Exploring the gap between hand washing knowledge and practices in Bangladesh: a cross-sectional comparative study.

PubMed

Rabbi, Sifat E; Dey, Nepal C

2013-01-30

Hand washing is considered as one of the most effective hygiene promotion activities for public health in developing countries. This study compared hand washing knowledge and practices in BRAC's water; sanitation and hygiene (WASH) programme areas over time. This study is a cross-sectional comparative study between baseline (2006), midline (2009) and end-line (2011) surveys in 50 sub-districts from the first phase of the programme. Thirty thousand households from 50 sub-districts were selected in two steps: i) 30 villages were selected from each sub-district by cluster sampling, and ii) 20 households were chosen systematically from each village. The matched households were considered (26,404 in each survey) for analysis. Data were collected from households through face-to-face interview using a pre-tested questionnaire. Respondents were the adult female members of the same households, who had knowledge of day-to-day household activities related to water, sanitation and hygiene. A gap between perception and practice of proper hand washing practices with soap was identified in the study areas. Hand washing practice with soap before eating was much lower than after defecation. In baseline data, 8% reported to wash their hands with soap which significantly increased to 22% in end line. Hand washing knowledge and practices before cooking food, before serving food and while handling babies is considerably limited than other critical times. A multivariate analysis shows that socio-economic factors including education of household head and respondent, water availability and access to media have strong positive association with hand washing with soap. Gap between knowledge and practice still persists in hand washing practices. Long term and extensive initiatives can aware people about the effectiveness of hand washing.

Three years of national hand hygiene campaign in Germany: what are the key conclusions for clinical practice?

PubMed

Reichardt, C; Königer, D; Bunte-Schönberger, K; van der Linden, P; Mönch, N; Schwab, F; Behnke, M; Gastmeier, P

2013-02-01

The World Health Organization (WHO) started the 'Clean Care is Safer Care' campaign in 2005. Since then, more than 120 countries have pledged to improve hand hygiene as a keystone of their national or subnational healthcare-associated infection prevention programmes. Thirty-eight countries have implemented national campaigns. Germany started a national campaign to improve hand hygiene compliance on 1 January 2008. The campaign, 'AKTION Saubere Hände', is funded by the German Ministry of Health and was initiated by the National Reference Centre for the Surveillance of Nosocomial Infections, the Society for Quality Management in Health Care and the German Coalition for Patient Safety. The campaign is designed as a multi-modal campaign based on the WHO implementation strategy. Since the end of 2010, more than 700 healthcare institutions have been actively participating in the campaign, among which are 28 university hospitals. Voluntarily participating hospitals have to implement the following measures: active support by hospital administrators of local campaign implementation, participation in a one-day introductory course, education of healthcare workers at least once a year, measurement of alcohol-based hand-rub consumption (AHC) and feedback on resulting data, implementation of the WHO 'My Five Moments for Hand Hygiene' model, increase in hand-rub availability, participation in national hand hygiene day at least every two years, and participation in national campaign network workshops at least once every two years. Observational studies to measure hand hygiene compliance are optional. Overall, there has been a significant increase of 11% in hand hygiene compliance in 62 hospitals that observed compliance before and after intervention. A total of 129 hospitals provided AHC data for three years and achieved an overall increase of 30.7%. The availability of alcohol-based hand rub increased from 86.8% to > 100% in intensive care units and from 63.6% to 91.3% in non-intensive care units. Overall, the implementation of a national campaign using the WHO multi-modal intervention strategy has led to improved hand hygiene compliance and hand-rub availability in participating settings. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Understanding of hygiene behaviour and diarrhoea in two villages in Botswana.

PubMed

Kaltenthaler, E C; Drasar, B S

1996-06-01

This paper describes a study which took place in two villages in north-east district of Botswana from July 1990 through July 1991. Qualitative data collection methods were used including: observations, key-informant interviews, focus groups, and in-depth interviews. The data were used for understanding and interpreting the cultural belief systems regarding specific hygiene behaviours and diarrhoea, with emphasis on hand washing. Hand washing was said to occur for three main reasons: to remove contamination, for social reasons, and for comfort reasons. Sources of dirt on the hands included human blood and faeces. Many perceived causes of diarrhoea were identified, including pogwana (dehydration associated with sunken anterior fontanelle). Traditional concepts regarding the treatment and prevention of diarrhoea were also identified. It is suggested that beliefs surrounding hygiene behaviour and diarrhoea should be incorporated into health education programmes.

Effects of a community-based nutrition promotion programme on child feeding and hygiene practices among caregivers in rural Eastern Ethiopia.

