene facilities shall be installed and supplied by the hospital in a sustained manner.
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Affiliation(s)
| | - Alebachew Shimelash
- Department of Environmental Health, Debre Markos University, Debre Markos, Ethiopia
| | - Eniyew Tegegne
- Department of Environmental Health, Debre Markos University, Debre Markos, Ethiopia
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Ofori SK, Hung YW, Schwind JS, Muniz-Rodriguez K, Kakou RJ, Alade SE, Diallo K, Sullivan KL, Cowling BJ, Fung ICH. The use of digital technology to improve and monitor handwashing among children 12 years or younger in educational settings: a scoping review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:547-564. [PMID: 32579032 DOI: 10.1080/09603123.2020.1784398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
Our scoping review aimed to identify and describe the application of digital technology in hand hygiene research among children in educational settings. We searched for articles in PubMed, IEEE Xplore, and Web of Science. Original hand hygiene research with a form of digital technology used among children ≤12 years in educational settings was eligible for inclusion. Twelve studies met the eligibility criteria and the data were extracted by two teams of independent co-authors for narrative synthesis. Ten studies used digital technology as an intervention tool and two for monitoring purposes. Three main digital technologies were identified including computer games (n = 2), videos (n = 8), and video cameras (n = 2). Digital technologies found in our scoping review were reported to be effective in hand hygiene studies over short temporal periods especially when used in combination with other measures. Future research may demonstrate the effectiveness of digital technology in helping children develop sustainable handwashing behaviors.
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Affiliation(s)
- Sylvia K Ofori
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Yuen Wai Hung
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Jessica S Schwind
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Kamalich Muniz-Rodriguez
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Reece J Kakou
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Sunmisola E Alade
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Kadiatou Diallo
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Kelly L Sullivan
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - I C H Fung
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
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Barbon HCV, Fermin JL, Kee SL, Tan MJT, AlDahoul N, Karim HA. Going Electronic: Venturing Into Electronic Monitoring Systems to Increase Hand Hygiene Compliance in Philippine Healthcare. Front Pharmacol 2022; 13:843683. [PMID: 35250592 PMCID: PMC8892004 DOI: 10.3389/fphar.2022.843683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Jamie Ledesma Fermin
- Department of Electronics Engineering, University of St. La Salle, Bacolod, Philippines
| | - Shaira Limson Kee
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines
| | - Myles Joshua Toledo Tan
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines
- Department of Chemical Engineering, University of St. La Salle, Bacolod, Philippines
- *Correspondence: Myles Joshua Toledo Tan, ; Hezerul Abdul Karim,
| | - Nouar AlDahoul
- Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
| | - Hezerul Abdul Karim
- Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
- *Correspondence: Myles Joshua Toledo Tan, ; Hezerul Abdul Karim,
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Deshommes T, Nagel C, Tucker R, Dorcélus L, Gautier J, Koster MP, Lechner BE. A Quality Improvement Initiative to Increase Hand Hygiene Awareness and Compliance in a Neonatal Intensive Care Unit in Haiti. J Trop Pediatr 2021; 67:5864459. [PMID: 32594158 DOI: 10.1093/tropej/fmaa029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Healthcare-associated infections (HCAI) are major causes of morbidity, mortality, increased lengths of stay and are an economic burden on healthcare systems in resources-limited settings. This is especially true for neonates, who are more susceptible with underdeveloped immune systems. Hand hygiene (HH) is a key weapon against HCAI, yet globally, HH compliance remains substandard. This study sought to determine the compliance with HH among healthcare workers (HCWs) in a children's hospital neonatal intensive care unit (NICU) in Haiti. METHODS A HH educational intervention was performed in the NICU, including lectures and posters. Pre- and post-intervention HH data were collected on HCWs and parents using the World Health Organization '5 Moments for HH'. Data were analyzed using standard statistical analysis. RESULTS HH increased in all HCW roles but not in parents. Correct HH increased in all groups, including parents. HH was more likely to occur prior to patient contact than after patient contact. Correct HH was more likely to occur with alcohol-based hand rub than with soap and water. CONCLUSION This study demonstrates that an inexpensive and simple intervention can significantly increase HH compliance in a resource-limited NICU, which may lead to decreased rates of hospital-acquired sepsis. Parents, however, due to cultural norms as well as literacy and language barriers, need targeted educational interventions distinct from those that HCW benefit from.
