Positive deviance in infection prevention and control: A systematic literature review

Abstract Background: Healthcare-associated infections (HAIs) remain a major challenge. Various strategies have been tried to prevent or control HAIs. Positive deviance, a strategy that has been used in the last decade, is based on the observation that a few at-risk individuals follow uncommon, useful practices and that, consequently, they experience better outcomes than their peers who share similar risks. We performed a systematic literature review to measure the impact of positive deviance in controlling HAIs. Methods: A systematic search strategy was used to search PubMed, CINAHL, Scopus, and Embase through May 2020 for studies evaluating positive deviance as a single intervention or as part of an initiative to prevent or control healthcare-associated infections. The risk of bias was evaluated using the Downs and Black score. Results: Of 542 articles potentially eligible for review, 14 articles were included for further analysis. All studies were observational, quasi-experimental (before-and-after intervention) studies. Hand hygiene was the outcome in 8 studies (57%), and an improvement was observed in association with implementation of positive deviance as a single intervention in all of them. Overall HAI rates were measured in 5 studies (36%), and positive deviance was associated with an observed reduction in 4 (80%) of them. Methicillin-resistant Staphylococcus aureus infections were evaluated in 5 studies (36%), and positive deviance containing bundles were successful in all of them. Conclusions: Positive deviance may be an effective strategy to improve hand hygiene and control HAIs. Further studies are needed to confirm this effect.

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Hand Hygiene Practices to Reduce Hospital Acquired Infection

10.47363/jcbr/2019(1)103 ◽

2019 ◽

pp. 1-4

Author(s):

Liana Monica DEAC Babes ◽

Keyword(s):

Hand Hygiene ◽

Personal Hygiene ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Effective Measure ◽

Hospital Acquired Infection ◽

Hygiene Practices ◽

Healthcare Associated ◽

Hospital Acquired ◽

And Control

Hands are the most effective mode of transfer of microorganism in healthcare and can result in healthcare associated infections which are major causes of morbidity and mortality worldwide. Reduction of infection by this mode of transfer can be achieved by a simple but very effective measure of performing hand hygiene at the appropriate time which is one of the most fundamental principles in infection prevention and control. Good hand hygiene practices have been shown to reduce healthcare associated infections. Hand washing with soap and water has been considered a measure of personal hygiene for several years

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Hand Hygiene Practices to Reduce Hospital Acquired Infection

Journal of Gastroenterology & Digestive Systems ◽

10.33140/jgds.03.03.01 ◽

2019 ◽

Vol 3 (3) ◽

Keyword(s):

Hand Hygiene ◽

Personal Hygiene ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Effective Measure ◽

Hospital Acquired Infection ◽

Hygiene Practices ◽

Healthcare Associated ◽

Hospital Acquired ◽

And Control

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Motivating healthcare professionals (nurses, nurse assistants, physicians) to integrate new practices for preventing healthcare-associated infections into the care continuum: turning Positive Deviance into positive norms

BMC Infectious Diseases ◽

10.1186/s12879-021-06215-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anat Gesser-Edelsburg ◽

Ricky Cohen ◽

Adva Mir Halavi ◽

Mina Zemach

Keyword(s):

Infection Prevention ◽

Healthcare Professionals ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Central Processing ◽