PubMed

Kang, Yunhee; Suh, Youn Kyoung; Debele, Lemma; Juon, Hee-Soon; Christian, Parul

2017-06-01

To evaluate the effectiveness of a community-based participatory nutrition promotion (CPNP) programme involving a 2-week group nutrition session in improving child feeding and hygiene practices among caregivers. Cluster randomized trial. In the intervention area (six clusters), the CPNP programme was added to the context of government nutrition programmes; the control area (six clusters) received the government programme only. Child feeding practices were assessed every 3 months using a 24 h dietary recall questionnaire, and hand washing with soap was assessed every 6 months, over a period of 12 months. Feeding and hygiene measures at each visit were scored and the scores summed up for the entire follow-up period. Habro and Melka Bello districts, Ethiopia. Randomly selected mothers with a child aged 6-12 months (n 1790). A total of 1199 mothers, 629 in the control and 570 in the intervention areas, were assessed at all visits and included in the analysis. Mothers in the intervention area showed higher scores than those in the control area regarding meal frequency (difference: 1·04, 95 % CI 0·35, 1·73), composite feeding score_1 (difference: 1·25, 95 % CI 0·37, 2·13; a summing score of currently breast-feeding, meal frequency and dietary diversity) and composite feeding score_2 (difference: 1·40, 95 % CI 0·49, 2·32; a summing score of meal frequency and dietary diversity). However, there were no differences in the scores of breast-feeding, dietary diversity and hand washing between the two areas (all P>0·05). The CPNP programme was effective in improving some child feeding behaviours in rural Eastern Ethiopia.

[Hygiene tips for kids. Concept and examples of realisation].

PubMed

Gebel, J; Teichert-Barthel, U; Hornbach-Beckers, S; Vogt, A; Kehr, B; Littmann, M; Kupfernagel, F; Ilschner, C; Simon, A; Exner, M

2008-11-01

Basic hygiene measures aim at promoting and maintaining good health. The necessary routines are most effectively learned and adopted during childhood. These key findings form the basis for the educational programme "Hygiene Tips for Kids" which was initiated at the Department of Hygiene and Public Health at Bonn University under the auspices of WHO Europe in 2003. The programme addresses children, teachers and parents and offers a range of materials and activities tailored to the specific needs of the target groups based on expert advice. The objective is to exert a long-lasting, positive influence on the performance of hygiene routines. Campaigns are usually directed at pre-school, kindergarten and primary school settings, with the public health service personnel playing a crucial role in coordinating and implementing the various activities. Evaluation of a campaign in the federal state of Mecklenburg-Vorpommern has proven a positive effect on hand washing routines in pre-school as well as in the domestic setting. Moreover, Hygiene Tips for Kids has a sustained positive effect on the cooperation and communication between public health authorities and teachers, children and their parents. Teachers implement their own ideas within a framework of standardised information to suit their local needs. A long-term goal would be the obligatory integration of a sensible health education programme in the syllabus of pre-school, kindergarten and primary schools.

The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006

PubMed Central

O'REILLY, C. E.; FREEMAN, M. C.; RAVANI, M.; MIGELE, J.; MWAKI, A.; AYALO, M.; OMBEKI, S.; HOEKSTRA, R. M.; QUICK, R.

2008-01-01

SUMMARY Safe drinking water and hygiene are essential to reducing Kenya's diarrhoeal disease burden. A school-based safe water and hygiene intervention in Kenya was evaluated to assess its impact on students' knowledge and parents' adoption of safe water and hygiene practices. We surveyed 390 students from nine schools and their parents at baseline and conducted a final evaluation of 363 students and their parents. From baseline to final evaluation, improvement was seen in students' knowledge of correct water treatment procedure (21–65%, P<0·01) and knowing when to wash their hands. At final evaluation, 14% of parents reported currently treating their water, compared with 6% at baseline (P<0·01). From 2004 to 2005, school absenteeism in the September–November term decreased in nine project schools by 35% and increased in nine neighbouring comparison schools by 5%. This novel programme shows promise for reducing school absenteeism and promoting water and hygiene interventions in the home. PMID:17306051

Hygiene training of food handlers in hospital settings: important factor in the prevention of nosocomial infections.

PubMed

Lazarević, Konstansa; Stojanović, Dusica; Bogdanović, Dragan; Dolićanin, Zana

2013-09-01

The aim of this study was to evaluate the effects of food hygiene training of food handlers on sanitary-hygienic conditions in hospital kitchens, based on microbiological analysis of smears taken in hospital kitchens. The study was conducted in the 1995-2009 period at the Clinical Centre Nis, Serbia. The food hygiene training was conducted in February 2005, by an infection control officer. 1,076 smears in the central kitchen and 4,025 smears in distributive kitchens were taken from hands and work clothes, work surfaces, equipment, and kitchen utensils. Microbiological analysis of smears was carried out in an accredited laboratory of the Public Health Institute Nis (Serbia). A significantly lower percentage of smears with isolates of bacteria (p < 0.001) taken from hands and work clothes, work surfaces, equipment and kitchen utensils in the central and distributive kitchens was observed in the period following the food safety education programme (2005-2009). The most commonly isolated bacteria was: Enterobacter spp., Acinetobacter spp., Citrobacter spp., and E. coli. Our results confirmed that food hygiene training improved hygiene and is also an important component for the prevention of nosocomial infection.

Hand hygiene compliance: is there a theory-practice-ethics gap?

