scholarly journals A Decade in Trying to Increase Hand Hygiene—Finally Success

2020 ◽  
Vol 41 (S1) ◽  
pp. s93-s94
Author(s):  
Linda Huddleston ◽  
Sheila Bennett ◽  
Christopher Hermann
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Bloodstream Infections ◽  
Central Line ◽  
Second Phase ◽  
Two Phase ◽  
Hygiene Compliance ◽  
Tract Infections ◽  
The Voice

Background: Over the past 10 years, a rural health system has tried 10 different interventions to reduce hospital-associated infections (HAIs), and only 1 intervention has led to a reduction in HAIs. Reducing HAIs is a goal of nearly all hospitals, and improper hand hygiene is widely accepted as the main cause of HAIs. Even so, improving hand hygiene compliance is a challenge. Methods: Our facility implemented a two-phase longitudinal study to utilize an electronic hand hygiene reminder system to reduce HAIs. In the first phase, we implemented an intervention in 2 high-risk clinical units. The second phase of the study consisted of expanding the system to 3 additional clinical areas that had a lower incidence of HAIs. The hand hygiene baseline was established at 45% for these units prior to the voice reminder being turned on. Results: The system gathered baseline data prior to being turned on, and our average hand hygiene compliance rate was 49%. Once the voice reminder was turned on, hand hygiene improved nearly 35% within 6 months. During the first phase, there was a statistically significant 62% reduction in the average number of HAIs (catheter associated urinary tract infections (CAUTI), central-line–acquired bloodstream infections (CLABSIs), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant organisms (MDROs), and Clostridiodes difficile experienced in the preliminary units, comparing 12 months prior to 12 months after turning on the voice reminder. In the second phase, hand hygiene compliance increased to >65% in the following 6 months. During the second phase, all HAIs fell by a statistically significant 60%. This was determined by comparing the HAI rates 6 months prior to the voice reminder being turned on to 6 months after the voice reminder was turned on. Conclusions: The HAI data from both phases were aggregated, and there was a statistically significant reduction in MDROs by 90%, CAUTIs by 60%, and C. difficile by 64%. This resulted in annual savings >$1 million in direct costs of nonreimbursed HAIs.Funding: NoneDisclosures: None

scholarly journals Using targeted solution tools as an initiative to improve hand hygiene: challenges and lessons learned

2017 ◽  
Vol 146 (2) ◽  
pp. 276-282 ◽  
Author(s):  
J. A. AL-TAWFIQ ◽  
M. TREBLE ◽  
R. ABDRABALNABI ◽  
C. OKEAHIALAM ◽  
S. KHAZINDAR ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Blood Stream ◽  
Lessons Learned ◽  
Healthcare Associated Infection ◽  
Contributing Factors ◽  
Improve Hand Hygiene ◽  
Hygiene Compliance ◽  
Tract Infections

SUMMARYThe Joint Commission Centre for Transforming Healthcare's Web-based Targeted Solutions Tool (TST) for improving hand hygiene was implemented to elucidate contributing factors to low compliance rates of hand hygiene. Monitoring of compliance was done by trained unknown and known observers and rates of hospital-acquired infections were tracked and correlated against the changes in hand hygiene compliance. In total, 5669 of hand hygiene observations were recorded by the secret observers. The compliance rate increased from 75·4% at baseline (May–August 2014) to 88·6% during the intervention (13 months) and the control periods (P < 0·0001). Reductions in healthcare-associated infection rates were recorded for Clostridium difficle infections from 7·95 (CI 0·8937–28·72) to 1·84 (CI 0·02411–10·26) infections per 10 000 patient-days (P = 0·23), central line-associated blood-stream infections from 5·9 (CI 1·194–17·36) to 2·9 (0·7856–7·475) per 1000 device days (P = 0·37) and catheter-associated urinary tract infections from 5·941 (CI 1·194–17·36) to 0 per 1000 device days (P = 0·42). The top contributing factors for non-compliance were: improper use of gloves, hands full of supplies or medications and frequent entry or exit in isolation areas. We conclude that the application of TST allows healthcare organisations to improve hand hygiene compliance and to identify the factors contributing to non-compliance.

scholarly journals Effect of Removing Contact Precautions for Multidrug-Resistant Organisms on Hospital Infections in a Pediatric Health System

