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Boyce JM. Hand and environmental hygiene: respective roles for MRSA, multi-resistant gram negatives, Clostridioides difficile, and Candida spp. Antimicrob Resist Infect Control 2024; 13:110. [PMID: 39334403 PMCID: PMC11437781 DOI: 10.1186/s13756-024-01461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Healthcare-associated infections (HAIs) caused by multidrug-resistant organisms (MDROs) represent a global threat to human health and well-being. Because transmission of MDROs to patients often occurs via transiently contaminated hands of healthcare personnel (HCP), hand hygiene is considered the most important measure for preventing HAIs. Environmental surfaces contaminated with MDROs from colonized or infected patients represent an important source of HCP hand contamination and contribute to transmission of pathogens. Accordingly, facilities are encouraged to adopt and implement recommendations included in the World Health Organization hand hygiene guidelines and those from the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America/Association for Professionals in Infection Control and Epidemiology. Alcohol-based hand rubs are efficacious against MDROs with the exception of Clostridiodes difficile, for which soap and water handwashing is indicated. Monitoring hand hygiene adherence and providing HCP with feedback are of paramount importance. Environmental hygiene measures to curtail MDROs include disinfecting high-touch surfaces in rooms of patients with C. difficile infection daily with a sporicidal agent such as sodium hypochlorite. Some experts recommend also using a sporicidal agent in rooms of patients colonized with C. difficile, and for patients with multidrug-resistant Gram-negative bacteria. Sodium hypochlorite, hydrogen peroxide, or peracetic acid solutions are often used for daily and/or terminal disinfection of rooms housing patients with Candida auris or other MDROs. Products containing only a quaternary ammonium agent are not as effective as other agents against C. auris. Portable medical equipment should be cleaned and disinfected between use on different patients. Detergents are not recommended for cleaning high-touch surfaces in MDRO patient rooms, unless their use is followed by using a disinfectant. Facilities should consider using a disinfectant instead of detergents for terminal cleaning of floors in MDRO patient rooms. Education and training of environmental services employees is essential in assuring effective disinfection practices. Monitoring disinfection practices and providing personnel with performance feedback using fluorescent markers, adenosine triphosphate assays, or less commonly cultures of surfaces, can help reduce MDRO transmission. No-touch disinfection methods such as electrostatic spraying, hydrogen peroxide vapor, or ultraviolet light devices should be considered for terminal disinfection of MDRO patient rooms. Bundles with additional measures are usually necessary to reduce MDRO transmission.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 214 Hudson View Terrace, Hyde Park, NY, USA.
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2
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Delpont M, Chavoix C, Fourtune L, Durivage A, Guérin JL, Vaillancourt JP, Paul MC. Making the invisible visible: Effectiveness of a training program to increase awareness and biosecurity compliance in poultry barn anterooms, using glowing substances. Prev Vet Med 2024; 233:106349. [PMID: 39317119 DOI: 10.1016/j.prevetmed.2024.106349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 09/18/2024] [Accepted: 09/20/2024] [Indexed: 09/26/2024]
Abstract
Biosecurity is the cornerstone of prevention strategies to limit infectious pathogen spread between poultry farms. However, poor compliance of biosecurity measures is often observed when entering or exiting barns. The lack of knowledge, understanding, risk perception or technical skill are often described for anteroom-related biosecurity errors (i.e., not respecting anteroom zoning in relation to changing boots, clothing, and hand sanitation). In this study, we designed and assessed the efficacy of an intervention aiming at improving biosecurity compliance in anterooms, using substances glowing under ultraviolet light, which mimic microbiological contamination. Training exercises offered in a single session were proposed to 145 participants with an interest in animal farming (veterinary students, agricultural students, poultry farmers and poultry farm advisors). The exercises' efficacy was assessed by measuring the change in attitude and intentions of participants about specific biosecurity measures. The participants' attitudes and intentions were quantified using a questionnaire before and after training. The change in score was assessed in a multivariate linear regression model to measure the effect of various parameters on this change. The attitudes and intentions of participants were statistically improved (p < 0.05) and were affected by the initial attitude and intention score, the gender of the participants and the status of the participant (type of student or activity in the poultry industry). The use of this exercise material, perceived as playful and engaging, could be included in the framework of biosecurity training for all stakeholders of the poultry industry.
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Affiliation(s)
- Mattias Delpont
- IHAP, Université de Toulouse, INRAE, ENVT, Toulouse, France.
| | - Chloé Chavoix
- IHAP, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - Lisa Fourtune
- IHAP, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - André Durivage
- Department of Administrative Science, Université du Québec en Outaouais, Gatineau, QC, Canada
| | | | - Jean-Pierre Vaillancourt
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, St-Hyacinthe, QC, Canada
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Yousif Mohamed AM, Muhammed A, Mohammed Hamed FJ, Ibrahim Algak AM, Abdelrhim Attaelmanan EE, Ahmed Abdalla AS, Modawy Alkheder MA, Awad MSA. Implementing an Internal Audit: Evaluating Hand Scrub Compliance in a Tertiary Care Hospital. Cureus 2024; 16:e64778. [PMID: 39156340 PMCID: PMC11330165 DOI: 10.7759/cureus.64778] [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] [Accepted: 07/09/2024] [Indexed: 08/20/2024] Open
Abstract
Background Aseptic protocol adherence and sterilization are the most important factors in a patient's satisfactory recovery after surgery. The standard hand scrubbing procedure helps control infection and keeps the surgical site clean by adhering to aseptic principles. Methods Thirty-six young residents and house officers participated in this prospective audit after ethical clearance was obtained. The World Health Organization (WHO) standard criteria were adhered to both before and after the intervention. Participants were observed in the surgical operation theatre (OT) without prior notice to ensure hand hygiene compliance before surgical procedures. The intervention included a video presentation as well as a live demonstration. Results Only 64.41% (n=23) of residents and house officers followed the recommended standard hand hygiene procedures before the intervention. This percentage rose to 93.92% (n=33) following the intervention, suggesting a noteworthy improvement. Conclusion Significant changes in the acceptance rates for the essential requirements of hand hygiene were observed after the evaluation in the second cycle. Adhering to WHO guidelines for procedures will help reduce the risk of infections and promote awareness of asepsis in practice.
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Boyce JM, Pittet D. Rinse, gel, and foam - is there any evidence for a difference in their effectiveness in preventing infections? Antimicrob Resist Infect Control 2024; 13:49. [PMID: 38730473 PMCID: PMC11084031 DOI: 10.1186/s13756-024-01405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Following publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs). METHODS Data regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted. RESULTS The amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs. CONCLUSIONS Current evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.
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Affiliation(s)
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Guerrero-Soler M, Gras-Valentí P, Gómez-Sotero IL, Platas-Abenza G, Silva-Afonso RDF, Benito-Miralles CM, Fuster-Pérez M, Cartagena-Llopis L, Sánchez-Valero M, Sánchez-Payá J, Chico-Sánchez P. Impact of COVID-19 on the degree of compliance with hand hygiene: a repeated cross-sectional study. Epidemiol Infect 2024; 152:e69. [PMID: 38557427 PMCID: PMC11077604 DOI: 10.1017/s0950268824000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024] Open
Abstract
Hand hygiene (HH) is the paramount measure used to prevent healthcare-associated infections. A repeated cross-sectional study was undertaken with direct observation of the degree of compliance on HH of healthcare personnel during the SARS-CoV-2 pandemic. Between, 2018-2019, 9,083 HH opportunities were considered, and 5,821 in 2020-2022. Chi squared tests were used to identify associations. The crude and adjusted odds ratios were used along with a logistic regression model for statistical analyses. Compliance on HH increased significantly (p < 0.001) from 54.5% (95% CI: 53.5, 55.5) to 70.1% (95% CI: 68.9, 71.2) during the COVID-19 pandemic. This increase was observed in four of the five key moments of HH established by the World Health Organization (WHO) (p < 0.05), except at moment 4. The factors that were significantly and independently associated with compliance were the time period considered, type of healthcare-personnel, attendance at training sessions, knowledge of HH and WHO guidelines, and availability of hand disinfectant alcoholic solution in pocket format. Highest HH compliance occurred during the COVID-19 pandemic, reflecting a positive change in healthcare-personnel's behaviour regarding HH recommendations.
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Affiliation(s)
- Maria Guerrero-Soler
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Paula Gras-Valentí
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Isel Lilibeth Gómez-Sotero
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Guillermo Platas-Abenza
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Raissa de Fátima Silva-Afonso
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Carmen-María Benito-Miralles
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Marina Fuster-Pérez
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Lidia Cartagena-Llopis
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María Sánchez-Valero
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Sánchez-Payá
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pablo Chico-Sánchez
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
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6
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Park SY, Kim J, Lee E, Park S, Park JW, Yu SN, Kim T, Jeon MH, Choo EJ, Kim TH. Gender differences in psychosocial determinants of hand hygiene among physicians. Infect Control Hosp Epidemiol 2024; 45:215-220. [PMID: 37791517 PMCID: PMC10877538 DOI: 10.1017/ice.2023.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/30/2023] [Accepted: 07/30/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE We investigated gender differences in psychosocial determinants that affect hand hygiene (HH) performance among physicians. DESIGN The survey included a structured questionnaire with 7 parts: self-assessment of HH execution rate; knowledge, attitude, and behavior regarding HH; internal and emotional motivation for better HH; barriers to HH; need for external reminders; preference for alcohol gel; and embarrassment due to supervision. SETTING The study was conducted across 4 academic referral hospitals in Korea. PARTICIPANTS Physicians who worked at these hospitals were surveyed. METHODS The survey questionnaire was sent to 994 physicians of the hospitals in July 2018 via email or paper. Differences in psychosocial determinants of HH among physicians were analyzed by gender using an independent t test or the Fisher exact test. RESULTS Of the 994 physicians, 201 (20.2%) responded to the survey. Among them, 129 (63.5%) were men. Male physicians identified 4 barriers as significant: time wasted on HH (P = .034); HH is not a habit (P = .004); often forgetting about HH situations (P = .002); and no disadvantage when I do not perform HH (P = .005). Female physicians identified pain and dryness of the hands as a significant obstacle (P = .010), and they had a higher tendency to feel uncomfortable when a fellow employee performed inadequate HH (P = .098). Among the respondents, 26.6% identified diversifying the types of hand sanitizers as their first choice for overcoming barriers to improving HH, followed by providing reminders (15.6%) and soap and paper towels in each hospital room (13.0%). CONCLUSION A significant difference in the barriers to HH existed between male and female physicians. Promoting HH activities could help increase HH compliance.