PubMed

Mortell, Manfred

Practice is usually based on tradition, rituals and outdated information; there is often an additional gap between theoretical knowledge and its application in practice. This theory-practice gap has long existed (Allmark, 1995; Hewison et al, 1996). It often arises when theory is ignored because it is seen as idealistic and impractical, even if it is practical and beneficial. Most research relating to the lack of integration between theory and practice has concluded that environmental factors are responsible and will affect learning and practice outcomes. The author believes an additional dimension of ethics is required to bridge the gap between theory and practice. This would be a moral obligation to ensure theory and practice are integrated. To implement new practices effectively, healthcare practitioners must deem these practices worthwhile and relevant to their role. This introduces a new concept that the author calls the theory-practice-ethics gap. This theory-practice-ethics gap must be considered when examining some of the unacceptable outcomes in healthcare practice (Mortell, 2009). The literature suggests that there is a crisis of ethics where theory and practice integrate, and practitioners are failing to fulfil their duty as providers of healthcare and as patient advocates. This article examines the theory-practice-ethics gap when applied to hand hygiene. Non-compliance exists in hand hygiene among practitioners, which may increase patient mortality and morbidity rates, and raise healthcare costs. Infection prevention and control programmes to improve hand hygiene among staff include: ongoing education and training; easy access to facilities such as wash basins; antiseptic/alcohol handgels that are convenient, effective, and skin- and user-friendly; and organisational recognition and support for clinicians in hand washing and handgel practices. Yet these all appear to have failed to achieve the required and desired compliance in hand hygiene.

Talking dirty: how to save a million lives.

PubMed

Curtis, V

2003-06-01

Infectious diseases are still the number one threat to public health in developing countries. Diarrhoeal diseases alone are responsible for the deaths of at least 2 million children yearly - hygiene is paramount to resolving this problem. The function of hygienic behaviour is to prevent the transmission of the agents of infection. The most effective way of stopping infection is to stop faecal material getting into the child's environment by safe disposal of faeces and washing hands with soap once faecal material has contaminated them in the home. A review of the literature on handwashing puts it top in a list of possible interventions to prevent diarrhoea. Handwashing with soap has been calculated to save a million lives. However, few people do wash their hands with soap at these critical times. Obtaining a massive increase in handwashing worldwide requires a sea-change in thinking. Initial results from a new programme led by the World Bank, with many partner organisations, suggest that health is low on people's list of motives, rather, hands are washed to remove dirt, to rinse food off after eating, to make hands look and smell good, and as an act of motherly caring. Professional consumer and market research agencies are being used to work with the soap industry to design professional communications programmes to reach whole populations in Ghana and India. Tools and techniques for marketing handwashing and for measuring the actual impact on behaviour will be applied in new public-private handwashing programmes, which are to start up soon in Nepal, China, Peru and Senegal.

Mentor's hand hygiene practices influence student's hand hygiene rates.

PubMed

Snow, Michelle; White, George L; Alder, Stephen C; Stanford, Joseph B

2006-02-01

There were 3 objectives for this prospective quasiexperimental study. The first was to determine the effect of mentor's hand hygiene practices on student's hand hygiene rates during clinical rotations. The second was to assess the difference in hand hygiene rates for students with and without prior medical experience. The third was to assess the student's opinion and beliefs regarding hand hygiene. Sixty students enrolled in a certified nursing program were selected to participate in the study. Each study group was observed twice during the 30-day span. The first observational period was conducted on day 1 of clinical rotation. The second observational period was conducted on day 30 of clinical rotation. Students were observed for hand hygiene. Also assessed were medical experience, sex, gloving, age, and mentor's hand hygiene practices. After observational period 2, a brief questionnaire was given to students to determine their opinion and beliefs regarding hand hygiene. The questionnaire was divided into 5 sections: student's commitment to hand hygiene, their perception of hand hygiene inconvenience, the necessity of hand hygiene, the student's ability to perform hand hygiene, and their opinion on the frequency of medical staff's hand hygiene. The mentor's practice of hand hygiene was the strongest predictor of the student's rate of hand hygiene for both observational periods (P < .01). Furthermore, students without prior medical experience had a significant increase in hand hygiene rates when comparing observational period 1 to observational period 2 (P < .01). Glove usage was associated with increased hand hygiene rates by 50% during observational period 1 (P = .01) and 44% during observational period 2 (P < .01). Male students during observational period 1 practiced hand hygiene 30% less often than female students (P < .01); however, during observational period 2, there was no significant difference between hand hygiene rates for males and females (P = .82). Questionnaires were completed by 47 students, who reported a strong commitment to hand hygiene, belief in its necessity, and ability to perform hand hygiene (with scores in the high 90s on a 10 to 100 rating scale). Mentor's use of hand hygiene and glove usage was associated with increased hand hygiene among students. Even though students reported strongly positive attitudes toward hand hygiene, students had a low overall rate of hand hygiene.

Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia.

PubMed

Schmitz, Karen; Kempker, Russell R; Tenna, Admasu; Stenehjem, Edward; Abebe, Engida; Tadesse, Lia; Jirru, Ermias Kacha; Blumberg, Henry M

2014-03-17

Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia. This study included a before-and-after assessment of health care worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs' perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period. At baseline, hand washing materials were infrequently available, with only 20% of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign (OR = 6.8, 95% CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95% CI 3.5-9.3), in the emergency department (aOR = 4.9, 95% CI 2.8-8.6), during patient care that did not involve Attending Physician Rounds (aOR = 2.4, 95% CI 1.2-4.5), and after patient contact (aOR = 2.1, 95% CI 1.4-3.3). In the perceptions survey, 64.0% of HCWs indicated preference for commercially manufactured hand sanitizer and 71.4% indicated their hand hygiene adherence would improve with commercial hand sanitizer. There was a significant increase in hand hygiene adherence among Ethiopian HCWs following the implementation of a WHO-recommended multimodal hand hygiene campaign. Dissatisfaction with the current WHO-formulation for hand sanitizer was identified as a barrier to hand hygiene adherence in our setting.

