scholarly journals Improving Hand Hygiene Compliance in Nursing Homes: Protocol for a Cluster Randomized Controlled Trial (HANDSOME Study)

10.2196/17419 ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. e17419 ◽  
Author(s):  
Gwen R Teesing ◽  
Vicki Erasmus ◽  
Mariska Petrignani ◽  
Marion P G Koopmans ◽  
Miranda de Graaf ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Nursing Homes ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Disease Incidence ◽  
Controlled Trial ◽  
World Health ◽  
The World ◽  
Hygiene Compliance ◽  
Cluster Randomized

Background Hand hygiene compliance is considered the most (cost-)effective measure for preventing health care–associated infections. While hand hygiene interventions have frequently been implemented and assessed in hospitals, there is limited knowledge about hand hygiene compliance in other health care settings and which interventions and implementation methods are effective. Objective This study aims to evaluate the effect of a multimodal intervention to increase hand hygiene compliance of nurses in nursing homes through a cluster randomized controlled trial (HANDSOME study). Methods Nursing homes were randomly allocated to 1 of 3 trial arms: receiving the intervention at a predetermined date, receiving the identical intervention after an infectious disease outbreak, or serving as a control arm. Hand hygiene was evaluated in nursing homes by direct observation at 4 timepoints. We documented compliance with the World Health Organization’s 5 moments of hand hygiene, specifically before touching a patient, before a clean/aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. The primary outcome is hand hygiene compliance of the nurses to the standards of the World Health Organization. The secondary outcome is infectious disease incidence among residents. Infectious disease incidence was documented by a staff member at each nursing home unit. Outcomes will be compared with the presence of norovirus, rhinovirus, and Escherichia coli on surfaces in the nursing homes, as measured using quantitative polymerase chain reaction. Results The study was funded in September 2015. Data collection started in October 2016 and was completed in October 2017. Data analysis will be completed in 2020. Conclusions HANDSOME studies the effectiveness of a hand hygiene intervention specifically for the nursing home environment. Nurses were taught the World Health Organization’s 5 moments of hand hygiene guidelines using the slogan “Room In, Room Out, Before Clean, After Dirty,” which was developed for nursing staff to better understand and remember the hygiene guidelines. HANDSOME should contribute to improved hand hygiene practice and a reduction in infectious disease rates and related mortality. Trial Registration Netherlands Trial Register (NTR6188) NL6049; https://www.trialregister.nl/trial/6049 International Registered Report Identifier (IRRID) DERR1-10.2196/17419

scholarly journals Increased hand hygiene compliance in nursing homes after a multimodal intervention: A cluster randomized controlled trial (HANDSOME)

2020 ◽  
Vol 41 (10) ◽  
pp. 1169-1177
Author(s):  
Gwen R. Teesing ◽  
Vicki Erasmus ◽  
Daan Nieboer ◽  
Mariska Petrignani ◽  
Marion P.G Koopmans ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Nursing Home ◽  
Nursing Homes ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Controlled Trial ◽  
Multimodal Intervention ◽  
Randomized Controlled ◽  
Hygiene Compliance ◽  
Cluster Randomized

AbstractObjective:To assess the effect of a multimodal intervention on hand hygiene compliance (HHC) in nursing homes.Design, setting, and participants:HHC was evaluated using direct, unobtrusive observation in a cluster randomized controlled trial at publicly funded nursing homes in the Netherlands. In total, 103 nursing home organizations were invited to participate; 18 organizations comprising 33 nursing homes (n = 66 nursing home units) participated in the study. Nursing homes were randomized into a control group (no intervention, n = 30) or an intervention group (multimodal intervention, n = 36). The primary outcome measure was HHC of nurses. HHC was appraised at baseline and at 4, 7, and 12 months after baseline. Observers and nurses were blinded.Intervention:Audits regarding hand hygiene (HH) materials and personal hygiene rules, 3 live lessons, an e-learning program, posters, and a photo contest. We used a new method to teach the nurses the WHO-defined 5 moments of HH: Room In, Room Out, Before Clean, and After Dirty.Results:HHC increased in both arms. The increase after 12 months was larger for units in the intervention arm (from 12% to 36%) than for control units (from 13% to 21%) (odds ratio [OR], 2.10; confidence interval [CI], 1.35–3.28). The intervention arm exhibited a statistically significant increase in HHC at 4 of the 5 WHO-defined HH moments. At follow-up, HHC in the intervention arm remained statistically significantly higher (OR, 1.93; 95% CI, 1.59–2.34) for indications after an activity (from 37% to 39%) than for indications before an activity (from 14% to 27%).Conclusions:The HANDSOME intervention is successful in improving HHC in nursing homes.

