Hand Hygiene Practices in Medical Students: A Follow-Up Study

Objective. The study was conducted to study the impact of various measures instituted to improve hand hygiene practices of the medical students after having documented poor hand hygiene awareness and compliance in a study conducted in 2012. Methods. A self-designed questionnaire based on World Health Organization’s concept of “Five Moments for Hand Hygiene” was used to evaluate the awareness of the indications of hand hygiene. Compliance was observed during Objective Structured Clinical Examination (OSCE) sessions. Fifty-one students participated voluntarily in the study. Results. The awareness and compliance of hand hygiene among the medical students in 2014 had shown statistically significant improvement (P<0.005) as compared to figures of the study conducted in 2012. Conclusion. Dedicated multifaceted intervention can improve the hand hygiene practices in medical students.

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IMPLEMENTATION OF WHO HAND HYGIENE IMPROVEMENT STRATEGY IN TRNAVA UNIVERSITY HOSPITAL, SLOVAKIA

Polonia University Scientific Journal ◽

10.23856/3710 ◽

2020 ◽

Vol 37 (6) ◽

pp. 99-106

Author(s):

Janka Prnová ◽

Jaroslava Brňová ◽

Viera Rusnáková

Keyword(s):

Hand Hygiene ◽

Hand Hygiene Compliance ◽

Daily Basis ◽

University Hospital ◽

World Health ◽

Improvement Strategy ◽

Improve Hand Hygiene ◽

Hand Hygiene Improvement ◽

Hygiene Compliance ◽

The Impact

Hand hygiene is considered to be the most simple, effective and economic measure to prevent the spread of healthcare-associated infections and antimicrobial resistance. Based on the study, application of the World Health Organization’s Multimodal Hand Hygiene Improvement Strategy can improve hand hygiene compliance in hospital settings and reduce these infections. Trnava University Hospital was included to World Health Organization (WHO) launched a worldwide campaign focused on hand hygiene in 2013, when infection control specialist has started working on daily basis. Our objective was to evaluate the impact of implementing the Multimodal Hand Hygiene Strategy according to WHO. We assessed alcohol-based hand rub consumption during the period 2013 and 2018 and hand hygiene compliance in 2018 as a baseline. During observed period alcohol-based hand rub consumptions significantly increased from 15.7 L/1000 patient days to 24.3 L/1000 patient days (p<0.05). Overall compliance as per WHO guidelines were 38.9%.

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Access to Alcohol-Based Hand Rub Is Associated With Improved Hand Hygiene in an Ebola-Threatened District of Western Uganda

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1130 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s457-s457

Author(s):

Mohammed Lamorde ◽

Matthew Lozier ◽

Maureen Kesande ◽

Patricia Akers ◽

Olive Tumuhairwe ◽

...

Keyword(s):

Hand Hygiene ◽

Healthcare Workers ◽

Hand Hygiene Compliance ◽

Wide Distribution ◽

Patient Contact ◽

Improve Hand Hygiene ◽

Before And After ◽

Hygiene Compliance ◽

Handwashing With Soap

Background: Ebola virus disease (EVD) is highly transmissible and has a high mortality rate. During outbreaks, EVD can spread across international borders. Inadequate hand hygiene places healthcare workers (HCWs) at increased risk for healthcare-associated infections, including EVD. In high-income countries, alcohol-based hand rub (ABHR) can improve hand hygiene compliance among HCWs in healthcare facilities (HCF). We evaluated local production and district-wide distribution of a WHO-recommended ABHR formulation and associations between ABHR availability in HCF and HCW hand hygiene compliance. Methods: The evaluation included 30 HCF in Kabarole District, located in Western Uganda near the border with the Democratic Republic of the Congo, where an EVD outbreak has been ongoing since August 2018. We recorded baseline hand hygiene practices before and after patient contact among 46 healthcare workers across 20 HCFs in August 2018. Subsequently, in late 2018, WHO/UNICEF distributed commercially produced ABHR to all 30 HCFs in Kabarole as part of Ebola preparedness efforts. In February 2019, our crossover evaluation distributed 20 L locally produced ABHR to each of 15 HCFs. From June 24–July 5, 2019, we performed follow-up observations of hand hygiene practices among 68 HCWs across all 30 HCFs. We defined hand hygiene as handwashing with soap or using ABHR. We conducted focus groups with healthcare workers at baseline and follow-up. Results: We observed hand hygiene compliance before and after 203 and 308 patient contacts at baseline and follow-up, respectively. From baseline to follow-up, hand hygiene compliance before patient contact increased for ABHR use (0% to 17%) and handwashing with soap (0% to 5%), for a total increase from 0% to 22% (P < .0001). Similarly, hand hygiene after patient contact increased from baseline to follow-up for ABHR use (from 3% to 55%), and handwashing with soap decreased (from 12% to 7%), yielding a net increase in hand hygiene compliance after patient contact from 15% to 62% (P < .0001). Focus groups found that HCWs prefer ABHR to handwashing because it is faster and more convenient. Conclusions: In an HCF in Kabarole District, the introduction of ABHR appeared to improve hand hygiene compliance. However, the confirmation of 3 EVD cases in Uganda 120 km from Kabarole District 2 weeks before our follow-up hand hygiene observations may have influenced healthcare worker behavior and hand hygiene compliance. Local production and district-wide distribution of ABHR is feasible and may contribute to improved hand hygiene compliance among healthcare workers.Funding: NoneDisclosures: Mohammed Lamorde, Contracted Research - Janssen Pharmaceutica, ViiV, Mylan