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Affiliation(s)
- Se Yoon Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jaewoong Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sunghee Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jung-Wan Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Shi Nae Yu
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Tark Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Min Hyok Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Eun Ju Choo
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Plitman E, Kim E, Patel R, Kohout S, Jin R, Chan V, Dinsmore M. Development of an Automated and Scalable Virtual Assistant to Aid in PPE Adherence: A Study with Implications for Applications within Anesthesiology. J Med Syst 2023; 48:7. [PMID: 38157145 DOI: 10.1007/s10916-023-02028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
Virtual assistants (VAs) are conversational agents that are able to provide cognitive aid. We developed a VA device for donning and doffing personal protective equipment (PPE) procedures and compared it to live human coaching to explore the feasibility of using VAs in the anesthesiology setting. An automated, scalable, voice-enabled VA was built using the Amazon Alexa device and Alexa Skills application. The device utilized voice-recognition technology to allow a touch-free interactive user experience. Audio and video step-by-step instructions for proper donning and doffing of PPE were programmed and displayed on an Echo Show device. The effectiveness of VA in aiding adherence to PPE protocols was compared to traditional human coaching in a randomized, controlled, single-blinded crossover design. 70 anesthesiologists, anesthesia assistants, respiratory therapists, and operating room nurses performed both donning and doffing procedures, once under step-by-step VA instructional guidance and once with human coaching. Performance was assessed using objective performance evaluation donning and doffing checklists. More participants in the VA group correctly performed the step of "Wash hands for 20 seconds" during both donning and doffing tests. Fewer participants in the VA group correctly performed the steps of "Put cap on and ensure covers hair and ears" and "Tie gown on back and around neck". The mean doffing total score was higher in the VA group; however, the donning score was similar in both groups. Our study demonstrates that it is feasible to use commercially available technology to create a voice-enabled VA that provides effective step-by-step instructions to healthcare professionals.
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Affiliation(s)
- Eric Plitman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Edward Kim
- Department of Computer Sciences, Drexel University, Philadelphia, USA
| | - Rajesh Patel
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Seema Kohout
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Rongyu Jin
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Vincent Chan
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Dinsmore
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
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Keene R, Chatterjee P, Jinadatha C, Williams M. Using a handheld UV device for disinfection in the patient care environment: A descriptive qualitative study. Nurs Health Sci 2023; 25:556-562. [PMID: 37640509 DOI: 10.1111/nhs.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/15/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Frontline nurses play a critical role in the prevention of healthcare-acquired infections (HAIs) through daily practices of hand hygiene and decontamination of surfaces. Despite these practices, environmental contamination and HAIs persist. Emerging use of UV light at wavelengths safe for human exposure provides additional strategies for disinfecting the patient care environment. The purpose of this qualitative study is to explore frontline nursing feedback regarding a novel handheld UV device prototype. A convenience sample of nurses were invited to participate in facilitated individual or small group discussions led by one member of the research team. Thematic analysis of discussion transcripts was completed by two members of the research team. Sixteen registered nurses participated. Four themes found in the study were time considerations, complexity, safety (patient and nurse), and characteristics of technology to improve patient care. Findings suggest that while nursing staff are willing to use technology, it must be considered valuable to patient care and should not hinder the provision of care. Inclusion of inputs from nursing staff for development of technology identifies potential barriers to acceptance and use in the practice environment.
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Affiliation(s)
- Robin Keene
- Central Texas Veterans Research Foundation, Temple, Texas, USA
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9
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Razzaque MS. Healthcare-associated infections in the context of the pandemic. FRONTIERS IN HEALTH SERVICES 2023; 3:1288033. [PMID: 38089543 PMCID: PMC10713836 DOI: 10.3389/frhs.2023.1288033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/10/2023] [Indexed: 05/31/2024]
Affiliation(s)
- Mohammed S. Razzaque
- Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, United States
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10
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Rutala WA, Weber DJ. Disinfection, sterilization and antisepsis: Principles, practices, current issues, new research and new technologies. Am J Infect Control 2023; 51:A1-A2. [PMID: 37890938 DOI: 10.1016/j.ajic.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 10/29/2023]
Affiliation(s)
- William A Rutala
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Hospitals, Chapel Hill, NC
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11
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Boyce JM. Current issues in hand hygiene. Am J Infect Control 2023; 51:A35-A43. [PMID: 37890952 DOI: 10.1016/j.ajic.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Multiple aspects of hand hygiene have changed in recent years. METHODS A PubMed search was conducted to identify recent articles about hand hygiene. RESULTS The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. CONCLUSIONS Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, CT, USA.
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12
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Duncombe TR, Garrod M, Wang X, Ng J, Lee E, Short K, Tan K. Risk factors associated with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission, outbreak duration, and mortality in acute-care settings. Infect Control Hosp Epidemiol 2023; 44:1643-1649. [PMID: 36815248 PMCID: PMC10587374 DOI: 10.1017/ice.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in acute-care settings affects patients, healthcare workers, and the healthcare system. We conducted an analysis of risk factors associated with outbreak severity to inform prevention strategies. METHODS This cross-sectional analysis of COVID-19 outbreaks was conducted at Fraser Health acute-care sites between March 2020 and March 2021. Outbreak severity measures included COVID-19 attack rate, outbreak duration, and 30-day case mortality. Generalized linear models with generalized estimating equations were used for all outcome measures. A P value of 0.05 indicated statistical significance. Analyses were performed using SAS version 3.8 software, R version 4.1.0 software, and Stata version 16.0 software. RESULTS Between March 2020 and March 2021, 54 COVID-19 outbreaks were declared in Fraser Health acute-care sites. Overall, a 10% increase in the hand hygiene rate during the outbreak resulted in an 18% decrease in the attack rate (P < .01), 1 fewer death (P = .03), and shorter outbreaks (P < .01). A 10-year increase in unit age was associated with 2.2 additional days of outbreak (P < 0.01) and increases in the attack rate (P < .05) and the number of deaths (P < .01). DISCUSSION We observed an inverse relationship between increased hand hygiene compliance during outbreaks and all 3 severity measures. Increased unit age was also associated with increases in each of the severity measures. CONCLUSION This study highlights the importance of hand hygiene practices during an outbreak and the difficulties faced by older facilities, many of which have infrastructural challenges. The latter reinforces the need to incorporate infection control standards into healthcare planning and construction.
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Affiliation(s)
- Tamara R. Duncombe
- Infection Prevention and Control, Fraser Health, Surrey, British Columbia, Canada
| | - Matthew Garrod
- Infection Prevention and Control, Fraser Health, Surrey, British Columbia, Canada
| | - Xuetao Wang
- Infection Prevention and Control, Fraser Health, Surrey, British Columbia, Canada
| | - Joyce Ng
- Infection Prevention and Control, Fraser Health, Surrey, British Columbia, Canada
| | - Eunsun Lee
- Infection Prevention and Control, Fraser Health, Surrey, British Columbia, Canada
| | - Katy Short
- Infection Prevention and Control, Fraser Health, Surrey, British Columbia, Canada
| | - Kennard Tan
- Department of Pathology and Laboratory Medicine, Fraser Health, Surrey, British Columbia, Canada
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13
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Siju J, Anagboso U, Vernet E, Moss M, Javaid W, Cassano K. Implementation of a quality improvement project using the patient as the observer to improve hand hygiene compliance in ambulatory care practices. J Hosp Infect 2023; 140:34-39. [PMID: 37562594 DOI: 10.1016/j.jhin.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Monitoring hand hygiene compliance in the ambulatory setting remains a challenge because a healthcare trained observer loses line of sight once the examination room door closes. This quality improvement project focused on the implementation of a hand hygiene compliance improvement programme that is amenable to the routines and work flows of the ambulatory setting. METHODS After a review of the literature, nursing leadership and infection prevention implemented the 'patient as the observer' hand hygiene programme across 32 ambulatory practices. RESULTS Patients completed 281,000 observations with an overall compliance rate of ≥90%. The average overall compliance rate by role was 91% for providers, 89% for nurses, and 91% for medical assistants/technicians/others. A 92% compliance average was noted 'before caring for you' and 89% 'after caring for you' for providers, 90% and 87% for nurses, and 92% and 89% for medical assistants/technicians/others. DISCUSSION This study demonstrated that the implementation of a hand hygiene compliance improvement programme using the patient as the observer can be adopted successfully in the ambulatory setting. CONCLUSION Hand hygiene compliance can be monitored effectively in the ambulatory setting with the involvement of the patient as the observer.
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Affiliation(s)
- J Siju
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA.
| | - U Anagboso
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
| | - E Vernet
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
| | - M Moss
- Infection Prevention and Control, Mount Sinai Health System, New York, USA
| | - W Javaid
- Infection Prevention and Control, Mount Sinai Health System, New York, USA
| | - K Cassano
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
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Park SY, Park S, Lee E, Jeong YS, Kim JH, Oh SM, Cheong S, Park H, Jo S, Kim TH. Steady amelioration of institutional hand hygiene behavior among health care personnel after 12-year consistent intervention. Am J Infect Control 2023; 51:1023-1027. [PMID: 36736385 DOI: 10.1016/j.ajic.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Institutional hand hygiene (HH) behavior is difficult to monitor and improve consistently, especially over long periods. This study aimed to investigate the long-term effects of HH promotion activities. METHOD We launched the HH promotion team in 2010 and conducted interventions including goal setting, observation and feedback, education, reward incentives, and accountability. Optimal HH compliance rates were calculated based on adherence to all 6-step HH technique and appropriate time recommended by the World Health Organization. HH and optimal HH compliance were calculated over 12 years. Poisson regression analysis was used to determine the trend in HH compliance according to year. RESULTS In 2010, HH and optimal HH compliance were 59.7% and 15.6%, respectively. HH compliance increased by 83.9% in 2013 and remained over 75%. HH compliance increased significantly, with a relative risk (RR) of 1.014 (95% CI 1.002-1.025, P = .018). Optimal HH compliance increased by 67.8% in 2013 and remained over 60%, except in 2016 (58.8%) and 2019 (59.8%). Optimal HH compliance increased with RR 1.033 (95% CI 0.991-1.076, P = .123). DISCUSSION HH and optimal HH compliance increased significantly over the 12 years when subgroup analysis was performed by job category. CONCLUSIONS HH promotion team activities improved and maintained optimal HH compliance among HCWs.