2020 ◽  
Vol 41 (S1) ◽  
pp. s199-s200
Author(s):  
Matthew Linam ◽  
Dorian Hoskins ◽  
Preeti Jaggi ◽  
Mark Gonzalez ◽  
Renee Watson ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Contact Precautions ◽  
Stewardship Program ◽  
Tract Infections ◽  
The Impact

Background: Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have failed to show an increase in associated transmission or infections in adult healthcare settings. Pediatric experience is limited. Objective: We evaluated the impact of discontinuing contact precautions for MRSA, VRE, and extended-spectrum β-lactamase–producing gram-negative bacilli (ESBLs) on device-associated healthcare-associated infections (HAIs). Methods: In October 2018, contact precautions were discontinued for children with MRSA, VRE, and ESBLs in a large, tertiary-care pediatric healthcare system comprising 2 hospitals and 620 beds. Coincident interventions that potentially reduced HAIs included blood culture diagnostic stewardship (June 2018), a hand hygiene education initiative (July 2018), a handshake antibiotic stewardship program (December 2018) and multidisciplinary infection prevention rounding in the intensive care units (November 2018). Compliance with hand hygiene and HAI prevention bundles were monitored. Device-associated HAIs were identified using standard definitions. Annotated run charts were used to track the impact of interventions on changes in device-associated HAIs over time. Results: Average hand hygiene compliance was 91%. Compliance with HAI prevention bundles was 81% for ventilator-associated pneumonias, 90% for catheter-associated urinary tract infections, and 97% for central-line–associated bloodstream infections. Overall, device-associated HAIs decreased from 6.04 per 10,000 patient days to 3.25 per 10,000 patient days after October 2018 (Fig. 1). Prior to October 2018, MRSA, VRE and ESBLs accounted for 10% of device-associated HAIs. This rate decreased to 5% after October 2018. The decrease in HAIs was likely related to interventions such as infection prevention rounds and handshake stewardship. Conclusions: Discontinuation of contact precautions for children with MRSA, VRE, and ESBLs were not associated with increased device-associated HAIs, and such discontinuation is likely safe in the setting of robust infection prevention and antibiotic stewardship programs.Funding: NoneDisclosures: None

scholarly journals Intranasal Antiseptic and Universal Antiseptic Baths Are Effective in Reducing MRSA Acquisition in Extended-Care Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s304-s305
Author(s):  
Angela Chow ◽  
Wei Zhang ◽  
Joshua Wong ◽  
Brenda Ang
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Care Facility ◽  
Clinical Problem ◽  
Clinical Samples ◽  
Extended Care ◽  
Care Facilities ◽  
The Mean ◽  
Hygiene Compliance

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a growing clinical problem in rehabilitation hospitals, where patients stay for extended periods for intensive rehabilitation therapy. In addition to cutaneous sites, the nares could be a source for nosocomial MRSA transmission. Decolonization of nasal and cutaneous reservoirs could reduce MRSA acquisition. We evaluated the effectiveness of topical intranasal octenidine gel, coupled with universal chlorhexidine baths, in reducing MRSA acquisition in an extended-care facility. Methods: We conducted a quasi-experimental before-and-after study from January 2013 to June 2019. All patients admitted to a 100-bed rehabilitation hospital specialized in stroke and trauma care in Singapore were screened for MRSA colonization on admission. Patients screened negative for MRSA were subsequently screened at discharge for MRSA acquisition. Screening swabs were obtained from the nares, axillae, and groin and were cultured on selective chromogenic agar. Patients who tested positive for MRSA from clinical samples collected >3 days after admission were also considered to have hospital-acquired MRSA. Universal chlorhexidine baths were implemented throughout the study period. Intranasal application of octenidine gel for MRSA colonizers for use for 5 days from admission was added to the hospital’s protocol beginning in September 2017. An interrupted time series with segmented regression analysis was performed to evaluate the trends in MRSA acquisition before the intervention (January 2013–July 2017) and after the intervention (September 2017–June 2019) with intranasal octenidine. August 2017 was excluded from the analysis because the intervention commenced midmonth. Results: In total, 77 observational months (55 before the intervention and 22 after the intervention) were included. The mean monthly MRSA acquisition rates were 7.0 per 1,000 patient days before the intervention and 4.4 per 1,000 patient days after the intervention (P < .001), with a mean number of patient days of 2,516.3 per month before the intervention and 2,427.2 per month after the intervention (P = .0172). The mean monthly number of MRSA-colonized patients on admission to the hospital decreased from 24.8 before the intervention to 18.7 after the intervention (P < .001). Mean monthly hand hygiene compliance rate increased significantly from 65.7% before the intervention to 87.4% after the intervention (P < .001). After adjusting for the number of MRSA-colonized patients on admission and hand hygiene compliance rates, a constant trend was observed from January 2013 to July 2017 (adjusted mean coefficient, 0.012; 95% CI, −0.037 to 0.06), with an immediate drop in September 2017 (adjusted mean coefficient, −2.145; 95% CI, −0.248 to −0.002; P = .033), followed by a significant reduction in MRSA acquisition after the intervention from September 2017 through June 2019 (adjusted mean coefficient, −0.125; 95% CI, -4.109 to -0.181; P = .047). Conclusions: Topical intranasal octenidine, coupled with universal chlorhexidine baths, can reduce MRSA acquisition in extended-care facilities. Further studies should be conducted to validate the findings in other healthcare settings.Funding: NoneDisclosures: None