Dissemination Process ◽

Healthcare Associated ◽

And Control ◽

Action Dialogue ◽

The Impact

Abstract Background The literature examining healthcare-associated infections (HAI) points to two main problems in conforming to infection prevention and control (IPC) guidelines among healthcare professionals (HP). One is the discrepancy between HPs’ behavioral intentions and their implementation in practice. The other refers to how HPs maintain these practices after the intervention stage ends. The method proposed in this study seeks to address both these issues by using the Positive Peviance (PD) approach to focus on the dissemination stage of interventions. The study seeks to offer a method for disseminating 27 PD practices to 135 HPs, among them nurses, nurse assistants and physicians, so as to help them maintain IPC guidelines, offer feedback on the dissemination process and examine the impact of the dissemination stage on changes in their behavior. Methods The theoretical model underlying this qualitative research was the Recognition-Primed dDecision (RPD) model, which we implemented in the field of healthcare-associated infections (HAIs). Moreover, we used the Discovery & Action Dialogue (DAD) and Think Aloud (TA) techniques to describe the methodological development of simulations for HPs. Feedback from the HP demonstrators underwent content analysis, while descriptive statistics were used to characterize behavioral changes. Results HPs’ information processing regarding infection prevention shifts from peripheral/automatic processing to intuition and analytical/central processing, turning PD practices into positive norms. The HPs personally experienced finding a solution and made repeated corrections until they overcame the barriers. Most of the HPs (69.4%) reported that the practices were fully implemented, together with additional practices. Conclusions Implementation of the dissemination stage indicates that in order for HPs to integrate and assimilate practices that are not in the official guidelines, merely observing simulations is not sufficient. Rather, each staff member must personally carry out the procedures.

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The financial impact of improved hand hygiene on healthcare-associated infections in the UK

Canadian Journal of Infection Control ◽

10.36584/cjic.2020.011 ◽

2020 ◽

pp. 117-122

Author(s):

Katie-Rose Cawthorne Cawthorne ◽

Jason Dean ◽

Richard PD Cooke

Keyword(s):

Hand Hygiene ◽

Financial Analysis ◽

Cost Savings ◽

Direct Costs ◽

Healthcare Associated Infections ◽

Financial Assessment ◽

Paediatric Hospital ◽

The Uk ◽

Healthcare Associated ◽

The Impact

Background: Though high hand hygiene (HH) levels significantly reduce the risk of healthcare-associated infections (HCAIs), the current cost of HCAIs and the impact of optimal HH practices on HCAIs are poorly defined. The last NHS England financial assessment was in 2009. Methods: The number of HCAIs per bed per year for NHS England were calculated and average costs were attributed using data from three sources; National Audit Office report, a commercially available calculator, and a financial analysis by a specialist paediatric hospital in England. Improved HH compliance for NHS England was based on a sustained rise in compliance rates from 50 to 80% combined with an HCAI reduction of at least 20%. The cost savings based on such improvements were then calculated. Results: In 2020, it is estimated that the number of HCAIs per bed per year ranges from 3.0 to 9.3, with a midpoint of 5.1. The direct costs of HCAI to NHS England were found to lie between £1.6 and £5 billion. Based on a 20% reduction in HCAI rates, this could lead to cost savings of between £322 million and £1 billion per year. Conclusion: Current direct costs of HCAIs consume approximately 1.3% to 4.1% of NHS England’s annual budget. Improving HH compliance among healthcare workers can lead to significant cost savings. There appears to be a strong financial argument for investment into innovative HH compliance technologies that have been historically perceived as too expensive.

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Point prevalence of healthcare-associated infections and antibiotic use in a tertiary care teaching hospital in Nepal: A cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211035827 ◽

2021 ◽

pp. 175717742110358

Author(s):

Sailesh Kumar Shrestha ◽

Swarup Shrestha ◽

Sisham Ingnam

Keyword(s):

Prevention And Control ◽

Tertiary Care ◽

Antibiotic Use ◽

Point Prevalence ◽

University Hospital ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Prevalence Survey ◽

Healthcare Associated ◽

And Control

Information on the burden of healthcare-associated infections (HAIs) and patterns of antibiotic use are prerequisites for infection prevention and control (IPC) and antibiotics stewardship programmes. However, a few studies have been reported from resource-limited settings and many of them have not used standard definitions to diagnose HAI precluding benchmarking with regional or international data. This study aims to estimate the prevalence of HAIs and antibiotic use in our centre. We conducted a point prevalence survey in a 350-bed university hospital in Kathmandu, Nepal in April 2019. We reviewed all patients aged ⩾ 18 years admitted to the hospital for at least two calendar days and evaluated for the three common HAIs—pneumonia, urinary tract infection and surgical site infection. We used the clinical criteria by the European Center for Disease Prevention and Control to diagnose the HAIs. We also collected information on the antibiotics used. Of 160 eligible patients, 18 (11.25%) had HAIs and 114 (87.5%) were on antibiotics, with more than half of them (61/114 patients, 53.5%) receiving two or more antibiotics. This highlights the need for effective implementation of IPC as well as antibiotics stewardship programmes in our centre.