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Affiliation(s)
- Se Yoon Park
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea; Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea; Centers for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Republic of Korea; Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
| | - Yeon Su Jeong
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jin Hwa Kim
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sun Mi Oh
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sojin Cheong
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyein Park
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - SoYea Jo
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
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15
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Zhang X, Ma Y, Kong L, Li Y, Wang J, Li N, Xia Y, Wang P, Zhang M, Liu L, Zhang D, Wen L, Wang S, Liu Z, Yue X, Wang J, Zhang T, Meng X. The impact of COVID-19 pandemic on hand hygiene compliance of healthcare workers in a tertiary hospital in East China. Front Med (Lausanne) 2023; 10:1160828. [PMID: 37425301 PMCID: PMC10324029 DOI: 10.3389/fmed.2023.1160828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Hand hygiene is a cost-effective measure to reduce healthcare-associated infections (HAIs) in healthcare facilities. The impact of the coronavirus disease 2019 (COVID-19) pandemic on hand hygiene performance (HHP) provided evidence for targeted hand hygiene intervention measures. Methods This study evaluated the HHP rate in a tertiary hospital before and after the COVID-19 outbreak. HHP was checked by infection control doctors or nurses every day, and they inputted the HHP rate to the full-time infection control staff every week. A random examination of HHP was conducted by a confidential worker every month. The HHP of healthcare workers (HCWs) was monitored in the outpatient department, inpatient ward, and operating room from January 2017 to October 2022. The influence of COVID-19 prevention and control strategies on HHP was elucidated by analyzing the results of HHP during the study period. Results The average HHP rate of HCWs was 86.11% from January 2017 to October 2022. The HHP rate of HCWs after the COVID-19 pandemic was statistically significantly higher than that before the pandemic (P < 0.001). The HHP rate was the highest (93.01%) in September 2022 when the local epidemic occurred. Among the different occupation categories, medical technicians showed the highest HHP rate (89.10%). The HHP rate was the highest after contact with body fluids or blood of patients (94.47%). Conclusion The HHP rate of HCWs in our hospital showed an increasing trend in the recent 6 years, especially during the COVID-19 pandemic, and the increase was most obvious during the local epidemic.
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Frödin M, Rogmark C, Nellgård B, Gillespie BM, Wikström E, Andersson AE. Interactive Interventions Can Improve Hand Hygiene and Aseptic Techniques During Perioperative Care-Experience From the "Safe Hands" Project. J Perianesth Nurs 2023; 38:284-290. [PMID: 36319520 DOI: 10.1016/j.jopan.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation. DESIGN This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention. METHODS The primary outcome was differences in HH practices "Before aseptic/clean procedure" (WHO moment 2), "After body fluid exposure risk" (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017. FINDINGS The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P = .014), WHO 3; from 22.2% to 42.3%, (P = .002), and aseptic techniques; from 17.5% to 31.6%, (P = .003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department. CONCLUSIONS This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care.
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Affiliation(s)
- Maria Frödin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden; Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden.
| | - Cecilia Rogmark
- Department of Orthopedics Malmö, Lund University, Skane University Hospital, Lund, Skane, Sweden; The Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Västra Götalandregionen, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Västra Götalandregionen, Sweden
| | - Brigid M Gillespie
- NMHRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University, Griffith, Queensland, Australia; Health Service, Gold Coast University Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ewa Wikström
- School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
| | - Annette E Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götalandregionen, Sweden
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17
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SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:355-376. [PMID: 36751708 PMCID: PMC10015275 DOI: 10.1017/ice.2022.304] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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18
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Viola GM, Szvalb AD, Malek AE, Chaftari AM, Hachem R, Raad II. Prevention of device-related infections in patients with cancer: Current practice and future horizons. CA Cancer J Clin 2023; 73:147-163. [PMID: 36149820 PMCID: PMC9992006 DOI: 10.3322/caac.21756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Over the past several years, multifaceted advances in the management of cancer have led to a significant improvement in survival rates. Throughout patients' oncological journeys, they will likely receive one or more implantable devices for the administration of fluids and medications as well as management of various comorbidities and complications related to cancer therapy. Infections associated with these devices are frequent and complex, often necessitating device removal, increasing health care costs, negatively affecting quality of life, and complicating oncological care, usually leading to delays in further life-saving cancer therapy. Herein, the authors comprehensively review multiple evidence-based recommendations along with best practices, expert opinions, and novel approaches for the prevention of diverse device-related infections. The authors present many general principles for the prevention of these infections followed by specific device-related recommendations in a systematic manner. The continuous involvement and meaningful cooperation between regulatory entities, industry, specialty medical societies, hospitals, and infection control-targeted interventions, along with primary care and consulting health care providers, are all vital for the sustained reduction in the incidence of these preventable infections.
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Affiliation(s)
- George M Viola
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ariel D Szvalb
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre E Malek
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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19
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Si Ali A, Cherel O, Brehaut P, Garrait V, Lombardin C, Schortgen F, Constan A, Lanceleur F, El-Assali A, Poullain S, Jung C. Impact of COVID-19 pandemic waves on health-care worker hand hygiene activity in department of medicine and ICU as measured by an automated monitoring system. Infect Dis Health 2022; 28:95-101. [PMID: 36641288 PMCID: PMC9760610 DOI: 10.1016/j.idh.2022.11.003] [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: 08/15/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hand hygiene (HH) compliance among health-care workers is important for preventing transmission of infectious diseases. AIM To describe health-care worker hand hygiene activity in ICU and non-ICU patients' rooms, using an automated monitoring system (AMS), before and after the onset of the COVID-19 pandemic. METHODS At the Intercommunal Hospital of Créteil, near Paris, France, alcohol-based hand sanitizer (ABHS) consumption in the Department of Medicine (DM) and ICU was recorded using an AMS during four periods: before, during, and after the first wave of the COVID-19 pandemic, and during its second wave. FINDINGS From 1st February to 30th November 2020, in the DM, the mean number of doses per patient-day for each of the four periods was, respectively, 5.7 (±0.3), 19.4 (±1.3), 17.6 (±0.7), and 7.9 (±0.2, P < 0.0001). In contrast, ICU ABHS consumption remained relatively constant. In the DM, during the pandemic waves, ABHS consumption was higher in rooms of COVID-19 patients than in other patients' rooms. Multivariate analysis showed ABHS consumption was associated with the period in the DM, and with the number of HCWs in the ICU. CONCLUSION An AMS allows real-time collection of ABHS consumption data that can be used to adapt training and prevention measures to specific hospital departments.
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Affiliation(s)
- Amine Si Ali
- Department of Infection Prevention and Control, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France,Corresponding author
| | - Olivia Cherel
- Department of Infection Prevention and Control, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | - Paula Brehaut
- Department of Infection Prevention and Control, Centre Hospitalier Intercommunal de Créteil (CHIC), Créteil, France
| | | | | | | | | | | | | | | | - Camille Jung
- Clinical Research Centre, CHIC, Créteil, France,Corresponding author
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20
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Observational bias within a hospital-wide hand hygiene program. Infect Control Hosp Epidemiol 2022; 43:1942-1944. [PMID: 34530944 DOI: 10.1017/ice.2021.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We assessed the extent to which healthcare workers report more favorable hand hygiene rates when observing members of their own professional group versus other groups' observations of them. Healthcare workers consistently reported higher compliance rates for their own group compared to others' observations of them (97 vs 92%; P ≤ .001).
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21
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Fukushige M, Syue LS, Morikawa K, Lin WL, Lee NY, Chen PL, Ko WC. Trend in healthcare-associated infections due to vancomycin-resistant Enterococcus at a hospital in the era of COVID-19: More than hand hygiene is needed. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1211-1218. [PMID: 35989164 PMCID: PMC9357275 DOI: 10.1016/j.jmii.2022.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Variable control measures for vancomycin-resistant Enterococcus (VRE) infections were adopted among different hospitals and areas. We investigated the burden and patient characteristics of healthcare-associated VRE infections in 2018-2019 and 2020, when multiple preventive measures for COVID-19 were taken. METHODS During the COVID-19 pandemic, mask waring and hand hygiene were enforced in the study hospital. The incidence densities of healthcare-associated infections (HAIs), including overall HAIs, methicillin-resistant Staphylococcus aureus (MRSA) HAIs, VRE HAIs, and VRE healthcare-associated bloodstream infections (HABSIs), consumption of broad-spectrum antibiotics and hygiene products, demographic characteristics and medical conditions of affected patients, were compared before and after the pandemic. RESULTS The incidence density of both VRE HAIs and VRE HABSIs did not change statistically significantly, however, the highest in 2020 than that in 2018 and 2019. This was in spite of universal mask waring and increased consumption of 75% alcohol in 2020 and consistent implementation of an antibiotic stewardship program in three observed years. The increased prescriptions of broad-spectrum cephalosporins might partially explain the increase of VRE infection. CONCLUSION Increased mask wearing and hand hygiene may not result in the decline in the development of VRE HAIs in the hospital during the COVID-19 pandemic, and continued monitoring of the dynamics of HAIs remains indispensable.
