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Seferi A, Parginos K, Jean W, Calero C, Fogel J, Modeste S, Scott BA, Daly-Walsh M, Yap W, Kaur M, Brady T, Madaline T. Hand hygiene behavior change: a review and pilot study of an automated hand hygiene reminder system implementation in a public hospital. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e122. [PMID: 37502248 PMCID: PMC10369449 DOI: 10.1017/ash.2023.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 07/29/2023]
Abstract
Objective To review and study implementation of an automated hand hygiene reminder system (AHHRS). Design Prospective, nonrandomized, before-after quality improvement pilot study conducted over 6 months. Setting Medical-surgical unit (MSU) and medical intensive care unit (MICU) at a public hospital in New York City. Participants There were 2,642 healthcare worker observations in the direct observation (DO) period versus 265,505 in the AHHRS period, excluding AHHRS observations collected during the 1-month crossover period when simultaneous DO occurred. Intervention We compared hand hygiene adherence (HHA) measured by DO prior to the pilot and after AHHRS implementation. We compared changes in HHA and potential cross-contamination events (CCEs) (room exit and subsequent entry without HHA) from baseline for each biweekly period during the pilot. Results Engagement, education/training, data transparency, and optimization period resulted in successful implementation and adoption of the AHHRS. Observations were greater utilizing AHHRS than DO (265,505 vs 2,642, P < .01). Due to the expected Hawthorne effect, HHA was significantly less for AHHRS than DO in MSU (90.99% vs 97.21%, P < .01) and MICU (91.21% vs 98.65%, P < .01). HHA significantly improved from 86.47% to 89.68% in MSU (P < .001) and 85.93% to 91.24% in the MICU (P < .001) from the first biweekly period of AHHRS utilization to the last. CCE decreased from 73.42% to 65.11% in the MSU and significantly decreased from 81.22% to 53.19% in the MICU (P < .05). Conclusions We describe how an AHHRS approach was successfully implemented at our facility. With ongoing feedback and system optimization, AHHRS improved HHA and reduced CCE over time.
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Affiliation(s)
- Arta Seferi
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Kalliopi Parginos
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Wiline Jean
- Department of Infection Prevention, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
- HealthCare Transformation, Chicago, IL, USA
| | - Christopher Calero
- Department of Infection Prevention, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Joshua Fogel
- Department of Obstetrics and Gynecology, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
- Department of Business Management, Brooklyn College, Brooklyn, NY, USA
| | - Shantel Modeste
- Department of Quality Management, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Beverley-Ann Scott
- Department of Quality Management, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Marjorie Daly-Walsh
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Wilfredo Yap
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Manjinder Kaur
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Terence Brady
- Department of Medicine, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
- Department of Medicine, St. George’s University School of Medicine, Grenada, West Indies
| | - Theresa Madaline
- Department of Medicine, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
- Department of Medicine, St. George’s University School of Medicine, Grenada, West Indies
- Department of Medicine, Touro College of Osteopathic Medicine, New York, NY, USA
- Department of Medicine, New York Institute of Technology College of Osteopathic Medicine, New York, NY, USA
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Wolde W, Mitiku H, Sarkar R, Shume T. Nasal Carriage Rate of Staphylococcus aureus, Its Associated Factors, and Antimicrobial Susceptibility Pattern Among Health Care Workers in Public Hospitals, Harar, Eastern Ethiopia. Infect Drug Resist 2023; 16:3477-3486. [PMID: 37287547 PMCID: PMC10243340 DOI: 10.2147/idr.s396570] [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: 11/07/2022] [Accepted: 05/25/2023] [Indexed: 06/09/2023] Open
Abstract
Background Staphylococcus aureus is the bacteria that colonizes the nasal nares of health-care workers and serves as a reservoir for the spread of pathogen for subsequent infections, mainly Methicillin-resistant Staphylococcus aureus. However, there is a limited study conducted regarding this topic in Harar, Eastern Ethiopia. Objective The main objective of this study was to determine the prevalence of nasal carriage of Staphylococcus aureus, associated factors and antimicrobial susceptibility patterns among health-care workers of public hospitals in Harar, Eastern Ethiopia from May 15 to July 30, 2021. Methods A hospital-based cross-sectional study was conducted on 295 health-care workers. A simple random sampling technique was used to select the participant. Nasal swabs were collected and cultured at 35°C for 24hrs. S. aureus was identified using the coagulase test and catalase test. Methicillin resistance S. aureus (MRSA) was screened using a cefoxitin disc on Muller Hinton agar using the Kirby-Bauer disc diffusion method. Data were entered into EPI-Info version-7 and transferred to SPSS-20 for analysis. Factors associated with nasal carriage of Staphylococcus aureus were determined by using chi-square analysis. A p-value of less than 0.05 was considered statistically significant. Results The prevalence of Staphylococcus aureus in this study was 15.6% (95% CI: 11.7%, 20.3%) and methicillin-resistant Staphylococcus aureus was 11.2% (95% CI: 7.8%, 15.4%), respectively. Age (P < 0.001), work experience (p < 0.001), working unit (p < 0.02), antibiotic use within 3 months (p < 0.001), hand washing habit (p < 0.01), hand rub use (p < 0.001), living with smokers (p < 0.001), living with pets (p < 0.001) and having chronic diseases (p < 0.001) were found significantly associated with Staphylococcus aureus nasal carriage. Conclusion The prevalence of Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus are high in our study. The study emphasizes the need for regular surveillance among hospital staff and the environment to prevent MRSA transmission among health-care personnel.
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Affiliation(s)
- Wondimagegn Wolde
- Department of Medical Microbiology and Immunology, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Habtamu Mitiku
- Department of Tropical and Infectious Disease and Parasitology, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Rajesh Sarkar
- Department of Medical Microbiology and Immunology, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Tadesse Shume
- Department of Medical Microbiology and Immunology, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Slaughter J, Ayra E, Bell E, Ayres A, Martin EM, Snyder GM. Utilizing an interview method to estimate potential bias in silent observer hand hygiene observations. Am J Infect Control 2022:S0196-6553(22)00844-6. [PMID: 36463975 DOI: 10.1016/j.ajic.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022]
Abstract
Interviewed health care workers to determine whether they had noticed a silent hand hygiene observer, thereby determining the legitimacy of the silent observers. Data supported the observers were typically unseen, and potential observer bias had a negligible role in hand hygiene compliance.
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Berkhout C, Berbra O, Favre J, Collins C, Calafiore M, Peremans L, Van Royen P. Defining and evaluating the Hawthorne effect in primary care, a systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1033486. [PMID: 36425097 PMCID: PMC9679018 DOI: 10.3389/fmed.2022.1033486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2023] Open
Abstract
In 2015, we conducted a randomized controlled trial (RCT) in primary care to evaluate if posters and pamphlets dispensed in general practice waiting rooms enhanced vaccination uptake for seasonal influenza. Unexpectedly, vaccination uptake rose in both arms of the RCT whereas public health data indicated a decrease. We wondered if the design of the trial had led to a Hawthorne effect (HE). Searching the literature, we noticed that the definition of the HE was unclear if stated. Our objectives were to refine a definition of the HE for primary care, to evaluate its size, and to draw consequences for primary care research. We designed a Preferred Reporting Items for Systematic reviews and Meta-Analyses review and meta-analysis between January 2012 and March 2022. We included original reports defining the HE and reports measuring it without setting limitations. Definitions of the HE were collected and summarized. Main published outcomes were extracted and measures were analyzed to evaluate odds ratios (ORs) in primary care. The search led to 180 records, reduced on review to 74 for definition and 15 for quantification. Our definition of HE is "an aware or unconscious complex behavior change in a study environment, related to the complex interaction of four biases affecting the study subjects and investigators: selection bias, commitment and congruence bias, conformity and social desirability bias and observation and measurement bias." Its size varies in time and depends on the education and professional position of the investigators and subjects, the study environment, and the outcome. There are overlap areas between the HE, placebo effect, and regression to the mean. In binary outcomes, the overall OR of the HE computed in primary care was 1.41 (95% CI: [1.13; 1.75]; I 2 = 97%), but the significance of the HE disappears in well-designed studies. We conclude that the HE results from a complex system of interacting phenomena and appears to some degree in all experimental research, but its size can considerably be reduced by refining study designs.
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Affiliation(s)
- Christophe Berkhout
- Department of General Practice/Family Medicine, Université de Lille, Lille, France
- Department of Family Medicine and Population Health, Universiteit Antwerpen, Antwerp, Belgium
| | - Ornella Berbra
- Department of General Practice/Family Medicine, Université de Lille, Lille, France
| | - Jonathan Favre
- Department of General Practice/Family Medicine, Université de Lille, Lille, France
| | | | - Matthieu Calafiore
- Department of General Practice/Family Medicine, Université de Lille, Lille, France
- ULR 2694 METRICS, Université de Lille, Lille, France
| | - Lieve Peremans
- Department of Family Medicine and Population Health, Universiteit Antwerpen, Antwerp, Belgium
- Department of Nursing and Midwifery, Universiteit Antwerpen, Antwerp, Belgium
| | - Paul Van Royen
- Department of Family Medicine and Population Health, Universiteit Antwerpen, Antwerp, Belgium
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Is the World Health Organization Multimodal Hand Hygiene Improvement Strategy applicable and effective at the primary care level in resource-limited settings? A quantitative assessment in healthcare centers of Faranah, Guinea. IJID REGIONS 2022; 3:27-33. [PMID: 35755468 PMCID: PMC9216394 DOI: 10.1016/j.ijregi.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/24/2022]
Abstract
The World Health Organization Multimodal Hand Hygiene Improvement Strategy is appropriate to improve compliance and knowledge. This tool is valid at the primary care level in low-resource settings when adapted. Primary care settings need to emphasize the amount of alcohol-based hand rub required and the hand hygiene technique.
Background The World Health Organization Multimodal Hand Hygiene Improvement Strategy aims at reducing healthcare-associated infections; however, evidence of applicability and effectiveness at the primary care level is scarce, especially in healthcare centers in resource-limited settings. The objectives of this study were to improve hand hygiene knowledge and compliance at two healthcare centers in the region of Faranah, Guinea, to increase the availability of alcohol-based hand rub (ABHR), and to assess the effectiveness of the strategy at the primary care level. Methods Knowledge, perceptions, and compliance were assessed prior to the intervention and compared to those of two follow-up assessments, immediately and 6 months after the intervention. The intervention consisted of training and the supply of ABHR. The monthly consumption of ABHR was monitored. Results Baseline knowledge increased from a score of 11/25 at baseline to 16/25 at first follow-up; it then decreased to 15/25 at the second follow-up. Compliance showed an increase from 15.6% to 84.4% (P < 0.001) at the first follow-up. At the second follow-up, compliance was lower than at the first follow-up (53.2%, P < 0.001), but still more than two times higher than at baseline (P < 0.001). ABHR consumption averaged 0.77 ml per consultation. Conclusions The World Health Organization hand hygiene strategy is an appropriate method to improve compliance and knowledge at the primary care level, but needs some adjustment: the inclusion of observation of the correctness of hand hygiene action, as well as training emphasizing the amount of ABHR to use.