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Affiliation(s)
- Theony Deshommes
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christian Nagel
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Richard Tucker
- Department of Pediatrics, Division of Neonatology, Women and Infants Hospital, Providence, RI 02905, USA
| | - Lindsay Dorcélus
- Department of Pediatrics, Division of Neonatology, Hôpital Saint-Damien, Nos Petits-Frères et Sœurs, Tabarre, Haiti 6110
| | - Jacqueline Gautier
- Department of Pediatrics, Division of Neonatology, Hôpital Saint-Damien, Nos Petits-Frères et Sœurs, Tabarre, Haiti 6110
| | - Michael P Koster
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA.,Department of Pediatrics, Hasbro Children's Hospital, Providence, RI 02903, USA
| | - Beatrice E Lechner
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA.,Department of Pediatrics, Division of Neonatology, Women and Infants Hospital, Providence, RI 02905, USA
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Hays T, Romani PW. Use of the Performance Diagnostic Checklist-Human Services to Assess Hand Hygiene Compliance in a Hospital. Behav Anal Pract 2021; 14:51-57. [PMID: 33732577 PMCID: PMC7900355 DOI: 10.1007/s40617-020-00461-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Poor hand hygiene in hospital settings leads to the spread of communicable disease to a population of individuals already medically compromised. The current study used the Performance Diagnostic Checklist-Human Services to develop an intervention targeting hand hygiene compliance for nine participants employed by an inpatient unit. The use of performance feedback and goal setting improved hand hygiene compliance when compared to baseline for eight of nine participants. Results are discussed in terms of strategies for using performance analysis to identify effective interventions to address performance deficits.
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Affiliation(s)
- Tara Hays
- Children’s Hospital Colorado, 13123 E. 16th Ave, Aurora, CO 80046 USA
| | - Patrick W. Romani
- Children’s Hospital Colorado, 13123 E. 16th Ave, Aurora, CO 80046 USA
- University of Colorado, Anschutz Medical Campus, 13001 E 17th. Place, Aurora, CO 80045 USA
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Molecular Epidemiology of Human Cryptosporidiosis in Low- and Middle-Income Countries. Clin Microbiol Rev 2021; 34:34/2/e00087-19. [PMID: 33627442 DOI: 10.1128/cmr.00087-19] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Cryptosporidiosis is one of the most important causes of moderate to severe diarrhea and diarrhea-related mortality in children under 2 years of age in low- and middle-income countries. In recent decades, genotyping and subtyping tools have been used in epidemiological studies of human cryptosporidiosis. Results of these studies suggest that higher genetic diversity of Cryptosporidium spp. is present in humans in these countries at both species and subtype levels and that anthroponotic transmission plays a major role in human cryptosporidiosis. Cryptosporidium hominis is the most common Cryptosporidium species in humans in almost all the low- and middle-income countries examined, with five subtype families (namely, Ia, Ib, Id, Ie, and If) being commonly found in most regions. In addition, most Cryptosporidium parvum infections in these areas are caused by the anthroponotic IIc subtype family rather than the zoonotic IIa subtype family. There is geographic segregation in Cryptosporidium hominis subtypes, as revealed by multilocus subtyping. Concurrent and sequential infections with different Cryptosporidium species and subtypes are common, as immunity against reinfection and cross protection against different Cryptosporidium species are partial. Differences in clinical presentations have been observed among Cryptosporidium species and C. hominis subtypes. These observations suggest that WASH (water, sanitation, and hygiene)-based interventions should be implemented to prevent and control human cryptosporidiosis in low- and middle-income countries.