scholarly journals Appropriate Number of Observations For Determining Hand Hygiene Compliance Among Healthcare Workers

2021 ◽  
Author(s):  
Se Yoon Park ◽  
Suyeon Park ◽  
Eunjung Lee ◽  
Tae Hyong Kim ◽  
Sungho Won
Keyword(s):  
Confidence Interval ◽  
Hand Hygiene ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Mean Value ◽  
World Health ◽  
The World ◽  
Minimum Number ◽  
Hygiene Compliance ◽  
Health Organization

Abstract We sought to determine the minimum number of observations needed to determine hand hygiene (HH) compliance among healthcare workers. The study was conducted at a referral hospital in South Korea. We retrospectively analyzed the result of HH monitoring from January to December 2018. HH compliance was calculated by dividing the number of observed HH actions by the total number of opportunities. Optimal HH compliance rates were calculated based on adherence to the six-step technique recommended by the World Health Organization. The minimum number of required observations (n) was calculated by the following equation using overall mean value (r), absolute precision (d), and confidence interval (CI) (1-α) [The equation: n ≥ Z2 α/2 * p * (1-p)/d2 ]. We considered ds of 5%, 10%, 20%, and 30%, with CIs of 99%, 95%, and 90%. During the study period, 8,791 HH opportunities among 1,168 healthcare workers were monitored. Mean HH compliance and optimal HH compliance rates were 80.3% and 59.7%, respectively. The minimum number of observations required to determine HH compliance rates ranged from 2 (d: 30%, CI: 90%) to 624 (d: 5%, CI: 99%), and that for optimal HH compliance ranged from 5 (d: 30%, CI: 90%) to 642 (d: 5%, CI: 99%). We found that at least five observations were needed to determine optimal HH compliance with 30% absolute precision and a 90% CI.

scholarly journals Appropriate Number of Observations to Determine Hand Hygiene Compliance Among Healthcare Workers

2021 ◽  
Vol 1 (S1) ◽  
pp. s64-s64
Author(s):  
Se Yoon Park ◽  
Eunjung Lee ◽  
Suyeon Park ◽  
Tae Hyong Kim ◽  
Sungho Won
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Mean Value ◽  
World Health ◽  
The World ◽  
Minimum Number ◽  
The Mean ◽  
Hygiene Compliance ◽  
Health Organization

Background: We sought to determine the minimum number of observations needed to determine hand hygiene (HH) compliance among healthcare workers. Methods: The study was conducted at a referral hospital. We retrospectively analyzed the result of HH monitoring from January to December 2018. HH compliance was calculated by dividing the number of observed HH actions by the total number of opportunities. Appropriate HH compliance rates were calculated based on the 6-step technique, modified from the World Health Organization (WHO) recommendation. The minimum number of required observations (n) was calculated by the following equation using overall mean value (r), absolute precision (d), and confidence interval (1-α) [The equation: n3 Zα/22×ρ×1-ρ/d2]. We considered ds of 5%, 10%, 20%, and 30%, with CIs of 99%, 95%, and 90%, respectively. Among the various cases, we focused on 10% for d and 95% for CI. Results: During the study period, 8,791 opportunities among 1,168 healthcare workers were monitored. The mean HH compliance and appropriate HH compliance rates were 80.3% and 59.7%, respectively (Table 1). The minimum number of observations required to determine HH compliance rates ranged from 2 (d, 30%; CI, 90%) to 624 (d, 5%; CI, 99%), and the minimum number of observations for optimal HH compliance ranged from 5 (d, 30%, CI, 90%) to 642 (d, 5%; CI, 99%) (Figure 1). At 10% absolute precision with 95% confidence, the minimum number of observations to determine HH and optimal HH compliance were 61 and 92, respectively. Conclusions: The minimum number of observations to determine HH compliance varies widely according to setting, but at least 5 were needed to determine optimal HH compliance.Funding: NoDisclosures: None

scholarly journals Appropriate number of observations for determining hand hygiene compliance among healthcare workers