scholarly journals Hand hygiene compliance monitoring in anaesthetics: Feasibility and validity

2018 ◽  
Vol 19 (3) ◽  
pp. 116-122 ◽  
Author(s):  
A Jeanes ◽  
J Dick ◽  
P Coen ◽  
N Drey ◽  
DJ Gould
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Care Delivery ◽  
Compliance Rate ◽  
Significant Risk ◽  
World Health ◽  
Compliance Monitoring ◽  
Infection Control Practitioner ◽  
Hygiene Compliance ◽  
Health Organization

Background: Hand hygiene compliance scores in the anaesthetic department of an acute NHS hospital were persistently low. Aims: To determine the feasibility and validity of regular accurate measurement of HHC in anaesthetics and understand the context of care delivery, barriers and opportunities to improve compliance. Methods: The hand hygiene compliance of one anaesthetist was observed and noted by a senior infection control practitioner (ICP). This was compared to the World Health Organization five moments of hand hygiene and the organisation hand hygiene tool. Findings: In one sequence of 55 min, there were approximately 58 hand hygiene opportunities. The hand hygiene compliance rate was 16%. The frequency and speed of actions in certain periods of care delivery made compliance measurement difficult and potentially unreliable. During several activities, taking time to apply alcohol gel or wash hands would have put the patients at significant risk. Discussion: We concluded that hand hygiene compliance monitoring by direct observation was invalid and unreliable in this specialty. It is important that hand hygiene compliance is optimal in anaesthetics particularly before patient contact. Interventions which reduce environmental and patient contamination, such as cleaning the patient and environment, could ensure anaesthetists encounter fewer micro-organisms in this specialty.

scholarly journals Incubator traffic light: the development of an alcohol-based hand rub dispenser system for neonatal incubators with visual feedback to improve hand hygiene compliance

2019 ◽  
Vol 5 (2-3) ◽  
pp. 70-77
Author(s):  
Ronald H J van Gils ◽  
Onno K Helder ◽  
Linda S G L Wauben
Keyword(s):  
Hand Hygiene ◽  
Behaviour Change ◽  
Visual Feedback ◽  
Hand Hygiene Compliance ◽  
Healthcare Professionals ◽  
Bloodstream Infections ◽  
Traffic Light ◽  
Improve Hand Hygiene ◽  
Drying Time ◽  
Hygiene Compliance

IntroductionSustained high compliance with hand hygiene prior to patient contact in a neonatal intensive care unit (NICU) could reduce the spread of pathogens and incidence of bloodstream infections of preterm infants. These infections are associated with high mortality, morbidity and additional costs. Behaviour change interventions to promote hand hygiene, such as education, have only temporary beneficial effect on compliance. Our aim is to develop a technical intervention that supports a sustainable behaviour change for appropriate hand hygiene among NICU healthcare professionals.MethodsStudents from different disciplines incrementally designed and evaluated solutions in co-creation with healthcare professionals of a NICU in a teaching hospital.ResultsA prototype of the ‘Incubator Traffic Light’ system for neonatal incubators was developed, that is, a touchless alcohol-based hand rub (ABHR) dispenser with integrated colour display and incubator door sensor with lights. The system provides visual feedback to support healthcare professionals’ compliance with the prescribed 30 s drying time for ABHR. After 30 s, green lights indicate that the incubator doors may be opened. In the event that doors are opened without dispensing ABHR or earlier than 30 s, blinking orange lights and a display message urge the person to close the doors. The system documents compliance data in a web-based database.ConclusionsWe developed a sophisticated technical intervention to support hand hygiene compliance. It is ready for clinical tests that should prove that the system contributes to sustainable hand hygiene compliance near neonatal incubators.