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Gon G, de Barra M, Dansero L, Nash S, Campbell OMR. Birth attendants' hand hygiene compliance in healthcare facilities in low and middle-income countries: a systematic review. BMC Health Serv Res 2020; 20:1116. [PMID: 33267879 PMCID: PMC7713338 DOI: 10.1186/s12913-020-05925-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 11/15/2020] [Indexed: 12/13/2022] Open
Abstract
Background With an increasing number of women delivering in healthcare facilities in Low and Middle Income Countries (LMICs), healthcare workers’ hand hygiene compliance on labour wards is pivotal to preventing infections. Currently there are no estimates of how often birth attendants comply with hand hygiene, or of the factors influencing compliance in healthcare facilities in LMICs. Methods We conducted a systematic review to investigate the a) level of compliance, b) determinants of compliance and c) interventions to improve hand hygiene during labour and delivery among birth attendants in healthcare facilities of LMICs. We also aimed to assess the quality of the included studies and to report the intra-cluster correlation for studies conducted in multiple facilities. Results We obtained 797 results across four databases and reviewed 71 full texts. Of these, fifteen met our inclusion criteria. Overall, the quality of the included studies was particularly compromised by poorly described sampling methods and definitions. Hand hygiene compliance varied substantially across studies from 0 to 100%; however, the heterogeneity in definitions of hand hygiene did not allow us to combine or compare these meaningfully. The five studies with larger sample sizes and clearer definitions estimated compliance before aseptic procedures opportunities, to be low (range: 1–38%). Three studies described two multi-component interventions, both were shown to be feasible. Conclusions Hand hygiene compliance was low for studies with larger sample sizes and clear definitions. This poses a substantial challenge to infection prevention during birth in LMICs facilities. We also found that the quality of many studies was suboptimal. Future studies of hand hygiene compliance on the labour ward should be designed with better sampling frames, assess inter-observer agreement, use measures to improve the quality of data collection, and report their hand hygiene definitions clearly.
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Affiliation(s)
- Giorgia Gon
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Mícheál de Barra
- Brunel University London, Department of Life Sciences, Uxbridge, UK
| | | | - Stephen Nash
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Oona M R Campbell
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Campbell JI, Pham TT, Le T, Dang TTH, Chandonnet CJ, Truong TH, Duong H, Nguyen DD, Le TH, Tran TH, Nguyen TKO, Ho TMT, Le KN, Pollack TM, Sandora TJ. Facilitators and barriers to a family empowerment strategy to improve healthcare worker hand hygiene in a resource-limited setting. Am J Infect Control 2020; 48:1485-1490. [PMID: 32492500 DOI: 10.1016/j.ajic.2020.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The World Health Organization recommends empowering patients/families to remind healthcare workers (HCWs) to perform hand hygiene (HH). We sought to understand acceptability of a family empowerment strategy in a Vietnamese pediatric intensive care unit (PICU). METHODS With end-user input, we designed a tool to help families in a PICU in Vietnam to remind HCWs to perform HH. We conducted 3 preliminary focus group discussions (FGDs) with patients' family members (n = 8), physicians (n = 9), and nurses (n = 8) to understand acceptability of preliminary tools, attitudes towards HH and barriers to HH. Tools were then modified and implemented in a 5-week intervention study. We then conducted 3 more FGDs with families (n = 7), physicians (n = 7), and nurses (n = 8). Discussions were analyzed using qualitative directed content analysis. Families who used the tool were asked to complete written surveys. FINDINGS Both family members and HCWs felt that HCWs had a responsibility to perform HH. Barriers to performing HH were identified, including forgetfulness and time constraints. Family members felt shy reminding HCWs to perform HH. However, the HH reminder tool was acceptable, and some felt it could overcome barriers to reminding HCWs to perform HH. HCWs felt embarrassed when reminded to perform HH, but felt that the reminder was useful. Nearly all (99%) survey respondents felt that family members should speak up if they noticed HCWs omitting HH. CONCLUSIONS A tool given to families to remind HCWs to perform HH was largely acceptable in a pediatric ICU in Vietnam. Perceived benefits of improving HH were felt to surmount barriers to tool use.