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Affiliation(s)
- Mizuho Fukushige
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan,Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ling-Shang Syue
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Wen-Liang Lin
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Corresponding author. Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan, 704, Taiwan. Fax: +886 6 2752038
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22
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Al-Anazi S, Al-Dhefeery N, Al-Hjaili R, Al-Duwaihees A, Al-Mutairi A, Al-Saeedi R, Al-Dhaen R, Al-Rabiah S, Sharaf-Alddin R. Compliance with hand hygiene practices among nursing staff in secondary healthcare hospitals in Kuwait. BMC Health Serv Res 2022; 22:1325. [PMID: 36348401 PMCID: PMC9640802 DOI: 10.1186/s12913-022-08706-8] [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: 06/24/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hand hygiene (HH) among healthcare workers, especially nurses, is the main preventive measure to control healthcare associated infections but compliance with hand hygiene (CwHH) remains low in various settings including Kuwait. This study aimed to assess the knowledge of, attitudes towards, and CwHH among nursing staff in secondary care hospitals in Kuwait. Methods A cross-sectional study was conducted on nursing staff in all six secondary care hospitals in Kuwait. Data on knowledge of, attitudes towards, and self-reported CwHH were collected through a self-administered questionnaire that was developed based on WHO’s questionnaire, while the data on actual compliance were objectively collected through direct observation of nurses during routine care by two independent observers using WHO’s observation form. Results Of 829 nurses approached, 765 (92.2%) responded and participated. Of all participants, 524 (68.5%) were able to list “My Five Moments for Hand Hygiene” fully and appropriately. However, several misconceptions (e.g. air circulation in hospital is the main route of infection) about HH were found among the nurses. CwHH was (25.0%) by direct observation while self-reported compliance was (69.5%) each varied significantly (p < 0.001) between different hospitals. Female nurses compared to male nurses and non-Arab compared to Arab nationalities were more likely to report CwHH in multivariable analysis. Several items on knowledge of and attitudes towards HH were also associated with self-reported CwHH. Conclusion Observed CwHH among nursing staff in secondary care hospitals in Kuwait was low, which highlights the need to make more efforts to improve HH practices. Interventions that have been used elsewhere and found to be effective may be tested in Kuwait. Despite the good overall knowledge on HH among nurses, there are several misconceptions that need to be corrected.
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23
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Croke L. Strategies to Improve Hand Hygiene Compliance. AORN J 2022; 116:P4-P6. [PMID: 36165673 DOI: 10.1002/aorn.13800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022]
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Direct hand hygiene observations and feedback increased hand hygiene compliance among nurses and doctors in medical and surgical wards - an eight-year observational study. J Hosp Infect 2022; 127:83-90. [PMID: 35724953 DOI: 10.1016/j.jhin.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The improvement of hand hygiene compliance (HHC) is critical to preventing healthcare-associated infections (HCAIs). The present study explored how direct observation and feedback influences HHC among nurses and doctors in surgical and medical wards, and whether these actions impact HCAI incidence. METHODS In this longitudinal observational study, HHC and the incidence of HCAIs were observed in six medical and seven surgical wards in a tertiary hospital in Finland from May 2013 to Dec 2020. Data of the observations of five hand hygiene (HH) moments were collected from the hospital HH and the HCAI monitoring registries. For statistical analyses a multivariable logistic regression analysis and a Poisson regression model were used. FINDINGS HH monitoring included 24 614 observations among nurses and 6 396 observations among doctors. In medical wards, HHC rates increased 10.8% - from 86.2% to 95.5%, and HCAI incidence decreased from 15.9 to 13.5 per 1000 patient days (p<0.0001). In surgical wards, HHC increased 32.7% - from 67.6% to 89.7%, and HCAI incidence decreased from 13.7 to 12.0 per 1000 patient days (p< 0.0001). The overall HHC increased significantly among nurses (17.8%) and doctors (65.8%). The HHC was better among nurses than doctors (in medical wards; OR 3.36; 95% CI 2.90-3.90, p<0.001 and in surgical wards; OR 9.85; 95% CI 8.97-10.8, p<0.001). CONCLUSION Direct observations and feedback of HH increased significantly HHC among nurses and doctors over an eight-year period. During the same period, the incidence of HCAIs significantly decreased in both medical and surgical wards.
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Abu TZ, Elliott SJ. The critical need for WASH in emergency preparedness in health settings, the case of COVID-19 pandemic in Kisumu Kenya. Health Place 2022; 76:102841. [PMID: 35667223 PMCID: PMC9149240 DOI: 10.1016/j.healthplace.2022.102841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022]
Abstract
The devastating effects of inadequate basic utilities such as water, sanitation, hygiene, waste management and environmental cleaning (WASH) is underscored by the current global pandemic declared on March 11, 2020. This paper explores the experiences of key informants (n = 15) ie government and non-government organization officials on the impacts of the COVID-19 pandemic in health care facilities (HCFs) and the role of WASH in emergency preparedness in health settings and the communities they serve using Kisumu, Kenya as a case study. The results from interviews with the key informants indicate socioecological challenges shaping access to hygiene services in HCFs and related disparities in social determinants of health such as WASH that serve as barriers to the pandemic response. All participants indicated the healthcare system was ill-prepared for the pandemic. Health care workers experienced such severe psychosocial impacts due to the lack of preparedness that they subsequently embarked on strikes in protest. These situations influenced citizens' perceptions of the COVID-19 pandemic as a hoax and resulted in a surge in other population health indicators (e.g., increased maternal mortality; decreased vaccination rates for other illnesses such as measles). We recommend authentic partnerships among all stakeholders to develop and implement context-driven sustainable solutions that integrate WASH and emergency preparedness in HCFs and the communities they serve across all spatial scales, from the global to the local.
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Affiliation(s)
- Thelma Zulfawu Abu
- Department of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3GI, Canada; Department of Geography, Geomatics and Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON, L5L 1C6, Canada.
| | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3GI, Canada.
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Abstract
Zusammenfassung
Hintergrund und Zielstellung
Eine hohe Händehygiene-Compliance (HHC) ist eine effektive Maßnahme zur Prävention von nosokomialen Infektionen. Die WHO empfiehlt direkte Beobachtungen als Goldstandard, um die HHC zu stratifizieren. Hohe Compliance-Raten bei der chirurgischen Händedesinfektion legen eine hohe Gesamt-Compliance im OP-Bereich nahe. Zahlen zur hygienischen Händedesinfektion im OP sind allerdings rar. Ziel war es, die HHC systematisch zu beobachten und durch maßgeschneiderte Interventionen zu steigern.
Methode
Um die HHC in den Jahren 2017 und 2018 zu erfassen, wurde ein Beobachtungsbogen genutzt. Chirurgen und Op.-Pflege sowie Anästhesisten und Anästhesiepflege wurden erfasst. Für die Erprobung einer maßgeschneiderten Intervention wurden 2 OP-Bereiche ausgewählt. Zur Überprüfung der Effektivität erfolgten nur in einem OP-Bereich eine maßgeschneiderte Fortbildung und sog. Compliance-Begleitungen mit direktem Feedback durch die Hygienefachkräfte. In dem anderen OP-Bereich erfolgte keine Intervention.
Ergebnis
Über 1500 Indikationen zur Händehygiene wurden in den Jahren 2017 und 2018 im operativen Bereich erfasst. Die Gesamt-Compliance der Interventionsgruppe konnte im Beobachtungszeitraum von 40 auf 75 % gesteigert werden (p < 0,001). Die Gesamt-Compliance der Kontrollgruppe veränderte sich nicht signifikant (48 auf 55 %; p = 0,069).
Diskussion
Durch die hohe Compliance-Rate bei der chirurgischen Händedesinfektion entstand die Annahme, die Compliance bei der hygienischen Händedesinfektion sei ebenfalls auf einem hohen Niveau. Im Rahmen der Feedbackgespräche zeigte sich, dass die Mitarbeiter nicht wussten, dass die Indikationen der „5 Momente der Händehygiene“ auch im OP anzuwenden seien, und zeigten somit ihr Unwissen über die assoziierten Indikationen.
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Wang Y, Yang J, Qiao F, Feng B, Hu F, Xi ZA, Wu W, Ni ZL, Liu L, Yuan Y. Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis. Am J Infect Control 2022; 50:563-571. [PMID: 34883162 PMCID: PMC8648372 DOI: 10.1016/j.ajic.2021.11.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hand hygiene (HH) is a cost-effective measure to reduce health care-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among health care providers during the COVID-19 pandemic provided evidence for targeted HH intervention measures. AIM To systematically review the literature and conduct a meta-analysis of studies investigating the rate of HHC and the characteristics of HH during the COVID-19 pandemic. METHODS The PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were searched. All the original articles with valid HHC data among health care providers during the COVID-19 pandemic (from January 1, 2020 to October 1, 2021) were included. Meta-analysis was performed using a DerSimonian and Laird model to yield a point estimate and a 95% CI for the HHC rate. The heterogeneity of the studies was evaluated using the Cochrane Q test and I2 statistics and a random-effects model was used to contrast between different occupations, the WHO 5-moments of HH and different observation methods. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. FINDINGS Seven studies with 2,377 health care providers reporting HHC were identified. The estimated overall HHC was 74%, which was higher than that reported in previous studies (5%-89%). Fever clinic has become a new key place for HHC observation. Nurses had the highest HHC (80%; 95% CI:74%-87%) while auxiliary workers (70%; 95%CI:62%-77%) had the lowest. For the WHO 5-moments, the health care providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%-94%), while before contact with patient's health care providers had the lowest HHC (68%; 95% CI:62%-74%) which was consistent with before the pandemic. There existed great HHC differences among different monitoring methods (automatic monitoring system:53%; 95% CI:44%-63% versus openly and secretly observation: 91%; 95% CI: 90%-91%). CONCLUSIONS During the COVID-19 pandemic, the compliance of health care providers' HH showed a great improvement. The fever clinics have become the focused departments for HH monitoring. The HHC of auxiliary workers and the HH opportunity for "before contact with patients" should be strengthened. In the future, it will be necessary to develop standardized HH monitoring tools for practical work.
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Affiliation(s)
- Ying Wang
- Department of Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China; Institute of Hospital Management, Wuhan University, Wuhan, Hubei, P. R. China
| | - Jinru Yang
- Cancer Center of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Fu Qiao
- Infection Prevention and Control Department, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Bilong Feng
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China; Clinical Research Center of Hubei Critical Care Medicine, Wuhan, Hubei, P. R. China
| | - Zi-Ang Xi
- School of Architecture, Tsinghua University, Beijing, P. R. China
| | - Wenwen Wu
- School of Public Health and Management, Hubei University of Medicine, Shiyan, China
| | - Zi-Ling Ni
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Li Liu
- School of Architecture, Tsinghua University, Beijing, P. R. China.
| | - Yufeng Yuan
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.
