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Daba C, Atamo A, Debela SA, Gebrehiwot M. Observational assessment of hand hygiene compliance among healthcare workers in public hospitals of Northeastern Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:792-802. [PMID: 36689677 DOI: 10.1080/09603123.2023.2168629] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
This study examined the magnitude and predictors of hand hygiene compliance among 325 healthcare workers in three public hospitals of Northeastern Ethiopia using standardized observational tool. A multivariable logistic regression analysis was computed to identify factors associated with non-compliance. The overall proportion of observed hand hygiene non-compliance was 41.8% (95%CI: 36.6-48.1). Having <5 years of work experience (AOR = 1.5; 95%CI: 1.2-2.5), absence of hand washing soap (AOR = 3.1; 95%CI: 2.3-5.4), work overload (AOR = 2.5; 95%CI: 1.9-4.1), pipe water supply interruption (AOR = 2.8; 95%CI: 2.1-4.9), lack of hand hygiene training (AOR = 3.1; 95%CI: 2.2-4.4), and absence of infection prevention committee (AOR = 2.1; 95%CI: 1.5-4.9) were determinant factors for hand hygiene non-compliance. Therefore, regional health bureau and hospitals' managers should work towards the provision of regular hand hygiene trainings, uninterrupted piped water supply, hand washing soap, and establishment of functional infection prevention committee. Moreover, healthcare workers should be also committed to comply with hand hygiene.
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Affiliation(s)
- Chala Daba
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amanuel Atamo
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Sisay Abebe Debela
- Department of Public Health, College of Medicine and Health Sciences, Salale University, Fitche, Ethiopia
| | - Mesfin Gebrehiwot
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Arunakumar SPK, B G R, S R L, Ramabhatta S, K R, Puli R, Chaudhary R. Improving 'Hand-Hygiene Compliance' among the Health Care Personnel in the Special Newborn Care Unit. Indian J Pediatr 2024; 91:23-29. [PMID: 37052765 PMCID: PMC10098230 DOI: 10.1007/s12098-022-04466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/25/2022] [Accepted: 11/13/2022] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To improve the hand-hygiene (HH) compliance among the health care personnel from 69 to 85% by 4 mo plan-do-study-act (PDSA) cycles, based on the WHO's five moments of hand hygiene and to study the impact of HH compliance upon the health care-associated infections (HAI) rate in the authors' special newborn care unit. METHODS HH compliance study was undertaken based on the prioritization matrix. The barriers to HH compliance were identified and evaluated using fishbone analysis. An operational team was formed, and measures for improvement were chalked out. The baseline score was recorded through observation. A total of three PDSA cycles were carried out. Appropriate education and counseling regarding the WHO's five moments of hand hygiene were taught to the health care personnel. Interventions such as posters and supply of nonmedicated liquid hand soap, autoclaved paper towels, and alcohol-based hand sanitizer were provided. The effect of interventions on HH compliance was assessed at the end of each PDSA cycle. HAI data were collected and compared with the previous records. RESULTS The HH compliance recorded during baseline, PDSA 1, PDSA 2, and PDSA 3 are respectively, as follows: 69% (16.75 ± 3.46), 74.58% (43.07 ± 7.50; p = 0.043), 63.75% (24.43 ± 5.16; p = 0.083), and 84.70% (47.45 ± 10.59; p = 0.014). The sum of HH scores from the three PDSA cycles when compared to the baseline is significant (p = 0.022). The HAI rate decreased from 13.81 to 1000 patient days to 10.43 per 1000 patient days (p = 0.566). CONCLUSION HH compliance among health care personnel can be improved through information, education, and communication with constant monitoring.
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Affiliation(s)
| | - Raghunandan B G
- Department of Pediatrics, K. C. General Hospital, Bengaluru, Karnataka, 560003, India
| | - Lakshmipathy S R
- Department of Pediatrics, K. C. General Hospital, Bengaluru, Karnataka, 560003, India
| | - Sujatha Ramabhatta
- Department of Pediatrics, K. C. General Hospital, Bengaluru, Karnataka, 560003, India.
| | - Rashmi K
- Department of Pediatrics, K. C. General Hospital, Bengaluru, Karnataka, 560003, India
| | - Rahul Puli
- Department of Pediatrics, K. C. General Hospital, Bengaluru, Karnataka, 560003, India
| | - Ravi Chaudhary
- Department of Pediatrics, K. C. General Hospital, Bengaluru, Karnataka, 560003, India
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Nyantakyi E, Caci L, Castro M, Schlaeppi C, Cook A, Albers B, Walder J, Metsvaht T, Bielicki J, Dramowski A, Schultes MT, Clack L. Implementation of infection prevention and control for hospitalized neonates: A narrative review. Clin Microbiol Infect 2024; 30:44-50. [PMID: 36414203 DOI: 10.1016/j.cmi.2022.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/04/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The most prevalent infections encountered in neonatal care are healthcare-associated infections. The majority of healthcare-associated infections are considered preventable with evidence-based infection prevention and control (IPC) practices. However, substantial knowledge gaps exist in IPC implementation in neonatal care. Furthermore, the knowledge of factors which facilitate or challenge the uptake and sustainment of IPC programmes in neonatal units is limited. The integration of implementation science approaches in IPC programmes in neonatal care aims to address these problems. OBJECTIVES The aim of this narrative review was to identify determinants which have been reported to influence the implementation of IPC programmes and best practices in inpatient neonatal care settings. SOURCES A literature search was conducted in PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) in May 2022. Primary study reports published in English, French, German, Spanish, Portuguese, Italian, Danish, Swedish or Norwegian since 2000 were eligible for inclusion. Included studies focused on IPC practices in inpatient neonatal care settings and reported determinants which influenced implementation processes. CONTENT The Consolidated Framework for Implementation Research was used to identify and cluster reported determinants to the implementation of IPC practices and programmes in neonatal care. Most studies reported challenges and facilitators at the organizational level as particularly relevant to implementation processes. The commonly reported determinants included staffing levels, work- and caseloads, as well as aspects of organizational culture such as communication and leadership. IMPLICATIONS The presented knowledge about factors influencing neonatal IPC can support the design, implementation, and evaluation of IPC practices.
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Affiliation(s)
- Emanuela Nyantakyi
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland.
| | - Laura Caci
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Marta Castro
- Neonatal Intensive Care Unit, University Children's Hospital, Basel, Switzerland
| | - Chloé Schlaeppi
- Paediatric Infectious Diseases and Vaccinology, University Children's Hospital, Basel, Switzerland
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom
| | - Bianca Albers
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Joel Walder
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Tuuli Metsvaht
- Department of Paediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Julia Bielicki
- Paediatric Infectious Diseases and Vaccinology, University Children's Hospital, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marie-Therese Schultes
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care, Medical Faculty, University of Zurich, Zurich, Switzerland; Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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Kouhi R, Panahi R, Ramezankhani A, Amin Sobhani M, Khodakarim S, Amjadian M. The effect of education based on health belief model on hand hygiene behavior in the staff of Tehran dentistry centers: A quasi-experimental intervention study. Health Sci Rep 2023; 6:e1408. [PMID: 37425231 PMCID: PMC10324357 DOI: 10.1002/hsr2.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
Background and Aims Considering the increasing prevalence of dental services in the community and the impossibility of identifying each infected patient, hand sanitation is the most critical factor in controlling infection in these centers. Therefore, this study aimed to determine the effect of educational intervention on the hand health behavior of the staff of Tehran dentistry clinics based on the health belief model (HBM). Methods In this quasi-experimental study in 2017, 128 employees of the health centers were selected through a multistage sampling method and they were placed in two groups of intervention and control (each 64 people). The data was collected using a questionnaire devised by the researcher. The validity and reliability of the questionnaire were determined. The questionnaire consisted of demographics, knowledge, structures of the HBM, and behavior variables. Then, the intervention was administered based on HBM-based education. Data were analyzed by SPSS16 and independent t test, χ 2, and repeated measurement analysis of variance. Results Before the intervention, the two intervention and control groups did not differ significantly in terms of demographic variables, mean scores of knowledge, constructs of HBM, and hand hygiene behavior (p > 0.05), while the intervention group was scored higher significantly compared to the control one after the intervention (p < 0.001). Conclusion According to the findings, the HBM can be used as a framework for designing educational interventions to improve hand hygiene behavior to control infection in health centers.
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Affiliation(s)
- Reza Kouhi
- Department of Health Education, School of HealthShahid Beheshti University of Medical SciencesTehranIran
| | - Rahman Panahi
- Department of Public Health, Qaen School of Medical SciencesBirjand University of Medical SciencesBirjandIran
| | - Ali Ramezankhani
- Department of Public HealthShahid Beheshti University of Medical SciencesTehranIran
| | - Mohsen Amin Sobhani
- Department of Endodontics, School of DentistryAja University of Medical SciencesTehranIran
| | - Soheila Khodakarim
- Department of BiostatisticsShiraz University of Medical SciencesShirazIran
| | - Mohiadin Amjadian
- Department of English LanguageKurdistan University of Medical SciencesSanandajIran
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Brachio SS, Gu W, Saiman L. Next Steps for Health Care-Associated Infections in the Neonatal Intensive Care Unit. Clin Perinatol 2023; 50:381-397. [PMID: 37201987 DOI: 10.1016/j.clp.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We discuss the burden of health care-associated infections (HAIs) in the neonatal ICU and the role of quality improvement (QI) in infection prevention and control. We examine specific QI opportunities and approaches to prevent HAIs caused by Staphylococcus aureus , multidrug-resistant gram-negative pathogens, Candida species, and respiratory viruses, and to prevent central line-associated bloodstream infections (CLABSIs) and surgical site infections. We explore the emerging recognition that many hospital-onset bacteremia episodes are not CLABSIs. Finally, we describe the core tenets of QI, including engagement with multidisciplinary teams and families, data transparency, accountability, and the impact of larger collaborative efforts to reduce HAIs.