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Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
| | - Thanh Thuy Pham
- Department of Medicine, Beth Israel Deaconess Medical Center, and The Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Trang Le
- Department of Medicine, Beth Israel Deaconess Medical Center, and The Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Thi Thu Huong Dang
- Department of Infection Prevention and Control, Vietnam National Children's Hospital, Hanoi, Vietnam
| | | | - Thi Hoa Truong
- Department of Cardiology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Hao Duong
- Department of Medicine, Beth Israel Deaconess Medical Center, and The Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Duc Duat Nguyen
- Department of Medicine, Beth Israel Deaconess Medical Center, and The Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Thi Huyen Le
- The Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Thi Ha Tran
- The Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Thi Kim Oanh Nguyen
- Department of Infection Prevention and Control, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Thi Minh Than Ho
- Department of Infection Prevention and Control, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Kien Ngai Le
- Department of Infection Prevention and Control, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Todd M Pollack
- Department of Medicine, Beth Israel Deaconess Medical Center, and The Partnership for Health Advancement in Vietnam, Hanoi, Vietnam
| | - Thomas J Sandora
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, MA
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Peters A, Palao VC, Lotfinejad N, Pittet D. WHO Year of the Nurse and Midwife: More clean and educated hands for all. J Infect Prev 2020; 21:166-169. [PMID: 33193817 DOI: 10.1177/1757177420958042] [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: 04/29/2020] [Accepted: 07/23/2020] [Indexed: 01/11/2023] Open
Abstract
For the last 10 years, the World Health Organization has been celebrating World Hand Hygiene Day on the 5th of May, bringing together the global healthcare ecosystem to celebrate hand hygiene. This day was created to raise awareness about the importance of hand hygiene in healthcare settings, as well as to focus on a specific annual topic to be highlighted to a global audience. The World Health Assembly designated 2020 as the Year of the Nurse and Midwife, and the slogan of this year's 5th of May was "Nurses and Midwifes: Clean Care is in Your Hands". This 5th of May helped us to highlight the need for increased staffing and hand hygiene training. In this paper we aimed to raise awareness about the global impact linked to adherence to proper hand hygiene practices by nurses and midwives.
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Affiliation(s)
- Alexandra Peters
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Switzerland
| | | | - Nasim Lotfinejad
- Department of Research, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Didier Pittet
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Switzerland
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A family empowerment strategy is associated with increased healthcare worker hand hygiene in a resource-limited setting. Infect Control Hosp Epidemiol 2019; 41:202-208. [PMID: 31822321 DOI: 10.1017/ice.2019.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Guidelines recommend empowering patients and families to remind healthcare workers (HCWs) to perform hand hygiene (HH). The effectiveness of empowerment tools for patients and their families in Southeast Asia is unknown. METHODS We performed a prospective study in a pediatric intensive care unit (PICU) of a Vietnamese pediatric referral hospital. With family and HCW input, we developed a visual tool for families to prompt HCW HH. We used direct observation to collect baseline HH data. We then enrolled families to receive the visual tool and education on its use while continuing prospective collection of HH data. Multivariable logistic regression was used to identify independent predictors of HH in baseline and implementation periods. RESULTS In total, 2,014 baseline and 2,498 implementation-period HH opportunities were observed. During the implementation period, 73 families were enrolled. Overall, HCW HH was 46% preimplementation, which increased to 73% in the implementation period (P < .001). The lowest HH adherence in both periods occurred after HCW contact with patient surroundings: 16% at baseline increased to 24% after implementation. In multivariable analyses, the odds of HCW HH during the implementation period were significantly higher than baseline (adjusted odds ratio [aOR], 2.94; 95% confidence interval [CI], 2.54-3.41; P < .001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs evening or weekend), and HH moment. CONCLUSIONS The introduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese PICU. Future research should explore acceptability and barriers to use of similar tools in low- and middle-income settings.