Improvement of hand hygiene compliance among health professional staff of Neonatology Department in Nyamata Hospital

2016 ◽  
Vol 24 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Solange Umulisa ◽  
Angele Musabyimana ◽  
Rex Wong ◽  
Eva Adomako ◽  
April Budd ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Professional Staff ◽  
Routine Practice ◽  
Improve Hand Hygiene ◽  
Improvement Project ◽  
Content Type ◽  
Hygiene Compliance

Purpose The purpose of this study is to improve the hand hygiene compliance in a hospital in Rwanda. Hand hygiene is a fundamental routine practice that can greatly reduce risk of hospital-acquired infections; however, hand hygiene compliance in the hospital was low. Design/methodology/approach A multiple-strategy intervention was implemented with a focus on ensuring stable water supply was available through installing mobile hand hygiene facilities. Findings The intervention significantly increased the overall hand hygiene compliance rate by 35 per cent. The compliance for all of the five hand hygiene moments and all professions also significantly increased. Practical implications By implementing an intervention that involved multiple strategies to address the root causes of the problem, this quality improvement project successfully created an enabling environment to increase hand hygiene compliance. The hospital should encourage using the strategic problem-solving method to conduct more quality improvement projects in other departments. Originality/value Findings from this study may be useful for hospitals in similar settings seeking to improve hand hygiene compliance.

scholarly journals Implementation of the Comprehensive Unit-Based Safety Program to Improve Infection Prevention and Control Practices in Four Neonatal Intensive Care Units in Pune, India

2022 ◽  
Vol 9 ◽  
Author(s):  
Julia Johnson ◽  
Asad Latif ◽  
Bharat Randive ◽  
Abhay Kadam ◽  
Uday Rajput ◽  
...  
Keyword(s):  
Patient Safety ◽  
Hand Hygiene ◽  
Safety Culture ◽  
Neonatal Intensive Care ◽  
Hand Hygiene Compliance ◽  
Patient Safety Culture ◽  
Central Line ◽  
Infection Prevention And Control ◽  
Central Line Insertion ◽  
Hygiene Compliance

Objective: To implement the Comprehensive Unit-based Safety Program (CUSP) in four neonatal intensive care units (NICUs) in Pune, India, to improve infection prevention and control (IPC) practices.Design: In this quasi-experimental study, we implemented CUSP in four NICUs in Pune, India, to improve IPC practices in three focus areas: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous fluid preparation and administration. Sites received training in CUSP methodology, formed multidisciplinary teams, and selected interventions for each focus area. Process measures included fidelity to CUSP, hand hygiene compliance, and central line insertion checklist completion. Outcome measures included the rate of healthcare-associated bloodstream infection (HA-BSI), all-cause mortality, patient safety culture, and workload.Results: A total of 144 healthcare workers and administrators completed CUSP training. All sites conducted at least 75% of monthly meetings. Hand hygiene compliance odds increased 6% per month [odds ratio (OR) 1.06 (95% CI 1.03–1.10)]. Providers completed insertion checklists for 68% of neonates with a central line; 83% of checklists were fully completed. All-cause mortality and HA-BSI rate did not change significantly after CUSP implementation. Patient safety culture domains with greatest improvement were management support for patient safety (+7.6%), teamwork within units (+5.3%), and organizational learning—continuous improvement (+4.7%). Overall workload increased from a mean score of 46.28 ± 16.97 at baseline to 65.07 ± 19.05 at follow-up (p &lt; 0.0001).Conclusion: CUSP implementation increased hand hygiene compliance, successful implementation of a central line insertion checklist, and improvements in safety culture in four Indian NICUs. This multimodal strategy is a promising framework for low- and middle-income country healthcare facilities to reduce HAI risk in neonates.

scholarly journals The effect of education on improving hand hygiene compliance among healthcare workers

