Establishing Evidence-Based Criteria for Directly Observed Hand Hygiene Compliance Monitoring Programs: A Prospective, Multicenter Cohort Study

2014 ◽  
Vol 35 (9) ◽  
pp. 1163-1168 ◽  
Author(s):  
Jun Yin ◽  
Heather Schacht Reisinger ◽  
Mark Vander Weg ◽  
Marin L. Schweizer ◽  
Andrew Jesson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Sample Size Calculation ◽  
Hawthorne Effect ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Surveillance Programs ◽  
Hygiene Compliance ◽  
The Impact

ObjectiveHand hygiene surveillance programs that rely on direct observations of healthcare worker activity may be limited by the Hawthorne effect. In addition, comparing compliance rates from period to period requires adequately sized samples of observations. We aimed to statistically determine whether the Hawthorne effect is stable over an observation period and statistically derive sample sizes of observations necessary to compare compliance rates.DesignProspective multicenter cohort study.SettingFive intensive care units and 6 medical/surgical wards in 3 geographically distinct acute care hospitals.MethodsTrained observers monitored hand hygiene compliance during routine care in fixed 1-hour periods, using a standardized collection tool. We estimated the impact of the Hawthorne effect using empirical fluctuation processes and F tests for structural change. Standard sample-size calculation methods were used to estimate how many hand hygiene opportunities are required to accurately measure hand hygiene across various levels of baseline and target compliance.ResultsExit hand hygiene compliance increased after 14 minutes of observation (from 56.2% to 60.5%; P < .001) and increased further after 50 minutes (from 60.5% to 66.0%; P < .001). Entry compliance increased after 38 minutes (from 40.4% to 43.4%; P = .005). Between 79 and 723 opportunities are required during each period, depending on baseline compliance rates (range, 35%–90%) and targeted improvement (5% or 10%).ConclusionsLimiting direct observation periods to approximately 15 minutes to minimize the Hawthorne effect and determining required number of hand hygiene opportunities observed per period on the basis of statistical power calculations would be expected to improve the validity of hand hygiene surveillance programs.Infect Control Hosp Epidemiol 2014;35(9):1163-1168

Variability in the Hawthorne Effect With Regard to Hand Hygiene Performance in High- and Low-Performing Inpatient Care Units

2009 ◽  
Vol 30 (3) ◽  
pp. 222-225 ◽  
Author(s):  
Erol Kohli ◽  
Judy Ptak ◽  
Randall Smith ◽  
Eileen Taylor ◽  
Elizabeth A. Talbot ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Inpatient Care ◽  
Hand Hygiene Compliance ◽  
Hospital Staff ◽  
High Rate ◽  
Hawthorne Effect ◽  
High Performing ◽  
Hygiene Compliance ◽  
The Impact ◽  
Student Intern

Objective.To determine the impact of known observers on hand hygiene performance in inpatient care units with differing baseline levels of hand hygiene compliance.Design.Observational study.Setting.Three inpatient care units, selected on the basis of past hand hygiene performance, in a hospital where hand hygiene observation and feedback are routine.Participants.Three infection control practitioners (ICPs) and a student intern observed hospital staff.Methods.Beginning in late 2005, the 3 ICPs, who were well known to the hospital staff, performed frequent, regular observations of hand hygiene in all 3 inpatient care units of the hospital, as part of routine surveillance. During the study period (January-May 2007), a student intern who was unknown to the hospital staff also performed observations of hand hygiene in the 3 inpatient care units. The rates of hand hygiene compliance observed by the 3 ICPs were compared with those observed by the student intern.Results.The 3 ICPs observed 332 opportunities for hand hygiene during 15 observation periods, and the student intern observed 355 opportunities during 19 observation periods. The overall rate of hand hygiene compliance observed by the ICPs was 65% (ie, in 215 of the 332 opportunities, the performance of proper hand hygiene by hospital staff was observed), and the overall rate of hand hygiene compliance observed by the student intern was 58% (ie, in 207 of the 355 opportunities, the performance of proper hand hygiene by hospital staff was observed) (P = .1). Both the ICPs and the student intern were able to distinguish between inpatient care units with a high rate of hand hygiene compliance (hereafter referred to as high-performing units) and those with a low rate (hereafter referred to as low-performing units). However, in the 2 high-performing units, the ICPs observed significantly higher compliance rates than did the student intern, whereas in the low-performing unit, both the ICPs and the student intern measured similarly low rates of hand hygiene compliance.Conclusions.Recognized observers are associated with higher rates of hand hygiene compliance, even in a healthcare setting where such observations have become routine. This effect (ie, the Hawthorne effect) is more pronounced in high-performing units and insignificant in low-performing units. The use of unrecognized observers may be important for verifying high performance but is probably unnecessary for documenting poor performance. Moreover, the Hawthorne effect may be a useful tool for sustaining and improving hand hygiene compliance.

scholarly journals The Impact of Body Mass Index on Fluoroscopy Time During Lumbar Epidural Steroid Injection; A Multicenter Cohort Study

Pain Medicine ◽  
2016 ◽  
Vol 18 (1) ◽  
pp. 25-35 ◽  
Author(s):  
Zachary L. McCormick ◽  
Sarah C. Choxi ◽  
David T. Lee ◽  
Austin Marcolina ◽  
Joel Press ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cohort Study ◽  
Body Mass ◽  
Steroid Injection ◽  
Epidural Steroid Injection ◽  
Fluoroscopy Time ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Epidural Steroid ◽  
The Impact

scholarly journals Impact of Infection Control Training Program in Improving the Quality of Healthcare