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Affiliation(s)
- Sandhya S Brachio
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA.
| | - Wendi Gu
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA
| | - Lisa Saiman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH1-470, New York, NY 10032, USA; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
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Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, Jones MA, Hoffmann TC, Clark J, Beller EM, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2023; 1:CD006207. [PMID: 36715243 PMCID: PMC9885521 DOI: 10.1002/14651858.cd006207.pub6] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review last published in 2020. We include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL, and two trials registers in October 2022, with backwards and forwards citation analysis on the new studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, glasses, and gargling) to prevent respiratory virus transmission. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS We included 11 new RCTs and cluster-RCTs (610,872 participants) in this update, bringing the total number of RCTs to 78. Six of the new trials were conducted during the COVID-19 pandemic; two from Mexico, and one each from Denmark, Bangladesh, England, and Norway. We identified four ongoing studies, of which one is completed, but unreported, evaluating masks concurrent with the COVID-19 pandemic. Many studies were conducted during non-epidemic influenza periods. Several were conducted during the 2009 H1N1 influenza pandemic, and others in epidemic influenza seasons up to 2016. Therefore, many studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Adherence with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included 12 trials (10 cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate-certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate-certainty evidence). Harms were rarely measured and poorly reported (very low-certainty evidence). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; 3 trials, 7779 participants; very low-certainty evidence). N95/P2 respirators compared with medical/surgical masks may be effective for ILI (RR 0.82, 95% CI 0.66 to 1.03; 5 trials, 8407 participants; low-certainty evidence). Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate-certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low-certainty evidence). One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non-inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID-19 patients. Hand hygiene compared to control Nineteen trials compared hand hygiene interventions with controls with sufficient data to include in meta-analyses. Settings included schools, childcare centres and homes. Comparing hand hygiene interventions with controls (i.e. no intervention), there was a 14% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.86, 95% CI 0.81 to 0.90; 9 trials, 52,105 participants; moderate-certainty evidence), suggesting a probable benefit. In absolute terms this benefit would result in a reduction from 380 events per 1000 people to 327 per 1000 people (95% CI 308 to 342). When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.94, 95% CI 0.81 to 1.09; 11 trials, 34,503 participants; low-certainty evidence), and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials, 8332 participants; low-certainty evidence), suggest the intervention made little or no difference. We pooled 19 trials (71, 210 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. Pooled data showed that hand hygiene may be beneficial with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.83 to 0.94; low-certainty evidence), but with high heterogeneity. In absolute terms this benefit would result in a reduction from 200 events per 1000 people to 178 per 1000 people (95% CI 166 to 188). Few trials measured and reported harms (very low-certainty evidence). We found no RCTs on gowns and gloves, face shields, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children. There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory-confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Department for Continuing Education, University of Oxford, Oxford OX1 2JA, UK
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit. Trop Med Infect Dis 2022; 8:tropicalmed8010027. [PMID: 36668933 PMCID: PMC9867086 DOI: 10.3390/tropicalmed8010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/28/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. METHODS We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). RESULTS A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was 'basic' (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to 'intermediate' level (262). There was no change in the neonatal unit HA-BSI rate. CONCLUSION Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.
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Meshi EB, Nakamura K, Seino K, Alemi S. Equity in water, sanitation, hygiene, and waste management services in healthcare facilities in Tanzania. PUBLIC HEALTH IN PRACTICE 2022; 4:100323. [PMID: 36304419 PMCID: PMC9593710 DOI: 10.1016/j.puhip.2022.100323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives To determine coverage and the reliability of water, sanitation, hygiene (WASH) and healthcare waste management (HCWM) services in healthcare facilities (HCFs) in Tanzania. Study design Cross-sectional study design. Methods Data of 1066 HCFs in Tanzania from the 2014-15 Tanzania Service Provision Assessment (TSPA) survey were analyzed. The availability of WASH and HCWM services was examined across facility locations, types, and managing authorities. Descriptive statistics, and bivariate and multivariate logistic regression analyses were performed. Results HCFs with improved water sources, with functional improved latrines for patients, and using the incineration method to treat sharps waste before final disposal were 81.2%, 70.6%, and 41.3%, respectively. Among the HCFs with improved water sources and with functional improved latrines for patients, 50.9% and 50.6% respectively experienced water outages. Rural HCFs were less likely to have water sources on-site within 500 m (AOR 0.41; 95%CI 0.24-0.68), and soap, running water or alcohol-based hand rub (AOR 0.54; 95%CI 0.37-0.80). Rural HCFs were 0.25 times less likely to have functioning improved latrines for patients than urban HCFs (p < 0.001). Public HCFs were 0.5 times less likely to have an incineration method for sharps waste treatment than private HCFs (p < 0.001). Conclusion Access inequity in WASH and HCWM was observed in HCFs in rural areas and those under public management. To attain equity and sustainability, investing in improving WASH and HCWM services for both new and renovations projects, must consider the circumstance status of the marginalized society.
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Affiliation(s)
- Eugene Benjamin Meshi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan,Department of Public Health, School of Nursing and Public Health, The University of Dodoma, P.O. BOX 259, Dodoma, United Republic of Tanzania
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan,Corresponding author.
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Sharifullah Alemi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
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Amaan A, Dey SK, Zahan K. Improvement of Hand Hygiene Practices among the Healthcare Workers in a Neonatal Intensive Care Unit. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:7688778. [PMID: 35795864 PMCID: PMC9252715 DOI: 10.1155/2022/7688778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/28/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Healthcare workers' (HCWs) hands become progressively colonized with potential pathogens during their patient care and act as a vehicle for transmission of microorganisms to other patients. Hand hygiene is undisputedly one of the most effective infection control measures. The objective of this study was to measure the hand hygiene (HH) compliance among the doctors and nurses before and after intervention. Methodology. This quasi-experimental (before and after) study was conducted from July 2019 to July 2020 in the neonatal intensive care unit in a tertiary hospital in Bangladesh. The doctors and nurses were observed for their compliance to HH before and after the intervention. Several group discussions were arranged, and posters on HH were attached as reminders at the workstations during the intervention period. Binary logistic regression analysis of the predictors for the outcome as HH noncompliance was performed. RESULT The overall compliance to HH was significantly increased in both before (from 42.9 to 83.8%, p=<0.0001) and after (28.5 to 95.9%, p=<0.000) patient contact, in both the case of high-risk and low-risk contacts (p=<0.000) following the intervention. A significant reduction in the frequency of inadequate HH (20.2 to 9.7%, p = .000) was documented. In logistic regression analysis, compliance to HH was found more after the intervention (aOR = 13.315, 95% CI: 7.248-24.458). Similarly, being a physician (aOR = 0.012, 95% CI: 0.005-0.030) and moments after patient contact (aOR = 0.114, 95% CI: 0.049-0.261), significant positive predictors for compliance to HH were found. CONCLUSION Significant improvements in HH compliance were achieved through a systemic, multidimensional intervention approach among the doctors and nurses in an intensive newborn care setting.
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Affiliation(s)
- Abdullahel Amaan
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Sanjoy Kumer Dey
- Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Khainoor Zahan
- Bangladesh National Nutrition Council (BNNC), Mohakhali, Dhaka, Bangladesh
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10
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Ganesan V, Sundaramurthy R, Thiruvanamalai R, Raghavan M, Chavan SKD, Pusa R, Sakthivadivel V, Gaur A, Balan Y. Hand Hygiene Auditing: Is It a Roadway to Improve Adherence to Hand Hygiene Among Hospital Personnel? Cureus 2022; 14:e25221. [PMID: 35746985 PMCID: PMC9213211 DOI: 10.7759/cureus.25221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Over the years, there has been an increase in hospital-acquired infections (HAIs) among patients in India. One of the main reasons is a lack of compliance with infection control guidelines, such as hand hygiene. So the present study was conducted to determine the compliance of hand hygiene among healthcare workers in a private tertiary care teaching hospital in South India. Materials and methods The prospective observational study was carried out between April 2017 and March 2020. Nineteen areas were directly observed for hand hygiene (HH) compliance. At each location, HH audit was conducted for one hour per day for five days per month. HH complete adherence rate (HHCAR) and HH partial adherence rate (HHPAR) were analyzed. Results Nine hundred and twenty observation periods were completed during the entire study period. Overall, hand hygiene complete adherence rate was 29.9% (11,981/39,998); partial adherence rate was 45.3% (18,131/39,998) and the non-adherence rate was 24.7% (9886/39,998). A better adherence rate was seen among nurses (44.7%), followed by other staff (33.7%) and doctors (33.04%). Moment-specific adherence rates show almost equal adherence rates of 50.7%, 50.75%, and 50.1%, respectively, for moments 2, 3, and 4, and comparatively low for moments 1 and 5 (48.4% and 47.6%, respectively). Conclusion Despite adequate hand hygiene facilities, compliance remains low. Hand hygiene is a bundle care approach that needs to consider factors including healthcare staff, clinical, institutional, environmental, and behavioral changes. Multimodal interventions and multidisciplinary commitment are mandatory for sustained compliance.
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11
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Dhamnaskar SS, Chaudhari GM, Koranne MS. Health Care Workers' Adherence to Hand Hygiene Guidelines in Emergency Surgical Room of a Tertiary Care Hospital. Surg J (N Y) 2022; 8:e136-e140. [PMID: 35783030 PMCID: PMC9246539 DOI: 10.1055/s-0042-1749426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Out of every 100 hospitalized patients, 7 patients in advanced countries and 10 patients in emerging countries acquire health care-associated infections (HCAIs). Hand hygiene (HH) procedures are the simple and cost-effective solution to significantly reduce HCAI. We wanted to know the compliance rate of HH procedures among health care workers (HCWs) working in emergency surgical room (ESR) of our institute, so that feedback can be given to them and further interventions can be planned.
Methodology
This is a cross-sectional observational study conducted in ESR. Resident doctors and faculties, interns, and nurses were directly observed for all the five moments of HH recommended by World Health Organization (WHO). The data have been recorded with the WHO recommended form for observation and basic compliance calculation for HH.
Results
In total, 1,370 HH opportunities were observed and recorded, of which 690 were for resident doctors and faculties, and 340 each for interns and nurses. The overall total HH compliance rate among all HCWs was 41.3% and resident doctors and faculties had the poorest compliance. Poorest compliance was observed for moment 1, whereas maximum compliance was for moment 3 among all the HCWs.
Conclusion
HCWs' adherence to HH guidelines in ESR of this tertiary care hospital is low and is least in resident doctors and faculties.