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Hand Hygiene Compliance at Critical Points of Care

Clinical Infectious Diseases ◽

10.1093/cid/ciaa130 ◽

2020 ◽

Cited By ~ 1

Author(s):

Nai-Chung Nelson Chang ◽

Heather Schacht Reisinger ◽

Marin L Schweizer ◽

ichael Jones ◽

Elizabeth Chrischilles ◽

...

Keyword(s):

Hand Hygiene ◽

Healthcare Workers ◽

Hand Hygiene Compliance ◽

Random Effect ◽

Task Type ◽

Resistant Bacteria ◽

Improve Hand Hygiene ◽

Hygiene Practices ◽

Hygiene Compliance ◽

Better Than

Abstract Background Most articles on hand hygiene report either overall compliance or compliance with specific hand hygiene moments. These moments vary in the level of risk to patients if healthcare workers (HCWs) are noncompliant. We assessed how task type affected HCWs’ hand hygiene compliance. Methods We linked consecutive tasks individual HCWs performed during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study into care sequences and identified task pairs—2 consecutive tasks and the intervening hand hygiene opportunity. We defined tasks as critical and/or contaminating. We determined the odds of critical and contaminating tasks occurring, and the odds of hand hygiene compliance using logistic regression for transition with a random effect adjusting for isolation precautions, glove use, HCW type, and compliance at prior opportunities. Results Healthcare workers were less likely to do hand hygiene before critical tasks than before other tasks (adjusted odds ratio [aOR], 0.97 [95% confidence interval {CI}, .95–.98]) and more likely to do hand hygiene after contaminating tasks than after other tasks (aOR, 1.12 [95% CI, 1.10–1.13]). Nurses were more likely to perform both critical and contaminating tasks, but nurses’ hand hygiene compliance was better than physicians’ (aOR, 0.94 [95% CI, .91–.97]) and other HCWs’ compliance (aOR, 0.87 [95% CI, .87–.94]). Conclusions Healthcare workers were more likely to do hand hygiene after contaminating tasks than before critical tasks, suggesting that habits and a feeling of disgust may influence hand hygiene compliance. This information could be incorporated into interventions to improve hand hygiene practices, particularly before critical tasks and after contaminating tasks.

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The effect of training and awareness of subtle control on the frequency of hand hygiene among intensive care unit nurses

BMC Research Notes ◽

10.1186/s13104-019-4635-z ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Zeinab Farmani ◽

Marzieh Kargar ◽

Zahra Khademian ◽

Shahram Paydar ◽

Najaf Zare

Keyword(s):

Intensive Care ◽

Hand Hygiene ◽

Hand Hygiene Compliance ◽

Intervention Group ◽

World Health ◽

Control Group ◽

Chi Square ◽

Improve Hand Hygiene ◽

The Mean ◽

Hygiene Compliance

Abstract Objective This study aimed to determine the effect of awareness of subtle control after training on the hand hygiene compliance among nurses in intensive care units (ICUs). The study was conducted in two ICUs of a trauma center in Shiraz, Iran on 48 nurses. The nurses of one ICU were randomly allocated to the intervention and the nurses of the other ICU were allocated to the control group. All nurses were trained on hand hygiene. Then a fake closed camera television (CCTV) was visibly installed in the intervention group’s ICU, while the nurses were aware of it. The degree of compliance with hand hygiene was observed in both groups before and after the intervention. Data were gathered using a checklist based on the World Health Organization hand hygiene protocol and analyzed using SPSS 16 and the Chi square, Wilcoxon, Mann–Whitney U, and Independent T-tests, were performed. Results The mean percentage of hand hygiene compliance in the intervention group after the intervention was significantly higher than before the intervention (p < 0.001). Additionally, the changes in the mean percentage of the intervention group was significantly higher than that for the control group (p = 0.001). The findings showed that a fake CCTV after training, installed in ICUs, can improve hand hygiene compliance.