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Using video-based surveillance for monitoring hand hygiene compliance according to the World Health Organization (WHO) Five Moments framework: A pragmatic trial. Infect Control Hosp Epidemiol 2022; 44:721-727. [DOI: 10.1017/ice.2021.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective:
To examine the utility of video-based monitoring systems (VMSs) for auditing hand hygiene compliance according to the World Health Organization (WHO) Five Moments.
Design:
Pragmatic quasi-experimental observation trial.
Setting:
The New South Wales Biocontainment Centre, Westmead, New South Wales, Australia.
Participants:
Volunteer healthcare workers (HCWs).
Method:
Six high-fidelity simulations were recorded and subsequently assessed for their ability to audit hand hygiene compliance according to the WHO Five Moments for hand hygiene criteria using tools provided by the National Hand Hygiene Initiative (NHHI).
Results:
In total, 206 minutes of recorded footage were reviewed in 120 minutes, yielding 111 moments. Overall HCW hand hygiene compliance was 88% according to the WHO Five Moments framework. The cost per moment was $0.91 AUD ($0.66 USD) and the time required per moment was 64 seconds.
Conclusions:
Auditing of hand hygiene compliance according to all 5 of the WHO Five Moments from recorded footage is not only possible but provides cost and time savings. In addition, the process may produce output that is less subject to the biases inherent in direct human observational auditing.
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Methodological and technical considerations for video-based auditing of hand hygiene compliance in clinical practice: an exploratory study. Am J Infect Control 2021; 49:1384-1391. [PMID: 33940065 DOI: 10.1016/j.ajic.2021.04.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Direct observation is the gold standard method for measuring hand hygiene compliance but its utility is increasingly being questioned. Various alternative electronic methods have been proposed, yet there is a paucity of research examining the use of these according to the World Health Organization's (WHO) '5 Moments for Hand Hygiene'. As a part of the process of developing a video-based monitoring system (VMS) capable of measuring hand hygiene compliance against the 5 moments criteria this paper reports methodological and technical issues that might arise from the use of a VMS for auditing in clinical practice. METHODS In-depth semi-structured interviews were conducted with 27 Australian content experts in hand hygiene auditing and infection prevention to explore their responses to proposed VMS auditing approaches. Transcripts were analyzed using thematic and content analysis. RESULTS Technical and methodological considerations for the use of VMS were interrelated and included concerns surrounding privacy, footage security, fears of surveillance and the potential for medico-legal consequences. Additionally, possible detrimental impacts on healthcare worker (HCW) -patient relationships, issues of cost versus benefits, HCW and patient safety and changes to feedback were also identified. CONCLUSIONS The primary methodological and technical issues to overcome in order to implement VMS for hand hygiene auditing in clinical practice, centered upon issues of acceptability to patients and health professionals, privacy, consent and liability. CHECKLIST COREQ.
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Shi C, Zhang Y. The application of quality control circle to improve functional exercise execution rate of orthopaedic surgery patients: A SQUIRE-compliant quality-improving study. Medicine (Baltimore) 2021; 100:e27514. [PMID: 34731138 PMCID: PMC8519257 DOI: 10.1097/md.0000000000027514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/27/2021] [Indexed: 01/05/2023] Open
Abstract
Since its application in medical institutions in China, quality control circle (QCC) has gained achievements in medical care and thus earned more attention from the administrative department of health. This paper focuses on the application of QCC (bone-strength test circle) as a new management concept and tool circle in improving the implementation rate of functional exercise in patients undergoing orthopedic surgery, which further effectively improve the accuracy and compliance of functional exercise in patients undergoing surgery, and further effectively promote the rehabilitation of patients.From July 2018 to November 2018, the management tools and statistical methods of QCC were used to compare the promotion effect of functional exercise execution rate of orthopedic surgery patients before and after QCC activities.The checklist investigated 6 key causes of functional exercise in patients undergoing orthopedic surgery, the operative rate of orthopaedic surgery in all aspects changed significantly. Among them, the factors of inadequate propaganda and education were compared before and after the improvement, which decreased by 71% after the improvement. The incorrect factors of exercise decreased by 69% after improvement, the effect was more obvious, the difference was statistically significant (P < .05). The improvement rate was 59.4%.Through this activity, functional exercise education process and functional exercise paths, and corresponding standards for various orthopedic diseases were established. At the same time, the measures such as health education for patients were strengthened, and the expected goals were effectively achieved.
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Ward-level factors associated with methicillin-resistant Staphylococcus aureus acquisition-an electronic medical records study in Singapore. PLoS One 2021; 16:e0254852. [PMID: 34292998 PMCID: PMC8297767 DOI: 10.1371/journal.pone.0254852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Methicillin-Resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide. Intrahospital transfers may impact MRSA acquisition risk experienced by patients. In this study, we investigated ward characteristics and connectivity that are associated with MRSA acquisition. Methods We analysed electronic medical records on patient transfers and MRSA screening of in-patients at an acute-care tertiary hospital in Singapore to investigate whether ward characteristics and connectivity within a network of in-patient wards were associated with MRSA acquisition rates over a period of four years. Results Most patient transfers concentrated in a stable core network of wards. Factors associated with increased rate of MRSA acquisition were MRSA prevalence among patients transferred from other wards (rate ratio (RR): 7.74 [95% confidence interval (CI): 3.88, 15.44], additional 5 percentage point), critical care ward (RR: 1.72 [95% CI: 1.09, 2.70]) and presence of MRSA cohorting beds (RR: 1.39 [95% CI: 1.03, 1.90]. Oncology ward (RR: 0.66 [95% CI: 0.46, 0.94]) (compared to medical ward), and median length of stay (RR: 0.70 [95% CI: 0.55, 0.90], additional 1.5 days) were associated with lower acquisition rates. In addition, we found evidence of interaction between MRSA prevalence among patients transferred from other wards and weighted in-degree although the latter was not associated with MRSA acquisition after controlling for confounders. Conclusion Wards with higher MRSA prevalence among patients transferred from other wards were more likely to have higher MRSA acquisition rate. Its effect further increased in wards receiving greater number of patients. In addition, critical care ward, presence of MRSA cohorting beds, ward specialty, and median length of stay were associated with MRSA acquisition.
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Nunu WN, Ndlovu B, Mudonhi N, Moyo N, Murwira TS. Effectiveness of peer to peer strategy in reducing accidents and injuries at a selected platinum mine in Zimbabwe. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hand Hygiene Compliance at a Canadian provincial cancer centre - the complementary roles of nurse auditor-driven and patient auditor-driven audit processes and impact upon practice in ambulatory cancer care. Am J Infect Control 2021; 49:571-575. [PMID: 33096127 DOI: 10.1016/j.ajic.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND We examined the patterns of hand hygiene compliance (HHC) among health care providers (HCP) as observed by trained nurse and patient auditors over time in an ambulatory care Canadian provincial cancer agency. METHODS Nurse and volunteer patient auditors completed separate standardized forms documenting hand-cleansing opportunities during clinic visits. HHC rates were compared over time by HCP group and by specialty teams. Observations from 10 calendar quarters were analyzed from April 2015 to September 2019. RESULTS Nurse audit HHC rates ranged from 84% to 96%, encompassing 7,213 opportunities with no significant time-dependent trends by linear regression (R2 = 2.3E-005, P = .9895). The patient audit HHC rates ranged from 57% to 82%, encompassing 23,402 opportunities, were lower overall compared to the nurse audit (73.6% vs 89.2%, respectively, P < .0001), but displayed an increasing trend (R2 = 0.5374, P = .0159) over the same 10 time periods. The relative risk ratio for the differences decreased over time (R2 = .5101, P = .0203). Patients acknowledged the importance of HHC and the audit process, but were reticent to remind HCP to comply. CONCLUSIONS The nurse audit measuring HCP HHC before entering and after exiting patient examination rooms showed persistently high compliance over time whereas the patient-driven audit measuring HHC within the examination room increased over time suggesting a training effect upon practice. These measures appeared complementary.
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Zhang L, Qin X, Zeng J, Feng Y, Zhang N, Tan Y, Chen J, Chen S. A kindergarten-based, family-involved intervention to improve children's hand hygiene behavior: A cluster-randomized controlled trial. Public Health Nurs 2021; 38:738-750. [PMID: 33682194 DOI: 10.1111/phn.12882] [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: 08/08/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The present study determined the feasibility and initial efficacy of a kindergarten-based, family-involved intervention in improving children's hand hygiene (HH) behaviors. DESIGN A cluster-randomized controlled trial was performed, with a cluster defined as a kindergarten class. SAMPLE Participants were recruited from 20 classes in six kindergartens. A total of 289 children and their families were enrolled in the intervention group, and 293 children and their families were enrolled in the control group. MEASUREMENTS HH behavior and a related knowledge survey, as well as data on absences due to infection, were collected. INTERVENTION An 8-week training session on HH for children and an education program combining a seminar and WeChat groups for parents were provided to participants in the intervention group. RESULTS Two HH behaviors of children, namely, HH after playing outside and 7-stage HH compliance, were significantly different between the two groups after the intervention. The two HH behaviors and knowledge of infections of parents/legal guardians in the intervention group were better than those in the control group after the intervention. The number of absences due to infections in children was lower in the intervention group than in the control group. CONCLUSIONS Kindergarten-based, family-involved interventions effectively improved the HH behavior of kindergarten children and decreased absences due to infections.