Status of infection control policies and organisation in European hospitals, 2001: the ARPAC study.

PubMed

Struelens, M J; Wagner, D; Bruce, J; MacKenzie, F M; Cookson, B D; Voss, A; van den Broek, P J; Gould, I M

2006-08-01

Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedures implemented in 2001 for the surveillance and control of nosocomial infection and antibiotic resistance was completed by 169 acute-care hospitals from 32 European countries, categorised by five geographical regions. A formal IC programme existed in 72% of hospitals, and a multidisciplinary IC committee was operational in 90%. Trained IC nurses (ICNs) were present in 80% of hospitals (ranging from 54% in south-east and central-eastern Europe, to 100% in northern Europe), whereas 74% had one or more trained IC doctors (ICDs) (ranging from 46% in south-east Europe to 84% in western Europe). Median staffing levels were 2.33 ICNs/1,000 beds and 0.94 ICDs/1,000 beds. The intensity of IC programmes scored higher in centres from northern and western Europe than from other European regions. Written guidelines promoted hand hygiene for healthcare workers in 89% of hospitals, education in 85%, and audit in 46%. Guidelines recommended use of alcohol-based solutions (70%) and/or medicated/antiseptic soap (43%) for decontamination of non-soiled hands. Use of alcohol-based solutions varied according to region, from 41% in southern Europe to 100% in northern Europe, compared with use of medicated soap from 77% in southern Europe to 11% in northern Europe (p < 0.01). These findings showed that IC programmes in European hospitals suffer from major deficiencies in human resources and policies. Staffing levels for ICNs were below recommended standards in the majority of hospitals. Education programmes were incomplete and often not supported by audit of performance. Hand hygiene procedures were sub-standard in one-third of centres. Strengthening of IC policies in European hospitals should be a public health priority.

Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia

PubMed Central

2014-01-01

Background Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia. Methods This study included a before-and-after assessment of health care worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs’ perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period. Results At baseline, hand washing materials were infrequently available, with only 20% of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign (OR = 6.8, 95% CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95% CI 3.5-9.3), in the emergency department (aOR = 4.9, 95% CI 2.8-8.6), during patient care that did not involve Attending Physician Rounds (aOR = 2.4, 95% CI 1.2-4.5), and after patient contact (aOR = 2.1, 95% CI 1.4-3.3). In the perceptions survey, 64.0% of HCWs indicated preference for commercially manufactured hand sanitizer and 71.4% indicated their hand hygiene adherence would improve with commercial hand sanitizer. Conclusions There was a significant increase in hand hygiene adherence among Ethiopian HCWs following the implementation of a WHO-recommended multimodal hand hygiene campaign. Dissatisfaction with the current WHO-formulation for hand sanitizer was identified as a barrier to hand hygiene adherence in our setting. PMID:24636693

Inexpensive and Time-Efficient Hand Hygiene Interventions Increase Elementary School Children's Hand Hygiene Rates

ERIC Educational Resources Information Center

Snow, Michelle; White, George L.; Kim, Han S.

2008-01-01

Routine hand hygiene has been cited by the World Health Organization and the Centers for Disease Control and Prevention as a cost-effective and important hygiene measure in preventing the spread of infectious diseases. Several studies have explored children's hand hygiene habits, effects of scheduled hand hygiene, hand hygiene environmental…

Hand hygiene: Back to the basics of infection control

PubMed Central

Mathur, Purva

2011-01-01

Health care associated infections are drawing increasing attention from patients, insurers, governments and regulatory bodies. This is not only because of the magnitude of the problem in terms of the associated morbidity, mortality and cost of treatment, but also due to the growing recognition that most of these are preventable. The medical community is witnessing in tandem unprecedented advancements in the understanding of pathophysiology of infectious diseases and the global spread of multi-drug resistant infections in health care set-ups. These factors, compounded by the paucity of availability of new antimicrobials have necessitated a re-look into the role of basic practices of infection prevention in modern day health care. There is now undisputed evidence that strict adherence to hand hygiene reduces the risk of cross-transmission of infections. With “Clean Care is Safer Care” as a prime agenda of the global initiative of WHO on patient safety programmes, it is time for developing countries to formulate the much-needed policies for implementation of basic infection prevention practices in health care set-ups. This review focuses on one of the simplest, low cost but least accepted from infection prevention: hand hygiene. PMID:22199099

The effect of automated monitoring and real-time prompting on nurses' hand hygiene performance.

PubMed

Levchenko, Alexander I; Boscart, Veronique M; Fernie, Geoff R

2013-10-01

Adequate hand hygiene compliance by healthcare staff is considered an effective method to reduce hospital-acquired infections. The electronic system developed at Toronto Rehabilitation Institute automatically detects hand hygiene opportunities and records hand hygiene actions. It includes an optional visual hand hygiene status indication, generates real-time hand hygiene prompting signals, and enables automated monitoring of individual and aggregated hand hygiene performance. The system was installed on a complex continuous care unit at the entrance to 17 patient rooms and a utility room. A total of 93 alcohol gel and soap dispensers were instrumented and 14 nurses were provided with the personal wearable electronic monitors. The study included three phases with the system operating in three different modes: (1) an inactive mode during the first phase when hand hygiene opportunities and hand hygiene actions were recorded but prompting and visual indication functions were disabled, (2) only hand hygiene status indicators were enabled during the second phase, and (3) both hand hygiene status and real-time hand hygiene prompting signals were enabled during the third phase. Data collection was performed automatically during all of the three phases. The system indicated significantly higher hand hygiene activity rates and compliance during the third phase, with both hand hygiene indication and real-time prompting functions enabled. To increase the efficacy of the technology, its use was supplemented with individual performance reviews of the automatically collected data.

