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Nettelrodt KME, Tomsic I, Stolz M, Krauth C, Chaberny IF, von Lengerke T. Psychometric Properties of Scales Assessing Psychosocial Determinants of Staff Compliance with Surgical Site Infection Prevention: The WACH-Study. Psychol Res Behav Manag 2024; 17:2757-2767. [PMID: 39070067 PMCID: PMC11283262 DOI: 10.2147/prbm.s464335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/23/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance. Participants and Methods N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression. Results The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (β = 0.301) and planning (β = 0.201) showed associations with compliance for nurses only. Conclusion The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.
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Affiliation(s)
- Karolin M E Nettelrodt
- Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Ivonne Tomsic
- Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Maike Stolz
- Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Christian Krauth
- Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health, Hannover Medical School, Hannover, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
- Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, Germany
| | - Thomas von Lengerke
- Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany
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Boyce JM, Pittet D. Rinse, gel, and foam - is there any evidence for a difference in their effectiveness in preventing infections? Antimicrob Resist Infect Control 2024; 13:49. [PMID: 38730473 PMCID: PMC11084031 DOI: 10.1186/s13756-024-01405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Following publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs). METHODS Data regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted. RESULTS The amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs. CONCLUSIONS Current evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.
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Affiliation(s)
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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3
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Keil V, Schaumburg T, Buchta F, Luz JK, Kolbe-Busch S, Chaberny IF, von Lengerke T. Improving leadership skills of infection prevention and control teams by psychological empowerment: study protocol for a cluster randomised controlled trial (IP-POWER). BMJ Open 2024; 14:e083806. [PMID: 38346888 PMCID: PMC10862334 DOI: 10.1136/bmjopen-2023-083806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) teams are routinely confronted with intense emotions in their daily work, as they are involved in many change processes with front-line medical staff, for example, when promoting compliance with basic IPC measures. In addition, they are confronted with challenges due to their role as intermediaries. Based on former research, this study aims to empower IPC teams to promote clinicians' compliance through interventions focusing on the IPC teams' leadership skills. METHODS AND ANALYSIS The IP-POWER study (Infection Prevention with head and heart: Psychological empowerment of IPC teams), a multicentre, two-arm, non-blinded, cluster-randomised controlled trial with a parallel waiting control group, is planned to be conducted in Germany as of February to November 2024. A group of 10 voluntary hospitals is going to participate in a multistage intervention programme, including 2 days of intense psychological training; 5 hospitals will be randomly assigned to the waiting control group. After the workshops, there will be a 12-week follow-up period during which the contents learnt within the workshops can be applied and internalised into IPC practice. The proposed outcomes (both self-assessed and other-assessed leadership competencies of IPC team members and their task profiles, perceived workload, motivation to act in order to implement IP measures and goal attainment) are going to be collected with an online questionnaire, followed by an analysis with IBM SPSS (Statistics 29 (or later)) using descriptive analyses and multiple linear regressions. Additionally, as external data sources, hand hygiene compliance rates from the study hospitals' monitoring systems will be analysed using χ² tests. ETHICS AND DISSEMINATION This study was reviewed and approved by the ethics committee of the University of Leipzig (184/23-ek; vote from 4 July 2023). Findings will be disseminated via peer-review publications, and national and international conference presentations. TRIAL REGISTRATION NUMBER DRKS00031879.
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Affiliation(s)
- Valentine Keil
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Tiffany Schaumburg
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Frederike Buchta
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - J Katrin Luz
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Susanne Kolbe-Busch
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Iris Freya Chaberny
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
- Christian-Albrecht University of Kiel, University Medical Center Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, Germany
| | - Thomas von Lengerke
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
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Bai Y, Wong CL, Chen J, So WKW. Implementing a tailored communication intervention to increase colonoscopy screening rates among first-degree relatives of people with colorectal cancer: Lessons learned. Eur J Oncol Nurs 2023; 67:102408. [PMID: 37806150 DOI: 10.1016/j.ejon.2023.102408] [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: 09/29/2022] [Revised: 07/23/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE To report the process evaluation of a tailored communication intervention for first-degree relatives of colorectal cancer patients in a randomized controlled trial. METHOD Based on the MRC process evaluation framework, the process of delivering a two-arm RCT intervention were evaluated on 3 themes: (1) implementation, (2) mechanism, and (3) contextual factors. Implementation data were collected through a logbook, online tool platform feedback, and questionnaire surveys. Subgroup analysis was conducted for implementation outcomes. The mechanism and contextual factors were analyzed by mediation and moderation analysis. RESULTS From March 2019 to May 2019, 188 (57%) eligible participants were recruited to participate in this study in Shenzhen, China. In the intervention group, 68 (72.3%) participants received written and verbal sessions. Relatively high satisfaction rates (77.6%-100%) were achieved. The mediating effect was found for perceived barriers (95%CI = -0.880, -0.133) and cues to action (95%CI = 0.043, 0.679). No moderators were identified. People who received the first two sessions are more likely to receive a colonoscopy, whereas the time spent on intervention did not influence the colonoscopy uptake. CONCLUSIONS Potential strategies to enlarge the tailored effect were identified, including tailoring communication on the perceived barriers and cues to action and reinforcing patients' compliance in the first written and verbal sessions. To accomplish the difficult task of recruiting at-risk family members, direct approaches and adequate records on contact information of at-risk family members are suggested when the cancer cases were identified for the first time.
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Affiliation(s)
- Yang Bai
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jieling Chen
- School of Nursing, Sun Yat-Sen University, Guangzhou, China.