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Affiliation(s)
| | - Gautami Milind Chaudhari
- Department of General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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12
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Discordance among Belief, Practice, and the Literature in Infection Prevention in the NICU. CHILDREN 2022; 9:children9040492. [PMID: 35455536 PMCID: PMC9027430 DOI: 10.3390/children9040492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
This study evaluates practices of infection control in the NICU as compared with the available literature. We aimed to assess providers’ awareness of their institutional policies, how strongly they believed in those policies, the correlation between institution size and policies adopted, years of experience and belief in a policy’s efficacy, and methods employed in the existing literature. An IRB-approved survey was distributed to members of the AAP Neonatal Section. A systematic review of the literature provided the domains of the survey questions. Data was analyzed as appropriate. A total of 364 providers responded. While larger NICUs were more likely to have policies, their providers are less likely to know them. When a policy is in place and it is known, providers believe in the effectiveness of that policy suggesting consensus or, at its worst, groupthink. Ultimately, practice across the US is non-uniform and policies are not always consistent with best available literature. The strength of available literature is adequate enough to provide grade B recommendations in many aspects of infection prevention. A more standardized approach to infection prevention in the NICU would be beneficial and is needed.
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13
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Chaurasia V, Gupta A, Patel R, Chauhan S, Adichwal NK, Kamble S. Self-care, Household Cleaning and Disinfection During COVID-19 Pandemic: A Study from Metropolitan Cities of India. ANNALS OF DATA SCIENCE 2022; 9:1085-1101. [PMID: 38624936 PMCID: PMC8942059 DOI: 10.1007/s40745-022-00377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/13/2022]
Abstract
Hygiene has been noticed as one of the most effective procedures against COVID-19 cross-transmission, especially hand hygiene and covering the face with the mask. Therefore, this study tried to peek into the people movements and seeks to understand how people are handling their daily use items like fruits and vegetables, how people are managing unavoidable grooming services, how people are disinfecting themselves after coming from outside, and what all hygienic practices they are following during this pandemic. Furthermore, this study attempts to explore ways through which people are disinfecting their houses. At last, the study seeks to explore the knowledge/information people have about Coronavirus. The study collected primary data through a self-administered questionnaire. A quota sampling technique was used to collect the data. Bivariate analysis was carried out to reach the study findings. Based on the findings, it is the need of the hour to disseminate the information on the use of unhealthy disinfectants as they lack the knowledge about the safe use of various types of cleaners and disinfectants. It is also reiterated that there is an urgency to promote further information on risk factors of Coronavirus among people and compulsion to promote healthy hand hygiene and sanitation practices. There is a need to promote information through mass media and other modes of awareness, such as artwork and announcements.
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Affiliation(s)
- Vaishali Chaurasia
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Ajay Gupta
- Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Mumbai, India
| | - Ratna Patel
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Shekhar Chauhan
- Department of Population Policies and Programmes, International Institute for Population Sciences, Mumbai, India
| | - Nitesh Kumar Adichwal
- Department of General Management, University of Petroleum and Energy Studies, Dehradun, Uttarakhand India
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14
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Quality Improvement Initiative to Improve Hand Hygiene Compliance in Indian Special Newborn Care Unit. Pediatr Qual Saf 2021; 6:e492. [PMID: 34934876 PMCID: PMC8678003 DOI: 10.1097/pq9.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/15/2021] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Pilot data on Hand hygiene (HH) compliance using a standard World Health Organisation checklist for 1-week suggested only 20% compliance. So, we planned a Quality Improvement study to improve HH compliance among health care providers in our Special Newborn Care Unit from 20% to 60% over 12 months.
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15
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Chavignon M, Reboux M, Tasse J, Tristan A, Claris O, Laurent F, Butin M. Persistent microbial contamination of incubators despite disinfection. Pediatr Res 2021; 90:1215-1220. [PMID: 33627818 DOI: 10.1038/s41390-021-01407-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND In neonatal intensive care units (NICUs), hygiene and disinfection measures are pivotal to protect neonates from nosocomial infections. This study aimed to evaluate the efficacy of the classical incubators disinfection procedure and to follow-up neonates housed in the incubators for the development of late-onset sepsis (LOS). METHODS In a tertiary NICU, 20 incubators were monitored for bacterial contamination at three times: before disinfection, after disinfection, and 24 h after turning on and housing a new neonate. Clinical data of neonates housed in these incubators were retrieved from the medical records. RESULTS All 20 incubators were contaminated at the 3 times of the study, mainly on mattresses and balances. Coagulase-negative Staphylococci, Enterococcus, and Bacillus-resisted disinfection while enterobacteria and Staphylococcus aureus were eradicated. After 24 h, the bacterial colonisation was similar to the one observed before disinfection. The bacteria isolated on incubators were also found on the caregivers' hands. During the study, two preterm neonates developed a LOS involving a bacterial species that has been previously isolated in their incubator. CONCLUSION Pathogenic contaminants persist on incubators despite disinfection and represent a risk for subsequent infection in preterm neonates. Improvements are needed concerning both the disinfection process and incubator design. IMPACT Procedures of disinfection that are usually recommended in NICUs do not allow for totally eradicating bacteria from incubators. Preterm neonates are housed in incubators colonised with potentially pathogenic bacteria. The control of nosocomial infections in NICUs requires further researches concerning mechanisms of bacterial persistence and ways to fight against environmental colonisation.
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Affiliation(s)
- Marie Chavignon
- Equipe « Pathogénèse des Infections à Staphylocoques », Centre International de Recherche en Infectiologie, INSERM U1111, Lyon, France
| | - Marion Reboux
- Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Jason Tasse
- Equipe « Pathogénèse des Infections à Staphylocoques », Centre International de Recherche en Infectiologie, INSERM U1111, Lyon, France.,BioFilm Control, Saint-Beauzire, France
| | - Anne Tristan
- Equipe « Pathogénèse des Infections à Staphylocoques », Centre International de Recherche en Infectiologie, INSERM U1111, Lyon, France.,Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Olivier Claris
- Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.,EA 4129, Université Claude Bernard, Villeurbanne, France
| | - Frédéric Laurent
- Equipe « Pathogénèse des Infections à Staphylocoques », Centre International de Recherche en Infectiologie, INSERM U1111, Lyon, France.,Institut des Agents Infectieux, Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Marine Butin
- Equipe « Pathogénèse des Infections à Staphylocoques », Centre International de Recherche en Infectiologie, INSERM U1111, Lyon, France. .,Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
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16
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Gopalakrishnan S, Chaurasia S, Sankar MJ, Paul VK, Deorari AK, Joshi M, Agarwal R. Stepwise interventions for improving hand hygiene compliance in a level 3 academic neonatal intensive care unit in north India. J Perinatol 2021; 41:2834-2839. [PMID: 34321595 DOI: 10.1038/s41372-021-01141-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We evaluated effect of sequentially introducing four WHO-recommended interventions to promote hand-hygiene compliance in tertiary-care NICU. STUDY DESIGN Four dedicated research nurses directly observed doctors and nurses to record success in hand-hygiene opportunities at randomly selected NICU beds and randomly sampled time-slots in four phases (of 4-weeks each): I-Baseline, II-Self-directed learning; III-Participatory learning; IV-Closed-Circuit Television (CCTV); and V-CCTV-plus (with feedback). FINDINGS Hand-hygiene compliance changed from 61.8% (baseline) to 77% (end) with overall relative change: 24.6% (95% CI 18, 32; p value= 0.003); compared with preceding phase, relative changes of 21% (15, 28; <0.001), 4% (0, 8; 0.008), -10% (-13, -6; <0.001), and 10% (5, 15; <0.001) during phases II, III, IV, and V, respectively were observed. Rise in hand-hygiene compliance was higher for after-WHO-moments (12.7%; upto 2.5-folds for moment 5, <0.001) compared to before-WHO-moments (5.2%). Educational interventions, feedback and monitoring WHO moments can improve hand-hygiene compliance significantly among health-care providers in NICU.
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Affiliation(s)
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Dehradun, 249203, Uttarakhand, India.
| | - M J Sankar
- Newborn Health Knowledge Centre (NHKC) and WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - V K Paul
- Department of Pediatrics, AIIMS, New Delhi, India
| | - A K Deorari
- WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - M Joshi
- WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Agarwal
- Newborn Health Knowledge Centre (NHKC) and WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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17
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Noah N, Potas N. Association between nursing work stress, burnout and nosocomial infection rate in a neonatal intensive care unit in Hargeisa, Somaliland. Trop Doct 2021; 52:46-52. [PMID: 34806491 DOI: 10.1177/00494755211055250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our study looks at the effects of burnout and stress levels of nurses, behaviour regarding medical waste, and other effective risk factors on the first time and recurrent diagnosis of nosocomial infection (NI) in neonatal intensive care units in Hargeisa, Somaliland. This multicentric follow-up study was conducted and repeated measurements were taken from 72 neonates and 45 nurses working in three hospitals for a period of five months. Nurses with high burnout levels had 3.7 times higher risk of neonates under their care being diagnosed with an NI (odds ratio: 3.743; 95% CI: 1.498-9.356). By controlling other variables, the stress level of nurses increased the incidence rate of neonates being diagnosed more than once with NI by 3.2 times. Statistically, the direction of causal association was from the high burnout among nurses to the diagnosis of NI, and high stress was associated with the recurrent diagnosis of infections in neonates.
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Affiliation(s)
- Nasra Noah
- Institute of Social Sciences, 37511Gazi University, Ankara, Turkey
| | - Nihan Potas
- Department of Healthcare Management, 523228Ankara Hacı Bayram Veli University, Ankara, Turkey
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18
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Jansen SJ, Lopriore E, Beek MT, Veldkamp KE, Steggerda SJ, Bekker V. The road to zero nosocomial infections in neonates-a narrative review. Acta Paediatr 2021; 110:2326-2335. [PMID: 33955065 PMCID: PMC8359829 DOI: 10.1111/apa.15886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
Aim Nosocomial infections (NI) in neonates are associated with prolonged hospitalisation, adverse neurodevelopmental outcome and high mortality. Over the past decade, numerous prevention strategies have resulted in significant reductions in NI rates. In this review, we aim to provide an overview of current NI rates from large, geographically defined cohorts. Methods PubMed, Web of Science, EMBASE and Cochrane Library were searched for evidence regarding epidemiology and prevention of NI in neonates. Extracted studies were synthesised in a narrative form with experiential reflection. Results Despite the abundance of geographically defined incidence proportions, an epidemiological overview of NI is difficult to provide, given the lack of consensus definition for neonatal NI and different baseline populations being compared. Successful prevention efforts have focused on implementing evidence‐based practices while eliminating outdated strategies. The most promising model for reduction in infection rates is based on quality improvement (QI) collaboratives and benchmarking, involving identification and implementation of best practices, selection of measurable outcomes and fostering a sense of community and transparency. Conclusion The preventative rather than curative approach forms the new paradigm for reducing the burden of neonatal infections. Despite progress achieved, continued work towards improved prevention practices is required in the strive towards zero NIs.