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Affiliation(s)
- Lifeng Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xiuqun Qin
- Pediatric Department, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jixiao Zeng
- Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yongshen Feng
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Ningning Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yuqin Tan
- Abdominal and Pelvic Oncology Department, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jielin Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Shiyin Chen
- Research Management Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Cawthorne KR, Cooke RP. A standardised approach to validate both the accuracy and precision of electronic hand hygiene monitoring systems is needed. J Infect Prev 2020; 22:42-43. [PMID: 33841561 PMCID: PMC7841713 DOI: 10.1177/1757177420963791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Katie-Rose Cawthorne
- Swansea University Medical School, Institute of Life Science 2, Swansea, West Glamorgan, UK
| | - Richard Pd Cooke
- Departments of Medical Microbiology and Innovation, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
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Healthcare workers' attitudes to how hand hygiene performance is currently monitored and assessed. J Hosp Infect 2020; 105:705-709. [DOI: 10.1016/j.jhin.2020.05.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
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Liu K, Xu Z, Wang X, Chen Y, Mao XD. The application of quality control circle to improve the quality of samples: A SQUIRE-compliant quality-improving study. Medicine (Baltimore) 2020; 99:e20333. [PMID: 32481320 PMCID: PMC7249848 DOI: 10.1097/md.0000000000020333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Since its application in medical institutions in China, quality control circle (QCC) has gained achievements in medical care and thus earned more attention from the administrative department of health.In order to improve the quality of laboratory specimens, we launched a QCC activity to solve the problems and evaluate the effect of it. The data of 30,105 unqualified specimens in our hospital were collected from February to June 2017. After the QCC activity, the data of 43,125 specimens taken from July to December 2017 were collected.The defect rate of the specimens before the QCC activity was 0.98% (297/30105), and after the QCC activity, it was 0.45% (193/43125), showing a significant statistical difference (P < .05). The achievement rate and improvement rate were 108.2% and 54.1%, respectively.After the implementation of QCC, the defect rate of specimens in clinical laboratories was significantly decreased, and the intangible factors were also improved, which demonstrated the positive effects of QCC on the quality control of specimens.
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Affiliation(s)
- Kangsheng Liu
- Department of Clinical Laboratory, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing
| | - Zhirong Xu
- Department of Clinical Laboratory, the First affiliated Hospital of Soochow University, Suzhou
| | - Xiangdong Wang
- Department of Clinical Laboratory, Nanjing Chest Hospital, Medical School of Southeast university
| | - Yajun Chen
- Department of Clinical Laboratory, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing
| | - Xiao-Dong Mao
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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Irehovbude J, Okoye CA. Hand hygiene compliance: bridging the awareness-practice gap in sub-Saharan Africa. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc06. [PMID: 32547906 PMCID: PMC7273322 DOI: 10.3205/dgkh000341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review provides an exploratory overview of hand hygiene compliance in sub-Saharan Africa and examines strategies to bridge the compliance gap. While there is increasing awareness on hand hygiene, empirical evidence suggests that there is no concurrent increase in correct hand hygiene practice among key populations in sub-Saharan Africa. Children, adolescents and even healthcare providers (HCPs) in sub-Saharan Africa consistently assume poor hand hygiene compliance levels resulting in negative health consequences. Faecal-oral diseases remain common among schoolchildren, leading to school absenteeism and disease-specific morbidity. Additionally, the incidence of nosocomial infections in health facilities in sub-Saharan Africa remains high, as many HCPs do not adopt good hand hygiene practice. Increased disease burden, high healthcare costs and eroding public confidence in the healthcare system are a few implications of HCPs’ poor compliance with hand hygiene. These trends underscore the inadequacies of educational approaches (cognition model) to hand hygiene promotion commonly adopted in sub-Saharan Africa. It was therefore recommended that the governments of sub-Saharan Africa should focus on promoting skill-based hygiene education which will help schoolchildren develop good hand hygiene practice as a lifelong skill. In addition, efforts should be made to implement a multimodal hand hygiene strategy in healthcare facilities in order to increase compliance by healthcare providers.
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Affiliation(s)
- Jahmai Irehovbude
- Department of Human Kinetics and Health Education, Ambrose Alli University, Ekpoma, Edo State, Nigeria
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Saitoh A, Sato K, Magara Y, Osaki K, Narita K, Shioiri K, Fowler KE, Ratz D, Saint S. Improving Hand Hygiene Adherence in Healthcare Workers Before Patient Contact: A Multimodal Intervention in Four Tertiary Care Hospitals in Japan. J Hosp Med 2020; 15:262-267. [PMID: 32379022 DOI: 10.12788/jhm.3446] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies. OBJECTIVES Our objectives were to evaluate hand hygiene adherence among physicians and nurses before touching hospitalized patients and to evaluate changes in hand hygiene adherence after a multimodal intervention was implemented. DESIGN, SETTING, AND PARTICIPANTS We conducted a pre- and postintervention study with HCWs at four tertiary hospitals in Niigata, Japan. Hand hygiene observations were conducted from June to August 2018 (preintervention) and February to March 2019 (postintervention). INTERVENTION The multimodal hand hygiene intervention recommended by the World Health Organization was tailored to each hospital and implemented from September 2018 to February 2019. MAIN OUTCOMES AND MEASURES We observed hand hygiene adherence before touching patients in each hospital and compared rates before and after intervention. Intervention components were also evaluated. RESULTS There were 2,018 patient observations preintervention and 1,630 postintervention. Overall, hand hygiene adherence improved from 453 of 2,018 preintervention observations (22.4%) to 548 of 1,630 postintervention observations (33.6%; P < .001). Rates improved more among nurses (13.9 percentage points) than among doctors (5.7 percentage points). Improvement varied among the hospitals: Hospital B (18.4 percentage points) was highest, followed by Hospitals D (11.4 percentage points), C (11.3 percentage points), and Hospital A (6.5 percentage points). CONCLUSIONS A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary. Given the current suboptimal hand hygiene adherence rates in Japanese hospitals, the spread of COVID-19 within the hospital setting is a concern.
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Affiliation(s)
- Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata Japan
| | - Kiyomi Sato
- Department of Nursing, Niigata Saiseikai Daini Hospital, Niigata, Japan
| | - Yoko Magara
- Department of Nursing, Niigata Saiseikai Daini Hospital, Niigata, Japan
| | - Kakuei Osaki
- Department of Nursing, Niigata City General Hospital, Niigata, Japan
| | - Kiyoko Narita
- Department of Nursing, Naga-oka Red Cross Medical Center, Niigata, Japan
| | - Kumiko Shioiri
- Department of Nursing, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Karen E Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - David Ratz
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sanjay Saint
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Wong MW, Xu YZ, Bone J, Srigley JA. Impact of patient and visitor hand hygiene interventions at a pediatric hospital: A stepped wedge cluster randomized controlled trial. Am J Infect Control 2020; 48:511-516. [PMID: 31706550 DOI: 10.1016/j.ajic.2019.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patient and visitor hand hygiene has the potential to prevent health care-associated infections, but there are few data on the efficacy of interventions to improve patient/visitor hand hygiene. OBJECTIVE To determine whether conventional and front-line ownership (FLO) patient/visitor hand hygiene interventions improve patient/visitor and health care worker (HCW) hand hygiene rates. METHODS A stepped wedge cluster randomized controlled trial was conducted on inpatient units and the emergency department. A conventional intervention included pediatric-focused posters, which also served as reminders for HCWs. This was compared to a FLO intervention aimed at finding "positive deviants," staff who were already taking steps to improve patient/visitor hand hygiene. Patient/visitor and HCW hand hygiene rates were measured covertly by trained medical students. RESULTS Patient/visitor hand hygiene rates increased from 9.2% at baseline to 13.9% in the post-intervention period. Hand hygiene rates on units randomized to the standard intervention changed from 7.3% to 10.9% (P = .46), but FLO intervention units significantly changed from 14.3% to 25% (P = .03). The baseline HCW hand hygiene rate was 68.2%, which increased to a greater extent in the FLO group (79.1%) than in the standard intervention (73.1%), but the change was not statistically significant for either intervention compared to control (P = .18 and P = .64, respectively). CONCLUSIONS Hand hygiene interventions in hospitals can improve patient/visitor and HCW hand hygiene rates, and a FLO intervention appears to be more effective than a conventional intervention.
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Cawthorne KR, Cooke RPD. Innovative technologies for hand hygiene monitoring are urgently needed in the fight against COVID-19. J Hosp Infect 2020; 105:362-363. [PMID: 32304726 PMCID: PMC7158775 DOI: 10.1016/j.jhin.2020.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - R P D Cooke
- Department of Medical Innovation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Vaisman A, Bannerman G, Matelski J, Tinckam K, Hota SS. Out of sight, out of mind: a prospective observational study to estimate the duration of the Hawthorne effect on hand hygiene events. BMJ Qual Saf 2020; 29:932-938. [DOI: 10.1136/bmjqs-2019-010310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 12/28/2022]
Abstract
BackgroundHuman auditing has been the gold standard for evaluating hand hygiene (HH) compliance but is subject to the Hawthorne effect (HE), the change in subjects’ behaviour due to their awareness of being observed. For the first time, we used electronic HH monitoring to characterise the duration of the HE on HH events after human auditors have left the ward.MethodsObservations were prospectively conducted on two transplant wards at a tertiary centre between May 2018 and January 2019. HH events were measured using the electronic GOJO Smartlink Activity Monitoring System located throughout the ward. Non-covert human auditing was conducted in 1-hour intervals at random locations on both wards on varying days of the week. Two adjusted negative binomial regression models were fit in order to estimate an overall auditor effect and a graded auditor effect.ResultsIn total, 365 674 HH dispensing events were observed out of a possible 911 791 opportunities. In the adjusted model, the presence of an auditor increased electronic HH events by approximately 2.5-fold in the room closest to where the auditor was standing (9.86 events per hour/3.98 events per hour; p<0.01), an effect sustained across only the partial hour before and after the auditor was present but not beyond the first hour after the auditor left. This effect persisted but was attenuated in areas distal from the auditor (total ward events of 6.91*6.32–7.55, p<0.01). Additionally, there was significant variability in the magnitude of the HE based on temporal and geographic distribution of audits.ConclusionThe HE on HH events appears to last for a limited time on inpatient wards and is highly dynamic across time and auditor location. These findings further challenge the validity and value of human auditing and support the need for alternative and complementary monitoring methods.
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A new approach to infection prevention: A pilot study to evaluate a hand hygiene ambassador program in hospitals and clinics. Am J Infect Control 2020; 48:246-248. [PMID: 31917012 DOI: 10.1016/j.ajic.2019.11.007] [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: 07/30/2019] [Revised: 11/07/2019] [Accepted: 11/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND A pilot study was conducted to assess the perceptions of visitors, patients, and staff to the presence of a hand hygiene ambassador (HHA). METHODS Two hundred and twenty-five entrants to various health care settings were surveyed. Only entrants who failed to clean their hands at the alcohol-based handrub (ABHR) station on entry to the lobby were offered application of ABHR by an HHA. Several questions were also asked to assess their attitudes about the presence of an HHA. RESULTS When asked whether they think it is a good idea to have an HHA place ABHR on an entrant's hands, the majority of staff, visitors, and patients agreed. No one refused administration of handrub by the HHA. DISCUSSION HHA programs have direct and indirect benefits. Although the cost of such an initiative should be considered prior to implementation, it should be weighed against the annual spending for health care-associated infections. CONCLUSIONS Considering that hand hygiene compliance and health care-associated infection are clearly linked, a new approach using an HHA may help reduce infection, acting as a source of hand hygiene on entry to the hospital and possibly as a reminder to perform hand hygiene elsewhere in the hospital and clinics.