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
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Crawshaw J, Meyer C, Antonopoulou V, Antony J, Grimshaw JM, Ivers N, Konnyu K, Lacroix M, Presseau J, Simeoni M, Yogasingam S, Lorencatto F. Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals. Implement Sci 2023; 18:63. [PMID: 37990269 PMCID: PMC10664600 DOI: 10.1186/s13012-023-01318-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is among the most widely used implementation strategies, providing healthcare professionals with summaries of their practice performance to prompt behaviour change and optimize care. Wide variability in effectiveness of A&F has spurred efforts to explore why some A&F interventions are more effective than others. Unpacking the variability of the content of A&F interventions in terms of their component behaviours change techniques (BCTs) may help advance our understanding of how A&F works best. This study aimed to systematically specify BCTs in A&F interventions targeting healthcare professional practice change. METHODS We conducted a directed content analysis of intervention descriptions in 287 randomized trials included in an ongoing Cochrane systematic review update of A&F interventions (searched up to June 2020). Three trained researchers identified and categorized BCTs in all trial arms (treatment & control/comparator) using the 93-item BCT Taxonomy version 1. The original BCT definitions and examples in the taxonomy were adapted to include A&F-specific decision rules and examples. Two additional BCTs ('Education (unspecified)' and 'Feedback (unspecified)') were added, such that 95 BCTs were considered for coding. RESULTS In total, 47/95 BCTs (49%) were identified across 360 treatment arms at least once (median = 5.0, IQR = 2.3, range = 129 per arm). The most common BCTs were 'Feedback on behaviour' (present 89% of the time; e.g. feedback on drug prescribing), 'Instruction on how to perform the behaviour' (71%; e.g. issuing a clinical guideline), 'Social comparison' (52%; e.g. feedback on performance of peers), 'Credible source' (41%; e.g. endorsements from respected professional body), and 'Education (unspecified)' (31%; e.g. giving a lecture to staff). A total of 130/287 (45%) control/comparator arms contained at least one BCT (median = 2.0, IQR = 3.0, range = 0-15 per arm), of which the most common were identical to those identified in treatment arms. CONCLUSIONS A&F interventions to improve healthcare professional practice include a moderate range of BCTs, focusing predominantly on providing behavioural feedback, sharing guidelines, peer comparison data, education, and leveraging credible sources. We encourage the use of our A&F-specific list of BCTs to improve knowledge of what is being delivered in A&F interventions. Our study provides a basis for exploring which BCTs are associated with intervention effectiveness. TRIAL REGISTRATIONS N/A.
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Affiliation(s)
- Jacob Crawshaw
- Centre for Evidence-Based Implementation, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Carly Meyer
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
| | - Vivi Antonopoulou
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB, UK
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Jesmin Antony
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Kristin Konnyu
- Department of Health Services, Policy and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Meagan Lacroix
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Justin Presseau
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Michelle Simeoni
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sharlini Yogasingam
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Fabiana Lorencatto
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, WC1E 7HB, UK.
- NIHR Policy Research Unit in Behavioural Science, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
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van Dijk MD, van Beeck EF, Huis A, van der Gun BT, Polinder S, van Eijsden RA, Burdorf A, Vos MC, Erasmus V. Effects of a management team training intervention on the compliance with a surgical site infection bundle: a before-after study in operating theatres in the Netherlands. BMJ Open 2023; 13:e073137. [PMID: 37085301 PMCID: PMC10124304 DOI: 10.1136/bmjopen-2023-073137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES To assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating theatre (OT). DESIGN Multicentre before-after study. SETTING This study was performed in four Dutch hospitals. INTERVENTION The QI team training intervention consisted of four sessions per hospital and stimulated participants to set culture norms and targets, identify barriers, and formulate management activities to improve compliance with four standard operating procedures (SOPs) of a SSI bundle in the OT. Participants were executive board members, top-level managers, leading clinicians and support staff. The four SOPs were: (1) reducing door movements; (2) preoperative antibiotic prophylaxis prescribing; (3) preoperative shaving; and (4) postoperative normothermia. Poisson and logistic regression analyses were performed to analyse the effect of the intervention on compliance with the individual SOPs (primary outcome measure) and on the influence of medical specialty, time of day the procedure took place and time in the OT (secondary outcome measures). RESULTS Not all management layers were successfully involved during all sessions in the hospitals. Top-level managers were best represented in all hospitals, leading clinicians the least. The number of implemented improvement activities was low, ranging between 2 and 14. The team training intervention we developed was not associated with improvements in the compliance with the four SOP of the SSI bundle. Medical specialty, time of day, and time in OT were associated with median number of door movements, and preoperative antibiotic prophylaxis administration. CONCLUSION This study showed that after the QI team training intervention the overall compliance with the four SOPs did not improve. Minimal involvement of leading clinicians and a low number of self-initiated activities after the team training were important barriers for compliance.
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Affiliation(s)
- Manon D van Dijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ed F van Beeck
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Anita Huis
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Bernardina Tf van der Gun
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rianne Am van Eijsden
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Kolbe-Busch S, Chaberny IF. [Resource conservation from the perspective of infection prevention]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:220-229. [PMID: 36592189 DOI: 10.1007/s00104-022-01784-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Procedures to prevent surgical site infections require a high input of human, technical and natural resources. This paper explores ways to optimize the use of resources in caring for patients who undergo a surgical procedure without compromising patient safety. METHODS Review of the contribution of selected procedures for infection prevention in surgical patients considering current evidence and recommendations by comparing current guidelines and results of clinical trials. Analysis of interventions to implement and increase compliance. RESULTS Knowledge of current evidence-based recommendations enables not only the identification of procedures with proven effect on infection prevention but also those that are ineffective and thus dispensable. There is still need for further controlled studies, e.g. on the use of antiseptics, that can confirm the evidence level of preventive procedures. Infection surveillance in combination with process and compliance monitoring by infection prevention specialists with a feedback system to healthcare workers are suitable control instruments for infection control management. In the case of increased infection rates, the implementation of evidence-based recommended measures through tailored bundle interventions is successful. Technical measures to maintain environmental conditions must be included in the control process. CONCLUSION The reduction of healthcare-associated infections by implementing tailored interventions of infection prevention measures and elimination of ineffective procedures conserves resources and promotes patient safety.