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Affiliation(s)
- Sophie J. Jansen
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
| | - Enrico Lopriore
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
| | - Martha T. Beek
- Department of Medical Microbiology Leiden University Medical Center (LUMC Leiden The Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology Leiden University Medical Center (LUMC Leiden The Netherlands
| | - Sylke J. Steggerda
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
| | - Vincent Bekker
- Division of Neonatology Department of Pediatrics Willem Alexander Children's Hospital – Leiden University Medical Center (LUMC) Leiden The Netherlands
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19
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Deshommes T, Nagel C, Tucker R, Dorcélus L, Gautier J, Koster MP, Lechner BE. A Quality Improvement Initiative to Increase Hand Hygiene Awareness and Compliance in a Neonatal Intensive Care Unit in Haiti. J Trop Pediatr 2021; 67:5864459. [PMID: 32594158 DOI: 10.1093/tropej/fmaa029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Healthcare-associated infections (HCAI) are major causes of morbidity, mortality, increased lengths of stay and are an economic burden on healthcare systems in resources-limited settings. This is especially true for neonates, who are more susceptible with underdeveloped immune systems. Hand hygiene (HH) is a key weapon against HCAI, yet globally, HH compliance remains substandard. This study sought to determine the compliance with HH among healthcare workers (HCWs) in a children's hospital neonatal intensive care unit (NICU) in Haiti. METHODS A HH educational intervention was performed in the NICU, including lectures and posters. Pre- and post-intervention HH data were collected on HCWs and parents using the World Health Organization '5 Moments for HH'. Data were analyzed using standard statistical analysis. RESULTS HH increased in all HCW roles but not in parents. Correct HH increased in all groups, including parents. HH was more likely to occur prior to patient contact than after patient contact. Correct HH was more likely to occur with alcohol-based hand rub than with soap and water. CONCLUSION This study demonstrates that an inexpensive and simple intervention can significantly increase HH compliance in a resource-limited NICU, which may lead to decreased rates of hospital-acquired sepsis. Parents, however, due to cultural norms as well as literacy and language barriers, need targeted educational interventions distinct from those that HCW benefit from.
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Affiliation(s)
- Theony Deshommes
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Christian Nagel
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Richard Tucker
- Department of Pediatrics, Division of Neonatology, Women and Infants Hospital, Providence, RI 02905, USA
| | - Lindsay Dorcélus
- Department of Pediatrics, Division of Neonatology, Hôpital Saint-Damien, Nos Petits-Frères et Sœurs, Tabarre, Haiti 6110
| | - Jacqueline Gautier
- Department of Pediatrics, Division of Neonatology, Hôpital Saint-Damien, Nos Petits-Frères et Sœurs, Tabarre, Haiti 6110
| | - Michael P Koster
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA.,Department of Pediatrics, Hasbro Children's Hospital, Providence, RI 02903, USA
| | - Beatrice E Lechner
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI 02903, USA.,Department of Pediatrics, Division of Neonatology, Women and Infants Hospital, Providence, RI 02905, USA
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20
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Ghali H, Ben Cheikh A, Bhiri S, Khefacha S, Latiri HS, Ben Rejeb M. Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211067930. [PMID: 34910605 PMCID: PMC8689600 DOI: 10.1177/00469580211067930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning. AIM To describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI. METHODS The current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors. RESULTS Overall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% (P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98). CONCLUSION Contrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.
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Affiliation(s)
- Hela Ghali
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Research Laboratory Emerging Bacterial Resistance in Hospitals Veterinarians and the Environment and Security of Care, Sahloul University Hospital
| | - Asma Ben Cheikh
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Research Laboratory Emerging Bacterial Resistance in Hospitals Veterinarians and the Environment and Security of Care, Sahloul University Hospital
| | - Sana Bhiri
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Selwa Khefacha
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- Research Laboratory Emerging Bacterial Resistance in Hospitals Veterinarians and the Environment and Security of Care, Sahloul University Hospital
| | - Houyem Said Latiri
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Research Laboratory Emerging Bacterial Resistance in Hospitals Veterinarians and the Environment and Security of Care, Sahloul University Hospital
| | - Mohamed Ben Rejeb
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Research Laboratory Emerging Bacterial Resistance in Hospitals Veterinarians and the Environment and Security of Care, Sahloul University Hospital
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21
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Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Jones MA, Thorning S, Beller EM, Clark J, Hoffmann TC, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2020; 11:CD006207. [PMID: 33215698 PMCID: PMC8094623 DOI: 10.1002/14651858.cd006207.pub5] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review published in 2007, 2009, 2010, and 2011. The evidence summarised in this review does not include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL on 1 April 2020. We searched ClinicalTrials.gov, and the WHO ICTRP on 16 March 2020. We conducted a backwards and forwards citation analysis on the newly included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs of trials investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, and gargling) to prevent respiratory virus transmission. In previous versions of this review we also included observational studies. However, for this update, there were sufficient RCTs to address our study aims. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. Three pairs of review authors independently extracted data using a standard template applied in previous versions of this review, but which was revised to reflect our focus on RCTs and cluster-RCTs for this update. We did not contact trialists for missing data due to the urgency in completing the review. We extracted data on adverse events (harms) associated with the interventions. MAIN RESULTS We included 44 new RCTs and cluster-RCTs in this update, bringing the total number of randomised trials to 67. There were no included studies conducted during the COVID-19 pandemic. Six ongoing studies were identified, of which three evaluating masks are being conducted concurrent with the COVID pandemic, and one is completed. Many studies were conducted during non-epidemic influenza periods, but several studies were conducted during the global H1N1 influenza pandemic in 2009, and others in epidemic influenza seasons up to 2016. Thus, studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Compliance with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included nine trials (of which eight were cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and seven in the community). There is low certainty evidence from nine trials (3507 participants) that wearing a mask may make little or no difference to the outcome of influenza-like illness (ILI) compared to not wearing a mask (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.82 to 1.18. There is moderate certainty evidence that wearing a mask probably makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask (RR 0.91, 95% CI 0.66 to 1.26; 6 trials; 3005 participants). Harms were rarely measured and poorly reported. Two studies during COVID-19 plan to recruit a total of 72,000 people. One evaluates medical/surgical masks (N = 6000) (published Annals of Internal Medicine, 18 Nov 2020), and one evaluates cloth masks (N = 66,000). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). There is uncertainty over the effects of N95/P2 respirators when compared with medical/surgical masks on the outcomes of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; very low-certainty evidence; 3 trials; 7779 participants) and ILI (RR 0.82, 95% CI 0.66 to 1.03; low-certainty evidence; 5 trials; 8407 participants). The evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirator compared to a medical/surgical mask probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; moderate-certainty evidence; 5 trials; 8407 participants). Restricting the pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies. One ongoing study recruiting 576 people compares N95/P2 respirators with medical surgical masks for healthcare workers during COVID-19. Hand hygiene compared to control Settings included schools, childcare centres, homes, and offices. In a comparison of hand hygiene interventions with control (no intervention), there was a 16% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.84, 95% CI 0.82 to 0.86; 7 trials; 44,129 participants; moderate-certainty evidence), suggesting a probable benefit. When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.98, 95% CI 0.85 to 1.13; 10 trials; 32,641 participants; low-certainty evidence) and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials; 8332 participants; low-certainty evidence) suggest the intervention made little or no difference. We pooled all 16 trials (61,372 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. The pooled data showed that hand hygiene may offer a benefit with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.84 to 0.95; low-certainty evidence), but with high heterogeneity. Few trials measured and reported harms. There are two ongoing studies of handwashing interventions in 395 children outside of COVID-19. We identified one RCT on quarantine/physical distancing. Company employees in Japan were asked to stay at home if household members had ILI symptoms. Overall fewer people in the intervention group contracted influenza compared with workers in the control group (2.75% versus 3.18%; hazard ratio 0.80, 95% CI 0.66 to 0.97). However, those who stayed at home with their infected family members were 2.17 times more likely to be infected. We found no RCTs on eye protection, gowns and gloves, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low compliance with the interventions during the studies hamper drawing firm conclusions and generalising the findings to the current COVID-19 pandemic. There is uncertainty about the effects of face masks. The low-moderate certainty of the evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of randomised trials did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks during seasonal influenza. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Chris B Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Sarah Thorning
- GCUH Library, Gold Coast Hospital and Health Service, Southport, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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22
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Mitchell SJ. Improving outcomes for surgical patients. BMJ 2020; 371:m3929. [PMID: 33148633 DOI: 10.1136/bmj.m3929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Simon J Mitchell
- Department of Anaesthesiology, University of Auckland, Auckland 1142, New Zealand
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23
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Evolution and associated factors of hand hygiene compliance in a pediatric tertiary hospital. Am J Infect Control 2020; 48:1305-1310. [PMID: 32442654 DOI: 10.1016/j.ajic.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND The objective is to know the evolution of the Degree of Compliance with Recommendations (DCR) on hand hygiene (HH) and its associated factors in the pediatric care areas (PCAs) of a tertiary hospital. METHODS Observational, cross-sectional study, repeated over time, with direct observation of the DCR on HH during the daily activity of health care workers. Over 13 years, 9226 HH opportunities were observed. Associations between DCR, PCA and other variables (eg, age, sex, and professional position) were examined using χ² and adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS DCR on HH in 9 PCAs was 64.3% (95% CI, 63.3-65.3), and in the group of non-pediatric areas it was 49.6% (95% CI, 49.1-50.1). The areas with the highest degree of compliance were Oncology 72.8% (95% CI, 69.2-76.4), Neonatology 73.2% (95% CI, 71.3-75.1), and Neonatal intensive care unit 70.0% (95% CI, 67.5-72.6). These were the areas with the strongest association with HH compliance, with aOR:2.8 (95% CI, 2.2-3.6); aOR, 3.0 (95% CI, 2.6-3.6) aOR:2.6 (95% CI, 2.1-3.1), respectively. Other associated factors were the indications "after an activity," aOR, 1.6 (95% CI, 1.5-1.8) and the availability of pocket-size alcohol-based solution, aOR, 2.1(95% CI, 1.9-2.3). CONCLUSIONS The DCR on HH in PCAs is higher than in other areas, although there is still margin for improvement. We have identified modifiable factors that have an independent association with HH compliance in PCAs. Focusing on modifiable factors will increase compliance with HH with the ultimate goal of reducing healthcare associated infections.