2019 ◽  
Vol 3 (2) ◽  
pp. 66-71
Author(s):  
Abigail Mitchell ◽  
Christian Schadt ◽  
Shamarra Johnson ◽  
Mary Thisbe Quilab
Keyword(s):  
Interventional Radiology ◽  
Hand Hygiene ◽  
Cardiac Catheterization ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Statistical Significance ◽  
Compliance Rate ◽  
Observation Data ◽  
Cardiac Catheterization Laboratory ◽  
Hygiene Compliance

Background: Proper hand hygiene is the most effective way to reduce healthcare-associated infections (HAI). Hand hygiene compliance rates among healthcare workers remain unsatisfactory. This study investigated the effects of unit in-service education on hand hygiene compliance in an Interventional Radiology and Cardiac Catheterization Laboratory department in a tertiary hospital in Florida. Methods: An observational study was conducted for five weeks. A total of 120 participants, consisting of 40 physicians, 40 registered nurses, 40 technologists were observed by a secret shopper pre-education and post education. A pre-education baseline compliance rate was established for each group. Pre-education observation occurred for two weeks before the intervention, one week for the implementation of unit in-service education, another two weeks for post education observation. The hand hygiene audit tool was utilized to record the observation data. Data analysis: Quantitative data were analyzed using a one-tailed T-test to determine P values for each group. Results: Results showed a 20 % increase among physicians, 15% among nurses and 5% among technologists. There was a statistical significance for the physician and nurse groups. Conclusion: The study implies that education is an effective intervention in improving hand hygiene compliance rates among the staff in the interventional radiology and cardiac catheterization department.

scholarly journals GAMBARAN KEPATUHAN TENAGA KESEHATAN DALAM MENERAPKAN HAND HYGIENE DI RAWAT INAP RSUP PROF. Dr. R D. KANDOU MANADO

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Citra Prasilya Karuru ◽  
Theresia Isye Mogi ◽  
Lidwina Sengkey
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Health Workers ◽  
Compliance Rate ◽  
Cross Sectional ◽  
Route Of Transmission ◽  
Health Care Associated Infections ◽  
Cross Sectional Design ◽  
Hygiene Compliance

Abstract: Hands are the main route of transmission of germs during patient care. Nosocomial infection transmission can occur due to poor sanitation. Hand hygiene of health workers is very helpful in preventing the transmission of harmful germs and health care-associated infections. However, health workers still have less attention about the role of hand hygiene. This study aimed to determine the doctors and nurses’ compliance rate in implementing hand hygiene in Prof. Dr. R.D. Kandou Hospital Manado. This was an observational study with a cross-sectional design. Samples were specialist doctors, residents, and nurses in IRINA A, E, and F. The general compliance rate of hand hygiene was 5,2%. Based on the profession, the hand hygiene compliance rate of doctors was 2.4% (n=21) and of nurses 6.6% (n=113). Based on the monitored time, the compliance rate before entering rooms was 3.02% (n=39) and after entering rooms 7.35% (n=95). Conclusion: Hand hygiene compliance rate among health workers was still low.Keywords: health workers, hand hygiene compliance rate Abstrak: Tangan merupakan jalur utama penularan kuman selama perawatan pasien. Penularan infeksi nosokomial bisa terjadi akibat sanitasi yang kurang. Kebersihan tangan tenaga kesehatan sangat membantu pencegahan penularan kuman berbahaya dan mencegah infeksi terkait perawatan kesehatan. Namun, pentingnya penerapan hand hygiene masih kurang mendapat perhatian oleh tenaga kesehatan. Penelitian ini bertujuan untuk melihat gambaran kepatuhan tenaga kesehatan yakni tenaga dokter dan perawat dalam menerapkan hand hygiene di ruang rawat inap RSUP Prof. Dr. R. D. Kandou Manado. Metode penelitian yang digunakan ialah observasional dengan desain potong lintang. Sampel meliputi dokter spesialis, dokter residen, dan perawat. Angka kepatuhan keseluruhan ialah 5,2%. Berdasarkan kelompok pekerjaan, angka kepatuhan dokter 2,4% (n=21) dan perawat 6,6% (n=113). Dari dua indikasi yang diamati, angka kepatuhan sebelum masuk ruangan 3,02% (n=39) dan setelah keluar ruangan 7,35% (n=95). Simpulan: Tingkat kepatuhan hand hygiene tenaga kesehatan masih rendah.Kata kunci: tenaga kesehatan, tingkat kepatuhan hand hygiene

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