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Affiliation(s)
- Susanne Kolbe-Busch
- Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Liebigstr. 22, 04103, Leipzig, Deutschland.
| | - Iris F Chaberny
- Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Liebigstr. 22, 04103, Leipzig, Deutschland
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Zwicker P, Meng M, Friesecke S, Stein T, Herzog A, Herzer C, Kammerlander M, Gebhardt T, Kugler C, Kramer A. An interactive feedback system for increasing hand antisepsis adherence in stationary intensive care. J Hosp Infect 2023; 133:73-80. [PMID: 36646137 DOI: 10.1016/j.jhin.2022.12.017] [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: 10/06/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Pathogens causing infections are in many cases transmitted via the hands of personnel. Thus, hand antisepsis has strong epidemiological evidence of infection prevention. Depending on various factors, hand antisepsis adherence ranges between 9.1% and 85.2%. AIM To evaluate a new transponder system that reminded medical staff to use an alcohol-based hand rub based on indication by giving real-time feedback, to detect hand antisepsis adherence. METHODS The monitoring system consisted of three components: a portable transponder detecting alcohol-based hand rub and able to give feedback; a beacon recognizing entries to and exits from the patient's surroundings; and a sensor placed at the hand-rub dispensers to count the number of hand rubs. With these components, the system provided feedback when hand antisepsis was not conducted although it was necessary according to moments 1, 4, and 5 of hand antisepsis. Adherence was measured in two use-cases with five phases, starting with the baseline measurement followed by intervention periods and phases without intervention to test the sustainability of the feedback. FINDINGS Using the monitoring system, hand antisepsis adherence was increased by up to 104.5% in comparison to the baseline measurement. When the intervention ceased, however, hand antisepsis adherence decreased to less than or equal to the baseline measurement. CONCLUSION A short-term intervention alone is not sufficient to lead to a long-term change in hand antisepsis adherence. Rather, permanent feedback and/or the integration in a multi-modal intervention strategy are necessary.
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Affiliation(s)
- P Zwicker
- Institute of Hygiene and Environmental Medicine, University Medicine, Greifswald, Germany; Section Antiseptic Stewardship of the German Society of Hospital Hygiene, Berlin, Germany.
| | - M Meng
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Federal Institute for Vocational Education and Training (VET), Bonn, Germany
| | - S Friesecke
- Department of Internal Medicine B, Medical Intensive Care Unit, University Medicine, Greifswald, Germany
| | - T Stein
- Neurological Rehabilitation Center gGmbH, Greifswald, Germany
| | - A Herzog
- HyHelp AG, Frankfurt am Main, Germany; United-Ventures GmbH, Frankfurt am Main, Germany
| | - C Herzer
- GWA Hygiene GmbH, Stralsund, Germany
| | - M Kammerlander
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | | | - C Kugler
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine, Greifswald, Germany; Section Antiseptic Stewardship of the German Society of Hospital Hygiene, Berlin, Germany
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Lamping J, Tomsic I, Stolz M, Krauth C, Chaberny IF, von Lengerke T. Do task and item difficulty affect overestimation of one's hand hygiene compliance? A cross-sectional survey of physicians and nurses in surgical clinics of six hospitals in Germany. Antimicrob Resist Infect Control 2022; 11:147. [PMID: 36461038 PMCID: PMC9716516 DOI: 10.1186/s13756-022-01188-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND One barrier to hand hygiene compliance is overestimation of one's own performance. Overconfidence research shows that overestimation tends to be higher for difficult tasks, which suggests that the magnitude of overestimation also depends on how it is assessed. Thus, we tested the hypothesis that overestimation was stronger for hand hygiene indications with low compliance (i.e., high difficulty), and the hypothesis that self-reported overall compliance based on a single item is higher than based on "5 Moments of Hand Hygiene" (WHO-5) items, since the single item implies an aggregation across indications. METHODS In the WACH trial (German Clinical Trials Register [DRKS] ID: DRKS00015502), a questionnaire survey was conducted among physicians and nurses in nine surgical clinics (general/visceral surgery or orthopedics/trauma surgery) of six German hospitals. Self-reported compliance was assessed both by a single item and the WHO-5-items using percentage scales. These were compared with each other and with direct observations. Relative frequencies of the WHO-5 indications used to calculate the WHO-5-based self-reported overall compliance rate were estimated by a systematized review of the literature (see appendix). In analysis, t-tests, Chi2-tests and multiple linear regressions were used. RESULTS Ninety-three physicians (response rate: 28.4%) and 225 nurses (30.4%) participated. Significant compliance differences between physicians and nurses were found for direct observations and were in favor of nurses, while no such differences were found for self-reports. Across the WHO-5, overestimation showed inverse correlations with observed compliance (physicians: r = -0.88, p = 0.049; nurses: r = -0.81, p = 0.093). Support for the hypothesis that the self-reported overall compliance based on one item is higher than that based on WHO-5 items was found for physicians (M = 87.2 vs. 84.1%, p = 0.041; nurses: 84.4 vs. 85.5%, p = 0.296). Exploratory analyses showed that this effect was confined to orthopedic/trauma surgeons (89.9 vs. 81.7%, p = 0.006). CONCLUSION Among physicians, results indicate stronger hand hygiene overestimation for low-compliance indications, and when measurements are based on a single item versus the five WHO-5 items. For practice, results contribute to infection prevention and control's understanding of overestimation as a psychological mechanism that is relevant to professional hand hygiene.