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Are Invasive Procedures and a Longer Hospital Stay Increasing the Risk of Healthcare-Associated Infections among the Admitted Patients at Hiwot Fana Specialized University Hospital, Eastern Ethiopia?

Advances in Preventive Medicine ◽

10.1155/2020/6875463 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Moti Tolera ◽

Dadi Marami ◽

Degu Abate ◽

Merga Dheresa

Keyword(s):

Cigarette Smoking ◽

Hospital Stay ◽

University Hospital ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Invasive Procedures ◽

Healthcare Associated Infection ◽

Eastern Ethiopia ◽

Healthcare Associated ◽

The Impact

Background. Healthcare-associated infection is a major public health problem, in terms of mortality, morbidity, and costs. Majorities of the cause of these infections were preventable. Understanding the potential risk factors is important to reduce the impact of these avoidable infections. The study was aimed to identify factors associated with healthcare-associated infections among patients admitted at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia. Methods. A cross-sectional study was carried out among 433 patients over a period of five months at Hiwot Fana Specialized University Hospital. Sociodemographic and clinical data were obtained from a patient admitted for 48 hours and above in the four wards (surgical, medical, obstetrics/gynecology, and pediatrics) using a structured questionnaire. A multivariate logistic regression model was applied to identify predictors of healthcare-associated infections. A p value <0.05 was considered statistically significant. Results. Fifty-four (13.7%) patients had a history of a previous admission. The median length of hospital stay was 6.1 days. Forty-six (11.7%) participants reported comorbid conditions. Ninety-six (24.4%) participants underwent surgical procedures. The overall prevalence of healthcare-associated infection was 29 (7.4%, 95% CI: 5.2–10.6). Cigarette smoking (AOR: 5.18, 95% CI: 2.15–20.47), staying in the hospital for more than 4 days (AOR: 4.29, 95% CI: 2.31–6.15), and undergoing invasive procedures (AOR: 3.58, 95% CI: 1.11–7.52) increase the odds of acquiring healthcare-associated infections. Conclusion. The cumulative prevalence of healthcare-associated infections in this study was comparable with similar studies conducted in developing countries. Cigarette smoking, staying in the hospital for more than 4 days, and undergoing invasive procedures increase the odds of healthcare-associated infections. These factors should be considered in the infection prevention and control program of the hospital.

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The Burden of Healthcare-Associated Infections in Southeast Asia: A Systematic Literature Review and Meta-analysis

Clinical Infectious Diseases ◽

10.1093/cid/civ095 ◽

2015 ◽

Vol 60 (11) ◽

pp. 1690-1699 ◽

Cited By ~ 70

Author(s):

M. L. Ling ◽

A. Apisarnthanarak ◽

G. Madriaga

Keyword(s):

Literature Review ◽

Southeast Asia ◽

Systematic Literature Review ◽

Meta Analysis ◽

Healthcare Associated Infections ◽

Healthcare Associated

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Strengthening infection prevention and control and systematic surveillance of healthcare associated infections in India

BMJ ◽

10.1136/bmj.j3768 ◽

2017 ◽

pp. j3768 ◽

Cited By ~ 8

Author(s):

Soumya Swaminathan ◽

Jagdish Prasad ◽

Akshay C Dhariwal ◽

Randeep Guleria ◽

Mahesh C Misra ◽

...

Keyword(s):

Prevention And Control ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

And Control

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Burden of Healthcare-Associated Infections in Italy: Disability-Adjusted Life Years

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.175 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

V Bordino ◽

C Vicentini ◽

A D'Ambrosio ◽

F Quattrocolo ◽

C M Zotti

Keyword(s):

Prevention And Control ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Disability Adjusted Life Years ◽

