An interventional implementation project: hand hygiene improvement

Abstract Background Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a “Train-the-Trainers” (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries. Methods We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training. Results Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively. Conclusions The TTT in hand hygiene model proved to be effective in enhancing participant’s knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.

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Sustained Hand Hygiene Improvement in a Pediatric Teaching Hospital During and After the H1N1 Influenza Pandemic

American Journal of Infection Control ◽

10.1016/j.ajic.2011.04.287 ◽

2011 ◽

Vol 39 (5) ◽

pp. E171-E172

Author(s):

Lilly M. Guardia-LaBar ◽

Kathleen Harriman ◽

Ann Petru

Keyword(s):

Hand Hygiene ◽

Teaching Hospital ◽

Influenza Pandemic ◽

H1n1 Influenza ◽

Hand Hygiene Improvement ◽

H1n1 Influenza Pandemic

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Hand Hygiene, Cohorting, or Antibiotic Restriction to Control Outbreaks of Multidrug-Resistant Enterobacteriaceae

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.284 ◽

2015 ◽

Vol 37 (3) ◽

pp. 272-280 ◽

Cited By ~ 27

Author(s):

Camille Pelat ◽

Lidia Kardaś-Słoma ◽

Gabriel Birgand ◽

Etienne Ruppé ◽

Michaël Schwarzinger ◽

...

Keyword(s):

Hand Hygiene ◽

Multidrug Resistant ◽

Transmission Model ◽

Patient Contact ◽

Hand Hygiene Improvement ◽

Single Carrier ◽

Before And After ◽

Hygiene Compliance ◽

Using Data ◽

Improvement Intervention

BACKGROUNDThe best strategy for controlling extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) transmission in intensive care units (ICUs) remains elusive.OBJECTIVEWe developed a stochastic transmission model to quantify the effectiveness of interventions aimed at reducing the spread of ESBL-PE in an ICU.METHODSWe modeled the evolution of an outbreak caused by the admission of a single carrier in a 10-bed ICU free of ESBL-PE. Using data obtained from recent muticenter studies, we studied 26 strategies combining different levels of the following 3 interventions: (1) increasing healthcare worker compliance with hand hygiene before and after contact with a patient; (2) cohorting; (3) reducing antibiotic prevalence at admission with or without reducing antibiotherapy duration.RESULTSImproving hand hygiene compliance from 55% before patient contact and 60% after patient contact to 80% before and 80% after patient contact reduced the nosocomial incidence rate of ESBL-PE colonization by 91% at 90 days. Adding cohorting to hand hygiene improvement intervention decreased the proportion of ESBL-PE acquisitions by an additional 7%. Antibiotic restriction had the lowest impact on the epidemic. When combined with other interventions, it only marginally improved effectiveness, despite strong hypotheses regarding antibiotic impact on transmission.CONCLUSIONOur results suggest that hand hygiene is the most effective intervention to control ESBL-PE transmission in an ICU.Infect. Control Hosp. Epidemiol. 2016;37(3):272–280

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Hand hygiene – social network analysis of peer-identified and management-selected change agents

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0644-x ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 2

Author(s):

Yew Fong Lee ◽

Mary-Louise McLaws ◽

Loke Meng Ong ◽

Suraya Amir Husin ◽

Hock Hin Chua ◽

...

Keyword(s):

Social Network ◽

Hand Hygiene ◽

Leadership Style ◽

Healthcare Workers ◽

Change Agents ◽

Organisational Culture ◽

Post Intervention ◽

Hand Hygiene Improvement ◽

The Social ◽

Hygiene Compliance

Abstract Background Hand hygiene compliance can be improved by strategies fostering collaborative efforts among healthcare workers (HCWs) through change agents. However, there is limited information about how change agents shape the social networks of work teams, and how this relates to organisational culture. The objectives of this study were to describe the influence of peer-identified change agents (PICAs) and management-selected change agents (MSCAs) on hand hygiene, perception of their leadership style by peers, and the role of the organisational culture in the process of hand hygiene promotion. Methods This study, stratified in pre-, during, and post-intervention periods, was conducted between February 2017 and March 2018 in two wards at a tertiary care hospital in Malaysia. Hand hygiene promotion was facilitated either by PICAs (study arm 1) or MSCAs (study arm 2), and the two wards were randomly allocated to one of the two interventions. Outcomes were: 1) perceived leadership styles of PICAs and MSCAs by staff, vocalised during question and answer sessions; 2) the social network connectedness and communication patterns between HCWs and change agents by applying social network analysis; and 3) hand hygiene leadership attributes obtained from HCWs in the post-intervention period by questionnaires. Results Hand hygiene compliance in study arm 1 and study arm 2 improved by from 48% (95% CI: 44–53%) to 66% (63–69%), and from 50% (44–55%) to 65% (60–69%), respectively. There was no significant difference between the two arms. Healthcare workers perceived that PICAs lead by example, while MSCAs applied an authoritarian top-down leadership style. The organisational culture of both wards was hierarchical, with little social interaction, but strong team cohesion. Position and networks of both PICAs and MSCAs were similar and generally weaker compared to the leaders who were nominated by HCWs in the post-intervention period. Healthcare workers on both wards perceived authoritative leadership to be the most desirable attribute for hand hygiene improvement. Conclusion Despite experiencing successful hand hygiene improvement from PICAs, HCWs expressed a preference for the existing top-down leadership structure. This highlights the limits of applying leadership models that are not supported by the local organisational culture.

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Hand hygiene promotion delivered by change agents—Two attitudes, similar outcome

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.339 ◽

2020 ◽

Vol 41 (3) ◽

pp. 273-279 ◽

Cited By ~ 1

Author(s):

Yew Fong Lee ◽

Mary-Louise McLaws ◽

Loke Meng Ong ◽

Suraya Amir Husin ◽

Hock Hin Chua ◽

...

Keyword(s):

Hand Hygiene ◽

Hand Hygiene Compliance ◽

Tertiary Care ◽

Change Agents ◽

Controlled Study ◽

Care Hospital ◽

Hand Hygiene Improvement ◽

Significant Difference ◽

Hygiene Promotion ◽

Hygiene Compliance

AbstractObjective:To assess the effect of peer-identified change agents (PICAs) compared to management-selected change agents (MSCAs) on hand hygiene behavior in acute care.Design:Randomized-controlled study.Setting:Two internal medicine wards of a public, university-affiliated, tertiary-care hospital in Malaysia.Methods:We randomly allocated 2 wards to hand hygiene promotion delivered either by PICAs (study arm 1) or by MSCAs (study arm 2). The primary outcome was hand hygiene compliance using direct observation by validated auditors. Secondary outcomes were hand hygiene knowledge and observations from ward tours.Results:Mean hand hygiene compliance in study arm 1 and study arm 2 improved from 48% (95% confidence interval [CI], 44%–53%) and 50% (95% CI, 44%–55%) in the preintervention period to 66% (63%–69%) and 65% (60%–69%) in the intervention period, respectively. We detected no statistically significant difference in hand hygiene improvement between the 2 study arms. Knowledge scores on hand hygiene in study arm 1 and study arm 2 improved from 60% and 63% to 98% and 93%, respectively. Staff in study arm 1 improved hand hygiene because they did not want to disappoint the efforts taken by the PICAs. Staff in study arm 2 felt pressured by the MSCAs to comply with hand hygiene to obtain good overall performance appraisals.Conclusion:Although the attitude of PICAs and MSCAs in terms of leadership, mode of action and perception of their task by staff were very different, or even opposed, both PICAs and MSCAs effectively changed behavior of staff toward improved hand hygiene to comparable levels.

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