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Affiliation(s)
- Jonas Lamping
- grid.10423.340000 0000 9529 9877Department of Medical Psychology, Center of Public Health and Health Care, Hannover Medical School, Hannover, Germany
| | - Ivonne Tomsic
- grid.10423.340000 0000 9529 9877Department of Medical Psychology, Center of Public Health and Health Care, Hannover Medical School, Hannover, Germany
| | - Maike Stolz
- grid.10423.340000 0000 9529 9877Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health and Health Care, Hannover Medical School, Hannover, Germany
| | - Christian Krauth
- grid.10423.340000 0000 9529 9877Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health and Health Care, Hannover Medical School, Hannover, Germany
| | - Iris F. Chaberny
- grid.411339.d0000 0000 8517 9062Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Interdisciplinary Center for Infectious Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Thomas von Lengerke
- grid.10423.340000 0000 9529 9877Department of Medical Psychology, Center of Public Health and Health Care, Hannover Medical School, Hannover, Germany
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Baier C, Tinne M, von Lengerke T, Gossé F, Ebadi E. Compliance with hand disinfection in the surgical area of an orthopedic university clinic: results of an observational study. Antimicrob Resist Infect Control 2022; 11:22. [PMID: 35101127 PMCID: PMC8802282 DOI: 10.1186/s13756-022-01058-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/10/2022] [Indexed: 01/17/2023] Open
Abstract
Background Hand hygiene using alcoholic hand rub solution is essential for the prevention of surgical site infections. There are several opportunities for hygienic hand disinfection (termed “hand hygiene” in the following) during immediate pre-, intra- and postoperative orthopedic patient care. However, the level of hand hygiene compliance among surgical and anesthesia staff in this context is unclear. Therefore, we conducted an observational study in operating theatres of an orthopedic university clinic in northern Germany during July and August 2020. Methods One trained person directly and comprehensively observed hand hygiene compliance of surgical and anesthesia staff according to the WHO “My 5 moments for hand hygiene” model (WHO-5). In addition to cross-tabulations with Chi2 tests, multiple logistic regression models were used to study associations between occupational group, medical specialty, and compliance (both overall and for each WHO-5 indication). Models were adjusted for hand hygiene opportunities being associated with female or male healthcare workers, being located within or outside the operation room, and occurring in adult or pediatric surgery. Results In total, 1145 hand hygiene opportunities during 16 surgeries were observed. The overall compliance was 40.8% (95% CI 37.9–43.6%), with a larger difference between surgical versus anesthesia staff (28.4% vs. 46.1%, p < 0.001) than between physicians versus nurses (38.5% vs. 42.9%, p = 0.13). Adjusting for sex, place of observation, and adult versus pediatric operation theatre, logistic regression analyses revealed a significant interaction between medical specialty and occupational group (p < 0.001). In particular, the odds for compliance were higher for anesthesiologists (47.9%) than for surgeons (19.6%) (OR = 4.8, 95% CI 3.0–7.6). In addition, compliance was higher in pediatric surgery (OR = 1.9, 95% CI 1.4–2.6). In general, WHO-5-stratified results were in line with these overall patterns. Conclusions Hygienic hand disinfection compliance was approximately 41%. Notably, surgeons performed worse than anesthesiologists did. These results indicate that hand hygiene compliance in orthopedic surgery needs to be improved. Tailored interventions promise to be an appropriate way to address each occupational group’s specific needs. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01058-2.
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Schena CA, de’Angelis GL, Carra MC, Bianchi G, de’Angelis N. Antimicrobial Challenge in Acute Care Surgery. Antibiotics (Basel) 2022; 11:antibiotics11101315. [PMID: 36289973 PMCID: PMC9598495 DOI: 10.3390/antibiotics11101315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 12/07/2022] Open
Abstract
The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients’ morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship.
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Affiliation(s)
- Carlo Alberto Schena
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
- Correspondence:
| | - Maria Clotilde Carra
- Rothschild Hospital, AP-HP, Université Paris Cité, U.F.R. of Odontology, 75006 Paris, France
| | - Giorgio Bianchi
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Nicola de’Angelis
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
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12
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Händehygiene im OP – (k)ein Thema? Unfallchirurg 2022:10.1007/s00113-022-01181-0. [PMID: 35499764 PMCID: PMC10319668 DOI: 10.1007/s00113-022-01181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund und Zielstellung
Eine hohe Händehygiene-Compliance (HHC) ist eine effektive Maßnahme zur Prävention von nosokomialen Infektionen. Die WHO empfiehlt direkte Beobachtungen als Goldstandard, um die HHC zu stratifizieren. Hohe Compliance-Raten bei der chirurgischen Händedesinfektion legen eine hohe Gesamt-Compliance im OP-Bereich nahe. Zahlen zur hygienischen Händedesinfektion im OP sind allerdings rar. Ziel war es, die HHC systematisch zu beobachten und durch maßgeschneiderte Interventionen zu steigern.
Methode
Um die HHC in den Jahren 2017 und 2018 zu erfassen, wurde ein Beobachtungsbogen genutzt. Chirurgen und Op.-Pflege sowie Anästhesisten und Anästhesiepflege wurden erfasst. Für die Erprobung einer maßgeschneiderten Intervention wurden 2 OP-Bereiche ausgewählt. Zur Überprüfung der Effektivität erfolgten nur in einem OP-Bereich eine maßgeschneiderte Fortbildung und sog. Compliance-Begleitungen mit direktem Feedback durch die Hygienefachkräfte. In dem anderen OP-Bereich erfolgte keine Intervention.
Ergebnis
Über 1500 Indikationen zur Händehygiene wurden in den Jahren 2017 und 2018 im operativen Bereich erfasst. Die Gesamt-Compliance der Interventionsgruppe konnte im Beobachtungszeitraum von 40 auf 75 % gesteigert werden (p < 0,001). Die Gesamt-Compliance der Kontrollgruppe veränderte sich nicht signifikant (48 auf 55 %; p = 0,069).
Diskussion
Durch die hohe Compliance-Rate bei der chirurgischen Händedesinfektion entstand die Annahme, die Compliance bei der hygienischen Händedesinfektion sei ebenfalls auf einem hohen Niveau. Im Rahmen der Feedbackgespräche zeigte sich, dass die Mitarbeiter nicht wussten, dass die Indikationen der „5 Momente der Händehygiene“ auch im OP anzuwenden seien, und zeigten somit ihr Unwissen über die assoziierten Indikationen.
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13
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Freivogel C, Lehmann SH, Visschers VHM. Tailoring Can Improve Consumers’ Hygienic Food-Handling Behavior to Reduce the Transmission Risk of Antimicrobial-Resistant Bacteria through Food. Eur J Investig Health Psychol Educ 2022; 12:169-192. [PMID: 35200236 PMCID: PMC8871282 DOI: 10.3390/ejihpe12020014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/22/2022] [Accepted: 01/28/2022] [Indexed: 11/23/2022] Open
Abstract
Antimicrobial-resistant (AMR) bacteria spread via food to humans and can seriously impair infection treatment. Hygienic food handling is an effective measure to avoid the transmission of bacteria. Therefore, we tested three types of interventions (tailored, generic, and no intervention) for their effectiveness in improving consumers’ hygienic food handling against the spread of antimicrobial-resistant bacteria through foods in a longitudinal randomized control trial. We based the determinants of hygienic food-handling behavior on the Health Action Process Approach (HAPA). The tailored intervention raised self-reported hygienic food handling, self-efficacy, and perceived likelihood of risk compared to no intervention. Moreover, interventions yielded different effects for participants with high vs. low intentions to improve their food-handling behavior. However, there were no differences between the tailored and generic interventions. More research is needed to find out whether including other behavior change techniques in the tailored intervention may increase the effect of tailoring.