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Farmani Z, Kargar M, Khademian Z, Paydar S, Zare N. The effect of training and awareness of subtle control on the frequency of hand hygiene among intensive care unit nurses. BMC Res Notes 2019; 12:647. [PMID: 31590689 PMCID: PMC6781344 DOI: 10.1186/s13104-019-4635-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022] Open
Abstract
Objective This study aimed to determine the effect of awareness of subtle control after training on the hand hygiene compliance among nurses in intensive care units (ICUs). The study was conducted in two ICUs of a trauma center in Shiraz, Iran on 48 nurses. The nurses of one ICU were randomly allocated to the intervention and the nurses of the other ICU were allocated to the control group. All nurses were trained on hand hygiene. Then a fake closed camera television (CCTV) was visibly installed in the intervention group’s ICU, while the nurses were aware of it. The degree of compliance with hand hygiene was observed in both groups before and after the intervention. Data were gathered using a checklist based on the World Health Organization hand hygiene protocol and analyzed using SPSS 16 and the Chi square, Wilcoxon, Mann–Whitney U, and Independent T-tests, were performed. Results The mean percentage of hand hygiene compliance in the intervention group after the intervention was significantly higher than before the intervention (p < 0.001). Additionally, the changes in the mean percentage of the intervention group was significantly higher than that for the control group (p = 0.001). The findings showed that a fake CCTV after training, installed in ICUs, can improve hand hygiene compliance.
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Affiliation(s)
- Zeinab Farmani
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Kargar
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Khademian
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Najaf Zare
- Department of Biostatistics, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Jamil N, Handiyani H, Pujasari H. A multimodal approach as a strategy to improve hand hygiene compliance: A literature review. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gartmeier M, Baumgartner M, Burgkart R, Heiniger S, Berberat PO. Why hand hygiene is not sufficient: modeling hygiene competence of clinical staff as a basis for its development and assessment. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc39. [PMID: 31544139 PMCID: PMC6737265 DOI: 10.3205/zma001247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/06/2019] [Accepted: 05/28/2019] [Indexed: 06/10/2023]
Abstract
Adhering to hygiene standards in daily clinical work is an important characteristic of qualitatively high-value medical care. In this regards, hand hygiene is often focused on in the literature. From the viewpoint of medical education research, we argue that this focus is too narrow to explain how staff who are working clinically with patients implement and adhere to standards of hygiene across a wide variety of tasks of their daily clinical routine. We present basic features of a differentiated concept of hygiene competence, which includes specialized knowledge, corresponding inner attitudes, and action routines that are customized to the needs of specific situations. Building on that, we present a current simulation-based course concept aimed at developing hygiene competence in medical education. Furthermore, we describe a test instrument that is designed according to the principle of a situational judgment test and that appears promising for the assessment of hygiene competence. The course and the measurement instrument are discussed in regards to their fit to the competence model and the related perspectives for research and teaching.
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Affiliation(s)
- Martin Gartmeier
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Maria Baumgartner
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Rainer Burgkart
- Technical University of Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany
| | - Susanne Heiniger
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Pascal O. Berberat
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
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A multifaceted hand hygiene improvement program on the intensive care units of the National Referral Hospital of Indonesia in Jakarta. Antimicrob Resist Infect Control 2019; 8:93. [PMID: 31171964 PMCID: PMC6547605 DOI: 10.1186/s13756-019-0540-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/13/2019] [Indexed: 12/25/2022] Open
Abstract