Back to basics: hand hygiene and surgical hand antisepsis.

PubMed

Spruce, Lisa

2013-11-01

Health care-associated infections (HAIs) are a significant issue in the United States and throughout the world, but following proper hand hygiene practices is the most effective and least expensive way to prevent HAIs. Hand hygiene is inexpensive and protects patients and health care personnel alike. The four general types of hand hygiene that should be performed in the perioperative environment are washing hands that are visibly soiled, hand hygiene using alcohol-based products, surgical hand scrubs, and surgical hand scrubs using an alcohol-based surgical hand rub product. Barriers to proper hand hygiene may include not thinking about it, forgetting, skin irritation, a lack of role models, or a lack of a safety culture. One strategy for improving hand hygiene practices is monitoring hand hygiene as part of a quality improvement project, but the most important aspect for perioperative team members is to set an example for other team members by following proper hand hygiene practices and reminding each other to perform hand hygiene. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of a community-based clinical teaching programme by current and former student dental therapists and dental hygienists: a pilot investigation.

PubMed

Lynch, C D; Ash, P J; Chadwick, B L

2011-05-28

There has been considerable expansion in the involvement of community-based clinical teaching programmes (sometimes termed 'outreach teaching') in UK and other international dental schools. While there has been much interest in the role of this educational methodology in the professional and educational development of student dentists, there has been little, if no, consideration of this form of teaching in relation to dental care professional (DCP) students. The aim of this pilot investigation was to report the feedback and evaluation of current and former student dental therapists and dental hygienists on their experience on the St David's community-based clinical teaching programme at Cardiff. In Autumn 2009, a questionnaire was distributed by hand to the current second year student dental therapist and dental hygiene class at Cardiff (n = 18) and by post to the dental therapist and dental hygiene classes of 2004 (n = 16) and 2007 (n = 17). The questionnaire included both 'open' and 'closed' questions. Thirty responses were returned (response rate = 59%; 2004 (n = 5, 31%), 2007 (n = 9, 53%), current class (n = 16, 89%)). Seventy percent of respondents (n = 21) reported that they found the community-based clinical teaching programme to be a pleasant working environment and close to subsequent independent practice. Seventy-seven percent (n = 23) reported that their confidence performing nonsurgical periodontal treatment had increased while at the programme. One respondent commented that the programme was '...an invaluable and insightful introduction to what it would be like working in practice. Without being given the experience, it would have been a big shock to the system when I started working in practice...' This pilot investigation has revealed that current and former dental therapist and dental hygiene students are enthusiastic in their support for the inclusion of community-based clinical teaching programmes in their educational and professional development. Most former and current dental therapist and dental hygiene students noted the positive effects of this form of training on their subsequent clinical careers.

Systemic mistakes in hand hygiene practice in Ukraine: detection, consequences and ways of elimination

PubMed Central

Klymenko, Iryna; Kampf, Günter

2015-01-01

Aim: Every year, millions of people around the world suffer from different infectious diseases, considerable part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to reduce the level of infection. We evaluated various aspects related to the situational behavior and prioritization regarding hand hygiene measures among the healthcare workers of Ukraine. Method: Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315 master-classes and presentations on proper hand hygiene were realized. The target audience included health care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took part in anonymous survey on hand hygiene practice. Results: The most common mistakes were to regard hand washing and hand disinfection equally, to wash hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and pharmaceutical industry workers highlighted the need for practical and understandable instructions of various hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground for us to create individual master classes on hand hygiene for each cluster of healthcare workers. Conclusions: Changing hand hygiene behavior and attitude is possible by beginning to observe clinical practice and by involving healthcare workers in teaching and training. PMID:25699224

Health in our hands, but not in our heads: understanding hygiene motivation in Ghana.

PubMed

Scott, Beth; Curtis, Val; Rabie, Tamer; Garbrah-Aidoo, Nana

2007-07-01

Each year more than 2 million children die from diarrhoeal diseases; the same number again die from acute respiratory infections. The simple hygiene behaviour of washing hands with soap represents an effective way of preventing the transmission of many of these infections. However, rates of handwashing across the globe are low, presenting a challenge for health promotion programmes. Behaviour change is not easy, and past efforts based upon health education have met with limited success. New approaches are needed. We propose that much can be learnt from the world of consumer marketing. Rather than base communications programmes for behaviour change on increasing knowledge, marketers aim to respond to the inner desires and motivations of their target audiences. This study used consumer research to investigate the factors motivating handwashing with soap in order to inform a national communications campaign for Ghana. It revealed that the strongest motivators for handwashing with soap were related to nurturance, social acceptance and disgust of faeces and latrines, especially their smell. Protection from disease is mentioned as a driving force, but was not a key motivator of handwashing behaviour. The ways in which these findings have been translated into a handwash promotion campaign are discussed.

Guideline Implementation: Hand Hygiene.

PubMed

Goldberg, Judith L

2017-02-01

Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Hand hygiene--comparison of international recommendations.