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24
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Nalule Y, Buxton H, Flynn E, Oluyinka O, Sara S, Cumming O, Dreibelbis R. Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria. BMC Pregnancy Childbirth 2020; 20:589. [PMID: 33023531 PMCID: PMC7541299 DOI: 10.1186/s12884-020-03282-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/24/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility-based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. METHODS This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first 6 hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. RESULTS Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. CONCLUSIONS In this setting, hand hygiene practices during post-natal care and the first 6 hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.
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Affiliation(s)
- Yolisa Nalule
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Helen Buxton
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Erin Flynn
- Infection and Immunity, South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
| | - Olutunde Oluyinka
- Maternal and Child Survival Program (MCSP)/Save the Children Nigeria, Abuja, Nigeria
| | - Stephen Sara
- Maternal and Child Survival Program (MCSP)/Save the Children US, Washington, DC, 20036, USA
| | - Oliver Cumming
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Robert Dreibelbis
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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25
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Seliger G, Krol I, Worlitzsch D, Kantelhardt EJ, Moritz S, Tchirikov M. Reduktion des Besucher- und Personal- assoziierten Infektionsrisikos
durch komplexe Intervention auf perinatologischen Stationen. Z Geburtshilfe Neonatol 2020; 224:297-305. [DOI: 10.1055/a-1226-7257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Ziel dieser prospektiven, klinischen Studie ist der Nachweis
für perinatologische Stationen: (a) dass eine komplexe Intervention
die Compliance bzgl. Händehygiene bei Besuchern, Geschwisterkindern
und Personal verbessert und (b) dass automatisierte Sprachansagen am
Desinfektionsmittelspender die Rate effektiv durchgeführter
Händedesinfektionen erhöhen.
Studiendesign (a) Pretest-Posttest-Follow-up-Design mit Kontroll-
(1–12/2016), Interventions- (1–12/2017),
Follow-up-Kontroll-Periode (1/2018–12/2019). (b)
Randomisiert-kontrollierter Studienteil im quasi Crossover-Design.
Primäre Endpunkte: (a) Desinfektionsmittelverbrauch pro
Patientenliegetag (b) DMV am Desinfektionsmittelspender pro Passant am
Eingang zu den Stationen.
Ergebnisse Die multimodale Strategie innerhalb der
Interventions-Periode zeigte einen relevanten positiven Effekt auf die
Compliance bzgl. Händehygiene (Interventions-Periode: 26,2%
mehr DMV; p=0,088). Sprachansagen steigern den
Desinfektionsmittelverbrauch um 28,6% (p=0,025).
Sekundärendpunkte: Die Odds-Ratio für den Vergleich
hochpositiver Fingerkuppen-Abklatschproben zwischen Kontroll- und
Interventions-Periode bei Besucher-Kindern lag bei 0,35 (95% CI
[0,1074–0,9708] p=0,039).
Schlussfolgerungen Eine komplexe Intervention inklusive
Awareness-fördernder Maßnahmen und automatisierter
Sprachansagen am Desinfektionsmittelspender sind auf perinatologischen
Stationen wirksam. Installation von Desinfektionsmittelspendern in
kindgerechter Position und adäquates Informationsmaterial spricht
auch Kinder an. Die Daten stellen z. B. in einer Pandemie-Situation
einen wichtigen Beitrag zur Optimierung von Handhygienemaßnahmen von
Personal und Besuchern in Krankenhäusern dar.
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Affiliation(s)
- Gregor Seliger
- Universitätsklinik und Poliklinik für Geburtshilfe und
Pränatalmedizin, Martin-Luther-Universität Halle-Wittenberg,
Halle
| | - Inna Krol
- Universitätsklinik und Poliklinik für Geburtshilfe und
Pränatalmedizin, Martin-Luther-Universität Halle-Wittenberg,
Halle
| | - Dieter Worlitzsch
- Universitätsklinikum/Stabsstelle Krankenhaushygiene,
Martin-Luther-Universität Halle-Wittenberg, Halle
| | - Eva Johanna Kantelhardt
- Institut für Medizinische Epidemiologie, Biometrie und
Informatik, Martin-Luther-Universität Halle-Wittenberg,
Halle
| | - Stefan Moritz
- Medizincontrolling/Sachgebiet Klinische Infektologie,
Universitätsklinikum Halle (Saale), Martin-Luther-Universität
Halle-Wittenberg, Halle
| | - Michael Tchirikov
- Universitätsklinik und Poliklinik für Geburtshilfe und
Pränatalmedizin, Martin-Luther-Universität Halle-Wittenberg,
Halle
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26
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Howard MC. Understanding face mask use to prevent coronavirus and other illnesses: Development of a multidimensional face mask perceptions scale. Br J Health Psychol 2020; 25:912-924. [PMID: 32588949 PMCID: PMC7361913 DOI: 10.1111/bjhp.12453] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/24/2020] [Indexed: 12/13/2022]
Abstract
Face masks are an avenue to curb the spread of coronavirus, but few people in Western societies wear face masks. Social scientists have rarely studied face mask wearing, leaving little guidance for methods to encourage these behaviours. In the current article, we provide an approach to address this issue by developing the 32‐item and 8‐dimension Face Mask Perceptions Scale (FMPS). We begin by developing an over‐representative item list in a qualitative study, wherein participants’ responses are used to develop items to ensure content relevance. This item list is then reduced via exploratory factor analysis in a second study, and the eight dimensions of the scale are supported. We also support the validity of the FMPS, as the scale significantly relates to both face mask wearing and health perceptions. We lastly confirm the factor structure of the FMPS in a third study via confirmatory factor analysis. From these efforts, we identify an avenue that social scientists can aid in preventing coronavirus and illness more broadly – by studying face mask perceptions and behaviours.
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Affiliation(s)
- Matt C Howard
- Mitchell College of Business, The University of South Alabama, Mobile, Alabama, USA
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27
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Ben Fredj S, Ben Cheikh A, Bhiri S, Ghali H, Khefacha S, Dhidah L, Merzougui L, Ben Rejeb M, Said Latiri H. Multimodal intervention program to improve hand hygiene compliance: effectiveness and challenges. J Egypt Public Health Assoc 2020; 95:11. [PMID: 32813132 PMCID: PMC7364722 DOI: 10.1186/s42506-020-00039-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hand hygiene (HH) is considered the most important measure to tackle the transmission of healthcare-associated pathogens. However, compliance with recommendations is usually low and effective improvement strategies are needed. We aimed to assess the effectiveness of an intervention targeting hand hygiene promotion among healthcare workers (HCWs). METHODS We conducted a pre-post interventional study design in the university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The intervention program consisted of training sessions and distribution of posters of hand hygiene guidelines. To assess the evolution of HH observance at pre- and post-intervention, the same observation form was distributed and collected at healthcare workers' workplace. RESULTS Of the 1201 and 1057 opportunities for hand hygiene observed among all categories of HCWs, overall compliance enhanced significantly from 32.1 to 39.4% (p < 0.001) respectively at pre- and post-intervention. Nurses were the most compliant with a significant improvement from 34.1 to 45.7% (p < 0.001) respectively at pre- and post-intervention. Furthermore, analysis by department showed significant improvement of compliance in orthopedic department (p < 0.001), maxillofacial-surgery department (p < 0.001), pediatrics department (p = 0.013), and emergencies (p = 0.038). CONCLUSION This study showed the feasibility and effectiveness of a health-setting-based intervention to enhance hand hygiene observance in the context of a developing country.
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Affiliation(s)
- Sihem Ben Fredj
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
| | - Asma Ben Cheikh
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Sana Bhiri
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Hela Ghali
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
| | - Salwa Khefacha
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
| | - Lamine Dhidah
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Latifa Merzougui
- Department of Epidemiology, University Hospital Ibn El Jazzar, 3100 Kairouan, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Houyem Said Latiri
- Department of Prevention and Care Safety, University Hospital Sahloul, 4011 Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia
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Lacey G, Zhou J, Li X, Craven C, Gush C. The impact of automatic video auditing with real-time feedback on the quality and quantity of handwash events in a hospital setting. Am J Infect Control 2020; 48:162-166. [PMID: 31358419 DOI: 10.1016/j.ajic.2019.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor quality handwashing contributes to the spread of nosocomial infections. We investigate the impact of automatic video auditing (AVA) with feedback on the quality and quantity of handwashing in a hospital setting. METHODS AVA systems were mounted over all handwash sinks in a surgical unit. Phase 1 established baseline handwashing quality and quantity. Phase 2 examined the impact of real-time performance feedback, and phase 3 examined the incremental impact of weekly team performance reports. Phase 4 remeasured the baseline without feedback. RESULTS A total of 3,606 handwash events were audited. During phase 2 and 3, compliance with the World Health Organization technique improved from 15.7%-46% (P < .0001), and the average number of handwash events per patient per day increased from 0.91-2.25 (P < .0001). Performance returned to baseline in phase 4. CONCLUSIONS AVA with real-time feedback significantly improved the quality and quantity of handwashing. The combination of AVA with electronic monitoring will allow simultaneous auditing of hand hygiene quantity and quality. The impact of cognitive offloading onto the technology may have contributed to the return to baseline at the end of the study, and suggests further research is required in this area.
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Engdaw GT, Gebrehiwot M, Andualem Z. Hand hygiene compliance and associated factors among health care providers in Central Gondar zone public primary hospitals, Northwest Ethiopia. Antimicrob Resist Infect Control 2019; 8:190. [PMID: 31788237 PMCID: PMC6880540 DOI: 10.1186/s13756-019-0634-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/24/2019] [Indexed: 01/17/2023] Open
Abstract
Background Poor hand hygiene compliance is one in all the leading contributory factors to healthcare-associated infections. This is an important source of complications across the continuum of care and poses a serious threat to people admitted to hospitals. However, the magnitude and associated factors of hand hygiene compliance in public primary hospitals were not well investigated in Ethiopia. Therefore, this study was conducted to assess hand hygiene compliance and associated factors among health care providers in Central Gondar Zone public primary hospitals, Northwest Ethiopia. Methods An Institutional based cross-sectional study was conducted from March to April 2019 among health care providers. The data were collected using self-administered questionnaires and observational checklists. Using Epi Info 3.1, data was entered and analyzed using SPSS version 23. The data were analyzed using descriptive statistics and logistic regression models. A p-value less than 0.05 with 95% confidence interval was used to declare statistical significance. Results Of 335 study participants, 50 (14.9%), had good hand hygiene compliance. Training on hand hygiene (AOR = 8.07, 95%CI: 2.91, 22.39), availability of adequate soap and water for hand hygiene (AOR = 5.10, 95%CI: 1.93, 13.52), availability of alcohol-based hand rub (AOR = 3.23, 95%CI: 1.32, 7.92), knowledge about hand hygiene (AOR = 6.74, 95%CI: 2.96, 15.34) and attitude towards hand hygiene (AOR = 2.15, 95%CI: 1.04, 4.46) were factors associated with hand hygiene compliance. Conclusion The overall level of hand hygiene compliance among health care providers was poor. Training, availability of adequate soap and water, availability of alcohol-based hand rub, knowledge on hand hygiene, and attitude of health care providers were significantly associated with hand hygiene compliance.
