scholarly journals Large-Scale Analysis of Hand Hygiene Frequency Across Healthcare Facilities Varying in Key Hospital Characteristics

2020 ◽  
Vol 41 (S1) ◽  
pp. s448-s448
Author(s):  
Jessica Albright ◽  
Bruce White ◽  
Pete Carlson ◽  
Cheryl Littau
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Monitoring System ◽  
Healthcare Workers ◽  
Electronic Monitoring ◽  
Small Sample ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Area Classification ◽  
Hospital Characteristics

Background: Hand hygiene by healthcare personnel is a critical infection prevention intervention. Direct observation, the most widely utilized method to observe hand hygiene practices, often provides an incomplete picture due to small sample size and altered behavior in the presence of observers. A growing number of healthcare facilities are employing electronic hand hygiene monitoring systems to capture overall compliance rates. These electronic systems can provide a wealth of data on hand hygiene practices within and across healthcare facilities. Objective: We used high-accuracy electronic monitoring data to perform a detailed analysis of hand hygiene practices across numerous facilities that varied in key hospital characteristics. Methods: In total, 11 tertiary-care facilities were equipped with an electronic hand hygiene monitoring system. Hospitals varied in size, region, area classification (urban vs rural), acuity level, and teaching status. The electronic monitoring system was composed of uniquely assigned employee badges and electronically monitored dispensers. Every recorded dispensing event was time stamped and associated with a specific healthcare worker, the location of the dispenser, and the specific product being dispensed (ie, alcohol-based hand rub [ABHR] or hand soap). The total number of dispensing events for each product type and the total number of hours worked were calculated for each healthcare worker and were used to determine hand hygiene frequency. Hospital attributes, such as size and area classification, were obtained from publicly available sources including but not limited to facility-owned websites and CMS data. Results: More than 15.7 million hand hygiene events, performed by nearly 11,000 healthcare workers, were captured by the electronic monitoring system and were included in the analysis. Overall, median hand hygiene frequency was 4.1 events per hour and ranged from 2.0 events per hour to 5.6 events per hour, depending on the facility. ABHR use (median, 3.6 events per hour) was more frequent than handwashing (median, 0.4 events per hour). Hospitals included in the analysis ranged from small (<20 beds) rural facilities to large (>600 beds) academic hospitals and provided a variety of services from general medical-surgical treatment to intensive care. Interfacility differences in observed hand hygiene frequency were analyzed. Conclusions: The current analysis reinforces and builds upon previous work that examined a smaller subset of 5 hospitals located in a single geographic region. Combined, these datasets represent >20 million hand hygiene events among ∼15,000 healthcare workers from 16 unique healthcare facilities. This analysis provides detailed information about hand hygiene practices across a diverse set of healthcare facilities.Funding: Ecolab, Inc, provided support for this study.Disclosures: Jessica Carol Albright and Cheryl A Littau report salary from Ecolab.

scholarly journals Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

2020 ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Erin Flynn ◽  
Olutunde Oluyinka ◽  
Stephen Sara ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Newborn Care ◽  
Maternal Caregivers ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Post Natal Care ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn ◽  
Natal Care

Abstract Background Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. Methods This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first six hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. Results Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. Conclusions In this setting, hand hygiene practices during post-natal care and the first six hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.

scholarly journals Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Erin Flynn ◽  
Olutunde Oluyinka ◽  
Stephen Sara ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Newborn Care ◽  
Maternal Caregivers ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Post Natal Care ◽  
Maternal And Newborn Care ◽  
Maternal And Newborn ◽  
Natal Care

Abstract Background Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. Methods This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first 6 hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. Results Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. Conclusions In this setting, hand hygiene practices during post-natal care and the first 6 hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.

scholarly journals Hygiene Along the Continuum of Care in the Early Post-Natal Period: An Observational Study in Nigeria

2020 ◽  
Author(s):  
Yolisa Nalule ◽  
Helen Buxton ◽  
Erin Flynn ◽  
Olutunde Oluyinka ◽  
Stephen Sara ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Newborn Care ◽  
Limited Attention ◽  
Maternal Caregivers ◽  
Healthcare Facilities ◽  
Hygiene Practices ◽  
Increased Risk ◽  
Post Natal Care ◽  
Natal Care

Abstract Background: Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility–based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. Methods: This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first six hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge.Results: Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn.Conclusions: In this setting, hand hygiene practices during post-natal care and the first six hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.

scholarly journals 1187. Estimation of Individual Healthcare Workers’ Relative Hand Hygiene Compliance Using an Anonymous Electronic Monitoring System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S425-S426 ◽  
Author(s):  
Maxime-Antoine Tremblay ◽  
Mona Abou Sader ◽  
Yves Longtin
Keyword(s):  
Hand Hygiene ◽  
Monitoring System ◽  
Healthcare Workers ◽  
Electronic Monitoring ◽  
Tertiary Care ◽  
Care Hospital ◽  
Z Score ◽  
Significant Difference ◽  
Z Scores ◽  
Individual Healthcare