PubMed

Wendt, C

2001-08-01

The value of hand hygiene for the prevention of cross-infection was first observed in the middle of the 19th century. Since then, which procedure is the most suitable for hand hygiene has been repeatedly discussed and several different guidelines and recommendations have been published. The aim of this review is to compare different recommendations for hand hygiene regarding technique and indication. Medline, the internet and a personal library were searched to obtain as many written recommendations as possible. In addition, a small questionnaire was sent by e-mail to 20 international colleagues. As a result, written recommendations from 10 countries could be compared. Recommended methods of hand hygiene include handwashing (washing hands with plain soap), hygienic handwash (washing hands with medicated soap) and hygienic hand-rub (use of antiseptic rubs). In most countries handwashing and hygienic handwash are the methods of choice and only in central European countries is hygienic hand-rub the preferred technique. Situations in which performance of hand hygiene is recommended are comparable. However, no single indication is recommended in all guidelines. Hand hygiene is most often recommended before performing invasive procedures and after microbial contamination. Guidelines should be clear and easy to follow for them to become standard of care. Thus, guidelines are needed that do not leave to the health care worker a decision as to whether hand hygiene is indicated.

An elicitation study of critical care nurses' salient hand hygiene beliefs.

PubMed

Piras, Susan E; Lauderdale, Jana; Minnick, Ann

2017-10-01

To describe critical care nurses' hand hygiene attitudinal, normative referent, and control beliefs. Hand hygiene is the primary strategy to prevent healthcare-associated infections. Social influence is an underdeveloped hand hygiene strategy. This qualitative descriptive study was conducted with 25 ICU nurses in the southeastern United States. Data were collected using the Nurses' Salient Belief Instrument. Thematic analysis generated four themes: Hand Hygiene is Protective; Nurses look to Nurses; Time-related Concerns; and Convenience is Essential. Nurses look to nurses as hand hygiene referents and believe hand hygiene is a protective behaviour that requires time and functional equipment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparative study of presurgical hand hygiene with hydroalcoholic solution versus traditional presurgical hand hygiene.

PubMed

López Martín, M Beatriz; Erice Calvo-Sotelo, Alejo

To compare presurgical hand hygiene with hydroalcoholic solution following the WHO protocol with traditional presurgical hand hygiene. Cultures of the hands of surgeons and surgical nurses were performed before and after presurgical hand hygiene and after removing gloves at the end of surgery. Cultures were done in 2different days: the first day after traditional presurgical hand hygiene, and the second day after presurgical hand hygiene with hydroalcoholic solution following the WHO protocol. The duration of the traditional hand hygiene was measured and compared with the duration (3min) of the WHO protocol. The cost of the products used in the traditional technique was compared with the cost of the hydroalcoholic solution used. The variability of the traditional technique was determined by observation. Following presurgical hand hygiene with hydroalcoholic solution, colony-forming units (CFU) were detected in 5 (7.3%) subjects, whereas after traditional presurgical hand hygiene CFU were detected in 14 subjects (20.5%) (p < 0.05). After glove removal, the numbers of CFU were similar. The time employed in hand hygiene with hydroalcoholic solution (3min) was inferior to the time employed in the traditional technique (p < 0.05), its cost was less than half, and there was no variability. Compared with other techniques, presurgical hand hygiene with hydroalcoholic solution significantly decreases CFU, has similar latency time, a lower cost, and saves time. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Why language matters: a tour through hand hygiene literature.

PubMed

Pires, Daniela; Tartari, Ermira; Bellissimo-Rodrigues, Fernando; Pittet, Didier

2017-01-01

Hand hygiene has evolved over the last decades and many terminologies emerged. We aimed to analyse the evolution in the frequency of utilization of key hand hygiene terms in the literature along the years. We identified keywords and Medical Subject Headings (MeSH) used in MEDLINE® indexation related to hand hygiene by searching international guidelines and the MeSH database. We performed a MEDLINE® search combining the selected keywords and MeSH and analysed the number of publications retrieved yearly. The literature search yielded 9019 publications when all hand hygiene related search terms were combined, between 1921 and November 2016. The total number of publications per year increased from a median of 4 (IQR 3, 6) in the 1950's to 554 (IQR 478, 583) between 2011 and 2015. The most frequently used keywords are hand disinfection, hand hygiene, hand washing, handrub, hand sanitizer and alcohol-based hand rub (ABHR). Until the 1990s, hand disinfection and hand washing were the most frequently used terms. Whilst the last decade has seen a remarkable increase in publications mentioning hand disinfection and hand hygiene and for the first time handrub, hand sanitizers and ABHR were introduced in the literature. Hand disinfection, hand hygiene and hand sanitizers are the main MeSH used by MEDLINE®. Since 2013 hand hygiene is the most frequently used MeSH and keyword. The change seen in literature in the last two decades, from hand washing and hand disinfection to hand hygiene, most probably reflect the paradigm shift favouring use of ABHR over soap and water promoted by international guidelines in the early 2000s.

Skin reactions related to hand hygiene and selection of hand hygiene products.