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Improving hand hygiene compliance with patient zone demarcation: More than just lines on the floor

Journal of Patient Safety and Risk Management ◽

10.1177/2516043518816148 ◽

2018 ◽

Vol 24 (3) ◽

pp. 100-107 ◽

Cited By ~ 2

Author(s):

Shanqing Yin ◽

Phaik Kooi Lim ◽

Yoke Hwee Chan

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hand Hygiene ◽

Hand Hygiene Compliance ◽

Time Pressure ◽

World Health ◽

Post Intervention ◽

Improve Hand Hygiene ◽

Positive Effects ◽

Hygiene Compliance

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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An An assessment of the impact of educational interventions on hand hygiene compliance

Veterinary Evidence ◽

10.18849/ve.v5i3.320 ◽

2020 ◽

Vol 5 (3) ◽

Author(s):

Carla Husband ◽

Abbie McMillan ◽

Lauren Sweeney

Keyword(s):

Hand Hygiene ◽

Hand Hygiene Compliance ◽

Research Question ◽

Small Animal ◽

Educational Interventions ◽

Clinical Expertise ◽

Bottom Line ◽

Improve Hand Hygiene ◽

Hygiene Compliance ◽

The Impact

PICO question In small animal veterinary professions, does implementation of an educational intervention, when compared to no intervention, improve hand hygiene compliance? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Three papers were critically appraised. They were all prospective observational cohort studies Strength of evidence Weak Outcomes reported Two out of the three papers did not find educational implementation to have a statistically significant positive effect on hand hygiene compliance (HHC) in small animal veterinary professionals Conclusion The veterinary evidence reviewed does not provide strong justification for the use of education in the improvement of HHC in small animal practice. This contrasts with extensive human evidence which supports the use of educational interventions (Helder et al., 2010). However, a limited veterinary knowledge base in the field of HH, combined with the flawed methodologies of the appraised literature, suggests that this finding is not representative of the effect education could have on HHC. The conclusion drawn from the evidence assessed within this Knowledge Summary is that educational interventions are not significantly linked to an improvement in HHC within a small animal veterinary setting. When considering the volume of human evidence which supports education as a tool to improve HHC, the authors suggest this Knowledge Summary should be repeated in the future when additional veterinary evidence is available to reassess the conclusion drawn How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision-making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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Infection Prevention Promotion Program Based on the PRECEDE Model: Improving Hand Hygiene Behaviors among Healthcare Personnel

Infection Control and Hospital Epidemiology ◽

10.1086/663707 ◽

2012 ◽

Vol 33 (2) ◽

pp. 144-151 ◽

Cited By ~ 39

Author(s):

Hanan Aboumatar ◽

Polly Ristaino ◽

Richard O. Davis ◽

Carol B. Thompson ◽

Lisa Maragakis ◽

...

Keyword(s):

Hand Hygiene ◽

Program Implementation ◽

Hand Hygiene Compliance ◽

Infection Prevention ◽

Tertiary Care ◽

Healthcare Personnel ◽

Promotion Program ◽

Hygiene Practices ◽

Hygiene Compliance

Background.Healthcare-associated infections (HAIs) result in significant morbidity and mortality. Hand hygiene remains a cornerstone intervention for preventing HAIs. Unfortunately, adherence to hand hygiene guidelines among healthcare personnel is poor.Objective.To assess short- and long-term effects of an infection prevention promotion program on healthcare personnel hand hygiene behaviors.Design.Time series design.SettingOur study was conducted at a tertiary care academic center.Participants.Hospital healthcare personnel.Methods.We developed a multimodal program that included a multimedia communications campaign, education, leadership engagement, environment modification, team performance measurement, and feedback. Healthcare personnel hand hygiene practices were measured via direct observations over a 3-year period by “undercover” observers.Results.Overall hand hygiene compliance increased by 2-fold after full program implementation (P<.001), and this increase was sustained over a 20-month follow-up period (P< .001). The odds for compliance with hand hygiene increased by 3.8-fold in the 6 months after full program implementation (95% confidence interval, 3.53–4.23; P< .001), and this increase was sustained. There was even a modest increase at 20 months of follow up. Hand hygiene compliance increased among all disciplines and hospital units. Hand hygiene compliance increased from 35% in the first 6 months after program initiation to 77% in the last 6 months of the study period among nursing providers (P<.001), from 38% to 62% among medical providers (P<.001), and from 27% to 75% among environmental services staff (P<.001).Conclusions.Implementation of the infection prevention promotion program was associated with a significant and sustained increase in hand hygiene practices among healthcare personnel of various disciplines.Infect Control Hosp Epidemiol 2012;33(2):144-151