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Aouthmany S, Mehalik H, Bailey M, Pei M, Syed S, Brickman K, Morrison K, Khuder S. Use of ultraviolet light in graduate medical education to assess confidence among residents and fellows in handwashing instruction. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e65. [PMID: 36483347 PMCID: PMC9726597 DOI: 10.1017/ash.2021.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/26/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has made it imperative to focus on strategies to improve hand hygiene to minimize threats of viral transmission in hospitals. OBJECTIVE We investigated the potential of using ultraviolet (UV) light as a visual tool in hand-hygiene education to bring awareness of individual handwashing effectiveness to healthcare workers. METHODS In 2020, 117 individuals participated in the simulation and completed surveys on proper handwashing technique. Of these, 114 were first-year residents and fellows. Surveys of confidence in hand hygiene were obtained before and after formal hand-hygiene education utilizing UV light with Glo Germ lotion. The UV light and Glo Germ lotion were used to identify deficiencies in individual handwashing technique. RESULTS With a total response rate of 97.4%, first-year residents and fellows demonstrated a significant decrease in handwashing confidence in pre- and posteducation surveys. Study participants who had had formal hand-hygiene training in the previous 3 years also indicated confidence in hand hygiene similar to those who had not had previous hand-hygiene training. Conclusions: Overall, resident interns and fellows may have falsely elevated their hand-hygiene confidence levels. However, conclusions regarding the confidence of residents and fellows individually could not be made due to sample size. Many healthcare personnel practice improper handwashing techniques, which may be improved with education and training that includes UV light.
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Affiliation(s)
- Shaza Aouthmany
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Haley Mehalik
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Morgan Bailey
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Mitchell Pei
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Sameer Syed
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | | | - Kayla Morrison
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Sadik Khuder
- Department of Biostatistics and Epidemiology, University of Toledo, Toledo, Ohio
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Gebremeskel Kanno G, Diriba K, Getaneh B, Melaku A, Eshete Soboksa N, Agyemang-Badu SY, Negassa B, Alembo A, Tesfu Legesse M, Cherenet A, Genoro Abire B, Birhanie Aregu M. Effective Handwashing Practice in Dilla University Referral Hospital; Duration of Hand Rubbing and the Amount of Water as Key Enablers. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221093481. [PMID: 35465143 PMCID: PMC9021515 DOI: 10.1177/11786302221093481] [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: 01/02/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
Background Ineffective hand hygiene in healthcare settings is a global challenge that is associated with a high rate of nosocomial infections. The study aimed to measure the effectiveness of handwashing at Dilla University referral hospital. Method This study consisted of 2 parts; the survey work and laboratory analysis. A total of 63 participants were selected to take surveys using an interviewer-administered questionnaire to collect the data regarding the socio-demographic and hand hygiene-related practices. A laboratory tests (swab test) was used to assess handwashing effectiveness from 63 participants by taking 126 swab test (63 before and after hand washing sessions). A swab test was collected from the palms of each participant before and after hand washing using a sterile technique. The cultures were then incubated aerobically overnight at 37°C, and examined for microbial growth. The bacterial load was reported as the number of colony-forming units (CFU). Result The proportion of effective hand washing in Dilla University Referral Hospital was 82.5%. The mean colony-forming unit before and after handwashing were 55 and 2 CFU/ml, respectively with an average reduction of 94.6% in terms of CFU/ml. The mean amount of water used for effective handwashing was 336.03 (±219.46) ml. There was a significant mean difference in the amount of water used and duration of hand rubbing between effective and non-effective handwashing among the participants (P < 0.01). The bacterial load before and after handwashing indicated that there was a significant (53.3 mean CFU) reduction in bacterial load after handwashing practice which indicated that the handwashing intervention in the Referral hospital was effective (P < 0.01). Conclusion The proportion of effective Hand washing in Dilla University referral Hospital was 82.5% with a 94.6% reduction in terms of (CFU/ml). The amount of water use and the duration of hand rubbing showed a significant difference in the reduction of the microbial load.
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Affiliation(s)
- Girum Gebremeskel Kanno
- Department of Environmental Health, College of Health and Medical sciences, Dilla University, Ethiopia
| | - Kuma Diriba
- Department of Medical Microbiology, College of Health and Medical Science, Dilla University, Ethiopia
| | - Birtukan Getaneh
- Department of Biology, College of Natural and Computational Science, Dilla University, Ethiopia
| | - Abayneh Melaku
- Water Resource Institute, Addis Ababa University, Ethiopia
| | - Negasa Eshete Soboksa
- Department of Environmental Health, College of Health and Medical sciences, Dilla University, Ethiopia
| | - Samuel Yaw Agyemang-Badu
- College of Health – Yamfo, Department of Community Health, Ministry of Health Training Institution, Sunyani-Yamfo, Ghana
| | - Belay Negassa
- Department of Environmental Health, College of Health and Medical sciences, Dilla University, Ethiopia
| | - Awash Alembo
- Department of Environmental Health, College of Health and Medical sciences, Dilla University, Ethiopia
| | - Miheret Tesfu Legesse
- School of Public Health, collage of Health and Medical Sciences, Dilla University, Ethiopia
| | - Aneley Cherenet
- Department of Midwifery, College of Health and Medical sciences, Dilla University, Ethiopia
| | - Belayneh Genoro Abire
- Department of Statistics, College of Natural and Computational sciences, Dilla University, Ethiopia
| | - Mekonnen Birhanie Aregu
- Department of Environmental Health, College of Health and Medical sciences, Dilla University, Ethiopia
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Vilhelmsson A, Sant'Anna A, Wolf A. Nudging healthcare professionals to improve treatment of COVID-19: a narrative review. BMJ Open Qual 2021; 10:e001522. [PMID: 34887299 PMCID: PMC8662583 DOI: 10.1136/bmjoq-2021-001522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/25/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Andreas Vilhelmsson
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Occupational and Environmental Medicine, Lund University Faculty of Medicine, Lund, Sweden
| | | | - Axel Wolf
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Jia H, Zhang Y, Ye J, Xu W, Xu Y, Zeng W, Liao W, Chen T, Cao J, Wu Q, Zhou T. Outbreak of Multidrug-Resistant OXA-232-Producing ST15 Klebsiella pneumoniae in a Teaching Hospital in Wenzhou, China. Infect Drug Resist 2021; 14:4395-4407. [PMID: 34729016 PMCID: PMC8554319 DOI: 10.2147/idr.s329563] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/13/2021] [Indexed: 12/29/2022] Open
Abstract
Background OXA-232-producing carbapenem-resistant Klebsiella pneumoniae (CRKP) has the potential to become the "third epidemic" of carbapenem-resistant Klebsiella strain after KPC-2 and NDM in China. We investigated the first outbreak of CRKP in the First Affiliated Hospital of Wenzhou Medical University. Methods We collected 610 clinical isolates of CRKP from the First Affiliated Hospital of Wenzhou Medical University between January 2019 and September 2020 and screened them by Polymerase Chain Reaction (PCR). The multilocus sequence typing and pulsed-field gel electrophoresis were used to determine the genetic relatedness of the strains. The antimicrobial susceptibility test was performed to determine the drug resistance of the clinical isolates. The molecular mechanism underlying carbapenem resistance was elucidated by performing PCR and conjugation experiments. The virulence potential of the strains was determined by the string test, detection of virulence-associated genes and capsular serotypes, and Galleria mellonella larval infection model. Results Between September 2019 and May 2020, 26 OXA-232-producing CRKP were obtained from 12 patients in our hospital. Ten patients were hospitalized in the intensive care units (ICU) and the overall mortality of the inpatients involved in the outbreak was 50% (6/12). Epidemiological investigations reported that all the OXA-232-producing CRKP strains belonged to the sequence type ST15 and can be clonally transmitted among the inpatients in the ICU. All the strains had low virulence and were resistant to commonly used clinical antibiotics except for ceftazidime/avibactam, colistin, and tigecycline. The OXA-232-producing CRKP was sensitive to triclosan and chlorhexidine, and its eradication from our hospital can be achieved by the use of disinfectants in the ICU. Conclusion In our study, OXA-232-producing CRKP isolates appeared to be clonally transmitted and the sequence type ST15 was responsible for the outbreak. Therefore, effective measurements for the infection control of CRKP are urgently needed to prevent its epidemic in the nearby region in the future.
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Affiliation(s)
- Huaiyu Jia
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Ying Zhang
- Department of Medical Laboratory Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Jianzhong Ye
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Wenya Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Ye Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Weiliang Zeng
- Department of Medical Laboratory Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Wenli Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Tao Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Jianming Cao
- Department of Medical Laboratory Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Qing Wu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
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Mouajou V, Adams K, DeLisle G, Quach C. HAND HYGIENE COMPLIANCE IN THE PREVENTION OF HOSPITAL ACQUIRED INFECTIONS: A SYSTEMATIC REVIEW. J Hosp Infect 2021; 119:33-48. [PMID: 34582962 DOI: 10.1016/j.jhin.2021.09.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Healthcare worker's (HCW) hands are known to be a primary source of transmission of hospital-acquired infections (HAIs). Thus, practicing hand hygiene (HH) and adhering to HH guidelines are both expected to decrease the risk of transmission but there is no consensus on the optimal hand hygiene compliance (HHC) rate that HCWs should aim for. AIM The objective of this study was to systematically review the published literature to determine an optimal threshold of HCW HHC rate associated with the lowest incidence rate of HAIs. METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We searched online databases using a comprehensive search criterion for randomized controlled trials and non-randomized controlled studies, investigating the impact of HCW's HHC rate on HAI rates in patients of all ages, within healthcare facilities in high income countries. FINDINGS Of the 8,093 articles citations and abstracts screened, 35 articles were included in the review. Most studies reported overall HAIs per 1000 patient-days and device-associated HAIs per 1000 device-days. Most studies reported HHC rates between 60%-70%. Lower incidence HAI rates seemed to be achieved with HHC rates of approximately 60%. Studies included were not originally designed to assess the impact of HHC on HAI rates but risk of bias was assessed as per our predetermined exposure and outcome criterion. 11 (31%) of studies were deemed at low risk of bias. CONCLUSIONS Although HHC is part of HCW's code of conduct, very high HHC rates were difficult to reach. In observational studies, HHC and HAI followed a negative relationship up to about 60%. Due to flaws in study design, causality could not be inferred; only general trends could be discussed. Given the limitations, there is a need for high-quality evidence to support the implementation of specified targets of HHC rates.