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Mckay KJ, Shaban RZ, Ferguson P. Hand hygiene compliance monitoring: Do video-based technologies offer opportunities for the future? Infect Dis Health 2020; 25:92-100. [PMID: 31932242 DOI: 10.1016/j.idh.2019.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/18/2022]
Abstract
Hand hygiene is universally recognised as the primary measure to reduce healthcare-associated infections. Studies have convincingly demonstrated a link between increased hand hygiene compliance and reductions in rates of healthcare-associated infections. Direct observation is considered the gold standard method for monitoring hand hygiene compliance. Despite the acknowledged benefits of this approach, recent literature has highlighted a range of issues impacting on the reliability and validity of this data collection technique. The rise of technology in healthcare provides opportunity for alternative methods that promise advantages over direct human observation. There have been no published examples of systems that are able to capture data consistent with all the WHO '5 Moments for Hand Hygiene'. In this paper we explore current human-based auditing practises for monitoring hand hygiene compliance and raise for discussion and debate video-based technologies to monitor hand hygiene compliance. We raise questions regarding hybrid approaches that incorporate both direct human observation and indirect video-based surveillance, and the possible advantages and disadvantages therein for monitoring hand hygiene compliance. We suggest that such methods have the potential to ameliorate, or minimise, the inherent biases associated with direct observation, notably the Hawthorne Effect. Future research into the utility of a hybrid approach to auditing, including the technical specifications, efficacy, cost effectiveness and acceptability of such a model is warranted.
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Affiliation(s)
- Katherine J Mckay
- Infection Prevention and Control, Eastern Health, Box Hill, Victoria, Australia; Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia.
| | - Patricia Ferguson
- School of Medicine & Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW, Australia.
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Hand hygiene compliance surveillance with time series anomaly detection. Am J Infect Control 2019; 47:1449-1452. [PMID: 31326263 DOI: 10.1016/j.ajic.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hand hygiene is the most important intervention to reduce the risk of transmission of pathogens in health care. Assurance of effective hand hygiene improvement campaigns includes adequate data analytics for reporting compliance. Traditional analytical approaches for monitoring hand hygiene compliance suffer from several limitations, including autocorrelation. The objective of this study was to use a novel time series anomaly detection algorithm to analyze routine hand hygiene compliance data. METHODS Hand hygiene compliance data were collected daily by trained observers in a large academic medical center. Statistical process control p-charts were used as a comparison method of analysis per facility protocol. Time series anomaly detection was carried out using the seasonal and trend decomposition using LOESS (STL) algorithm. RESULTS A total of 34 months of hand hygiene compliance data were analyzed. Traditional statistical process control p-charts identified over 76% of rates as special-cause variation, whereas STL identified 18% of rates as anomalous. CONCLUSIONS This study supports the use of time series anomaly detection for the routine surveillance of hand hygiene compliance data. This method will facilitate specific and accurate feedback, helping to improve this critical approach for improving patient safety.
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Karampatakis T, Tsergouli K, Iosifidis E, Antachopoulos C, Volakli E, Karyoti A, Sdougka M, Tsakris A, Roilides E. Effects of an Active Surveillance Program and Enhanced Infection Control Measures on Carbapenem-Resistant Gram-Negative Bacterial Carriage and Infections in Pediatric Intensive Care. Microb Drug Resist 2019; 25:1347-1356. [DOI: 10.1089/mdr.2019.0061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Theodoros Karampatakis
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece
| | - Katerina Tsergouli
- Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece
| | - Elias Iosifidis
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
| | - Charalampos Antachopoulos
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
| | - Eleni Volakli
- Pediatric Intensive Care Unit, Hippokration General Hospital, Thessaloniki, Greece
| | - Angeliki Karyoti
- Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece
- Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
| | - Maria Sdougka
- Pediatric Intensive Care Unit, Hippokration General Hospital, Thessaloniki, Greece
| | - Athanassios Tsakris
- Microbiology Department, National and Kapodistrian University School of Medicine, Athens, Greece
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
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Grover E, Hossain MK, Uddin S, Venkatesh M, Ram PK, Dreibelbis R. Social Influence on Handwashing with Soap: Results from a Cluster Randomized Controlled Trial in Bangladesh. Am J Trop Med Hyg 2019; 99:934-936. [PMID: 30062982 DOI: 10.4269/ajtmh.17-0903] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We analyzed data from a cluster-randomized controlled trial conducted among 20 schools in Rajshahi, Bangladesh, to explore the role of social influence on handwashing with soap (HWWS) in a primary school setting. Using data collected through covert video cameras outside of school latrines, we used robust Poisson regression analysis to assess the impact of social influence-defined as the presence of another person near the handwashing location-on HWWS after a toileting event. In adjusted analyses, we found a 30% increase in HWWS when someone was present, as compared with when a child was alone (Prevalence ratio 1.30; 95% confidence interval: 1.14-1.47, P < 0.001). The highest prevalence of HWWS was found when both child(ren) and adult(s) were present or when just children were present (64%). Our study supports the conclusion that the presence of another individual after a toileting event can positively impact HWWS in a primary school setting.
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Affiliation(s)
- Elise Grover
- Department of Environmental and Occupational Health, Colorado School of Public Health, Aurora, Colorado.,Department of Civil Engineering and Environmental Science, Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
| | | | - Saker Uddin
- Save the Children, Bangladesh, Dhaka, Bangladesh
| | | | - Pavani K Ram
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Robert Dreibelbis
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Department of Civil Engineering and Environmental Science, Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
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Yoo E, Ursua L, Clark R, Seok J, Jeon J, Kim HB. The effect of incorporating covert observation into established overt observation-based hand hygiene promotion programs. Am J Infect Control 2019; 47:482-486. [PMID: 30558992 DOI: 10.1016/j.ajic.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Covert observation (CO) is reliable for measuring hand hygiene compliance (HHC). However, the benefit of adding CO to overt observation (OO) is uncertain. We evaluated whether incorporating CO into an OO-based hand hygiene (HH) promotion program improves HH rate. METHODS Health care worker's HH activities were observed through 5 monitoring sessions (2 in phases 1 and 2 and 1 in phase 3) of simultaneous CO and OO. An intervention was applied-barrier identification interview-only in phase 2. RESULTS Overall HHC was 91.0% for OO, and 49.3% for CO. HHC in phase 1 was not changed by repeated CO (34.7% and 34.0%, P = .70). HHC based on CO increased to 66.9% in phase 2 after the application of an intervention (P < .01), but decreased to 57.5% in phase 3 (P < .01). HHC based on OO increased significantly between only the first and second sessions in phase 2 (90.8% and 94.5%, respectively, P = .01). DISCUSSION Although CO did not significantly change behavior, HHC with CO responded promptly to the application and cessation of a new intervention. CONCLUSIONS CO reflects HHC change more reliably than does OO. However, it is uncertain whether CO will improve HHC.
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Jeanes A, Henderson F, Drey N, Gould D. Hand hygiene expectations in radiography: A critical evaluation of the opportunities for and barriers to compliance. J Infect Prev 2019. [DOI: 10.1177/1757177419836161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Good hand hygiene practices reduce the risk of transmission of infection in healthcare. In common with other areas of healthcare, infection control knowledge and practice in radiography has potential for improvement. Regular hand hygiene compliance (HHC) monitoring indicated poor compliance in radiology which did not accurately reflect practice in one organisation. Using a quality improvement cycle, the process and context of work undertaken in radiology were examined in order to improve the validity and utility of HHC monitoring data collection process in the department. Methods: Following examination of the evidence base and with agreement from the radiology team, the chest X-ray process was observed and actions notated. This was then scored using the organisation and the World Health Organization five moments of hand hygiene tool. An alternative risk-based scoring system was developed. Results: The HHC score of 22% was obtained using standard measurements. Achievement of 100% compliance would require the radiographer to clean their hands nine times for each X-ray. The sequence of taking a chest X-ray was examined and two points in the process were identified as key points at which hand cleaning should take place to reduce the risk of transmission of infection. Conclusions: Cleaning hands frequently to achieve compliance expectations in this short low-risk process is neither feasible nor beneficial. A pragmatic risk-based approach to hand hygiene expectations in predictable procedures such as taking a chest X-ray reduces ambiguity and potentially increases compliance.
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Affiliation(s)
- Annette Jeanes
- Infection Control Department, University College London Hospitals, London, UK
| | - Fiona Henderson
- Radiology Department, University College Hospital, London, UK
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Cleaning Staff's Attitudes about Hand Hygiene in a Metropolitan Hospital in Australia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16061067. [PMID: 30934579 PMCID: PMC6466087 DOI: 10.3390/ijerph16061067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 02/04/2023]
Abstract
Background: In 2009, the National Hand Hygiene Initiative (NHHI) was implemented in hospitals across Australia with the aim of improving hand hygiene practices and reducing healthcare-associated infections. Audits conducted post-implementation showed the lowest rates of compliance with hand hygiene practices are among operational staff including hospital cleaners. There is limited information about hand hygiene issues in hospital cleaners to inform development of evidence-based interventions to improve hand hygiene compliance in this group. Aim: This qualitative study was undertaken to explore the attitudes of hospital cleaning staff regarding hand hygiene and the National Hand Hygiene Initiative. Methodology: Focus groups were conducted with 12 cleaning staff at a large Australian hospital implementing the National Hand Hygiene Initiative. Findings: Hospital cleaners recognise the importance of hand hygiene in preventing healthcare-associated infections. Cleaners cite peer support, leadership, and the recognition and reward of those excelling in hand hygiene as strong motivators. Barriers to optimal hand hygiene practice include the presence of multiple conflicting guidelines, hand hygiene “overload” and a lack of contextualised education programs. This exploratory qualitative study reveals three themes about attitudes of hospital cleaning staff towards hand hygiene. These themes are: (1) “The culture of hand hygiene: It’s drummed into us”; (2) “Reminders and promotion for hand hygiene: We just need a big ‘Please wash your hands’ sign”; and (3) “The personal value of hand hygiene: Like he said, it’s second nature to us”. Conclusion: Hand-hygiene messages and training need to be more consistent and contextualised to achieve improvements in hand hygiene practices in hospital cleaning staff in Australia.