PubMed

Larson, Elaine; Girard, Raphaelle; Pessoa-Silva, Carmem Lucia; Boyce, John; Donaldson, Liam; Pittet, Didier

2006-12-01

In October 2004, The World Health Organization (WHO) launched the World Alliance for Patient Safety. Within the alliance, the first priority of the Global Patient Safety Challenge is to reduce health care-associated infection. A key action within the challenge is to promote hand hygiene in health care globally as well as at the country level through the campaign "Clean Care is Safer Care." As a result, the WHO is developing Guidelines on Hand Hygiene in Health Care, designed to be applicable throughout the world. This paper summarizes one component of the global WHO guidelines related to the impact of hand hygiene on the skin of health care personnel, including a discussion of types of skin reactions associated with hand hygiene, methods to reduce adverse reactions, and factors to consider when selecting hand hygiene products. Health care professionals have a higher prevalence of skin irritation than seen in the general population because of the necessity for frequent hand hygiene during patient care. Ways to minimize adverse effects of hand hygiene include selecting less irritating products, using skin moisturizers, and modifying certain hand hygiene practices such as unnecessary washing. Institutions need to consider several factors when selecting hand hygiene products: dermal tolerance and aesthetic preferences of users as well as practical considerations such as convenience, storage, and costs.

Patients' Hand Washing and Reducing Hospital-Acquired Infection.

PubMed

Haverstick, Stacy; Goodrich, Cara; Freeman, Regi; James, Shandra; Kullar, Rajkiran; Ahrens, Melissa

2017-06-01

Hand hygiene is important to prevent hospital-acquired infections. Patients' hand hygiene is just as important as hospital workers' hand hygiene. Hospital-acquired infection rates remain a concern across health centers. To improve patients' hand hygiene through the promotion and use of hand washing with soap and water, hand sanitizer, or both and improve patients' education to reduce hospital-acquired infections. In August 2013, patients in a cardiothoracic postsurgical step-down unit were provided with individual bottles of hand sanitizer. Nurses and nursing technicians provided hand hygiene education to each patient. Patients completed a 6-question survey before the intervention, at hospital discharge and 1, 2, and 3 months after the intervention. Hospital-acquired infection data were tracked monthly by infection prevention staff. Significant correlations were found between hand hygiene and rates of infection with vancomycin-resistant enterococci ( P = .003) and methicillin-resistant Staphylococcus aureus ( P = .01) after the intervention. After the implementation of hand hygiene interventions, rates of both infections declined significantly and patients reported more staff offering opportunities for and encouraging hand hygiene. This quality improvement project demonstrates that increased hand hygiene compliance by patients can influence infection rates in an adult cardiothoracic step-down unit. The decreased infection rates and increased compliance with hand hygiene among the patients may be attributed to the implementation of patient education and the increased accessibility and use of hand sanitizer. ©2017 American Association of Critical-Care Nurses.

Determinants of hand hygiene compliance in Egypt: building blocks for a communication strategy.

PubMed

Lohiniva, A-L; Bassim, H; Hafez, S; Kamel, E; Ahmed, E; Saeed, T; Talaat, M

2015-10-02

Hand hygiene of health-care staff is one of the most important interventions in reducing transmission of nosocomial infections. This qualitative study aimed to understand the behavioural determinants of hand hygiene in order to develop sustainable interventions to promote hand hygiene in hospitals. Fourteen focus group discussions were conducted with nurses in 2 university hospitals in Egypt. The interviews were tape recorded and transcribed. Thematic analysis was conducted by 2 independent investigators. The findings highlighted that nurses did not perceive the benefits of hand hygiene, and that they linked the need to wash hands to a sense of dirtiness. Knowledge of hand hygiene and related products was limited and preference for water and soap was obvious. Environmental constraints, lack of role models and social control were identified as barriers for compliance with hand hygiene. A multi-faceted hand hygiene strategy was developed based on existing cultural concepts valued by the hospital staff.

An educational intervention to improve hand hygiene compliance in Vietnam.

PubMed

Phan, Hang Thi; Tran, Hang Thi Thuy; Tran, Hanh Thi My; Dinh, Anh Pham Phuong; Ngo, Ha Thanh; Theorell-Haglow, Jenny; Gordon, Christopher J

2018-03-07

Hand hygiene compliance is the basis of infection control programs. In developing countries models to improve hand hygiene compliance to reduce healthcare acquired infections are required. The aim of this study was to determine hand hygiene compliance following an educational program in an obstetric and gynecological hospital in Vietnam. Health care workers from neonatal intensive care, delivery suite and a surgical ward from Hung Vuong Hospital, Ho Chi Minh City, Vietnam undertook a 4-h educational program targeting hand hygiene. Compliance was monitored monthly for six months following the intervention. Hand hygiene knowledge was assessed at baseline and after six months of the study. There were 7124 opportunities over 370 hand hygiene recording sessions with 1531 opportunities at baseline and 1620 at 6 months following the intervention. Hand hygiene compliance increased significantly from baseline across all sites (43.6% [95% Confidence interval CI: 41.1-46.1] to 63% [95% CI: 60.6-65.3]; p < 0.0001). Health care worker hand hygiene compliance increased significantly after intervention (p < 0.0001). There were significant improvements in knowledge scores from baseline to 2 months post educational intervention with mean difference standard deviations (SD): 1.5 (2.5); p < 0.001). A simple educational model was implemented in a Vietnamese hospital that revealed good hand hygiene compliance for an extended period of time. Hand hygiene knowledge increased during the intervention. This hand hygiene model could be used in developing countries were resources are limited.