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Affiliation(s)
- V Mouajou
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada
| | - K Adams
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - G DeLisle
- Research Centre, CHU Sainte-Justine, Montreal, QC, Canada
| | - C Quach
- Department of Microbiology, Infectious Disease and Immunology, University of Montreal, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada; Infection Prevention and Control, CHU Sainte-Justine, Montreal, QC, Canada.
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Calcagni N, Venier AG, Nasso R, Broc G, Ardichen E, Jarrige B, Parneix P, Quintard B. Barriers and facilitators on hand hygiene and hydro-alcoholic solutions' use: representations of health professionals and prevention perspectives. Infect Prev Pract 2021; 3:100169. [PMID: 34522880 PMCID: PMC8426555 DOI: 10.1016/j.infpip.2021.100169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Healthcare-associated infections pose a serious problem in terms of health and mortality. Their prevention is a necessity, and healthcare professionals are one of their main vectors. Thus, they must be at the centre of preventative strategies. As hydro-alcoholic solutions (alcohol-based hand rub) represent the most effective means of preventing these infections, it is necessary to identify the representations, barriers, and facilitators of their use. Method Forty-six healthcare professionals from two areas in France, New Aquitaine and Guadeloupe, were questioned about their practices through semi-structured registered interviews and four focus groups. Each interview and focus group were transcribed then analysed through lexicometric and thematic content analyses. Results The interviewed identified several barriers and facilitators related to the composition and characteristics of hydro-alcoholic solutions (unpleasantness, harmfulness, personal preferences for other hand hygiene products), personal factors (work habits, cognitive bias, lack of knowledge and communication) and organizational (professional constraints, product accessibility, financial resources). Conclusion Strategies to prevent healthcare-associated infections should be constructed with consideration of psychosocial facilitators and barriers for healthcare professionals in using hydro-alcoholic solutions. These strategies should also ensure that they are well informed about the effectiveness of alcohol-based solutions, through prevention campaigns and scientific articles. This awareness should equally be conveyed with educational tools that involve healthcare professionals and use the social dynamics of their work environment.
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Affiliation(s)
- Nicolas Calcagni
- INSERM U1219 équipe Handicap, Activité, Cognition, Santé, Université de Bordeaux, Bordeaux, F-33000, France
| | - Anne-Gaëlle Venier
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Nouvelle-Aquitaine, CHU de Bordeaux, Bordeaux, F-33000, France
| | - Raymond Nasso
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Iles de Guadeloupe, Pointe à Pitre, F-97100, France
| | - Guillaume Broc
- Unité Dynamique des capacités humaines et des conduites de santé, Université Paul-Valéry Montpellier 3, Montpellier, F-34000, France
| | - Eva Ardichen
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Nouvelle-Aquitaine, CHU de Bordeaux, Bordeaux, F-33000, France
| | - Bruno Jarrige
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Iles de Guadeloupe, Pointe à Pitre, F-97100, France
| | - Pierre Parneix
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Nouvelle-Aquitaine, CHU de Bordeaux, Bordeaux, F-33000, France
| | - Bruno Quintard
- INSERM U1219 équipe Handicap, Activité, Cognition, Santé, Université de Bordeaux, Bordeaux, F-33000, France
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Abstract
Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 62 Sonoma Lane, Middletown, CT 06457, USA.
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35
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Osme SF, Souza JM, Osme IT, Almeida APS, Arantes A, Mendes-Rodrigues C, Gontijo Filho PP, Ribas RM. Financial impact of healthcare-associated infections on intensive care units estimated for fifty Brazilian university hospitals affiliated to the unified health system. J Hosp Infect 2021; 117:96-102. [PMID: 34461175 DOI: 10.1016/j.jhin.2021.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Studies show that healthcare-associated infections (HAIs) represent a crucial issue in healthcare and can lead to substantial economic impacts in intensive care units (ICUs). AIM To estimate direct costs associated with the most significant HAIs in 50 teaching hospitals in Brazil, affiliated to the unified health system (Sistema Único de Saúde: SUS). METHODS A Monte Carlo simulation model was designed to estimate the direct costs of HAIs; first, epidemiologic and economic parameters were established for each HAI based on a cohort of 949 critical patients (800 without HAI and 149 with); second, simulation based on three Brazilian prevalence scenarios of HAIs in ICU patients (29.1%, 51.2%, and 61.6%) was used; and third, the annual direct costs of HAIs in 50 university hospitals were simulated. FINDINGS Patients with HAIs had 16 additional days in the ICU, along with an extra direct cost of US$13.892, compared to those without HAIs. In one hypothetical scenario without HAI, the direct annual cost of hospital care for 26,649 inpatients in adult ICUs of 50 hospitals was US$112,924,421. There was an increase of approximately US$56 million in a scenario with 29.1%, and an increase of US$147 million in a scenario with 61.6%. The impact on the direct cost became significant starting at a 10% prevalence of HAIs, where US$2,824,817 is added for each 1% increase in prevalence. CONCLUSION This analysis provides robust and updated estimates showing that HAI places a significant financial burden on the Brazilian healthcare system and contributes to a longer stay for inpatients.
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Affiliation(s)
- S F Osme
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - J M Souza
- Institute of Geography, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - I T Osme
- York University, Gledon Campus, Toronto, Canada
| | - A P S Almeida
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - A Arantes
- Clinical Hospital, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - C Mendes-Rodrigues
- Institute of Medicine, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - P P Gontijo Filho
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil
| | - R M Ribas
- Institute of Biomedical Sciences, Federal University of Uberlândia, Uberlândia, MG, Brazil.
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Iversen AM, Stangerup M, From-Hansen M, Hansen R, Sode LP, Kostadinov K, Hansen MB, Calum H, Ellermann-Eriksen S, Knudsen JD. Light-guided nudging and data-driven performance feedback improve hand hygiene compliance among nurses and doctors. Am J Infect Control 2021; 49:733-739. [PMID: 33186676 PMCID: PMC7654366 DOI: 10.1016/j.ajic.2020.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 12/30/2022]
Abstract
Background Evidence-based practices to increase hand hygiene compliance (HHC) among health care workers are warranted. We aimed to investigate the effect of a multimodal strategy on HHC. Methods During this 14-month prospective, observational study, an automated monitoring system was implemented in a 29-bed surgical ward. Hand hygiene opportunities and alcohol-based hand rubbing events were measured in patient and working rooms (medication, utility, storerooms, toilets). We compared baseline HHC of health care workers across periods with light-guided nudging from sensors on dispensers and data-driven performance feedback (multimodal strategy) using the Student's t test. Results The doctors (n = 10) significantly increased their HHC in patient rooms (16% vs 42%, P< .0001) and working rooms (24% vs 78%, P= .0006) when using the multimodal strategy. The nurses (n = 26) also increased their HHC significantly from baseline in both patient rooms (27% vs 43%, P = .0005) and working rooms (39% vs 64%, P< .0001). The nurses (n = 9), who subsequently received individual performance feedback, further increased HHC, compared with the period when they received group performance feedback (patient rooms: 43% vs 55%, P< .0001 and working rooms: 64% vs 80%, P< .0001). Conclusions HHC of doctors and nurses can be significantly improved with light-guided nudging and data-driven performance feedback using an automated hand hygiene system.
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Affiliation(s)
| | - Marie Stangerup
- Department of Quality and Education, Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
| | - Michelle From-Hansen
- Department of Quality and Education, Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
| | - Rosa Hansen
- Department of Orthopedic, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Louise Palasin Sode
- Department of Orthopedic, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | | | - Henrik Calum
- Department of Quality and Education, Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark; Department of Clinical Microbiology, Amager and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Effects of a 4-year intervention on hand hygiene compliance and incidence of healthcare associated infections: a longitudinal study. Infection 2021; 49:977-981. [PMID: 33988829 PMCID: PMC8120257 DOI: 10.1007/s15010-021-01626-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/06/2021] [Indexed: 01/02/2023]
Abstract
Purpose Studies have demonstrated improvements in hand hygiene (HH) compliance through interventions, noting the negative association of HH and healthcare associated infections (HAIs), but how to sustain long-term improvement is still unknown in the Chinese population. This study sought to determine the extent of change in HH compliance after multimodal HH interventions, and to evaluate the relationship between that change and HAI incidence. Methods We conducted a longitudinal study in a general teaching hospital in China from 2017 to 2020. Trained investigators observed HH practices based on the World Health Organization’s 5 moments for HH. We identified the incidence of HAIs using semi-automated constant surveillance software. We used the Cochran–Mantel–Haenszel test to assess the secular trend of HH compliance and HAIs. The Spearman correlation coefficient (rs) was used to evaluate the relationship between the incidence of HAIs and compliance with HH. Results The study made 480,943 observations, where HH was occurring between 2017 and 2020. HH compliance increased from 68.90 to 91.76% during that period (Ptrend < 0.01), while the incidence of HAIs decreased from 1.10 to 0.91%. Compliance also increased for each moment type and for each healthcare worker (Ptrend < 0.01). Lower HH compliance was observed in before-patient contact and after contact with patient surroundings, and among interns and cleaners. We also observed a weak but statistically significant negative correlation between the monthly HH compliance and incidence of HAIs (rs = − 0.27; P = 0.037). Conclusions The multimodal HH implementation delivered sustained improvement in HH compliance, and this change was associated with a decline in the incidence of HAIs. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01626-5.
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Ragusa R, Marranzano M, Lombardo A, Quattrocchi R, Bellia MA, Lupo L. Has the COVID 19 Virus Changed Adherence to Hand Washing among Healthcare Workers? Behav Sci (Basel) 2021; 11:53. [PMID: 33920791 PMCID: PMC8071195 DOI: 10.3390/bs11040053] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
The aim of the study was to assess adherence to hand washing by healthcare workers (HCWs) and its variations over time in hospital wards. We wanted to check whether the pandemic had changed the behavior of HCWs. The study was conducted between 1 January 2015, and 31 December 2020. The HCWs were observed to assess their compliance with the Five Moments for Hand Hygiene. We described the percentage of adherence to World Health Organization (WHO) guidelines stratified per year, per specialty areas, per different types of HCWs. We also observed the use of gloves. Descriptive data were reported as frequencies and percentages. We observed 13,494 hand hygiene opportunities. The majority of observations concerned nurses who were confirmed as the category most frequently involved with patients. Hospital's global adherence to WHO guidelines did not change in the last six years. During the pandemic, the rate of adherence to the procedure increased significantly only in Intensive Care Unit (ICU). In 2020, the use of gloves increased in pre-patient contact. The hand-washing permanent monitoring confirmed that it is very difficult to obtain the respect of correct hand hygiene in all opportunities, despite the ongoing pandemic and the fear of contagion.