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14
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von Lengerke T, Tomsic I, Krosta KME, Ebadi E, Keil V, Buchta F, Luz JK, Schaumburg T, Kolbe-Busch S, Chaberny IF. Tailoring implementation interventions of different order in infection prevention and control: A cascadic logic model (IPC-CASCADE). FRONTIERS IN HEALTH SERVICES 2022; 2:960854. [PMID: 36925806 PMCID: PMC10012664 DOI: 10.3389/frhs.2022.960854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023]
Abstract
Implementation interventions in infection prevention and control (IPC) differ by recipients. The two target groups are healthcare workers directly involved in patient care ("frontline") and IPC professionals as proxy agents, that is, implementation support practitioners. While both types of implementation interventions aim to promote compliance with clinical interventions to prevent healthcare-associated infections (HAI), their tailoring may be vastly different, for example, due to different behavioural outcomes. Additionally, IPC teams, as recipients of empowering tailored interventions, are under-researched. To overcome this gap and improve conceptual clarity, we proposed a cascadic logic model for tailored IPC interventions (IPC-CASCADE). In the model, we distinguished between interventions by IPC professionals targeting clinicians and those targeting IPC professionals (first- and second-order implementation interventions, respectively). Tailoring implies selecting behaviour change techniques matched to prospectively-assessed determinants of either clinician compliance (in first-order interventions) or interventions by IPC professionals for frontline workers (in second-order interventions). This interventional cascade is embedded in the prevailing healthcare system. IPC-CASCADE is horizontally structured over time and vertically structured by hierarchy or leadership roles. IPC-CASCADE aims to highlight the potential of increasing the impact of tailored interventions by IPC professionals for clinicians (to improve their compliance) via tailored interventions for IPC professionals (to improve their work as proxy agents). It underlines the links that IPC professionals define between macro contexts (healthcare and hospitals) and frontline workers in HAI prevention. It is specific, i.e., "tailored" to IPC, and expected to assist implementation science to better conceptualise tailoring.
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Affiliation(s)
- Thomas von Lengerke
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany
| | - Ivonne Tomsic
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany
| | - Karolin M E Krosta
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany
| | - Ella Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Center for Laboratory Medicine, Hannover, Germany
| | - Valentine Keil
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany.,Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Frederike Buchta
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - J Katrin Luz
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Tiffany Schaumburg
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
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15
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Ishibashi Y, Tsujimoto H, Sugasawa H, Mochizuki S, Okamoto K, Kajiwara Y, Shinto E, Takahata R, Kobayashi M, Fujikura Y, Hase K, Kishi Y, Ueno H. How has the COVID-19 pandemic affected gastrointestinal surgery for malignancies and surgical infections? NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 83:715-725. [PMID: 34916716 PMCID: PMC8648525 DOI: 10.18999/nagjms.83.4.715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected infection control and prevention measures. We investigated the impact of the COVID-19 pandemic on postoperative infections and infection control measures in patients underwent gastrointestinal surgery for malignancies. We retrospectively evaluated changes in clinicopathological features, frequency of alcohol-based hand sanitizer use, frequency of postoperative complications, and microbial findings among our patients in February-May in 2019 (Control group) and 2020 (Pandemic group), respectively. Surgical resection in pathological stage III or IV patients was more frequently performed in the Pandemic group than in the Control group (P = 0.02). The total length of hospitalization and preoperative hospitalization was significantly shorter in the Pandemic group (P = 0.01 and P = 0.008, respectively). During the pandemic, hand sanitizer was used by a patients for an average of 14.9±3.0 times/day during the pandemic as opposed to 9.6±3.0 times/day in 2019 (p<0.0001). Superficial surgical site infection and infectious colitis occurred less frequently during the pandemic (P = 0.04 and P = 0.0002, respectively). In Pandemic group, Enterobacter, Haemophilus, and Candida were significantly decreased in microbiological cultures (P < 0.05, P < 0.05, P = 0.02, respectively) compared with Control group. Furthermore, a significant decrease in Streptococcus from drainage cultures was observed in the Pandemic group (P < 0.05). During the COVID-19 pandemic, a decrease in nosocomial infections was observed in the presence of an increase in alcohol-based hand sanitizer use.
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Affiliation(s)
- Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
,Department of Medical Risk Management and Infection Control, National Defense Medical College, Tokorozawa, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Satsuki Mochizuki
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Risa Takahata
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
,Department of Medical Risk Management and Infection Control, National Defense Medical College, Tokorozawa, Japan
| | - Minako Kobayashi
- Department of Medical Risk Management and Infection Control, National Defense Medical College, Tokorozawa, Japan
| | - Yuji Fujikura
- Department of Medical Risk Management and Infection Control, National Defense Medical College, Tokorozawa, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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16
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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: 27] [Impact Index Per Article: 9.0] [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.
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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.