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Affiliation(s)
- Garedew Tadege Engdaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Gebrehiwot
- Department of Environmental and Occupational Health and Safety, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewudu Andualem
- Department of Environmental and Occupational Health and Safety, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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30
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Biswas A, Bhattacharya SD, Singh AK, Saha M. Addressing Hand Hygiene Compliance in a Low-Resource Neonatal Intensive Care Unit: a Quality Improvement Project. J Pediatric Infect Dis Soc 2019; 8:408-413. [PMID: 30189013 DOI: 10.1093/jpids/piy076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/01/2018] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit. MATERIALS AND METHODS We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively. RESULTS A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9-5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36-16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities. CONCLUSIONS Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.
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Affiliation(s)
- Arunava Biswas
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India
| | | | | | - Mallika Saha
- Department of Neonatology, IPGMER & SSKM Hospital, Kolkata, India
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Nasution TA, Yunita R, Pasaribu AP, Ardinata FM. Effectiveness Hand Washing and Hand Rub Method in Reducing Total Bacteria Colony from Nurses in Medan. Open Access Maced J Med Sci 2019; 7:3380-3383. [PMID: 32002055 PMCID: PMC6980800 DOI: 10.3889/oamjms.2019.427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Hospital-acquired infection (HAI) is a major problem for the patient’s health care and may impact the duration of treatment. Hand hygiene is a simple procedure but giving good prevention usually done among nurses at the hospital. AIM: Objective of the study is to determine the effectivity of handwashing method compared to hand rub to eliminate microorganisms on nurse’s hands at Sumatera Utara University Hospital. This is an experimental analytic study using random sampling technique. METHODS: There were 16 nurses enrolled in this study. There were 2 groups involved; the first group using handwashing with soap and the other one using hand rub. The swabs were taken from each hand from both groups before and after washing their hands. Moreover, the swabs directly sent to Microbiology Laboratory of Sumatera Utara University to identify bacteria which colonise the hand. RESULTS: There were no significant differences between using handwashing method compared to hand rub in reducing total bacterial colony on hands (p = 0.088). The average of total colony decreased by using handwashing method is 59.5%, and by using a hand, rub is 47.2%. CONCLUSION: Hand hygiene method using alcohol-based hand rub liquid has been recommended by WHO and can replace hand washing method in a particular situation.
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Affiliation(s)
- Tetty Aman Nasution
- Microbiology Department, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Rina Yunita
- Microbiology Department, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | | | - Fikri M Ardinata
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Kitsanapun A, Yamarat K. Evaluating the effectiveness of the "Germ-Free Hands" intervention for improving the hand hygiene practices of public health students. J Multidiscip Healthc 2019; 12:533-541. [PMID: 31371978 PMCID: PMC6628857 DOI: 10.2147/jmdh.s203825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/23/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE This quasi-experimental study sought to assess the effectiveness of a multidisciplinary intervention called "Germ-Free Hands" to improve the hand hygiene practices of students attending Thailand's Sirindhorn College of Public Health (SCPH). METHODS The intervention was developed and implemented at SCPH and incorporated education, training, a workshop, and performance feedback. The intervention targeted behavioral antecedents specified by the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Handwashing determinants (knowledge, beliefs, attitudes, subjective norms, perceived behavioral control, and intentions) and hand hygiene behaviors were assessed at baseline, immediately post-intervention, and 3 months post-intervention for the intervention group at (n=60) at the Suphanburi campus of SCPH and a matched control group (n=60) of students at the Ubonratchathani campus. Data analysis included descriptive statistics, independent samples t-tests, two-way measures of analysis of variance, and a generalized estimating equation to compare handwashing practices by self-reports between two groups. RESULTS The "Germ-Free Hands" intervention produced significant improvements in the intervention group's handwashing knowledge, behavioral and control beliefs, subjective norm scores, intentions, and behaviors, as compared to the control group. However, the intervention had no significant impact on normative beliefs, attitudes, or perceived behavioral control. Reported improvements also decreased 3 months post-intervention, and the number of bacterial colonies on students' hands increased over the course of the study. CONCLUSION This study adds to the evidence that multidisciplinary interventions can be effective at improving handwashing rates. However, education and training must be continuous, rather than delivered as a one-time program, in order to have sustained results. Participants may also require more in-depth instruction in correct handwashing and drying techniques to remove bacteria effectively and prevent recolonization.
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Affiliation(s)
- Apaporn Kitsanapun
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Khemika Yamarat
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Cao Y, Jiang S, Zhou Q. Introducing evidence-based practice improvement in Chinese neonatal intensive care units. Transl Pediatr 2019; 8:257-261. [PMID: 31413959 PMCID: PMC6675685 DOI: 10.21037/tp.2019.07.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
China has the largest population in the world. With rapid economic growth, the incidence of premature birth has shown an increasing trend and more neonatal intensive care units (NICUs) are being established across the country. However, there is substantial variability in clinical practice and variations in short- and long-term outcomes among patients in different NICUs. There remains a big gap between China and developed countries in terms of infant outcomes. The Evidence-based Practice for Improving Quality (EPIQ) is a successful model that has been implemented in NICUs across Canada to improve infant outcomes. We applied EPIQ in a single NICU in china and successfully reduced the incidence of ventilator-associated pneumonia, central line (CL) associated bloodstream infection (CLABSIs), and improved the breastmilk use in NICU. In the next phase, we are extending EPIQ to another 24 centers in China and have established the Chinese Neonatal Network for national collaboration, to improve infant outcomes across China.
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Affiliation(s)
- Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Qi Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China
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Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:608-626. [PMID: 29671025 DOI: 10.1007/s00103-018-2718-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Increased nurse workload is associated with bloodstream infections in very low birth weight infants. Sci Rep 2019; 9:6331. [PMID: 31004092 PMCID: PMC6474896 DOI: 10.1038/s41598-019-42685-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/29/2019] [Indexed: 11/25/2022] Open
Abstract
Neonatal sepsis is a major cause of morbidity and mortality in very low birth weight infants (VLBWI). Nurse workload considerably affects infection rates in intensive care units. However, data concerning the impact of staff workload on bloodstream infections (BSI) in VLBWI are scarce. The aim of the study was to examine the association between nurse workload and BSI in VLBWI. VLBWI admitted to our neonatal intensive care unit during 2016–2017 were retrospectively analysed. Association between nurse workload, determined by a standardized nursing score, and the BSI occurrence was investigated. A higher nurse workload was significantly associated with higher occurrence of BSI (p = 0.0139) in VLBWI. An assumed workload of 120% or higher, representing the need for additional nurses in our NICU setting, is associated with an elevated risk for BSI in this vulnerable population OR 2.32 (95% CI: 1.42–3.8, p = 0.0005). In conclusion, nurse understaffing is associated with a higher risk for BSI in VLBWI.
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Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach During 3 Years in 6 Hospitals in 3 Mexican Cities. J Patient Saf 2019; 15:49-54. [DOI: 10.1097/pts.0000000000000210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Vasudevan RS, Mojaver S, Chang KW, Maisel AS, Frank Peacock W, Chowdhury P. Observation of stethoscope sanitation practices in an emergency department setting. Am J Infect Control 2019; 47:234-237. [PMID: 30415805 DOI: 10.1016/j.ajic.2018.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stethoscopes harbor pathogens that can be transferred to patients when proper sanitary measures are not taken. Our aim was to assess medical provider stethoscope cleaning and hand hygiene in an emergency department setting. METHODS The frequency and methods of stethoscope cleaning during and after provider-patient encounters were observed anonymously in an emergency department of the VA San Diego Healthcare System. RESULTS Among the total of 426 encounters, 115 (26.9%) involved the use of a personal stethoscope. In 15 of these 115 encounters (13.0%), the provider placed a glove over the stethoscope before patient contact. In 13 of these 115 encounters (11.3%), the provider cleaned the stethoscope with an alcohol swab after patient interaction. Stethoscope hygiene with water and a hand towel before patient interaction was observed in 5 of these 115 encounters (4.3%). Hand sanitizer use or handwashing was observed in 213 of the 426 encounters (50.0%) before patient interaction. Gloves were used before patient interaction in 206 of these 426 encounters (48.4%). Hand sanitizer or handwashing was used in 332 of the 426 encounters (77.9%) after patient interaction. CONCLUSIONS Rates of stethoscope and hand hygiene performance were lower than expected. Further investigation of stethoscope contamination and the associated risk of nosocomial infection are needed. Perhaps clearer guidelines on proper stethoscope cleaning would reduce this risk.