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Jeanes A, Coen PG, Gould DJ, Drey NS. Validity of hand hygiene compliance measurement by observation: A systematic review. Am J Infect Control 2019; 47:313-322. [PMID: 30322815 DOI: 10.1016/j.ajic.2018.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hand hygiene is monitored by direct observation to improve practice, but this approach can potentially cause information, selection, and confounding bias, threatening the validity of findings. The aim of this study was to identify and describe the potential biases in hand hygiene compliance monitoring by direct observation; develop a typology of biases and propose improvements to reduce bias; and increase the validity of compliance measurements. METHODS This systematic review of hospital-based intervention studies used direct observation to monitor health care workers' hand hygiene compliance. RESULTS Seventy-one publications were eligible for review. None was free of bias. Selection bias was present in all studies through lack of data collection on the weekends (n = 61, 86%) and at night (n = 46, 65%) and observations undertaken in single-specialty settings (n = 35, 49%). We observed inconsistency of terminology, definitions of hand hygiene opportunity, criteria, tools, and descriptions of the data collection. Frequency of observation, duration, or both were not described or were unclear in 58 (82%) publications. Observers were trained in 56 (79%) studies. Inter-rater reliability was measured in 26 (37%) studies. CONCLUSIONS Published research of hand hygiene compliance measured by direct observation lacks validity. Hand hygiene should be measured using methods that produce a valid indication of performance and quality. Standardization of methodology would expedite comparison of hand hygiene compliance between clinical settings and organizations.
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Affiliation(s)
- Annette Jeanes
- Infection Control Department, University College London Hospitals, London, United Kingdom.
| | - Pietro G Coen
- Infection Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Nicolas S Drey
- School of Health Sciences, Cardiff, University of London, London, United Kingdom
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Werzen A, Thom KA, Robinson GL, Li S, Rock C, Herwaldt LA, Diekema DJ, Reisinger HS, Perencevich EN. Comparing brief, covert, directly observed hand hygiene compliance monitoring to standard methods: A multicenter cohort study. Am J Infect Control 2019; 47:346-348. [PMID: 30314747 DOI: 10.1016/j.ajic.2018.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/14/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
Hand hygiene compliance is subject to the Hawthorne effect, which may be attenuated by covert observers and brief observation periods. This study demonstrated that hand hygiene compliance rates were between 8% and 29% greater when reported by infection prevention programs than when reported by covert observers over brief observation periods.
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Alrumi N, Aghaalkurdi M, Habib H, Abed S, Böttcher B. Infection control measures in neonatal units: implementation of change in the Gaza-Strip. J Matern Fetal Neonatal Med 2019; 33:3490-3496. [PMID: 30691321 DOI: 10.1080/14767058.2019.1576168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Low-income countries rarely report infection control measures although they are key to reducing mortality and morbidity in healthcare. This audit examined healthcare personnel's adherence to infection control measures before entry to the NICU and in both minor and major procedures' bundles. Furthermore, it examined the effect of subsequent authorization and dissemination of infection control guidelines followed by education and training sessions on the adherence of healthcare personnel to infection control policies.Methods: This prospective observational study was conducted in two NICUs at two separate hospitals in the Gaza-Strip, Palestine. The initial observation period was June-August 2016 during which healthcare professionals' adherence to infection control policies was assessed by direct observation. This was followed by NICU feedback dissemination and on-site educational and training sessions. Then, the reaudit, following the same protocol, was carried out throughout February 2017.Results: There was a statistically significant improvement in the adherence to infection control measures among healthcare personnel. Significant improvements were found in both minor and major procedure infection control protocols' adherence rates. However, when comparing the general neonatal handling adherence rate between both audits, no significant change was noted.Discussion: This study highlights the effectiveness of using audit feedback and on-site educational and training sessions in the enhancement of adherence to infection control policies, demonstrating significant improvement in areas covered by the staff training program. Therefore, including regular infection control training combined with feedback in the curriculum of healthcare professionals can improve the sustainability of infection control programs. Further studies must examine the impact of such training also on the incidence of healthcare-associated infection rates as well as morbidity and mortality within neonatal units.
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Affiliation(s)
- N Alrumi
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestinian Territories
| | - M Aghaalkurdi
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestinian Territories
| | - H Habib
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestinian Territories
| | - S Abed
- Al Nassr Pediatric Hospital, Gaza, Palestinian Territories
| | - B Böttcher
- Evidence Based Medicine Unit, Faculty of Medicine, Islamic University of Gaza, Gaza, Palestinian Territories
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Woodnutt S. Is Lean sustainable in today's NHS hospitals? A systematic literature review using the meta-narrative and integrative methods. Int J Qual Health Care 2019; 30:578-586. [PMID: 29648651 DOI: 10.1093/intqhc/mzy070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/22/2018] [Indexed: 11/14/2022] Open
Abstract
Purpose Methodological variance and quality, heterogeneity of value and divergent approaches are reasons for the varied results of Lean interventions in healthcare despite ongoing global popularity. However, there is piecemeal evidence addressing the sustainability of initiatives-the aim of this review is to use an integrative approach to consider Lean's sustainability and the quality of available evidence in today's National Health Service (NHS). Data sources A literature review of AMED, CINAHL, Cochrane, JBI, SCOPUS, DelphiS, MEDLINE, EMBASE, MIDIRS, Web of Science and PsycINFO electronic databases was conducted. Study selection Peer-reviewed studies in NHS hospitals/trusts that concerned undiluted, service-wide Lean adoption and contained quantitative data were included. Reference lists were consulted for evidence via a snowball approach. Methodological quality was assessed using an adapted critical appraisal tool. Data extraction Research design, method of intervention, outcome measures and sustainability were extracted. Results of data synthesis Electronic searches identified 12 studies eligible for inclusion. This comprised of five quasi-experimental designs (one mixed-method), three multi-site analyses, one action research, one failure mode and effects analysis, one content analysis of annual reports and one systematic review. Six articles considered sustainability with two of these providing measured successes. Despite diverse and positive outcomes studies lacked scientific rigour, failed to consider confounding issues, were at risk of positive bias and did not demonstrate sustainability with any statistical significance. Conclusion Lean has ostensible value but it is difficult to draw a conclusion on efficacy or sustainability. Higher quality scientific research into Lean and the effect of staffing cultures on initiatives are needed to ascertain the extent that Lean can affect healthcare quality and subsequently be sustained.
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Rodríguez-Villar D, Del-Moral-Luque JA, San-Román-Montero J, Gil-de-Miguel Á, Rodríguez-Caravaca G, Durán-Poveda M. [Hand hygiene compliance with hydroalcoholic solutions in medical students. Cross-sectional study]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:232-237. [PMID: 30950257 PMCID: PMC6609939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess hand hygiene compliance covertly in medical students in a university teaching hospital. METHODS Cross-sectional study. Hand hygiene compliance in medical students was assessed in the units of Neonatology, Paediatrics, Neurology and Orthopaedic surgery. The five moments were covertly observed so as the hand rub technique. Hand hygiene compliance was described with the compliance percentages of the five moments. RESULTS We studied 456 opportunities of hand hygiene. Global compliance was 44.3%. The most registered unit was Orthopaedic surgery (59.6%). According to the different moments, global compliance was better "after touching a patient" (60.2%). The unit with the highest hand hygiene compliance was Neonatology (60%). Hand hygiene compliance was better in the different hospitalisation units (50%) than in the office rooms (33%) (P<0.05) and the mean duration of hand hygiene was 22 seconds. CONCLUSIONS Most of the moments were registered in the unit of Orthopaedic surgery and the moment with the highest hand hygiene compliance was "after touching a patient". The most hand hygiene compliance percentage was observed in Neonatology. Hand hygiene compliance was moderate, and it could and must be improved.
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Affiliation(s)
- Diego Rodríguez-Villar
- Departamento de Medicina Preventiva y Salud Pública. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Alcorcón. Madrid
| | - Juan Antonio Del-Moral-Luque
- Departamento de Medicina Preventiva y Salud Pública. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Alcorcón. Madrid.,Unidad de Medicina Preventiva y Salud Pública. Hospital Universitario Fundación Alcorcón. Madrid
| | - Jesús San-Román-Montero
- Departamento de Medicina y Cirugía. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Alcorcón. Madrid
| | - Ángel Gil-de-Miguel
- Departamento de Medicina Preventiva y Salud Pública. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Alcorcón. Madrid
| | - Gil Rodríguez-Caravaca
- Departamento de Medicina Preventiva y Salud Pública. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Alcorcón. Madrid.,Unidad de Medicina Preventiva y Salud Pública. Hospital Universitario Fundación Alcorcón. Madrid.,Correspondencia: Gil Rodríguez Caravaca Unidad de Medicina Preventiva, Hospital Universitario Fundación Alcorcón, C/ Budapest 1, 28922 Alcorcón (Madrid) Spain Tel.: +34 91 6219281 - Fax: +34 91 62199830 E-mail:
| | - Manuel Durán-Poveda
- Departamento de Medicina y Cirugía. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Alcorcón. Madrid
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Testing a novel audit and feedback method for hand hygiene compliance: A multicenter quality improvement study. Infect Control Hosp Epidemiol 2018; 40:89-94. [PMID: 30430974 DOI: 10.1017/ice.2018.277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Although most hospitals report very high levels of hand hygiene compliance (HHC), the accuracy of these overtly observed rates is questionable due to the Hawthorne effect and other sources of bias. In the study, we aimed (1) to compare HHC rates estimated using the standard audit method of overt observation by a known observer and a new audit method that employed a rapid (<15 minutes) "secret shopper" method and (2) to pilot test a novel feedback tool. DESIGN Quality improvement project using a quasi-experimental stepped-wedge design. SETTING This study was conducted in 5 acute-care hospitals (17 wards, 5 intensive care units) in the Midwestern United States. METHODS Sites recruited a hand hygiene observer from outside the acute-care units to rapidly and covertly observe entry and exit HHC during the study period, October 2016-September 2017. After 3 months of observations, sites received a monthly feedback tool that communicated HHC information from the new audit method. RESULTS The absolute difference in HHC estimates between the standard and new audit methods was ~30%. No significant differences in HHC were detected between the baseline and feedback phases (OR, 0.92; 95% CI, 0.84-1.01), but the standard audit method had significantly higher estimates than the new audit method (OR, 9.83; 95% CI, 8.82-10.95). CONCLUSIONS HHC estimates obtained using the new audit method were substantially lower than estimates obtained using the standard audit method, suggesting that the rapid, secret-shopper method is less subject to bias. Providing feedback using HHC from the new audit method did not seem to impact HHC behaviors.