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17
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Alhumaid S, Al Mutair A, Al Alawi Z, Alsuliman M, Ahmed GY, Rabaan AA, Al-Tawfiq JA, Al-Omari A. Knowledge of infection prevention and control among healthcare workers and factors influencing compliance: a systematic review. Antimicrob Resist Infect Control 2021; 10:86. [PMID: 34082822 PMCID: PMC8173512 DOI: 10.1186/s13756-021-00957-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 05/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Knowledge of infection prevention and control (IPC) procedures among healthcare workers (HCWs) is crucial for effective IPC. Compliance with IPC measures has critical implications for HCWs safety, patient protection and the care environment. AIMS To discuss the body of available literature regarding HCWs' knowledge of IPC and highlight potential factors that may influence compliance to IPC precautions. DESIGN A systematic review. A protocol was developed based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis [PRISMA] statement. DATA SOURCES Electronic databases (PubMed, CINAHL, Embase, Proquest, Wiley online library, Medline, and Nature) were searched from 1 January 2006 to 31 January 2021 in the English language using the following keywords alone or in combination: knowledge, awareness, healthcare workers, infection, compliance, comply, control, prevention, factors. 3417 papers were identified and 30 papers were included in the review. RESULTS Overall, the level of HCW knowledge of IPC appears to be adequate, good, and/or high concerning standard precautions, hand hygiene, and care pertaining to urinary catheters. Acceptable levels of knowledge were also detected in regards to IPC measures for specific diseases including TB, MRSA, MERS-CoV, COVID-19 and Ebola. However, gaps were identified in several HCWs' knowledge concerning occupational vaccinations, the modes of transmission of infectious diseases, and the risk of infection from needle stick and sharps injuries. Several factors for noncompliance surrounding IPC guidelines are discussed, as are recommendations for improving adherence to those guidelines. CONCLUSION Embracing a multifaceted approach towards improving IPC-intervention strategies is highly suggested. The goal being to improve compliance among HCWs with IPC measures is necessary.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Dhahran Street, Al-Ahsa, 31982, Saudi Arabia. .,College of Nursing, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia. .,School of Nursing, University of Wollongong, Wollongong, Australia.
| | - Zainab Al Alawi
- Department of Paediatrics, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Murtadha Alsuliman
- Department of Pharmacy, Hereditary Blood Diseases Centre, Al-Ahsa, Saudi Arabia
| | - Gasmelseed Y Ahmed
- Research Center, Almoosa Specialist Hospital, Dhahran Street, Al-Ahsa, 31982, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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18
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Ragusa R, Marranzano M, Lombardo A, Quattrocchi R, Bellia MA, Lupo L. Has the COVID 19 Virus Changed Adherence to Hand Washing among Healthcare Workers? Behav Sci (Basel) 2021; 11:53. [PMID: 33920791 PMCID: PMC8071195 DOI: 10.3390/bs11040053] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
The aim of the study was to assess adherence to hand washing by healthcare workers (HCWs) and its variations over time in hospital wards. We wanted to check whether the pandemic had changed the behavior of HCWs. The study was conducted between 1 January 2015, and 31 December 2020. The HCWs were observed to assess their compliance with the Five Moments for Hand Hygiene. We described the percentage of adherence to World Health Organization (WHO) guidelines stratified per year, per specialty areas, per different types of HCWs. We also observed the use of gloves. Descriptive data were reported as frequencies and percentages. We observed 13,494 hand hygiene opportunities. The majority of observations concerned nurses who were confirmed as the category most frequently involved with patients. Hospital's global adherence to WHO guidelines did not change in the last six years. During the pandemic, the rate of adherence to the procedure increased significantly only in Intensive Care Unit (ICU). In 2020, the use of gloves increased in pre-patient contact. The hand-washing permanent monitoring confirmed that it is very difficult to obtain the respect of correct hand hygiene in all opportunities, despite the ongoing pandemic and the fear of contagion.
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Affiliation(s)
- Rosalia Ragusa
- Health Technology Assessment Committee, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95123 Catania, Italy
| | - Marina Marranzano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Via Santa Sofia, 87 95123 Catania, Italy; (M.M.); (L.L.)
| | - Alessandro Lombardo
- Committee for the Control of Hospital Infections, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95128 Catania, Italy;
| | - Rosalba Quattrocchi
- U.O. Health Education, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95128 Catania, Italy;
| | - Maria Alessandra Bellia
- School of Specialization in Microbiology, University of Catania, Via Santa Sofia, 78 95123 Catania, Italy;
| | - Lorenzo Lupo
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Via Santa Sofia, 87 95123 Catania, Italy; (M.M.); (L.L.)
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19
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Tomsic I, Ebadi E, Gossé F, Hartlep I, Schipper P, Krauth C, Schock B, Chaberny IF, von Lengerke T. Determinants of orthopedic physicians' self-reported compliance with surgical site infection prevention: results of the WACH-trial's pilot survey on COM-B factors in a German university hospital. Antimicrob Resist Infect Control 2021; 10:67. [PMID: 33827692 PMCID: PMC8025554 DOI: 10.1186/s13756-021-00932-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/22/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prevention of surgical site infections (SSIs), which due to their long-term consequences are especially critical in orthopedic surgery, entails compliance with over 20 individual measures. However, little is known about the psychosocial determinants of such compliance among orthopedic physicians, which impedes efforts to tailor implementation interventions to improve compliance. Thus, for this professional group, this pilot survey examined psychosocial determinants of self-reported compliance, which have been theoretically derived from the COM-B (Capability, Opportunity, Motivation and Behavior) model. METHODS In 2019, a cross-sectional survey was conducted in a tertiary care university orthopedic clinic in Hannover, Germany, as a pilot for the WACH-trial ("Wundinfektionen und Antibiotikaverbrauch in der Chirurgie" [Wound Infections and Antibiotics Consumption in Surgery]). Fifty-two physicians participated (38 surgeons, 14 anesthesiologists; response rate: 73.2%). The questionnaire assessed self-reported compliance with 26 SSI preventive measures, and its psychosocial determinants (COM-B). Statistical analyses included descriptive, correlational, and linear multiple regression modeling. RESULTS Self-reported compliance rates for individual measures varied from 53.8 to 100%, with overall compliance (defined for every participant as the mean of his or her self-reported rates for each individual measure) averaging at 88.9% (surgeons: 90%, anesthesiologists: 85.9%; p = 0.097). Of the components identified in factor analyses of the COM-B items, planning, i.e., self-formulated conditional plans to comply, was the least pronounced (mean = 4.3 on the 7-point Likert scale), while motivation was reported to be the strongest (mean = 6.3). Bi-variately, the overall compliance index co-varied with all four COM-B-components, i.e., capabilities (r = 0.512, p < 0.001), opportunities (r = 0.421, p = 0.002), planning (r = 0.378, p = 0.007), and motivation (r = 0.272, p = 0.051). After mutual adjustment and adjustment for type of physician and the number of measures respondents felt responsible for, the final backward regression model included capabilities (β = 0.35, p = 0.015) and planning (β = 0.29, p = 0.041) as COM-B-correlates. CONCLUSION Though based on a small sample of orthopedic physicians in a single hospital (albeit in conjunction with a high survey response rate), this study found initial evidence for positive correlations between capabilities and planning skills with self-reported SSI preventive compliance in German orthopedic physicians. Analyses of the WACH-trial will further address the role of these factors in promoting SSI preventive compliance in orthopedic surgery. TRIAL REGISTRATION This survey was conducted as part of the research project WACH ("Wundinfektionen und Antibiotikaverbrauch in der Chirurgie" [Wound Infections and Antibiotic Consumption in Surgery]), which has been registered in the German Clinical Trial Registry ( https://www.drks.de/ ; ID: DRKS00015502).