Abstract Background The current hand hygiene (HH) auditing and feedback strategy include anonymized data collection using direct observation and feedback of aggregated data. We aimed to evaluate whether an anonymous (without wearable device) HH electronic monitoring system (EMS) could detect patterns associated with individual healthcare workers (HCWs) and estimate their relative HH performance. Methods Observational study of HH compliance via an EMS in 10 rooms in a tertiary care hospital. The EMS measures HH product dispenser activation (an indicator of HH events) as well as entries and exits from patient rooms (a surrogate of HH opportunities). HH rates were obtained by dividing the number of HH events by the number of opportunities. HH rates were aggregated at room-shift level (i.e., an 8-hour period for a single room). For each room-shift, the HH rate was converted to a Z score, which was then associated with the individual HCW assigned to that room-shift. The relative HH performance of individual HCWs was estimated by comparing the mean Z scores of each HCW with the rest of the group by the Student T-test, with a level of significance set at P < 0.001 after adjustment by Bonferroni’s correction. To investigate whether any association could be due to chance, we looked into the potential association between average Z scores and calendar days, as a counterexample. Results Over a 100-day period, there were 45 775 HH events and 136 821 opportunities (global compliance, 33%). Schedules were available for 2980 room-shifts. Fifty-four individual HCWs took part in at least one room-shift (average per HCW, 52 room-shifts; range 1–140). Eight HCWs (15%) had a mean Z score significantly above the group average (Figure 1, green boxes; mean Z score 0.71; range, 0.52 to 0.86; P < 0.001), whereas 9 HCWs (17%) had a significantly inferior Z score (Figure 1, red boxes; mean Z score -0.47, range -0.58 to -0.31, P < 0.001). In contrast, there was no significant difference in Z scores between calendar days (Figure 2; p >0.001). Conclusion Cross-linking a high-volume HH database with HCW schedules identified a significant association between individual HCWs and HH compliance in the rooms to which they were assigned. If confirmed in further studies, anonymous EMS could be used to provide HCWs with personalized relative HH compliance feedback. Disclosures All authors: No reported disclosures.

scholarly journals COVID-19 outbreak and healthcare worker behavioural change toward hand hygiene practices

2021 ◽  
Vol 111 ◽  
pp. 27-34 ◽  
Author(s):  
F. Huang ◽  
M. Armando ◽  
S. Dufau ◽  
O. Florea ◽  
P. Brouqui ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Behavioural Change ◽  
Hygiene Practices

Patients' Beliefs and Perceptions of Their Participation to Increase Healthcare Worker Compliance with Hand Hygiene

2009 ◽  
Vol 30 (9) ◽  
pp. 830-839 ◽  
Author(s):  
Yves Longtin ◽  
Hugo Sax ◽  
Benedetta Allegranzi ◽  
Stéphane Hugonnet ◽  
Didier Pittet
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Patient Participation ◽  
Healthcare Workers ◽  
Patient Empowerment ◽  
Healthcare Associated Infections ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Active Involvement ◽  
Healthcare Associated

Background.Research suggests that patients could improve healthcare workers' compliance with hand hygiene recommendations by reminding them to cleanse their hands.Objective.To assess patients' perceptions of a patient-participation program to improve healthcare workers' compliance with hand hygiene.Design.Cross-sectional survey of patient knowledge and perceptions of healthcare-associated infections, hand hygiene, and patient participation, defined as the active involvement of patients in various aspects of their health care.Setting.Large Swiss teaching hospital.Results.Of 194 patients who participated, most responded that they would not feel comfortable asking a nurse (148 respondents [76%]) or a physician (150 [77%]) to perform hand hygiene, and 57 (29%) believed that this would help prevent healthcare-associated infections. In contrast, an explicit invitation from a healthcare worker to ask about hand hygiene doubled the intention to ask a nurse (from 34% to 83% of respondents; P < .001) and to ask a physician (from 30% to 78%; P < .001). In multivariate analysis, being nonreligious, having an expansive personality, being concerned about healthcare-associated infections, and believing that patient participation would prevent healthcare-associated infections were associated with the intention to ask a nurse or a physician to perform hand hygiene (P < .05). Being of Jewish, Eastern Orthodox, or Buddhist faith was associated also with increased intention to ask a nurse (P < .05), compared with being of Christian faith.Conclusions.This study identifies several sociodemographic characteristics associated with the intention to ask nurses and physicians about hand hygiene and underscores the importance of a direct invitation from healthcare workers to increase patient participation and foster patient empowerment. These findings could guide the development of future hand hygiene-promotion strategies.

scholarly journals A spatiotemporal simulation study on the transmission of harmful microorganisms through connected healthcare workers in a hospital ward setting

2020 ◽  
Author(s):  
Magnus J. M. van Niekerk ◽  
Alfred A. Stein ◽  
Edwina M. H. E. Doting ◽  
Mariëtte M. Lokate ◽  
Annemarie L. M. A. Braakman-Jansen ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Radio Frequency Identification ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Infection Prevention And Control ◽  
Transmission Potential ◽  
Occupation Group ◽  
Frequency Identification ◽  
Hygiene Compliance

Abstract Background: 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 the transmission and spread of harmful microorganisms is the adherence to spatiotemporal hand hygiene policies, but adherence rates are relatively low and vary over space and time. The spatiotemporal effects on the transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance are unknown. The objectives of this study are to (1) identify a healthcare worker occupancy group of potential super-spreaders and (2) quantify spatiotemporal effects on the transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance caused by this group.Methods: Spatiotemporal data were collected in a ward of an academic hospital using radio frequency identification technology for seven days. A potential super-spreader healthcare worker occupation group was identified using the contact data derived from the frequency identification sensors. The effects of five probability distributions of hand hygiene compliance and three rates of harmful microorganism transmission were simulated using a dynamic agent-based simulation model. The effects of initial simulation assumptions on the simulation results were quantified using five risk factors.Results: Nurses, doctors and patients are together responsible for 78.8% of all contacts. Nurses made up 57% of all contacts, which is more than five times that of doctors (11.1%). 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 colonized nurse can transfer microbes to three of the 17 healthcare worker or patients encountered during the 87 minutes of visiting 22 rooms while colonized. 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 transmissions and spread of harmful microorganism by super-spreaders in a closed healthcare setting. These insights can be used to develop better-informed infection prevention and control strategies.

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