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Affiliation(s)
- Rajiv S Vasudevan
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA.
| | - Sean Mojaver
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - Kay-Won Chang
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - Alan S Maisel
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Punam Chowdhury
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA; Department of Emergency Medicine, VA San Diego Healthcare System, La Jolla, CA
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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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Optimizing Accessibility of a Hand-wash Gel to Infant's Cradle: Effect on Neonatal Conjunctivitis. Pediatr Infect Dis J 2019; 38:e7-e11. [PMID: 29570175 DOI: 10.1097/inf.0000000000002023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In our recent study in 2015, we showed a significant relationship between increased rate of clinical neonatal conjunctivitis (CNC) and performance of eye red reflex examination. Our study aim was to assess whether improved accessibility of staff to disinfectant gel (via attaching the gel bottle to infant's cradle) will increase the caring staff compliance with hand hygiene and decrease the rate of CNC. METHODS Our intervention included attaching bottles of alcohol-based gel to newborns' cradles to ensure full availability and accessibility of hand-wash disinfectant. We included all newborn infants who were born beyond 35 weeks' gestation and stayed in the well-baby nursery. We compared 2 periods: pre-intervention period (n = 9380) versus an intervention period (n = 8087). Three variables were recorded: (1) rate of CNC: number of conjunctival swabs sampled per 1000 newborns whenever an eye discharge was noted, (2) rate of bacterial conjunctivitis: number of positive swabs per 1000 newborns and (3) percentage of positive swabs out of all sampled swabs. RESULTS Compared with pre-intervention period, the rate of CNC dropped significantly during the intervention period: 28.6/1000 versus 21.3/1000, respectively, P < 0.01. However, the number of positive bacterial swabs per 1000 newborns (3.2 vs. 2.5) and the percentage of positive bacterial swabs of all sent samples (11.6% vs. 10.8%) were not different between the 2 periods. The majority of pathogens in swabs were Gram-negative sp. without difference between study periods (77.4% vs. 80%), respectively. Univariate analysis showed significant association between rate of CNC and longer length of stay >5 days (P < 0.001) and vaginal delivery. Logistic stepwise regression analysis showed that 4 variables were significantly and independently associated with higher rate of clinical conjunctivitis. These include birth during pre-intervention period [P = 0.018, odds ratio (OR) = 1.27, 95% confidence interval (CI): 1.04-1.54], length of stay 4-5 days (P < 0.001, OR = 2.23, CI: 1.63-3.06), length of stay >7 days (P < 0.001, OR = 6.51, CI: 4.24-10.02), vaginal delivery (P = 0.004, OR = 1.6, CI: 1.17-2.2) and male gender (P = 0.006, OR = 1.31, CI: 1.08-1.59). CONCLUSIONS Accessibility of a disinfectant gel within each newborn's cradle raised hygiene awareness among the caring staff and contributed to the reduction of CNC rate in the newborn nursery.
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Alsagher MR, Soudah SA, Khsheba AE, Fadel SM, Dadiesh MA, Houme MA, Eshagroni AS, Alosta FF, Almsalaty SM. Hand Washing Before and After Applying Different Hand Hygiene Techniques in Places of Public Concern in Tripoli-Libya. Open Microbiol J 2018. [DOI: 10.2174/1874285801812010364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Hand hygiene has being considered as one of the primary measures to improve standards and practice for hospital care and to minimize the transmission of nosocomial pathogens. There is substantial evidence that incidence of hospital acquired infections is reduced by applying hand antisepsis. Regarding hand hygiene and public concern, hand washing has revealed that 85% of the observed adults wash their hands after using public toilets.Objective:To compare the efficacy of hand rubbing with an alcohol based solution versus conventional hand washing with antiseptic and non-antiseptic soaps in reducing bacterial counts using different hand hygiene techniques.Methods:Ninety-three volunteers took part in this study; 57 from Tripoli Medical Center (TMC); 16 from school; 11 from bank; and 9 from office. All volunteers performed six hand hygiene techniques, immediately before and after a volunteer practice activity: hand washing with non-antiseptic soap for 10 and 30 second (s); hand washing with antiseptic soap for 10, 30 or 60 s; and alcohol-based hand rub. A total of 864 specimens were taken: 432 before and 432 after volunteer's hand hygiene. The fingertips of the dominant hand for each volunteer were pressed on to agar for culture before and after each hand hygiene technique. Plates were incubated at 37oC, and colony-forming units were counted after 48 hours and pathogenic bacteria were identified.Results:Results showed that 617 specimens (71.41%) were positive for bacterial growth. 301 (48.78%) were from TMC, 118 (19.12%) were from office; 107 (14.34%) were from school and 91 (14.75%) were from bank.Conclusion:Both antiseptic and non–antiseptic soaps did not work properly in reducing bacterial counts of worker’s hands at all places of study, but significantly improved by an application of alcohol based gel.
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Tyagi M, Hanson C, Schellenberg J, Chamarty S, Singh S. Hand hygiene in hospitals: an observational study in hospitals from two southern states of India. BMC Public Health 2018; 18:1299. [PMID: 30482180 PMCID: PMC6257976 DOI: 10.1186/s12889-018-6219-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hand hygiene is a simple and low-cost measure to reduce healthcare associated infection yet it has always been a concern in low as well as high resource settings across the globe. Poor hand hygiene during intra-partum and newborn care may result in sepsis, which is a major cause of death among newborns and puts a financial burden on already strained health systems. METHODS We conducted non-participatory observations in newborn care units and labour rooms from secondary and tertiary level, public and private hospitals, as part of a baseline evaluation of a quality improvement collaborative across two southern states of India. We assessed hand hygiene compliance during examinations and common procedures, using tools adapted from internationally recommended checklists and World Health Organization's concept of five moments of hand hygiene. We assessed differences in compliance by type (public/private), level (secondary/tertiary) and case load (low/intermediate/high). Analysis was adjusted for clustering and weighted as appropriate. RESULTS We included 49 newborn care units (19 private, 30 public) and 35 labour rooms (5 private, 30 public) that granted permission. We observed 3661 contacts with newborns and their environment, 242 per-vaginal examinations and 235 deliveries. For the newborns, a greater proportion of contacts in private newborn units than public complied with all steps of hand hygiene (44% vs 12%, p < 0.001), and similarly in tertiary than secondary units (33% vs 12%, p < 0.001) but there was no evidence of a difference by case load of the facility (low load-28%; intermediate load-14%; high load- 24%, p = 0.246). The component with lowest compliance was glove usage where indicated (20%). For deliveries, hand hygiene compliance before delivery was universal in private facilities but seen in only about one-quarter of observations in public facilities (100% vs 27%, p = 0.012). Average overall compliance for hand-hygiene during per-vaginal examinations was 35% and we found no evidence of differences by type of facility. CONCLUSION Observed compliance with hand hygiene was low overall, although better in private than public facilities in both newborn units and labour rooms. Glove usage was a particular problem in newborn care units. TRIAL REGISTRATION Retrospectively registered with Clinical Trials Registry- India ( CTRI/2018/04/013014 ).
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Affiliation(s)
- Mukta Tyagi
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad 500081 India
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Swecha Chamarty
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad 500081 India
| | - Samiksha Singh
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad 500081 India
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Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections - an overview. Infect Drug Resist 2018; 11:2321-2333. [PMID: 30532565 PMCID: PMC6245375 DOI: 10.2147/idr.s177247] [Citation(s) in RCA: 554] [Impact Index Per Article: 92.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. Multiple studies indicate that the common types of adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications. The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one in 17) die due to these. Several studies suggest that simple infection-control procedures such as cleaning hands with an alcohol-based hand rub can help prevent HCAIs and save lives, reduce morbidity, and minimize health care costs. Routine educational interventions for health care professionals can help change their hand-washing practices to prevent the spread of infection. In support of this, the WHO has produced guidelines to promote hand-washing practices among member countries.
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Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia,
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Muhamad Abu Bakar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia,
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De la Rosa-Zamboni D, Ochoa SA, Laris-González A, Cruz-Córdova A, Escalona-Venegas G, Pérez-Avendaño G, Torres-García M, Suaréz-Mora R, Castellanos-Cruz C, Sánchrez-Flores YV, Vázquez-Flores A, Águila-Torres R, Parra-Ortega I, Klünder-Klünder M, Arellano-Galindo J, Hernández-Castro R, Xicohtencatl-Cortes J. Everybody hands-on to avoid ESKAPE: effect of sustained hand hygiene compliance on healthcare-associated infections and multidrug resistance in a paediatric hospital. J Med Microbiol 2018; 67:1761-1771. [PMID: 30372411 DOI: 10.1099/jmm.0.000863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Hand hygiene is the most important strategy for preventing healthcare-associated infections (HCAIs); however, the impact of hand hygiene in middle-income countries has been poorly described. In this work, we describe the impact of the programme 'Let's Go for 100' on hand hygiene adherence, HCAIs rates and multidrug-resistant (MDR) bacteria, including the molecular typing of methicillin-resistant Staphylococcus aureus (MRSA) strains. METHODOLOGY A multimodal, hospital-wide hand hygiene programme was implemented from 2013. 'Let's Go for 100' involved all healthcare workers and encompassed education, awareness, visual reminders, feedback and innovative strategies. Monthly hand hygiene monitoring and active HCAI surveillance were performed in every ward. Molecular typing of MRSA was analysed by pulsed-field gel electrophoresis (PFGE).Results/Key findings. Hand hygiene adherence increased from 34.9 % during the baseline period to 80.6 % in the last 3 months of this study. The HCAI rate decreased from 7.54 to 6.46/1000 patient-days (P=0.004). The central line-associated bloodstream infection (CLABSIs) rate fell from 4.84 to 3.66/1000 central line-days (P=0.05). Negative correlations between hand hygiene and HCAIs rates were identified. The attack rate of MDR-ESKAPE group bloodstream infections decreased from 0.54 to 0.20/100 discharges (P=0.024). MRSA pulsotypes that were prevalent during the baseline period were no longer detected after the 5th quarter, although new strains were identified. CONCLUSIONS A multimodal hand hygiene programme in a paediatric hospital in a middle-income country was effective in improving adherence and reducing HCAIs, CLABSIs and MDR-ESKAPE bloodstream infections. Sustaining hand hygiene adherence at a level of >60 % for one year limited MRSA clonal transmission.