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Impact of an automated hand hygiene monitoring system and additional promotional activities on hand hygiene performance rates and healthcare-associated infections

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.77 ◽

2019 ◽

Vol 40 (7) ◽

pp. 741-747 ◽

Cited By ~ 6

Author(s):

John M. Boyce ◽

Jennifer A. Laughman ◽

Michael H. Ader ◽

Pamela T. Wagner ◽

Albert E. Parker ◽

...

Keyword(s):

Hand Hygiene ◽

Monitoring System ◽

Hand Hygiene Compliance ◽

Healthcare Personnel ◽

Incidence Density ◽

Healthcare Associated Infections ◽

Improve Hand Hygiene ◽

Hygiene Compliance ◽

Healthcare Associated ◽

The Impact

AbstractObjective:Determine the impact of an automated hand hygiene monitoring system (AHHMS) plus complementary strategies on hand hygiene performance rates and healthcare-associated infections (HAIs).Design:Retrospective, nonrandomized, observational, quasi-experimental study.Setting:Single, 93-bed nonprofit hospital.Methods:Hand hygiene compliance rates were estimated using direct observations. An AHHMS, installed on 4 nursing units in a sequential manner, determined hand hygiene performance rates, expressed as the number of hand hygiene events performed upon entering and exiting patient rooms divided by the number of room entries and exits. Additional strategies implemented to improve hand hygiene included goal setting, hospital leadership support, feeding AHHMS data back to healthcare personnel, and use of Toyota Kata performance improvement methods. HAIs were defined using National Healthcare Safety Network criteria.Results:Hand hygiene compliance rates generated by direct observation were substantially higher than performance rates generated by the AHHMS. Installation of the AHHMS without supplementary activities did not yield sustained improvement in hand hygiene performance rates. Implementing several supplementary strategies resulted in a statistically significant 85% increase in hand hygiene performance rates (P < .0001). The incidence density of non–Clostridioies difficile HAIs decreased by 56% (P = .0841), while C. difficile infections increased by 60% (P = .0533) driven by 2 of the 4 study units.Conclusion:Implementation of an AHHMS, when combined with several supplementary strategies as part of a multimodal program, resulted in significantly improved hand hygiene performance rates. Reductions in non–C. difficile HAIs occurred but were not statistically significant.

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Video observation of hand hygiene practices at a petting zoo and the impact of hand hygiene interventions

Epidemiology and Infection ◽

10.1017/s095026881100029x ◽

2011 ◽

Vol 140 (1) ◽

pp. 182-190 ◽

Cited By ~ 11

Author(s):

M. E. C. ANDERSON ◽

J. S. WEESE

Keyword(s):

Hand Hygiene ◽

Hand Hygiene Compliance ◽

Positive Impact ◽

Positive Association ◽

Video Observation ◽

Improve Hand Hygiene ◽

Significant Positive Association ◽

Hygiene Intervention ◽

Hygiene Compliance ◽

The Impact

SUMMARYPetting zoos are popular attractions, but can also be associated with zoonotic disease outbreaks. Hand hygiene is critical to reducing disease risks; however, compliance can be poor. Video observation of petting zoo visitors was used to assess animal and environmental contact and hand hygiene compliance. Compliance was also compared over five hand hygiene intervention periods. Descriptive statistics and multivariable logistic regression were used for analysis. Overall hand hygiene compliance was 58% (340/583). Two interventions had a significant positive association with hand hygiene compliance [improved signage with offering hand sanitizer, odds ratio (OR) 3·38, P<0·001; verbal hand hygiene reminders, OR 1·73, P=0·037]. There is clearly a need to improve hand hygiene compliance at this and other animal exhibits. This preliminary study was the first to demonstrate a positive impact of a hand hygiene intervention at a petting zoo. The findings suggest that active, rather than passive, interventions are more effective for increasing compliance.

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