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A hand hygiene intervention to decrease hand, foot and mouth disease and absence due to sickness among kindergarteners in China: A cluster-randomized controlled trial. J Infect 2018; 78:19-26. [PMID: 30134143 DOI: 10.1016/j.jinf.2018.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the effect of the "Clean Hands, Happy Life" intervention on the incidence of hand, food and mouth disease (HFMD) and on school absences due to sickness in kindergarten students. METHODS The intervention consisted of four hand hygiene (HH) promotion components and was evaluated in a cluster-randomized controlled trial among 8275 children and 18 kindergartens from May to October, 2015 in Shenzhen, China. We compared two intervention arms - received the intervention in kindergartens only and in both kindergartens and families, respectively - to the control arm in multilevel analyses. RESULTS During the follow-up, the incidence of HFMD in both intervention arms was significantly lower than in the control arm (IRR1: 0.39, 95%CI: 0.26-0.59; IRR2: 0.30, 95%CI: 0.19-0.49); the duration of absence due to sickness (in days) in both intervention arms was significantly shorter than in the control arm (β1 = 0.58, 95%CI: 0.41-0.74; β2 = 0.34, 95%CI: 0.17-0.50), controlling for the area type of kindergarten and grade level of children. Furthermore, during the follow-up we found that there were fewer episodes of absence due to respiratory, skin and eye infections (P < 0.05). CONCLUSIONS Our intervention is effective at reducing HFMD infections and absence due to sickness in children attending kindergartens in China.
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Identifying heterogeneity in the Hawthorne effect on hand hygiene observation: a cohort study of overtly and covertly observed results. BMC Infect Dis 2018; 18:369. [PMID: 30081843 PMCID: PMC6090841 DOI: 10.1186/s12879-018-3292-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 08/01/2018] [Indexed: 12/19/2022] Open
Abstract
Background Observation and feedback are core strategies of hand hygiene (HH) improvement. Direct overt observation is currently the gold standard method. Observation bias, also known as the Hawthorne effect, is a major disadvantage of this method. Our aim was to examine the variation of the Hawthorne effect on HH observation in different healthcare groups and settings. Methods A prospective cohort study was performed in a tertiary teaching hospital during a 15-month period. Up to 38 overt observers (82% nurses) and 93 covert observers (81% medical students) participated in HH observation. The HH events observed overtly were matched for occupation, department, observation time, and location with those observed covertly. The data of matched pairs were then analysed to detect possible Hawthorne effects on different variables. Results A total of 31,522 HH opportunities were observed (4581 overtly, 26,941 covertly). There were 3047 matched pairs after 1:1 matching of overt and covert observations. The overall HH compliance was higher with overt observation than with covert observation (78% vs. 55%, p < 0.001). The Hawthorne effect was nearly three times larger in nurses (30 percentage points) than in physicians (11 percentage points) and was significantly greater in outpatient clinics (41 percentage points) than in intensive care units (11 percentage points). The magnitude of the Hawthorne effect varied among healthcare worker occupations and observation locations (p values both < 0.001) but not among departments, observation times, or HH indications. Conclusions Heterogeneity in the Hawthorne effect may influence the interpretation of overt observations and prevent the correct identification of target populations with poor HH compliance. Therefore, directly observed HH compliance may not be an adequate performance indicator for infection control.
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Lemmen SW, Lewalter K. Antibiotic stewardship and horizontal infection control are more effective than screening, isolation and eradication. Infection 2018; 46:581-590. [PMID: 29796739 PMCID: PMC6182449 DOI: 10.1007/s15010-018-1137-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/29/2018] [Indexed: 12/26/2022]
Abstract
Purpose The global rise of multidrug resistant organisms (MDROs) is of major concern since infections by these pathogens are difficult, and in some cases, even impossible to treat. This review will discuss the effectiveness of a pathogen-independent alternative approach consisting of the implementation of antibiotic stewardship (ABS) programs, improvement of hand hygiene compliance, and daily antiseptic body washings instead of “screening, isolation and eradication” as recommended by many infection control guidelines today. Methods A review of the literature. Results The classical approach composed of screening, isolation and eradication has many limitations, including lack of standardization of the screening methods, risk of medical errors for patients in isolation and failure to eradicate resistant bacteria. Notably, concrete evidence that this current infection control approach actually prevents transmission is still lacking. We found that a novel approach with the training of infectious diseases specialists can reduce the usage of antimicrobials, thereby significantly decreasing the emergence of new MDROs. Moreover, increased hand hygiene compliance not only reduces transmission of MDROs, but also that of sensitive organisms causing the majority of nosocomial infections. Further, instruments, such as continuing education, bed-side observation, and the use of new tools, e.g. electronic wearables and Wi-Fi-equipped dispensers, are all options that can also improve the current low hand hygiene compliance levels. In addition, daily antiseptic body washes were observed to reduce the transmission of MDROs, especially those deriving from the body surface-like MRSA and VRE in specific settings. Finally, antiseptic body washes were seen to have similar effects on reducing transmission rates as screening and isolation measures. Conclusions In summary, this review describes a novel evidence-based approach to counteract the growing medical challenge of increasing numbers of MDROs.
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Affiliation(s)
- S W Lemmen
- Department of Infection Control and Infectious Diseases, Universtiy Hospital RWTH Aachen, 52074, Aachen, Germany.
| | - K Lewalter
- Department of Infection Control and Infectious Diseases, Universtiy Hospital RWTH Aachen, 52074, Aachen, Germany
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Karampatakis T, Tsergouli K, Iosifidis E, Antachopoulos C, Karapanagiotou A, Karyoti A, Gritsi-Gerogianni N, Tsakris A, Roilides E. Impact of active surveillance and infection control measures on carbapenem-resistant Gram-negative bacterial colonization and infections in intensive care. J Hosp Infect 2018; 99:396-404. [PMID: 29792971 DOI: 10.1016/j.jhin.2018.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/15/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Carbapenem-resistant Gram-negative bacteria (CRGNB) infections constitute a global threat for critically ill patients and the outcome of their hospitalization. Early identification of CRGNB through rectal surveillance cultures and routine infection control measures including contact precautions, use of appropriate disinfectants, staff education on cleaning, and hand hygiene may reduce the dissemination of CRGNB. AIM To assess the impact of enhanced infection control measures on CRGNB infections in a nine-bed polyvalent intensive care unit in a tertiary level hospital in an endemic area. METHODS A quasi-experimental study, which included patients with CRGNB infection retrospectively for six months and those participating in an active surveillance programme prospectively for the subsequent 22 months. Active surveillance programme (weekly rectal swabs) was implemented including two sub-periods with infection control measures and enhanced infection control measures. CRGNB incidence, prevalence, colonization pressure, infections and compliance with infection control measures and enhanced infection control measures were recorded. Analysis was performed through time-series and interrupted time-series. FINDINGS During the active surveillance programme, enhanced infection control measures led to a steeper downwards trend in incidence, prevalence, and colonization pressure for CRGNB compared to the infection control measures sub-period. The linear trend was for carbapenem-resistant Klebsiella pneumoniae (CRKP) and Pseudomonas aeruginosa (CRPA) infections to decrease from 19.6 to 8.1 infections per 1000 bed-days (IBD) (P = 0.001) and from 5.1 to 1.79 IBD (P = 0.043), respectively. By contrast, carbapenem-resistant Acinetobacter baumannii infections increased from 5.2 to 15.3 IBD (P = 0.001). CONCLUSION Enhanced infection control measures including enhanced hand hygiene, active surveillance combined with contact precautions, education, audits and feedback policies and interventions could reduce CRKP and CRPA in endemic areas.
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Affiliation(s)
- T Karampatakis
- Infectious Disease Unit, 3(rd) Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece; Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece
| | - K Tsergouli
- Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece
| | - E Iosifidis
- Infectious Disease Unit, 3(rd) Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece; Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
| | - C Antachopoulos
- Infectious Disease Unit, 3(rd) Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece; Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
| | - A Karapanagiotou
- Intensive Care Unit, Hippokration General Hospital, Thessaloniki, Greece
| | - A Karyoti
- Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece; Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece
| | | | - A Tsakris
- Microbiology Department, National and Kapodistrian University School of Medicine, Athens, Greece
| | - E Roilides
- Infectious Disease Unit, 3(rd) Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece; Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece.
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Legese H, Kahsay AG, Kahsay A, Araya T, Adhanom G, Muthupandian S, Gebreyesus A. Nasal carriage, risk factors and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus among healthcare workers in Adigrat and Wukro hospitals, Tigray, Northern Ethiopia. BMC Res Notes 2018; 11:250. [PMID: 29685170 PMCID: PMC5914064 DOI: 10.1186/s13104-018-3353-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/11/2018] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to determine nasal carriage, risk factors and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus among health care-workers of Adigrat and Wukro hospitals Northern Ethiopia. Results The overall prevalence of S. aureus and methicillin resistance S. aureus (MRSA) in the present study were 12% (29/242) and 5.8% (14/242) respectively. The rate of MRSA among S. aureus was 48.3%(14/29). In this study, MRSA carriage was particularly higher among nurse professionals (7.8%) and surgical ward (17.1%). None of the MRSA isolates were sensitive to penicillin and ampicillin. However, low resistance was found for chloramphenicol and clindamycin. Being diabetic and use of hands rub was statistically significant with MRSA colonization. Electronic supplementary material The online version of this article (10.1186/s13104-018-3353-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Haftom Legese
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia. .,Department of Medical Laboratory, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia.
| | - Atsebaha Gebrekidan Kahsay
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Amlisha Kahsay
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Tadele Araya
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Gebre Adhanom
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia.,Department of Medical Laboratory, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
| | - Saravanan Muthupandian
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Araya Gebreyesus
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
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Nurses Practice of Hand Hygiene in Hiwot Fana Specialized University Hospital, Harari Regional State, Eastern Ethiopia: Observational Study. Nurs Res Pract 2018; 2018:2654947. [PMID: 29850239 PMCID: PMC5926477 DOI: 10.1155/2018/2654947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/25/2018] [Indexed: 12/22/2022] Open
Abstract
Background Nurses, who are the majority, can contaminate their hands with different types of microorganism during "clean" activities (e.g., lifting a patient; taking a patient's pulse, blood pressure, or oral temperature; or touching a patient's hand, shoulder, or groin). Yet good hand hygiene, the simple task of cleaning hands at the right time and in the right way, can reduce HCAIs that are transmitted by healthcare workers' hands. Method Observational study conducted among nurses by observational tool which was adopted from WHO observational tool. And finally compliance was calculated as a percentage (i.e., compliance% = (observed hand hygiene action (HHA) ÷ hand hygiene opportunity (O)) × 100). The data were first coded, entered, and cleaned using EpiData statistical software version 3.1 and then exported into SPSS statistical software version 22 for analysis. Data were presented using descriptive statistics. Result A total of 110 study participants were observed who gave a response rate of 94.8%. Total of 3902 opportunities and 732 hand hygiene actions were observed with overall compliance of 18.7%. The highest 22.9% hand hygiene practice was observed "before clean∖aseptic procedure." Highest 19.6% compliance was recorded at night shift and 22.7% in ICU ward of the hospital. Alcohol based hand rub was a major means of method used to clean hands. Conclusion and Recommendation Observed practice of hand hygiene was poor. Lack of training, conveniently located sink, hand washing agents, and lack of time were major reasons for not practicing hand hygiene. Successful promotion of hand hygiene through instituting system change (e.g., making hand hygiene products available at the point of care) should be considered.
