A creative yet simple approach to improve hand hygiene compliance in the pediatric intensive care unit

Background Hand hygiene compliance can be difficult to improve as this prospective activity may not come to mind easily during busy clinical operations. Clinicians are often driven by clinical goals under time pressure, and the sudden recall to clean hands can either be disruptive or too late. Using patient zones as a reference has been known to be helpful. A low-tech solution of taping patient zones on the floor was introduced in a children’s intensive care unit. Coupled with this demarcation is a simplified protocol that uses patient zones for “just-in-time” reminders. Clinicians now clean their hands whenever they cross zone lines, namely “ before patient zone” and “ after patient zone”, along with “ before aseptic procedure” and “ after bodily fluids exposure”. Methods The mandatory national quarterly hand hygiene surveillance data for children’s intensive care unit and the entire hospital was tracked. Seven pre-intervention and seven post-intervention quarters were compared for improvement and sustainability. Results Overall, children’s intensive care unit hand hygiene compliance rose from an average of 77% to 90%, as well as physicians' hand hygiene compliance rates from 72% to 86%, and these differences are statistically significant. Hand Hygiene Moment 1 as defined by World Health Organization benefited the most from this intervention. Discussion Patient zone demarcation, along with more intuitive hand hygiene guidelines, is a cost-effective, operationally sensitive intervention that can improve hand hygiene compliance. The bundled solution taps on human factors science in understanding the cognitive challenges faced by clinicians. The positive effects are most profound in multi-bed cubicles where patient zones and infection control barriers are not clearly visible.

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A Hand Hygiene Campaign To Prevent the Transmission of RSV in the Pediatric Intensive Care Unit

American Journal of Infection Control ◽

10.1016/j.ajic.2004.04.140 ◽

2004 ◽

Vol 32 (3) ◽

pp. E93-E94

Author(s):

L. Reynolds∗ ◽

J. Mickell ◽

J. Ober ◽

G. Bearman ◽

M. Edmond

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hand Hygiene ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Hand Hygiene Campaign

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Addressing Hand Hygiene Compliance in a Low-Resource Neonatal Intensive Care Unit: a Quality Improvement Project

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piy076 ◽

2018 ◽

Vol 8 (5) ◽

pp. 408-413 ◽

Cited By ~ 1

Author(s):

Arunava Biswas ◽

Sangeeta Das Bhattacharya ◽

Arun Kumarendu Singh ◽

Mallika Saha

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hand Hygiene ◽

Neonatal Intensive Care Unit ◽

Conceptual Framework ◽

Neonatal Intensive Care ◽

Hand Hygiene Compliance ◽

Hand Washing ◽

Root Cause ◽

Hygiene Compliance

Abstract Objective Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit. Materials and Methods We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively. Results A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9–5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36–16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities. Conclusions Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.

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The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison

International Journal of Nursing Studies ◽

10.1016/j.ijnurstu.2010.03.005 ◽

2010 ◽

Vol 47 (10) ◽

pp. 1245-1252 ◽

Cited By ~ 58

Author(s):

Onno K. Helder ◽

Johannes Brug ◽

Caspar W.N. Looman ◽

Johannes B. van Goudoever ◽

René F. Kornelisse

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hand Hygiene ◽

Nosocomial Infection ◽

Neonatal Intensive Care ◽

Hand Hygiene Compliance ◽

Intervention Study ◽

Before And After ◽

Hygiene Compliance ◽

The Impact

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Hand hygiene compliance in the intensive care unit of the Onderstepoort Veterinary Academic Hospital.

10.21203/rs.2.17130/v1 ◽

2019 ◽

Author(s):

Dikeledi Carol Sebola ◽

Charlie Boucher ◽

Caroline Maslo ◽

Daniel Nenene Qekwana

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hand Hygiene ◽

Healthcare Workers ◽

Hand Hygiene Compliance ◽

Infection Prevention And Control ◽

Patient Contact ◽

Academic Hospital ◽

Hand Wash ◽

Hygiene Compliance

Abstract Hand hygiene compliance remains the cornerstone of infection prevention and control (IPC) in healthcare facilities. However, there is a paucity of information on the level of IPC in veterinary health care facilities in South Africa. Therefore, this study evaluated hand hygiene compliance of healthcare workers and visitors in the intensive care unit (ICU) at the Onderstepoort Veterinary Academic Hospital (OVAH). Method: A cross-sectional study was conducted among healthcare workers (HCWs) and visitors in the ICU using the infection control assessment tool (ICAT) as stipulated by the South African National Department of Health. Direct observations using the “five hand hygiene moments” criteria as set out by the World helath Organisation were also recorded. The level of compliance and a 95% confidence interval were calculated for all variables. Results: Individual bottles of alcohol-based hand-rub solution and hand-wash basins with running water, soap dispensers, and paper towels were easily accessible and available at all times in the ICU. In total, 296 observations consisting of 734 hand hygiene opportunities were recorded. Hand hygiene compliance was also evaluated during invasive (51.4%) and non-invasive (48.6%) procedures. The overall hand hygiene compliance was 24.3% (178/734). In between patients, most HCWs did not sanitize stethoscopes, leashes, and cellular phones used. Additionally, the majority of HCWs wore jewellery below the elbows. The most common method of hand hygiene was hand-rub (58.4%), followed by hand-wash (41.6%). Nurses had a higher (44%) level of compliance compared to students (22%) and clinicians (15%). Compliance was also higher after body fluid exposure (42%) compared to after patient contact (32%), before patient contact (19%), after contact with patient surroundings (16%), and before an aseptic procedure (15%). Conclusion: Hand hygiene compliance in this study was low, raising concerns of potential transmission of hospital-acquired infections and zoonoses in the ICU. Therefore, it is essential that educational programs be developed to address the low level of hand hygiene in this study.

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