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Affiliation(s)
- Daniela De la Rosa-Zamboni
- 1Departamento de Epidemiología. Hospital Infantil de México Federico Gómez. Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Sara A Ochoa
- 2Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Almudena Laris-González
- 1Departamento de Epidemiología. Hospital Infantil de México Federico Gómez. Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Ariadnna Cruz-Córdova
- 2Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Gerardo Escalona-Venegas
- 2Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Georgina Pérez-Avendaño
- 1Departamento de Epidemiología. Hospital Infantil de México Federico Gómez. Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Margarita Torres-García
- 1Departamento de Epidemiología. Hospital Infantil de México Federico Gómez. Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Roselia Suaréz-Mora
- 1Departamento de Epidemiología. Hospital Infantil de México Federico Gómez. Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Carmen Castellanos-Cruz
- 3Laboratorio Central de Bacteriología, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Yadhira V Sánchrez-Flores
- 1Departamento de Epidemiología. Hospital Infantil de México Federico Gómez. Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Adalberto Vázquez-Flores
- 1Departamento de Epidemiología. Hospital Infantil de México Federico Gómez. Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Rosalinda Águila-Torres
- 1Departamento de Epidemiología. Hospital Infantil de México Federico Gómez. Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Israel Parra-Ortega
- 3Laboratorio Central de Bacteriología, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Miguel Klünder-Klünder
- 4Subdirección de Investigación, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - José Arellano-Galindo
- 5Departamento de Infectología, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
| | - Rigoberto Hernández-Castro
- 6Departamento de Ecología de Agentes Patógenos, Hospital General Dr. Manuel Gea González, Tlalpan, 14080, Ciudad de México, México
| | - Juan Xicohtencatl-Cortes
- 2Laboratorio de Investigación en Bacteriología Intestinal, Hospital Infantil de México Federico Gómez, Dr. Márquez 162, Col. Doctores, Cuauhtémoc 06720. Ciudad de México, México
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Handler training improves decontamination of working canines with oil-based exposure in field conditions using disposable kits. J Vet Behav 2018; 29:4-10. [PMID: 30397397 DOI: 10.1016/j.jveb.2018.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Exposure to contaminants in the field is a reality for deployed canines. To date, there is no data evaluating the benefits of training for handlers associated with canine decontamination efforts. The objective of our work was to investigate the impact of handler training on the reduction of oil-based contaminants in working canines. Canine teams (n = 10) were randomly assigned to either TRAINED or UNTRAINED groups. Each team (handler and dog) in the TRAINED group received 30-minutes of interactive training using an illustrated guide on proper utilization of equipment provided. Teams in the UNTRAINED group received the same equipment and illustrated guide but no interactive training. Decontamination efforts were measured using an oil-based pseudo-contaminant (GloGerm®, Moab, UT) topically applied to four anatomical locations: cranial neck, between the shoulder blades, left medial hindlimb and left hind paw with pre- and post-washing images collected from a fixed distance of 20 inches. Visual assessment of contaminant reduction was scored as follows: 0 = <24% contaminant reduction; 1 = 25-50% contaminant reduction; 2 = 51-75% contaminant reduction; and 3 = >76% contaminant reduction. No score discrepancies >1 were reported between reviewers. Trained handlers were more effective at contamination reduction (P = .0093) as compared to their untrained counterparts. These results indicate that handlers, when properly trained, can achieve reduction of oil-based contaminants with a disposable decontamination kit and a garden hose.
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Laskar AM, R D, Bhat P, Pottakkat B, Narayan S, Sastry AS, Sneha R. A multimodal intervention to improve hand hygiene compliance in a tertiary care center. Am J Infect Control 2018; 46:775-780. [PMID: 29753498 DOI: 10.1016/j.ajic.2017.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a major threat to patient safety worldwide. HAIs are mainly transmitted via the hands of healthcare workers (HCWs), and HCW compliance with hand hygiene (HH) practices is reportedly low. Therefore, multimodal interventions are needed to develop effective HH improvement strategies. In this study, we assessed the effect of multimodal interventions on improvement of HH compliance. METHODS This study was conducted in 2 intensive care units from August 2016 to October 2016. It encompassed 3 phases: pre-intervention (20 days), intervention (1 month), and post-intervention (20 days). A total of 53 HCWs, including physicians, nurses, and housekeeping staff, were included in the HH audit. The audit was analyzed by direct observation and by a completed knowledge, attitude, and practice (KAP) questionnaire. RESULTS A total of 6350 HH opportunities were recorded; the results were 34.7%, 35%, and 69.7% for hand hygiene complete adherence rate (HHCAR), hand hygiene partial adherence rate (HHPAR), and hand hygiene adherence rate (HHAR), respectively. The HHCAR in the pre-intervention and post-intervention phases were 3% and 70.1%, respectively. HHCAR was highest among nurses (3.6% in the pre-intervention phase and 80.7% in the post-intervention phase). Other findings were that senior physicians had better HH compliance than junior physicians; in the pre-intervention phase, the HHCAR was better in the evening (4.8%); in the post-intervention phase, the HHCAR was better in the morning (72.1%); women had a higher HHCAR than men; and in the pre-intervention phase, good compliance was seen with Moments 2 and 3 of the World Health Organization's (WHO) Five Moments for Hand Hygiene, whereas in the post-intervention phase, good compliance was seen with Moments 3, 4, and 5. Questionnaire-based data were also analyzed to assess KAP of HH. We found that only 55%-82% of HCWs were aware of the WHO's Five Moments for Hand Hygiene. In the post-intervention phase, we observed a significant improvement in KAP of the study group. CONCLUSION Significant improvement in HH compliance can be achieved through a systematic, multidimensional intervention involving all types of HCWs.
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Hoang D, Khawar N, George M, Gad A, Sy F, Narula P. Video didactic at the point of care impacts hand hygiene compliance in the neonatal intensive care unit (NICU). J Healthc Risk Manag 2018; 37:9-15. [PMID: 29405485 DOI: 10.1002/jhrm.21314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To increase the hand-washing (HW) duration of staff and visitors in the NICU to a minimum of 20 seconds as recommended by the CDC. METHODS Intervention included video didactic triggered by motion sensor to play above wash basin. Video enacted Centers for Disease Control and Prevention (CDC) HW technique in real time and displayed timer of 20 seconds. HW was reviewed from surveillance video. Swabs of hands plated and observed for qualitative growth (QG) of bacterial colonies. RESULTS In visitors, the mean HW duration at baseline was 16.3 seconds and increased to 23.4 seconds at the 2-week interval (p = .003) and 22.9 seconds at the 9-month interval (p < .0005). In staff, the mean HW duration at baseline was 18.4 seconds and increased to 29.0 seconds at 2-week interval (p = .001) and 25.7 seconds at the 9-month interval (p < .0005). In visitors, HW compliance at baseline was 33% and increased to 52% at the 2-week interval (p = .076) and 69% at the 9-month interval (p = .001). In staff, HW compliance at baseline was 42% and increased to 64% at the 2-week interval (p = .025) and 72% at the 9-month interval (p = .001). Increasing HW was significantly associated with linear decrease in bacterial QG. CONCLUSIONS The intervention significantly increased mean HW time, compliance with a 20-econd wash time and decreased bacterial QG of hands and these results were sustained over a 9-month period.
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Affiliation(s)
- Danthanh Hoang
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Nayaab Khawar
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Maria George
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Ashraf Gad
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Farrah Sy
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Pramod Narula
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
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Phan HT, Tran HTT, Tran HTM, Dinh APP, Ngo HT, Theorell-Haglow J, Gordon CJ. An educational intervention to improve hand hygiene compliance in Vietnam. BMC Infect Dis 2018. [PMID: 29514595 PMCID: PMC5840927 DOI: 10.1186/s12879-018-3029-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Hand hygiene compliance is the basis of infection control programs. In developing countries models to improve hand hygiene compliance to reduce healthcare acquired infections are required. The aim of this study was to determine hand hygiene compliance following an educational program in an obstetric and gynecological hospital in Vietnam. Methods Health care workers from neonatal intensive care, delivery suite and a surgical ward from Hung Vuong Hospital, Ho Chi Minh City, Vietnam undertook a 4-h educational program targeting hand hygiene. Compliance was monitored monthly for six months following the intervention. Hand hygiene knowledge was assessed at baseline and after six months of the study. Results There were 7124 opportunities over 370 hand hygiene recording sessions with 1531 opportunities at baseline and 1620 at 6 months following the intervention. Hand hygiene compliance increased significantly from baseline across all sites (43.6% [95% Confidence interval CI: 41.1–46.1] to 63% [95% CI: 60.6–65.3]; p < 0.0001). Health care worker hand hygiene compliance increased significantly after intervention (p < 0.0001). There were significant improvements in knowledge scores from baseline to 2 months post educational intervention with mean difference standard deviations (SD): 1.5 (2.5); p < 0.001). Conclusions A simple educational model was implemented in a Vietnamese hospital that revealed good hand hygiene compliance for an extended period of time. Hand hygiene knowledge increased during the intervention. This hand hygiene model could be used in developing countries were resources are limited.
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Affiliation(s)
| | | | | | | | | | - Jenny Theorell-Haglow
- Department of Medical Sciences; Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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IMPACT OF HAND HYGIENE TRAINING MODULE AMONG HEALTHCARE PROVIDERS WORKING IN NEONATAL INTENSIVE CARE UNIT: A BEFORE AND AFTER TRIAL. ACTA ACUST UNITED AC 2018. [DOI: 10.32677/ijch.2018.v05.i04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lam SKK, Kwong EWY, Hung MSY, Pang SMC, Chiang VCL. Nurses' preparedness for infectious disease outbreaks: A literature review and narrative synthesis of qualitative evidence. J Clin Nurs 2018; 27:e1244-e1255. [PMID: 29193397 DOI: 10.1111/jocn.14210] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the core components that constitute nurses' preparedness in an epidemic event. BACKGROUND Healthcare service providers have worked to augment efforts to protect the public from the impact of epidemic events. While constituting the major healthcare taskforce, nurses are frequently tasked with fronting the response to an infectious disease outbreak. Given the crucial role of nurses in the management of prevailing epidemics, the constituents of their preparedness in epidemic events should be identified. DESIGN A systematic search was undertaken to identify eligible studies from the literature. A narrative synthesis approach was employed to extract and synthesise findings of the reviewed qualitative studies. METHODS Seven qualitative studies on nurses' experience and perceptions of epidemic events were examined for scientific quality using the Critical Appraisal Skills Programme Qualitative Checklist. Findings of these studies were synthesised adopting a narrative synthesis approach. RESULTS Three interplaying themes were identified as follows: (i) personal resources, (ii) workplace resources and (iii) situational influences. The findings suggest that an effective epidemic outbreak response would require further effort to reinforce the interplay between individual nurses, healthcare institutions and the governments. CONCLUSIONS The practical interplay among individual nurses, healthcare institutions and the governments is crucial in establishing an effective epidemic response. Further research on the understanding of the dynamic process of preparedness development is recommended to set future directions in research. RELEVANCE TO CLINICAL PRACTICE This study offers important insights for devising future strategies in enhancing nurses' preparedness and response to an epidemic event. These include recommendations on providing education and training to nurses regarding infectious diseases, fostering institutional assistance and support in an outbreak and revising government policies and planning.
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Affiliation(s)
- Stanley K K Lam
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Enid W Y Kwong
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | | | - Samantha M C Pang
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Vico C L Chiang
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
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Sass L, Karlowicz MG. Healthcare-Associated Infections in the Neonate. PRINCIPLES AND PRACTICE OF PEDIATRIC INFECTIOUS DISEASES 2018. [PMCID: PMC7152335 DOI: 10.1016/b978-0-323-40181-4.00094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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