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Geilleit R, Hen ZQ, Chong CY, Loh AP, Pang NL, Peterson GM, Ng KC, Huis A, de Korne DF. Feasibility of a real-time hand hygiene notification machine learning system in outpatient clinics. J Hosp Infect 2018; 100:183-189. [PMID: 29649558 DOI: 10.1016/j.jhin.2018.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Various technologies have been developed to improve hand hygiene (HH) compliance in inpatient settings; however, little is known about the feasibility of machine learning technology for this purpose in outpatient clinics. AIM To assess the effectiveness, user experiences, and costs of implementing a real-time HH notification machine learning system in outpatient clinics. METHODS In our mixed methods study, a multi-disciplinary team co-created an infrared guided sensor system to automatically notify clinicians to perform HH just before first patient contact. Notification technology effects were measured by comparing HH compliance at baseline (without notifications) with real-time auditory notifications that continued till HH was performed (intervention I) or notifications lasting 15 s (intervention II). User experiences were collected during daily briefings and semi-structured interviews. Costs of implementation of the system were calculated and compared to the current observational auditing programme. FINDINGS Average baseline HH performance before first patient contact was 53.8%. With real-time auditory notifications that continued till HH was performed, overall HH performance increased to 100% (P < 0.001). With auditory notifications of a maximum duration of 15 s, HH performance was 80.4% (P < 0.001). Users emphasized the relevance of real-time notification and contributed to technical feasibility improvements that were implemented in the prototype. Annual running costs for the machine learning system were estimated to be 46% lower than the observational auditing programme. CONCLUSION Machine learning technology that enables real-time HH notification provides a promising cost-effective approach to both improving and monitoring HH, and deserves further development in outpatient settings.
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Affiliation(s)
- R Geilleit
- Medical Innovation and Care Transformation, KK Women's and Children's Hospital, SingHealth Duke - NUS Academic Medical Centre, Singapore; Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Z Q Hen
- Medical Innovation and Care Transformation, KK Women's and Children's Hospital, SingHealth Duke - NUS Academic Medical Centre, Singapore
| | - C Y Chong
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Paediatrics Academic Medical Program, Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A P Loh
- Department of Biomedical Engineering, National University Singapore, Singapore
| | - N L Pang
- Quality, Safety and Risk Management, KK Women's and Children's Hospital, Singapore
| | - G M Peterson
- Health Services Innovation, School of Medicine, University of Tasmania, Australia
| | - K C Ng
- Medical Innovation and Care Transformation, KK Women's and Children's Hospital, SingHealth Duke - NUS Academic Medical Centre, Singapore
| | - A Huis
- Radboud Institute for Health Sciences, Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D F de Korne
- Medical Innovation and Care Transformation, KK Women's and Children's Hospital, SingHealth Duke - NUS Academic Medical Centre, Singapore; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Health Services and Systems Research, Duke-NUS Medical School, Singapore.
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Garcell HG, Arias AV, Garcés IB, Gil AC, Companioni PR, Arias KF, More OIE, Rodríguez NR, García FG. Assessment of Trained Hand Hygiene Observers Using Parallel Observations. Oman Med J 2018; 33:76-79. [PMID: 29468005 DOI: 10.5001/omj.2018.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives To validate hand hygiene (HH) observers following training and determine the concordance between the observers and the Kappa index. Methods This study was conducted during June 2017. HH observers from 15 hospital units received eight-hours training including a two-hour workshop conducted by the infection control practitioner and hospital epidemiologist. After its completion, parallel observations were conducted by trained nurses from each respective unit for a maximum of 20 minutes per session at any time or day. Results A total of 789 parallel observations were performed. In observed HH actions, the percentage of agreement between trained and experienced observers was 75.4%, with a Kappa index of agreement of 0.61 (95% confidence interval (CI): 0.57-0.66). For the observed HH moments, the agreement among observers was 83.8% with a Kappa index of 0.71 (95% CI: 0.66-0.75). Conclusions HH observers were validated after a dedicated training in correspondence with the recommendation to improve HH monitoring. Additional studies should focus on evaluating the sustainability of the agreement, the requirement of retraining, and other alternatives for observers' validation.
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Affiliation(s)
| | | | - Isme Borroto Garcés
- Nursing Department, The Cuban Hospital, Hamad Medical Corporation, Dukhan, Qatar
| | - Alexis Cardoso Gil
- Nursing Department, The Cuban Hospital, Hamad Medical Corporation, Dukhan, Qatar
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Brennan C, Greenhalgh J, Pawson R. Guidance on guidelines: Understanding the evidence on the uptake of health care guidelines. J Eval Clin Pract 2018; 24:105-116. [PMID: 28370699 DOI: 10.1111/jep.12734] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 12/25/2022]
Abstract
RATIONALE Regardless of health issue, health sector, patient condition, or treatment modality, the chances are that provision is supported by "a guideline" making professionally endorsed recommendations on best practice. Against this background, research has proliferated seeking to evaluate how effectively such guidance is followed. These investigations paint a gloomy picture with many a guideline prompting lip service, inattention, and even opposition. This predicament has prompted a further literature on how to improve the uptake of guidelines, and this paper considers how to draw together lessons from these inquiries. METHODS This huge body of material presents a considerable challenge for research synthesis, and this paper produces a critical, methodological comparison of 2 types of review attempting to meet that task. Firstly, it provides an overview of the current orthodoxy, namely, "thematic reviews," which aggregate and enumerate the "barriers and facilitators" to guideline implementation. It then outlines a "realist synthesis," focussing on testing the "programme theories" that practitioners have devised to improve guideline uptake. RESULTS Thematic reviews aim to provide a definitive, comprehensive catalogue of the facilitators and barriers to guideline implementation. As such, they present a restatement of the underlying problems rather than an improvement strategy. The realist approach assumes that the incorporation of any guideline into current practice will produce unintended system strains as different stakeholders wrestle over responsibilities. These distortions will prompt supplementary revisions to guidelines, which in turn beget further strains. Realist reviews follow this dynamic understanding of organisational change. CONCLUSIONS Health care decision makers operate in systems that are awash with guidelines. But guidelines only have paper authority. Managers do not need a checklist of their pros and cons, because the fate of guidelines depends on their reception rather than their production. They do need decision support on how to engineer and reengineer guidelines so they dovetail with evolving systems of health care delivery.
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Affiliation(s)
- Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Kurtz SL. Measuring and accounting for the Hawthorne effect during a direct overt observational study of intensive care unit nurses. Am J Infect Control 2017; 45:995-1000. [PMID: 28502361 DOI: 10.1016/j.ajic.2017.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/19/2017] [Accepted: 03/19/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because suspecting nurses could alter hand hygiene (HH) behavior when observed, the goal of this article was to describe how the Hawthorne effect (HE) was measured and accounted for in a direct observational prospective study. METHODS Observations were made 8 h/d for 3-5 days in 5 intensive care units (ICUs) (4 hospitals) on a convenience sample of 64 ICU nurses in Texas. The HE was measured so if hand hygiene adherence rates of the first 2 hours were 20% higher than the last 6 hours, the first 2 hours would be dropped and an additional 2 hours would be added at the end of the observation period. Hourly rates were recorded during the observation period, using room entry and room exit. RESULTS The difference between aggregated rates of the first 2 hours and last 6 hours was 0.56% (range, 0.02%-15.74%) and not significant. On 12 observation days, higher rates were observed during the first 2 hours. On 6 days, higher rates were observed in the last 6 hours, with difference in rates of 1.43% (day 1), 2.97% (day 2), and 1.42% (day 3). CONCLUSIONS The attempt at measuring and accounting for the HE showed little difference in HH rates throughout the observation period. Based on these results, necessity of the observer moving locations during HH surveillance after 10-20 minutes, because of a feared HE, might not be necessary.
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Su KC, Kou YR, Lin FC, Wu CH, Feng JY, Huang SF, Shiung TF, Chung KC, Tung YH, Yang KY, Chang SC. A simplified prevention bundle with dual hand hygiene audit reduces early-onset ventilator-associated pneumonia in cardiovascular surgery units: An interrupted time-series analysis. PLoS One 2017; 12:e0182252. [PMID: 28767690 PMCID: PMC5540591 DOI: 10.1371/journal.pone.0182252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 07/14/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND To investigate the effect of a simplified prevention bundle with alcohol-based, dual hand hygiene (HH) audit on the incidence of early-onset ventilation-associated pneumonia (VAP). METHODS This 3-year, quasi-experimental study with interrupted time-series analysis was conducted in two cardiovascular surgery intensive care units in a medical center. Unaware external HH audit (eHH) performed by non-unit-based observers was a routine task before and after bundle implementation. Based on the realistic ICU settings, we implemented a 3-component bundle, which included: a compulsory education program, a knowing internal HH audit (iHH) performed by unit-based observers, and a standardized oral care (OC) protocol with 0.1% chlorhexidine gluconate. The study periods comprised 4 phases: 12-month pre-implementation phase 1 (eHH+/education-/iHH-/OC-), 3-month run-in phase 2 (eHH+/education+/iHH+/OC+), 15-month implementation phase 3 (eHH+/education+/iHH+/OC+), and 6-month post-implementation phase 4 (eHH+/education-/iHH+/OC-). RESULTS A total of 2553 ventilator-days were observed. VAP incidences (events/1000 ventilator days) in phase 1-4 were 39.1, 40.5, 15.9, and 20.4, respectively. VAP was significantly reduced by 59% in phase 3 (vs. phase 1, incidence rate ratio [IRR] 0.41, P = 0.002), but rebounded in phase 4. Moreover, VAP incidence was inversely correlated to compliance of OC (r2 = 0.531, P = 0.001) and eHH (r2 = 0.878, P < 0.001), but not applied for iHH, despite iHH compliance was higher than eHH compliance during phase 2 to 4. Compared to eHH, iHH provided more efficient and faster improvements for standard HH practice. The minimal compliances required for significant VAP reduction were 85% and 75% for OC and eHH (both P < 0.05, IRR 0.28 and 0.42, respectively). CONCLUSIONS This simplified prevention bundle effectively reduces early-onset VAP incidence. An unaware HH compliance correlates with VAP incidence. A knowing HH audit provides better improvement in HH practice. Accordingly, we suggest dual HH audit and consistent bundle performance does matter in quality-of-care VAP prevention.