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Affiliation(s)
- Rosalia Ragusa
- Health Technology Assessment Committee, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95123 Catania, Italy
| | - Marina Marranzano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Via Santa Sofia, 87 95123 Catania, Italy; (M.M.); (L.L.)
| | - Alessandro Lombardo
- Committee for the Control of Hospital Infections, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95128 Catania, Italy;
| | - Rosalba Quattrocchi
- U.O. Health Education, University Hospital “G. Rodolico”, Via Santa Sofia, 78 95128 Catania, Italy;
| | - Maria Alessandra Bellia
- School of Specialization in Microbiology, University of Catania, Via Santa Sofia, 78 95123 Catania, Italy;
| | - Lorenzo Lupo
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Via Santa Sofia, 87 95123 Catania, Italy; (M.M.); (L.L.)
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Jia Q, Wang X, Yu X, Li Z, Che X, Shen J. Hand Hygiene Compliance and Influencing Factors Among Nursing Assistants in Nursing Homes. J Gerontol Nurs 2021; 47:45-52. [PMID: 34038250 DOI: 10.3928/00989134-20210310-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study explored compliance with hand hygiene and related influencing factors among nursing assistants (NAs) in nursing homes. A descriptive observational research design was used. Seven nursing homes in Chongqing, China, including hospital-affiliated, public, and private, were selected. A hand hygiene observation tool was used to assess NAs' (N = 237) hand hygiene practice (N = 2,370 opportunities). NAs' overall compliance rate was 3.6%: 6.8%, 3.1%, and 1.9% at hospital-affiliated, public, and private nursing homes, respectively. Compliance rate between two opportunities, after contact with residents and after contact with residents' surroundings, differed significantly (p = 0.002 and 0.038, respectively). The highest and lowest compliance rates occurred after bodily fluid exposure (8.3%; odds ratio [OR] = 0.37, 95% confidence interval [CI] [0.218, 0.627], p < 0.001) and before resident contact (1.2%; OR = 3.142, 95% CI [1.265, 7.805], p = 0.014), respectively. Working experience and educational background were the two major influencing factors for hand hygiene. It is urgent to improve NAs' hand hygiene accordingly. [Journal of Gerontological Nursing, 47(4), 45-52.].
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van Niekerk JM, Stein A, Doting MHE, Lokate M, Braakman-Jansen LMA, van Gemert-Pijnen JEWC. A spatiotemporal simulation study on the transmission of harmful microorganisms through connected healthcare workers in a hospital ward setting. BMC Infect Dis 2021; 21:260. [PMID: 33711939 PMCID: PMC7953685 DOI: 10.1186/s12879-021-05954-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 03/03/2021] [Indexed: 12/21/2022] Open
Abstract
Background Hand transmission of harmful microorganisms may lead to infections and poses a major threat to patients and healthcare workers in healthcare settings. The most effective countermeasure against these transmissions is the adherence to spatiotemporal hand hygiene policies, but adherence rates are relatively low and vary over space and time. The spatiotemporal effects on hand transmission and spread of these microorganisms for varying hand hygiene compliance levels are unknown. This study aims to (1) identify a healthcare worker occupancy group of potential super-spreaders and (2) quantify spatiotemporal effects on the hand transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance caused by this group. Methods Spatiotemporal data were collected in a hospital ward of an academic hospital using radio frequency identification technology for 7 days. A potential super-spreader healthcare worker occupation group was identified using the frequency identification sensors’ contact data. The effects of five probability distributions of hand hygiene compliance and three harmful microorganism transmission rates were simulated using a dynamic agent-based simulation model. The effects of initial simulation assumptions on the simulation results were quantified using five risk outcomes. Results Nurses, doctors and patients are together responsible for 81.13% of all contacts. Nurses made up 70.68% of all contacts, which is more than five times that of doctors (10.44%). This identifies nurses as the potential super-spreader healthcare worker occupation group. For initial simulation conditions of extreme lack of hand hygiene compliance (5%) and high transmission rates (5% per contact moment), a colonised nurse can transfer microbes to three of the 17 healthcare worker or patients encountered during the 98.4 min of visiting 23 rooms while colonised. The harmful microorganism transmission potential for nurses is higher during weeknights (5 pm – 7 am) and weekends as compared to weekdays (7 am – 5 pm). Conclusion Spatiotemporal behaviour and social mixing patterns of healthcare can change the expected number of hand transmissions and spread of harmful microorganisms by super-spreaders in a closed healthcare setting. These insights can be used to evaluate spatiotemporal safety behaviours and develop infection prevention and control strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05954-7.
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Affiliation(s)
- J M van Niekerk
- Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands. .,Department of Earth Observation Sciences, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands. .,Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - A Stein
- Department of Earth Observation Sciences, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
| | - M H E Doting
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Lokate
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L M A Braakman-Jansen
- Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands
| | - J E W C van Gemert-Pijnen
- Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands.,Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
Hand sanitizers have been developed as a convenient means to decontaminate an individual’s hands of bacterial pathogens in situations in which soap and water are not available. Yet to our knowledge, no study has compared the antibacterial efficacy of a large collection of hand sanitizers. Using zone of growth inhibition and kill curve assays, we assessed the performance of 46 commercially available hand sanitizers that were obtained from national chain big-box stores, gasoline stations, pharmacies, and boutiques for antibacterial activity toward prototypical Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacterial pathogens. Results revealed substantial variability in the efficacy of many sanitizers evaluated. Formulations following World Health Organization-recommended ingredients (80% ethanol or 75% isopropyl alcohol) or those including benzalkonium chloride as the active principal ingredient displayed excellent antibacterial activity, whereas others exhibited modest or poor activity in the assays performed. Results also revealed that E. coli was generally more susceptible to most sanitizers in comparison to S. aureus and that there was significant strain-to-strain variability in hand sanitizer antimicrobial efficacy regardless of the organism evaluated. Further, tests of a subset of hand sanitizers toward severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) revealed no direct correlation between antibacterial and antiviral performance, with all ethyl alcohol formulations performing equally well and displaying improved activity in comparison to benzalkonium chloride-containing sanitizer. Taken together, these results indicate that there is likely to be substantial variability in the antimicrobial performance of commercially available hand sanitizers, particularly toward bacterial pathogens, and a need to evaluate the efficacy of sanitizers under development. IMPORTANCE In response to the coronavirus disease 2019 (COVID-19) pandemic, hand hygiene has taken on a prominent role in efforts to mitigate SARS-CoV-2 transmission and infection, which has led to a radical increase in the number and types of hand sanitizers manufactured to meet public demand. To our knowledge, no studies have evaluated or compared the antimicrobial performance of hand sanitizers that are being produced under COVID-19 emergency authorization. Tests of 46 commercially available hand sanitizers purchased from national chain brick-and-mortar stores revealed considerable variability in their antibacterial performance toward two bacterial pathogens of immediate health care concern, S. aureus and E. coli. Expanded testing of a subset of hand sanitizers revealed no direct correlation between antibacterial performance of individual sanitizers and their activity toward SARS-CoV-2. These results indicate that as the pandemic subsides, there will be a need to validate the antimicrobial efficacy of sanitizers being produced.
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Afridayani M, Prastiwi YI, Aulawi K, Rahmat I, Nirwati H, Haryani. Relationship between hand hygiene behavior and Staphylococcus aureus colonization on cell phones of nurses in the intensive care unit. BELITUNG NURSING JOURNAL 2021; 7:24-30. [PMID: 37469800 PMCID: PMC10353620 DOI: 10.33546/bnj.1223] [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: 10/11/2020] [Revised: 11/10/2020] [Accepted: 01/10/2021] [Indexed: 07/21/2023] Open
Abstract
Background Healthcare-Associated Infections (HAIs) are infections that often occur in hospitals with Staphylococcus aureus as the primary cause. Staphylococcus aureus is usually found on nurses' hands and easily transferred by contact. Cell phones can be a convenient medium for transmitting bacteria. Accordingly, hand washing is one of the effective ways to prevent the transmission of Staphylococcus aureus. Objective This study aimed to determine the relationship between hand hygiene behavior and the colonization of Staphylococcus aureus on cell phones of nurses in the intensive care unit of the academic hospital. Methods This was an observational study with a cross-sectional design conducted from December 2019 to January 2020. The observations of hand hygiene behaviors were performed on 37 nurses selected using total sampling. Colonization of bacteria on each nurses' cell phone was calculated by swabbing the cell phones' surface. Colony counting was done using the total plate count method. Spearman Rank test and Mann Whitney test were used for data analysis. Results The nurses' hand hygiene behavior was 46.06%. Staphylococcus aureus colonization was found on 18.2% of the nurses' cell phones. However, there was no significant relationship between the nurses' hand hygiene behavior and the colonization of Staphylococcus aureus on their cell phones. Conclusion The hand hygiene behavior of nurses was still low, and there was evidence of Staphylococcus aureus colonization on their cell phones. As there was no relationship between the nurses' hand hygiene behavior with the colonization of Staphylococcus aureus on the cell phones, further research is needed to determine if there is an increase or decrease in colonization before and after regular observations.
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Affiliation(s)
- Meri Afridayani
- Master Program in Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yohana Ika Prastiwi
- Master Program in Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Khudazi Aulawi
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ibrahim Rahmat
- Department of Mental and Community Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hera Nirwati
- Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Haryani
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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The holy grail of hand hygiene compliance: Just-in-time peer coaching that leads to behavior change. Infect Control Hosp Epidemiol 2021; 41:229-232. [PMID: 31831091 DOI: 10.1017/ice.2019.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We describe the delivery of real-time feedback on hand hygiene compliance between healthcare personnel over a 3-year time period via a crowdsourcing web-based application. Feedback delivery as a metric can be used to examine and improve a culture of safety within a healthcare setting.