2020 ◽  
Vol 2 (5) ◽  
Author(s):  
Aeshah N. Alqahtani ◽  
Rana H. Almaghrabi ◽  
Mohammed M. Albaadani ◽  
Khalid Almossa
Keyword(s):  
Hand Hygiene ◽  
Training Program ◽  
Hand Hygiene Compliance ◽  
Training Programs ◽  
Financial Burden ◽  
Quality Of Healthcare ◽  
Healthcare Associated Infection ◽  
Hygiene Compliance ◽  
The Impact

The purpose of this study was to explore the impact of various training programs and guidelines on improving the healthcare quality and patient. The training programs that we have explained in this study are related to Hand Hygiene compliance, Improving clinical outcomes and reducing financial burden and Preventing healthcare associated infection, This study Applied to many health institutions and healthcare employees in the Kingdom of Saudi Arabia, It is from this analysis that improve quality of healthcare through control training program, IPC training program improve hand hygiene compliance and reduces the HAIs prevalence, improves patient outcomes and reduces healthcare costs, training of all the persons involved in primary healthcare may fill the IPC gaps.

scholarly journals COMBINATION OF TOCILIZUMAB AND STEROIDS TO IMPROVE MORTALITY IN PATIENTS WITH SEVERE COVID-19 INFECTION: A SPANISH, MULTICENTER, COHORT STUDY

2020 ◽  
Author(s):  
Belen Ruiz-Antoran ◽  
Aranzazu Sancho-Lopez ◽  
Ferran Torres ◽  
Victor Moreno-Torres ◽  
Itziar de Pablo Lopez de Abechuco ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Oxygen Therapy ◽  
Inclusion Criteria ◽  
Multicenter Cohort Study ◽  
Inverse Probability ◽  
Multicenter Cohort ◽  
Tertiary Hospitals ◽  
Randomised Controlled ◽  
The Impact

Background: We aimed to determine the impact of tocilizumab use in severe COVID-19 pneumonia mortality. Methods: We performed a multicentre retrospective cohort study in 18 tertiary hospitals in Spain, from March to April 2020. Consecutive patients admitted with severe COVID-19 treated with tocilizumab were compared to patients not treated with tocilizumab, adjusting by Inverse Probability of the Treatment Weights (IPTW). Tocilizumab effect in patients receiving steroids during the 48h following inclusion was analyzed. Results: During the study period, 506 patients with severe COVID-19 fulfilled inclusion criteria. Among them, 268 were treated with tocilizumab and 238 patients were not. Median time to tocilizumab treatment from onset of symptoms was 11 days (IQR 8-14). Global mortality was 23.7%. Mortality was lower in patients treated with tocilizumab than in controls (16.8% versus 31.5%, HR 0.514 [95CI 0.355-0.744], p<0.001; weighted HR 0.741 [95CI 0.619-0.887], p=0.001). Tocilizumab treatment reduced mortality by 14.7% relative to no tocilizumab treatment (RRR 46.7%). We calculated a number necessary to treat of 7. Among patients treated with steroids, mortality was lower in patients treated with tocilizumab than in those treated with steroids alone (10.9% versus 40.2%, HR 0.511 [95CI 0.352-0.741], p=0.036; weighted HR 0.6 [95CI 0.449-0.804], p<0.001) (Interaction p=0.094). Conclusions: These results show that survival of patients with severe COVID-19 is higher in patients treated with tocilizumab than in those not treated, and that tocilizumab effect adds to that of steroids administered to non-intubated cases with COVID-19 during the first 48 hours of presenting with respiratory failure despite of oxygen therapy. Randomised controlled studies are needed to confirm these results.

scholarly journals Gamma-glutamyl Transferase Levels are Associated with the Occurrence of Post-stroke Cognitive Impairment: A Multicenter Cohort Study

2021 ◽  
Author(s):  
Siqi Li ◽  
Xiaoling Liao ◽  
Yuesong Pan ◽  
Xianglong Xiang ◽  
Yumei Zhang
Keyword(s):  
Cohort Study ◽  
Cognitive Impairment ◽  
Gamma Glutamyl Transferase ◽  
Multicenter Cohort Study ◽  
Gamma Glutamyl ◽  
Post Stroke ◽  
Multicenter Cohort ◽  
Glutamyl Transferase ◽  
The Impact

Abstract Background: Gamma-glutamyl transferase (GGT) can maintain the physiological concentration of glutathione in cells, and protect them from oxidative stress-induced damage. However, its role in post-stroke cognitive impairment (PSCI) remains unknown. Here, we explored the impact of serum biomarker-GGT on PSCI. Methods: We conducted a prospective, multicenter cohort study. 1, 957 participants who suffered a stroke and measured baseline GGT were enrolled from the Impairment of Cognition and Sleep (ICONS) study of the China National Stroke Registry-3 (CNSR-3). They were categorized into four groups according to the quartiles of baseline GGT levels. Cognitive function was assessed by using the Montreal Cognitive Assessment (MoCA) approach. The multiple logistic regression models were performed to evaluate the relationship between GGT and PSCI at 3 months follow-up.Results: Among 1,957 participants, 671 (34.29%) patients suffered PSCI at 3 months follow-up. The highest GGT level quartile group exhibited a lower risk of PSCI in the fully adjusted model [OR (95% CI): 0.69 (0.50-0.96)], relative to the lowest group. Moreover, incorporation of GGT to the conventional model resulted in a slight improvement in PSCI outcomes after 3 months (NRI: 12.00%; IDI: 0.30%).Conclusions: Our findings demonstrated that serum GGT level was inversely associated with the risk of PSCI, with extremely low levels acting as a risk factor for PSCI.

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