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Affiliation(s)
- Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
- Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei City, Taiwan, ROC
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Yu Ru Kou
- Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei City, Taiwan, ROC
| | - Fang-Chi Lin
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Chieh-Hung Wu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Shiang-Fen Huang
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Tao-Fen Shiung
- Nursing Department, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Kwei-Chun Chung
- Nursing Department, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Yu-Hsiu Tung
- Nursing Department, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
- Genome Research Center, School of Medicine, National Yang-Ming University, Taipei City, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan, ROC
- * E-mail:
| | - Shi-Chuan Chang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan, ROC
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Electronic monitoring in combination with direct observation as a means to significantly improve hand hygiene compliance. Am J Infect Control 2017; 45:528-535. [PMID: 28456322 DOI: 10.1016/j.ajic.2016.11.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 01/16/2023]
Abstract
Monitoring hand hygiene compliance among health care personnel (HCP) is an essential element of hand hygiene promotion programs. Observation by trained auditors is considered the gold standard method for establishing hand hygiene compliance rates. Advantages of observational surveys include the unique ability to establish compliance with all of the World Health Organization "My 5 Moments for Hand Hygiene" initiative Moments and to provide just-in-time coaching. Disadvantages include the resources required for observational surveys, insufficient sample sizes, and nonstandardized methods of conducting observations. Electronic and camera-based systems can monitor hand hygiene performance on all work shifts without a Hawthorne effect and provide significantly more data regarding hand hygiene performance. Disadvantages include the cost of installation, variable accuracy in estimating compliance rates, issues related to acceptance by HCP, insufficient data regarding their cost-effectiveness and influence on health care-related infection rates, and the ability of most systems to monitor only surrogates for Moments 1, 4, and 5. Increasing evidence suggests that monitoring only Moments 1, 4, and 5 provides reasonable estimates of compliance with all 5 Moments. With continued improvement of electronic monitoring systems, combining electronic monitoring with observational methods may provide the best information as part of a multimodal strategy to improve and sustain hand hygiene compliance rates among HCP.
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Visan FA, Zakaria A, Castro J, Alhasanat O, Ismail KA, Ansari NA, Hamed M. SWITCH: Al Wakra Hospital Journey to 90% Hand Hygiene Practice Compliance, 2011 - 2015. BMJ QUALITY IMPROVEMENT REPORTS 2017; 6:u211699.w4824. [PMID: 28469905 PMCID: PMC5411721 DOI: 10.1136/bmjquality.u211699.w4824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Hand Hygiene is the cheapest and simplest way to prevent the spread of infection, however international compliance is below than 40% (WHO, 2009). In the experience of Al Wakra Hospital, the improvement in hand hygiene compliance highlighted not just interventions towards training and education but also behavioral motivation and physical allocations of hand hygiene appliances and equipment. Through motivating the behavioral, emotional, physical and intellectual dimensions of the different healthcare worker professions, hand hygiene compliance has increased from 60.78% in 2011 to 94.14% by the end of December 2015. It took 25 months of continuous and collaborative work with different healthcare workers to reach the 90% hand hygiene target. "Together, we have reached our goals and together we fight against infections! Because we always strive for excellence in everything we do - that is our vision here in Al Wakra Hospital."
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Affiliation(s)
| | | | | | | | | | | | - Manal Hamed
- Al Wakra Hospital, Hamad Medical Corporation, Qatar
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Duong MC, McLaws ML. Dangerous practices in a hemodialysis unit in Vietnam identify from mixed methods. BMC Infect Dis 2017; 17:181. [PMID: 28249573 PMCID: PMC5333403 DOI: 10.1186/s12879-017-2290-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/24/2017] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Non-compliance with infection control practices poses a serious risk to patients receiving chronic hemodialysis. We aimed to identify the type and frequency of non-compliance with infection control practices in a hemodialysis unit in Vietnam where a large outbreak of hepatitis C infection had occurred. METHODS Mixed methods approach included observations and discussions of non-compliance with all 12 nurses at the Hemodialysis Unit, District-6 Hospital in Ho Chi Minh City. Observations of nursing care activities were made between September 2013 and January 2014. Compliance with hand hygiene and glove use during nursing care activities were classified according to the potential for a serious risk of transmission of infection and reported as percentages. Each nurse was expected to provide 11 nursing care activities to three patients assigned per hemodialysis sessions. Activities were to be given on an individual patient-centered care basis, that is, one patient was to receive all 11 activities by their assigned nurse. On completion of the observations all nurses were enrolled in a focus group where observed non-compliance was discussed and transcripts were examined for themes. RESULTS Hand hygiene compliance rate was low (27%, 95%CI 25%-28%, 1633/6140) regardless of classification of seriousness of risk from this breach. Although glove use (76%, 95%CI 74-78%, 1211/1586) and other personal protective equipment use (81%, 95%CI 78%-83%, 773/959) were high gloves were observed to be reused with multiple patients during a single nursing care activity provided to consecutive patients. Nurses explained the breakdown of providing nursing care activities on an individual patient-centered basis was a response to limited supply of gloves and hand hygiene facilities and was exacerbated by nursing being co-opted by overly demanding patients to provide services without delay. CONCLUSIONS The adaption by the nurses to provide 11 single care activities to multiple consecutive patients in the absence of changing gloves and low hand hygiene compliance was potentially the central risk factor that facilitated the hepatitis C outbreak. Patient-centered care needs to be enforced to minimize multiple nurse-patient contacts that are associated with non-compliance classified as serious risk of infection transmission. Nurse empowerment to resist unreasonable patient demands may also be pivotal to assisting their compliance with hand hygiene and single patient-centered care. An audit program to measure infection control resources and practices may facilitate enforcement of the guidelines.
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Affiliation(s)
- Minh Cuong Duong
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Level 3 Samuels Building, Sydney, NSW 2052 Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Level 3 Samuels Building, Sydney, NSW 2052 Australia
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Wu KS, Chen YS, Lin HS, Hsieh EL, Chen JK, Tsai HC, Chen YH, Lin CY, Hung CT, Sy CL, Tseng YT, Lee SSJ. A nationwide covert observation study using a novel method for hand hygiene compliance in health care. Am J Infect Control 2017; 45:240-244. [PMID: 27838163 DOI: 10.1016/j.ajic.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 10/07/2016] [Accepted: 10/07/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evaluation and feedback is a core hand hygiene (HH) improvement strategy. The covert observation method avoids observation bias inherent to the overt method. The aim of the study was to observe HH compliance by a novel covert method in a real-world setting. METHODS We conducted a 2-year, nationwide, prospective, observational study in teaching hospitals across Taiwan. Medical students and students who may have contact with patients in their careers were recruited as participants. A novel, shorthand notation method for covert observation was used. Observation results were reported through a study website. RESULTS There were a total of 25,379 HH opportunities covertly observed by 93 observers. Overall HH compliance was 32.0%. Health care workers had the highest HH compliance for indication 4 (42.6%), and the lowest for indication 5 (21.7%). Overall handrubbing percentage was high, reaching 83.6%. The HH compliance increased significantly with an increase in the number of indications within 1 HH opportunity (P < .001). CONCLUSIONS The overall HH compliance by the covert observation method was low. An innovative shorthand notation method facilitated covert observation, and website reporting was demonstrated to be feasible for large-scale observation.
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Chen P, Yuan T, Sun Q, Jiang L, Jiang H, Zhu Z, Tao Z, Wang H, Xu A. Role of quality control circle in sustained improvement of hand hygiene compliance: an observational study in a stomatology hospital in Shandong, China. Antimicrob Resist Infect Control 2016. [PMID: 27980731 DOI: 10.1186/s13756-016-0160-1.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Hand hygiene is an important element of the WHO multimodal strategy for healthcare-associated infection control, whereas compliance of hand hygiene among healthcare workers (HCWs) remains a challenge to sustain. In order to increase the hand hygiene compliance of HCWs, a quality control circle (QCC) program was carried out in our hospital, and the plan-do-check-act (PDCA) method was applied for 12 months. FINDINGS Hand hygiene compliance rates improved over time, with significant improvement between preintervention (60.1%) and postintervention (97.2%) periods (P < 0.001). Nurses (88.3%) exhibited higher compliance than dentists (87.3%), and female (88.4%) HCWs were more likely to perform hand hygiene than males (85.6%), both P < 0.001. Overall hand hygiene compliance and observance of the five indications exhibited significant linear increases over time (P < 0.005). CONCLUSION This study highlights the success of a multifaceted intervention, conducted by QCC program and PDCA method, which led to a significant improvement of hand hygiene compliance. Though training is the most basic intervention element, surveillance, evaluation and feedback should be explored as additional interventions to ensure that hand hygiene compliance is achieved and sustained at high levels.
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Affiliation(s)
- Peng Chen
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong People's Republic of China.,Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Ting Yuan
- Department of General Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong People's Republic of China
| | - Qinfeng Sun
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Lili Jiang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Hongmin Jiang
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Zhenkun Zhu
- Shandong Provincial Key Laboratory of Oral Tissue Regeneration, Shandong University, Jinan, Shandong People's Republic of China.,School of Stomatology, Shandong University, Jinan, Shandong People's Republic of China
| | - Zexin Tao
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, Shandong People's Republic of China.,Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan, 250014 Shandong People's Republic of China
| | - Haiyan Wang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, Shandong People's Republic of China.,Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan, 250014 Shandong People's Republic of China
| | - Aiqiang Xu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong People's Republic of China.,Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan, Shandong People's Republic of China.,Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan, 250014 Shandong People's Republic of China
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