Background Hand hygiene (HH) is considered to be the single most effective measure in preventing healthcare-associated infections. However, HH compliance rates among nurses and doctors in hospitals are often very low. Few studies have addressed HH compliance in Indonesia, performed interventions to increase HH compliance, and none have had long-term follow-up. We, therefore, addressed this issue by performing long-term follow-up after a multifaceted intervention in the intensive care unit (ICU) setting. Methods This was an observational, prospective, before-and-after intervention study (May–September 2014, February–April 2017). We measured HH knowledge and HH compliance before (at baseline) and directly after a multifaceted improvement program (post-intervention) and performed a re-evaluation three years later. The multifaceted improvement program included education, feedback, reminders, interviews and the use of role models. The study involved nurses and physicians working in two ICUs of the Dr. Cipto Mangunkusumo Hospital in Jakarta. Results A total of 97 at baseline, and 72 at post-intervention HH knowledge questionnaires were completed. There was a statistically significant improvement in the median overall HH knowledge score at post-intervention (from 15 to 22, p < 0.001). There was no significant difference between the two ICUs. The overall HH compliance was 27% at baseline and significantly improved to 77% post-intervention (p < 0.001). For all five HH moments, the compliance of nurses and physicians separately improved significantly from the baseline phase to the post-intervention phase (p < 0.001), except for ‘moment 3’ (after body fluid exposure), for which baseline rates were already high. Most of the compliance rates were significantly lower in both groups of healthcare workers upon follow-up three years later. Overall, the HH compliance of the nurses was significantly better than the physicians’ compliance (p = 0.005). Conclusions Our multifaceted improvement program, for nurses and physicians of the ICUs in the largest hospital of Indonesia, resulted in a significant improvement of the HH knowledge and HH compliance, but HH compliance levels waned over time after the intervention, indicating a need for continued monitoring and repeated interventions. Trial registration The study was registered at www.trialregister.nl (No: 5541). Candidate number: 23527, NTR number: NTR5541, Date registered NTR: 22-DECEMBER-2015. Electronic supplementary material The online version of this article (10.1186/s13756-019-0540-4) contains supplementary material, which is available to authorized users.
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Cavallin F, Maziku D, Mkolomi R, Azzimonti G, Manenti F, Putoto G, Trevisanuto D. Changes in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting. J Matern Fetal Neonatal Med 2019; 33:4076-4082. [PMID: 30880512 DOI: 10.1080/14767058.2019.1594768] [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] [Indexed: 01/01/2023]
Abstract
Aim: Quality improvement approaches have been integrated into routine health care in high-resource settings, but not in low-resource settings. We aimed to report the achievements in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting.Methods: After a first quality assessment in 2012 at Tosamaganga hospital in Tanzania, main areas of intervention were identified and a quality improvement program was implemented. In 2016, a second quality assessment was conducted by the same assessment team by using the World Health Organization's maternal and neonatal quality of hospital care assessment tool. Some hospital indicators were also collected during the same period.Results: Access to hospital care, maternity ward and management of maternal complications improved from inadequate to substandard care, alongside with an increment of deliveries from 2145 to 2838 and a substantially stable rate of complicated deliveries (21-26%). The improvements in the maternity ward, maternal complications and emergency care coupled with the reduction of direct obstetric case fatality rate obstetric mortality that dropped from 2.9 to 0.27%. Some neonatal areas (neonatal ward, routine neonatal care, sick newborn care, monitoring, and follow-up) improved from poor to substandard care, while others (infection control and supportive care, emergency care, guidelines protocols, and audit) showed only limited improvements. These changes coupled with a decrease in the perinatal mortality rate from 5.8 to 2.9%.Conclusion: The quality improvement program resulted in substantial progress in most aspects of quality care, which coupled with a decrease in obstetric and perinatal mortality. Nevertheless, the overall quality of care remained substandard with the limited effect of the intervention on some areas, which require further efforts in order to achieve an acceptable level of care.
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Affiliation(s)
| | - Donald Maziku
- Department of Pediatrics, Tosamaganga Council Designated Hospital, Iringa, Tanzania
| | - Rosalia Mkolomi
- Department of Pediatrics, Tosamaganga Council Designated Hospital, Iringa, Tanzania
| | - Gaetano Azzimonti
- Doctors with Africa CUAMM, Tosamaganga Council Designated Hospital, Iringa, Tanzania
| | - Fabio Manenti
- Department of Pediatrics, Doctors with Africa CUAMM, Padova, Italy
| | - Giovanni Putoto
- Department of Pediatrics, Doctors with Africa CUAMM, Padova, Italy
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
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Kamran A, Rahimi G, Sharifian E, Zandian H. Predictors of hand hygiene behavior among nurses: A theoretical cross-sectional study. JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.4103/jmedsci.jmedsci_47_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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.
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