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Se Yoon Park ◽  
Suyeon Park ◽  
Beom Seuk Hwang ◽  
Eunjung Lee ◽  
Tae Hyong Kim ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Hand Hygiene ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Mean Value ◽  
World Health ◽  
The World ◽  
Minimum Number ◽  
Hygiene Compliance ◽  
Health Organization

AbstractWe sought to determine the minimum number of observations needed to determine hand hygiene (HH) compliance among healthcare workers. The study was conducted at a referral hospital in South Korea. We retrospectively analyzed the result of HH monitoring from January to December 2018. HH compliance was calculated by dividing the number of observed HH actions by the total number of opportunities. Optimal HH compliance rates were calculated based on adherence to the six-step technique recommended by the World Health Organization. The minimum number of required observations (n) was calculated by the following equation using overall mean value (ρ), absolute precision (d), and confidence interval (CI) (1 − α) [the equation: $${\text{n}} \ge Z_{\alpha /2}^{2} \times \rho \times \left( {1 - \rho } \right)/d^{2}$$ n ≥ Z α / 2 2 × ρ × 1 - ρ / d 2 ]. We considered ds of 5%, 10%, 20%, and 30%, with CIs of 99%, 95%, and 90%. During the study period, 8791 HH opportunities among 1168 healthcare workers were monitored. Mean HH compliance and optimal HH compliance rates were 80.3% and 59.7%, respectively. The minimum number of observations required to determine HH compliance rates ranged from 2 ($$d$$ d : 30%, CI: 90%) to 624 ($$d$$ d : 5%, CI: 99%), and that for optimal HH compliance ranged from 5 ($$d$$ d : 30%, CI: 90%) to 642 ($$d$$ d : 5%, CI: 99%). Therefore, we found that our hospital required at least five observations to determine optimal HH compliance.

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 Identifying the World Health Organization’s fifth moment for hand hygiene: Infection prevention in the operating room

2019 ◽  
Vol 21 (1) ◽  
pp. 28-34
Author(s):  
Fiona Smith ◽  
Karen Lee ◽  
Eleanor Binnie-McLeod ◽  
Mark Higgins ◽  
Elizabeth Irvine ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Operating Room ◽  
Direct Contact ◽  
Phase 1 ◽  
World Health ◽  
Phase 2 ◽  
Frontline Staff ◽  
The World ◽  
Hygiene Compliance ◽  
Health Organization

Background: The World Health Organization have designed the fifth of their ‘5 moments’ for hand hygiene to account for microbial transfer from patients to equipment in a narrow area around that patient, known as the patient zone. The study was prompted by emerging local confusion about application of the patient zone in the operating room (OR). Aim/Objectives: In two phases, we aimed to create a ‘5 moments’ style poster displaying an OR patient zone: phase 1, quantify equipment, in direct contact with the patient and, touched by non-scrubbed staff immediately after touching the patient; and phase 2, categorise equipment identified in phase 1 into patient zone and healthcare zone. An objective is to produce a ‘5 moments’ poster for the OR. Methods: The first phase used non-participant direct overt observation. In phase 2, phase 1 data were collaboratively assigned to patient zone or healthcare zone. Photography and graphic design were used to produce the OR ‘5 moments’ poster. Results: In 11 full-length surgeries, 20 pieces of equipment were in direct contact with the patient and 57 pieces of equipment were touched. In phase 2, a ‘5 moments’ poster showing an OR patient zone was designed. Discussion: Content of the patient zone was identified and displayed in a novel resource. Having shared understanding of the patient zone has potential to sustain hand hygiene compliance and equipment cleaning in the OR. Conclusion: Limitations in methods were balanced by collaboration with frontline staff. The study has been used as a teaching tool in the OR and similar settings.

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