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Affiliation(s)
- Ivonne Tomsic
- Centre for Public Health and Healthcare, Department of Medical Psychology (OE 5430), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Ella Ebadi
- Centre for Laboratory Medicine, Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Frank Gossé
- Spinal Surgery and Conservative Orthopaedics, Clinic of Orthopaedics of Hannover Medical School at DIAKOVERE Annastift, Hannover, Germany
| | - Ina Hartlep
- Center for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Pamela Schipper
- Center for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Christian Krauth
- Centre for Public Health and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Bettina Schock
- Center for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Iris F Chaberny
- Center for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Thomas von Lengerke
- Centre for Public Health and Healthcare, Department of Medical Psychology (OE 5430), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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20
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Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect 2021; 111:6-26. [PMID: 33744382 PMCID: PMC9585124 DOI: 10.1016/j.jhin.2021.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Background There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers. Aim This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene. Methods CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria. Findings Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the ‘Five Moments’. However, recording of hand hygiene technique was not common. Conclusion Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.
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21
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Derksen C, Keller FM, Lippke S. Obstetric Healthcare Workers' Adherence to Hand Hygiene Recommendations during the COVID-19 Pandemic: Observations and Social-Cognitive Determinants. Appl Psychol Health Well Being 2020; 12:1286-1305. [PMID: 33016518 PMCID: PMC7675238 DOI: 10.1111/aphw.12240] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023]
Abstract
Background Hand hygiene is crucial to avoid healthcare‐associated infections and the transmission of COVID‐19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social‐cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers’ adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID‐19 pandemic. Methods In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods (pre‐COVID‐19 pandemic, heightened awareness, and strict precautions). In addition, 115 healthcare workers answered questionnaires regarding social‐cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations. Results Adherence to hand hygiene recommendations increased from 47 per cent pre‐COVID‐19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self‐efficacy was associated with the intention to sanitise hands (β = .397, p < .001). Coping self‐efficacy mediated the association of intention with hand hygiene adherence. Conclusions Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID‐19 pandemic. To further improve interventions, social‐cognitive determinants should be considered, especially intention and (coping) self‐efficacy.
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22
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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.
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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
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23
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Tomsic I, Heinze NR, Chaberny IF, Krauth C, Schock B, von Lengerke T. Implementation interventions in preventing surgical site infections in abdominal surgery: a systematic review. BMC Health Serv Res 2020; 20:236. [PMID: 32192505 PMCID: PMC7083020 DOI: 10.1186/s12913-020-4995-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/14/2020] [Indexed: 02/07/2023] Open
Abstract
Background Surgical site infections (SSIs) are highly prevalent in abdominal surgery despite evidence-based prevention measures. Since guidelines are not self-implementing and SSI-preventive compliance is often insufficient, implementation interventions have been developed to promote compliance. This systematic review aims to identify implementation interventions used in abdominal surgery to prevent SSIs and determine associations with SSI reductions. Methods Literature was searched in April 2018 (Medline/PubMed and Web of Science Core Collection). Implementation interventions were classified using the implementation subcategories of the EPOC Taxonomy (Cochrane Review Group Effective Practice and Organisation of Care, EPOC). Additionally, an effectiveness analysis was conducted on the association between the number of implementation interventions, specific compositions thereof, and absolute and relative SSI risk reductions. Results Forty studies were included. Implementation interventions used most frequently (“top five”) were audit and feedback (80% of studies), organizational culture (70%), monitoring the performance of healthcare delivery (65%), reminders (53%), and educational meetings (45%). Twenty-nine studies (72.5%) used a multimodal strategy (≥3 interventions). An effectiveness analysis revealed significant absolute and relative SSI risk reductions. E.g., numerically, the largest absolute risk reduction of 10.8% pertained to thirteen studies using 3–5 interventions (p < .001); however, this was from a higher baseline rate than those with fewer or more interventions. The largest relative risk reduction was 52.4% for studies employing the top five interventions, compared to 43.1% for those not including these. Furthermore, neither the differences in risk reduction between studies with different numbers of implementation interventions (bundle size) nor between studies including the top five interventions (vs. not) were significant. Conclusion In SSI prevention in abdominal surgery, mostly standard bundles of implementation interventions are applied. While an effectiveness analysis of differences in SSI risk reduction by number and type of interventions did not render conclusive results, use of standard interventions such as audit and feedback, organizational culture, monitoring, reminders, and education at least does not seem to represent preventive malpractice. Further research should determine implementation interventions, or bundles thereof, which are most effective in promoting compliance with SSI-preventive measures in abdominal surgery.