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Sahiledengle B, Tekalegn Y, Woldeyohannes D. The critical role of infection prevention overlooked in Ethiopia, only one-half of health-care workers had safe practice: A systematic review and meta-analysis. PLoS One 2021; 16:e0245469. [PMID: 33444417 PMCID: PMC7808611 DOI: 10.1371/journal.pone.0245469] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/03/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Effective infection prevention and control measures, such as proper hand hygiene, the use of personal protective equipment, instrument processing, and safe injection practicein the healthcare facilitiesare essential elements of patient safety and lead to optimal patient outcomes. In Ethiopia, findings regarding infection prevention practices among healthcare workers have been highly variable and uncertain. This systematic review and meta-analysis estimates the pooled prevalence of safe infection prevention practices and summarizesthe associated factors among healthcare workers in Ethiopia. METHODS PubMed, Science Direct, Google Scholar, and the Cochran library were systematically searched. We included all observational studies reporting the prevalence of safe infection prevention practices among healthcare workers in Ethiopia. Two authors independently extracted all necessary data using a standardized data extraction format. Qualitative and quantitative analyseswere employed. The Cochran Q test statistics and I2 tests were used to assess the heterogeneity of the studies. A random-effects meta-analysis model was used to estimate the pooled prevalence of safe infection prevention practice. RESULTS Of the 187 articles identified through our search, 10 studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of safe infection prevention practice in Ethiopia was 52.2% (95%CI: 40.9-63.4). The highest prevalence of safe practice was observed in Addis Ababa (capital city) 66.2% (95%CI: 60.6-71.8), followed by Amhara region 54.6% (95%CI: 51.1-58.1), and then Oromia region 48.5% (95%CI: 24.2-72.8), and the least safe practices were reported from South Nation Nationalities and People (SNNP) and Tigray regions with a pooled prevalence of 39.4% (95%CI: 13.9-64.8). In our qualitative syntheses, the odds of safe infection prevention practice were higher among healthcare workers who had good knowledge and a positive attitude towards infection prevention. Also, healthcare workers working in facilities with continuous running water supply, having infection prevention guideline, and those received training were significantly associated withhigher odds of safe infection prevention practice. CONCLUSIONS Infection prevention practices in Ethiopia was poor, with only half of the healthcare workers reporting safe practices. Further, the study found out that there were regional and professional variations in the prevalence of safe infection prevention practices. Therefore, the need to step-up efforts to intensify the current national infection prevention and patient safety initiative as key policy direction is strongly recommended, along with more attempts to increase healthcare worker's adherence towards infection prevention guidelines.
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Affiliation(s)
- Biniyam Sahiledengle
- Department of Public Health, MaddaWalabu University Goba Referral Hospital, Bale Goba, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, MaddaWalabu University Goba Referral Hospital, Bale Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, MaddaWalabu University Goba Referral Hospital, Bale Goba, Ethiopia
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Moore LD, Robbins G, Quinn J, Arbogast JW. The impact of COVID-19 pandemic on hand hygiene performance in hospitals. Am J Infect Control 2021; 49:30-33. [PMID: 32818577 PMCID: PMC7434409 DOI: 10.1016/j.ajic.2020.08.021] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/23/2023]
Abstract
Background Achieving high levels of hand hygiene compliance of health care personnel has been an ongoing challenge. The objective of this study was to examine the impact of the COVID-19 pandemic on hand hygiene performance (HHP) rates in acute care hospitals. Methods HHP rates were estimated using an automated hand hygiene monitoring system installed in 74 adult inpatient units in 7 hospitals and 10 pediatric inpatient units in 2 children's hospitals. A segmented regression model was used to estimate the trajectory of HHP rates in the 10 weeks leading up to a COVID-19-related milestone event (eg, school closures) and for 10 weeks after. Results Three effects emerged, all of which were significant at P < .01. Average HHP rates increased from 46% to 56% in the months preceding pandemic-related school closures. This was followed by a 6% upward shift at the time school closures occurred. HHP rates remained over 60% for 4 weeks before declining to 54% at the end of the study period. Conclusions Data from an automated hand hygiene monitoring system indicated that HHP shifted in multiple directions during the early stages of the pandemic. We discuss possible reasons why HHP first increased as the pandemic began and then decreased as it progressed.
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Alsaidan MS, Abuyassin AH, Alsaeed ZH, Alshmmari SH, Bindaaj TF, Alhababi AA. The Prevalence and Determinants of Hand and Face Dermatitis during COVID-19 Pandemic: A Population-Based Survey. Dermatol Res Pract 2020; 2020:6627472. [PMID: 33376481 PMCID: PMC7726962 DOI: 10.1155/2020/6627472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND During the current COVID-19 pandemic, prevention is the key to limiting the spread of this disease. The frequent handwashing and use of sanitizers resulted in notable skin changes among some individuals. The aim of the study was to determine the prevalence and determinants of the new onset of dermatitis during the COVID-19 pandemic in a university population from Saudi Arabia. METHODS A cross-sectional study was conducted using a self-administered online questionnaire by sending an invitation link to students and employees of Prince Sattam Bin Abdulaziz University in June 2020. A chi-squared test was used to note differences regarding hand and face dermatitis. RESULTS Of the total 2356 participants, 34.8% reported skin changes or symptoms over hands, and 15.3% reported skin changes on their face during this pandemic. 88.7% of the participants reported a change in handwashing habits during the COVID-19 pandemic, and 62.2% of participants were not using any hand sanitizers before COVID-19 but began using them during the pandemic. There were significantly higher percentage of skin conditions in females (on hands (ScH): 42.6% and face (ScF):19.2%), individuals working in environments requiring frequent handwashing (ScH: 40.3% vs. ScF: 17.2%), those working in facilities where they have to interact with people during the pandemic (ScH: 41.1% vs. ScF: 18.7%), those encountering COVID-19 patients (ScH: 48.6% vs. ScF: 24.8%), those exposed to chemicals (ScH: 48.6% vs. ScF: 24.8%), and healthcare workers (ScH: 51.3% vs. ScF: 24.3%). CONCLUSION It was found that during the pandemic, skin changes were common among the general population as well as among healthcare workers. The frequency of handwashing and the use of alcohol-based sanitizers were contributing factors for dermatitis. Although hygiene is an extremely important preventive measure in this pandemic, maintaining skin integrity is also vital. Appropriate knowledge and good practice can prevent dermatitis in this pandemic, with regular hydration of the skin being a key factor.
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Affiliation(s)
- Mohammed Saud Alsaidan
- Internal Medicine Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Doll M, Marra AR, Apisarnthanarak A, Al-Maani AS, Abbas S, Rosenthal VD. Prevention of Clostridioides difficile in hospitals: A position paper of the International Society for Infectious Diseases. Int J Infect Dis 2020; 102:188-195. [PMID: 33122100 DOI: 10.1016/j.ijid.2020.10.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
Clostridioides difficile infection is an increasing presence worldwide. Prevention is multipronged, reflecting a complex and evolving epidemiology. Multiple guidelines exist regarding the prevention of C. difficile infection in healthcare settings; however, existing guidelines do not address C. difficile in low- and middle-income countries (LMIC). Nevertheless, the prevalence of C. difficile in LMIC likely parallels, if not exceeds, that of high-income countries, and LMIC may experience additional challenges in C. difficile diagnosis and control. A panel of experts was convened by the International Society for Infectious Diseases (ISID) to review the current state of C. difficile infections globally and make evidence-based recommendations for infection prevention that are broadly applicable.
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Affiliation(s)
- Michelle Doll
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexandre R Marra
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Amal Saif Al-Maani
- Department of Infection Control and Prevention, Ministry of Health, Muscat, Oman
| | - Salma Abbas
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Victor D Rosenthal
- International Nosocomial Infection Control Consortium (INICC), Buenos Aires, Argentina
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Derksen C, Keller FM, Lippke S. Obstetric Healthcare Workers' Adherence to Hand Hygiene Recommendations during the COVID-19 Pandemic: Observations and Social-Cognitive Determinants. Appl Psychol Health Well Being 2020; 12:1286-1305. [PMID: 33016518 PMCID: PMC7675238 DOI: 10.1111/aphw.12240] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023]
Abstract
Background Hand hygiene is crucial to avoid healthcare‐associated infections and the transmission of COVID‐19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social‐cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers’ adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID‐19 pandemic. Methods In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods (pre‐COVID‐19 pandemic, heightened awareness, and strict precautions). In addition, 115 healthcare workers answered questionnaires regarding social‐cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations. Results Adherence to hand hygiene recommendations increased from 47 per cent pre‐COVID‐19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self‐efficacy was associated with the intention to sanitise hands (β = .397, p < .001). Coping self‐efficacy mediated the association of intention with hand hygiene adherence. Conclusions Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID‐19 pandemic. To further improve interventions, social‐cognitive determinants should be considered, especially intention and (coping) self‐efficacy.
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Manresa Y, Abbo L, Sposato K, de Pascale D, Jimenez A. Improving patients' hand hygiene in the acute care setting: Is staff education enough? Am J Infect Control 2020; 48:1100-1101. [PMID: 31926757 DOI: 10.1016/j.ajic.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/29/2022]
Abstract
Patients' hand hygiene (PHH) has been associated with reduction of healthcare-associated infections. We compared staff education about the importance of PHH versus providing patients with alcohol wipes for PHH. Our study found that staff education increased the percentage of patients reporting that they had been educated/encouraged to perform PHH but this intervention alone did not resulted in a statistically significant increase of the average frequency of PHH per day.
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Affiliation(s)
- Yanet Manresa
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Lilian Abbo
- Department of Infection Prevention and Control, Jackson Health System, Miami, FL; Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL
| | - Kathleen Sposato
- Department of Infection Prevention and Control, Jackson Health System, Miami, FL
| | - Dennise de Pascale
- Department of Infection Prevention and Control, Jackson Health System, Miami, FL
| | - Adriana Jimenez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL; Department of Infection Prevention and Control, Jackson Health System, Miami, FL.
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Healthcare workers' attitudes to how hand hygiene performance is currently monitored and assessed. J Hosp Infect 2020; 105:705-709. [DOI: 10.1016/j.jhin.2020.05.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
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