Disability Adjusted Life ◽

Life Years ◽

Significant Burden ◽

Tract Infections ◽

Healthcare Associated ◽

And Control

Abstract Background Healthcare-Associated Infections (HAIs) significantly increase adverse clinical outcomes and healthcare costs. In 2016 Italy participated in the second European Centre for Disease Prevention and Control (ECDC) Point Prevalence Survey (PPS) of HAIs and antimicrobial use in acute care hospitals. The aim of this study was to estimate the burden of the 5 most common HAIs in Italy, by evaluating incidence, attributable deaths, Years of Life Lost (YLL), Years Lived with Disability (YLD) and Disability-Adjusted Life-Years (DALYs). Methods National PPS data were used to establish sex- and age-specific incidence of Healthcare-associated Pneumonia (HAP), HA Urinary tract infections (HA UTI), HA Bloodstream Infections (HA BSI) excluding neonatal BSI, Surgical Site Infections (SSI), HA Clostridium Difficile infections (HA CDI). Patients' life expectancy was adjusted according to the severity of underlying conditions using the McCabe score. Following the methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project, an adapted version of the disease models of the BCoDE toolkit was used. Results An overall yearly incidence of 643434 new cases of HAI in Italy was estimated. The aggregate burden of the 5 HAIs was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL), corresponding to 702.53 DALYs per 100000 total population. HA BSI and HAP had the highest burden with respectively 253868.22? and 126038.26 DALYs. The population strata with the highest burden were the ones with McCabe Score 1 for every considered HAI. The age groups with the highest burden were 70-74 for male and 45-49 for female patients. In total, 56% of DALYs were attributable to men and 44% to women. Conclusions This nation-wide study found a significant burden of disease due to HAIs in Italy. Results of this study could be used to guide policy-makers in the implementation of measures aiming to reduce the impact of HAIs. Key messages This study estimated the burden of 5 HAIs in Italy was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL according to 2016 PPS data. Considering the significant burden of HAIs found in this study, infection prevention and control measures should be a Public Health priority in Italy.

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Improvement in Infection Prevention and Control Measures at The Children Hospital, Lahore. A My Child Matters Collaborative Project

Journal of Global Oncology ◽

10.1200/jgo.18.90400 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 223s-223s

Author(s):

M. Faizan ◽

S. Anwar ◽

R.U.A. Kashif ◽

R. Saleem ◽

H. Javed ◽

...

Keyword(s):

Hand Hygiene ◽

Infection Control ◽

Pediatric Cancer ◽

Prevention And Control ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Improvement Strategy ◽

Targeted Interventions ◽

Healthcare Associated ◽

And Control

Background: Overcrowding, lack of operational funds, and healthcare associated infections are major challenges at the Children Hospital Lahore, a public healthcare facility in Pakistan with 900 new pediatric cancer admissions annually. In 2014, a collaboration between My Child Matters (MCM), St. Jude Global Infectious Diseases Program (SJ-GID), and our institution was established to address these issues. Aim: To describe the effect of a collaborative improvement strategy on the infection prevention and control (IPC) standards in a pediatric oncology unit in a resource-limited setting. Methods: Our study was a prospective before-and-after study. We compare the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and 4 modules of the St. Jude modified Infection Control Assessment Tool (ICAT) scores. Our strategy included: (1) creating a multidisciplinary team of pediatric hematology-oncology, infectious disease physicians, nurses, microbiologist, and a data manager, (2) engaging on monthly online IPC mentoring sessions with the SJ-GID and MCM mentors, (3) performing daily inpatient healthcare associated (HAI) surveillance rounds, and (4) providing regular hand hygiene training and compliance audits. Results: Our hand hygiene facility level per WHO scores increased from “Inadequate” during the baseline assessment to “Intermediate/Consolidation” by the end of 3-year implementation (122 vs 352 HHSAF scores). The sink: bed and hand sanitizer: bed ratios improved to 1:6 and 1:1 respectively. Six washrooms were added to our unit. ICAT general infection control module increased by 40% (45 vs 78 ICAT score) and hygiene compliance improved by 20% from baseline. Identification of HAI increased from baseline (4.07 vs 8.7 infections per 1000 patient days). A 25% of the isolates were multidrug-resistant microorganisms. Conclusion: Implementing a collaborative improvement strategy improved the IPC standards in our pediatric cancer center. The increase of HAI might be a result of a better surveillance and laboratory identification. Further targeted interventions should be develop to decrease HAI rates and infection-related morbidity and mortality in our population.

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