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Affiliation(s)
- Ivonne Tomsic
- Hannover Medical School, Centre for Public Health and Healthcare, Department of Medical Psychology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Nicole R Heinze
- Hannover Medical School, Centre for Public Health and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Iris F Chaberny
- Leipzig University Hospital, Centre for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Liebigstr. 22, 04103, Leipzig, Germany
| | - Christian Krauth
- Hannover Medical School, Centre for Public Health and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Bettina Schock
- Leipzig University Hospital, Centre for Infection Medicine (ZINF), Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Liebigstr. 22, 04103, Leipzig, Germany
| | - Thomas von Lengerke
- Hannover Medical School, Centre for Public Health and Healthcare, Department of Medical Psychology, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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24
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Vaillant L, Birgand G, Esposito-Farese M, Astagneau P, Pulcini C, Robert J, Zahar JR, Sales-Wuillemin E, Tubach F, Lucet JC. Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey. Antimicrob Resist Infect Control 2019; 8:173. [PMID: 31749961 PMCID: PMC6852912 DOI: 10.1186/s13756-019-0625-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Much effort has been made over the last two decades to educate and train healthcare professionals working on antimicrobial resistance in French hospitals. However, little has been done in France to assess perceptions, attitudes and knowledge regarding multidrug resistant organisms (MDROs) and, more globally, these have never been evaluated in a large-scale population of medical and non-medical healthcare workers (HCWs). Our aim was to explore awareness among HCWs by evaluating their knowledge of MDROs and the associated control measures, by comparing perceptions between professional categories and by studying the impact of training and health beliefs. Methods A multicentre cross-sectional study was conducted in 58 randomly selected French healthcare facilities with questionnaires including professional and demographic characteristics, and knowledge and perception of MDRO transmission and control. A knowledge score was calculated and used in a logistic regression analysis to identify factors associated with higher knowledge of MDROs, and the association between knowledge and perception. Results Between June 2014 and March 2016, 8716/11,753 (participation rate, 74%) questionnaires were completed. The mean knowledge score was 4.7/8 (SD: 1.3) and 3.6/8 (SD: 1.4) in medical and non-medical HCWs, respectively. Five variables were positively associated with higher knowledge: working in a university hospital (adjusted odds ratio, 1.41, 95% CI 1.16–1.70); age classes 26–35 years (1.43, 1.23–1.6) and 36–45 years (1.19, 1.01–1.40); medical professional status (3.7, 3.09–4.44), working in an intensive care unit (1.28, 1.06–1.55), and having been trained on control of antimicrobial resistance (1.31, 1.16–1.48). After adjustment for these variables, greater knowledge was significantly associated with four cognitive factors: perceived susceptibility, attitude toward hand hygiene, self-efficacy, and motivation. Conclusions We found a low level of MDRO awareness and knowledge of associated control measures among French HCWs. Training on hand hygiene and measures to control MDRO spread may be helpful in shaping beliefs and perceptions on MDRO control among other possible associated factors. Messages should be tailored to professional status and their perception. Other approaches should be designed, with more effective methods of training and cognitive interventions. Trial registration Clinical Trials.gov NCT02265471. Registered 16 October 2014 - Retrospectively registered.
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Affiliation(s)
- L Vaillant
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, 48 rue Henri Huchard, F-75018 Paris, France
| | - G Birgand
- 2Department of Medicine, NIHR, Imperial College London, Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infection Imperial College London, South Kensington Campus, London, SW7 2AZ UK
| | - M Esposito-Farese
- AP-HP, Bichat-Claude Bernard Hospital, Unité de Recherche Clinique Paris Nord Val de Seine and CIC-EC 1425, 48 rue Henri Huchard, F-75018 Paris, France
| | - P Astagneau
- 4Medecine Sorbonne University, AP-HP, Regional centre for Prevention of Healthcare-associated infections, 8 rue Maria Helena Vieira da Silva, 75014 Paris, France
| | - C Pulcini
- 5EA 4360 APEMAC, CHRU de Nancy, University of Lorraine, Infectious and Tropical Diseases Unit, 34 Cours Léopold, 54000 Nancy, France
| | - J Robert
- Sorbonne University, U1135, Team E13, CR7 INSERM, AP-HP, Pitié-Salpêtrière Hospital, Bactériologie-Hygiène, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - J R Zahar
- 7AP-HP, Avicenne Hospital, Infection Control Unit, 125 Rue de Stalingrad, 93000 Bobigny, France.,8University of Paris, INSERM, IAME, UMR 1137, Paris, France
| | | | - F Tubach
- INSERM, UMR 1123, AP-HP, Pitié-Salpêtrière Hospital, Centre de Pharmacoépidémiologie (Cephepi), 75013 Paris, France
| | - J C Lucet
- AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, 48 rue Henri Huchard, F-75018 Paris, France.,8University of Paris, INSERM, IAME, UMR 1137, Paris, France
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Martos-Cabrera MB, Mota-Romero E, Martos-García R, Gómez-Urquiza JL, Suleiman-Martos N, Albendín-García L, Cañadas-De la Fuente GA. Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173039. [PMID: 31443355 PMCID: PMC6747325 DOI: 10.3390/ijerph16173039] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/17/2019] [Accepted: 08/18/2019] [Indexed: 12/23/2022]
Abstract
Background: Patient safety is a priority of any healthcare system, and one of the most effective measures is hand hygiene. For this, it is important that health staff have correct adherence and perform the technique properly. Otherwise, the incidence of nosocomial infections can increase, with consequent complications. The aim here was to analyze hand hygiene training and the effectiveness of different methods and educational strategies among nurses and whether they maintained correct adherence over time. Methods: A systematic review was conducted in the sources CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Lilacs (Latin American and Caribbean Health Sciences Literature), ProQuest (Proquest Health and Medical Complete), Medline, SciELO (Scientific Electronic Library Online), and Scopus. The search equation with Medical Subject Headings (MeSH) descriptors was “Nurs* AND (handwashing OR hand hygiene) AND clinical trial”. The review was performed following the recommendations of the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: n = 17 clinical trials were included, with a total of 5747 nurses and nursing students. Strategies such as reminder sounds, practical simulations, videos, and audiovisual media improved handwashing compliance. Adherence overtime increased by up to 60%. The greatest effectiveness was related to the use of povidone–iodine, which reduced colony formation compared Hand hygiene teaching strategies among nursing staff: a systematic review to soap. Conclusions: The strategies that go beyond teaching techniques such as lectures may be more effective at increasing hand hygiene compliance. Combined approaches to learning/instruction improve user satisfaction by enabling self-management, flexibility, and repetition.
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Affiliation(s)
| | | | - Raúl Martos-García
- Andalusian Health Service, Avenida del Sur N. 11, 18014 Granada, Spain
- Red Cross School of Nursing, University of Sevilla, Avenida la Cruz Roja N. 1, 41009 Sevilla, Spain
| | - José L Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, Calle Cortadura Del Valle S.N., 51001 Ceuta, Spain.
| | - Luis Albendín-García
- Andalusian Health Service, Avenida del Sur N. 11, 18014 Granada, Spain
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
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