Handwashing: a simple, economical and effective method for preventing nosocomial infections in intensive care units.

PubMed

Akyol, A; Ulusoy, H; Ozen, I

2006-04-01

As most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered to be the single most important intervention to prevent nosocomial infections. However, studies have shown that handwashing practices are poor, especially among medical personnel. This review gives an overview of handwashing in health care and in the community, including some aspects that have attracted little attention, such as hand drying and cultural issues determining hand hygiene behaviour. Hand hygiene is the most effective measure for interrupting the transmission of micro-organisms which cause infection, both in the community and in the healthcare setting. Using hand hygiene as a sole measure to reduce infection is unlikely to be successful when other factors in infection control, such as environmental hygiene, crowding, staffing levels and education, are inadequate. Hand hygiene must be part of an integrated approach to infection control. Compliance with hand hygiene recommendations is poor worldwide. While the techniques involved in hand hygiene are simple, the complex interdependence of factors that determine hand hygiene behaviour makes the study of hand hygiene complex. It is now recognized that improving compliance with hand hygiene recommendations depends on altering human behaviour. Input from behavioural and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social needs.

Hand hygiene knowledge and practices of nursing students in Singapore.

PubMed

Nasirudeen, A M A; Koh, Josephine W N; Lau, Adeline Lee Chin; Li, Wenjie; Lim, Lay Seng; Ow, Cynthia Yi Xuan

2012-10-01

Hand hygiene is an important means of preventing nosocomial infections. Studies have shown a <50% compliance rate for hand hygiene among health care workers. A hand hygiene survey was administered to nursing students in a tertiary institution in Singapore. The results of this survey strongly indicate that nursing students understand the importance of hand hygiene compliance and perceive clinical internship programs and practical laboratory sessions to be effective methods of hand hygiene education. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan.

PubMed

Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Shimizu, Taro; Kamiya, Toru; Sato, Yumiko; Arakawa, Soichi; Lee, Jong Ja; Iwata, Kentaro; Mihashi, Mutsuko; Tokuda, Yasuharu

2016-03-01

Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.

Efficacy of an extended theory of planned behaviour model for predicting caterers' hand hygiene practices.

PubMed

Clayton, Deborah A; Griffith, Christopher J

2008-04-01

The main aim of this study was to determine the factors which influence caterers' hand hygiene practices using social cognitive theory. One hundred and fifteen food handlers from 29 catering businesses were observed carrying out 31,050 food preparation actions in their workplace. Caterers subsequently completed the Hand Hygiene Instrument (HHI), which ascertained attitudes towards hand hygiene using constructs from the Theory of Planned Behaviour (TPB) and the Health Belief Model. The TPB provided a useful framework for understanding caterers' implementation of hand hygiene practices, explaining 34% of the variance in hand hygiene malpractices (p < 0.05). Five components were identified as significant predictors of hand hygiene malpractices: attitudes, subjective norms, descriptive norms, perceived behavioural control and intention (p < 0.05). Thus, suggesting that hand hygiene practices cannot be improved solely through the provision of information to individuals. Effective interventions may need to focus on changing the organisational food safety culture.

Implementation and Impact of an Automated Group Monitoring and Feedback System to Promote Hand Hygiene Among Health Care Personnel

PubMed Central

Conway, Laurie J.; Riley, Linda; Saiman, Lisa; Cohen, Bevin; Alper, Paul; Larson, Elaine L.

2015-01-01

Article-at-a-Glance Background Despite substantial evidence to support the effectiveness of hand hygiene for preventing health care–associated infections, hand hygiene practice is often inadequate. Hand hygiene product dispensers that can electronically capture hand hygiene events have the potential to improve hand hygiene performance. A study on an automated group monitoring and feedback system was implemented from January 2012 through March 2013 at a 140-bed community hospital. Methods An electronic system that monitors the use of sanitizer and soap but does not identify individual health care personnel was used to calculate hand hygiene events per patient-hour for each of eight inpatient units and hand hygiene events per patient-visit for the six outpatient units. Hand hygiene was monitored but feedback was not provided during a six-month baseline period and three-month rollout period. During the rollout, focus groups were conducted to determine preferences for feedback frequency and format. During the six-month intervention period, graphical reports were e-mailed monthly to all managers and administrators, and focus groups were repeated. Results After the feedback began, hand hygiene increased on average by 0.17 events/patient-hour in inpatient units (interquartile range = 0.14, p = .008). In outpatient units, hand hygiene performance did not change significantly. A variety of challenges were encountered, including obtaining accurate census and staffing data, engendering confidence in the system, disseminating information in the reports, and using the data to drive improvement. Conclusions Feedback via an automated system was associated with improved hand hygiene performance in the short term. PMID:25252389

Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey

PubMed Central

Horng, L.M.; Unicomb, L.; Alam, M.-U.; Halder, A.K.; Shoab, A.K.; Ghosh, P.K.; Opel, A.; Islam, M.K.; Luby, S.P.

2017-01-01

SUMMARY Background Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions. Aim To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy. Methods The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities. Findings More than 96% of facilities had ‘improved’ water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78–92% of handwashing locations for doctors and nurses, but just 4–30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%). Conclusion Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi health-care facilities. PMID:27665311

Implementation and impact of an automated group monitoring and feedback system to promote hand hygiene among health care personnel.

PubMed

Conway, Laurie J; Riley, Linda; Saiman, Lisa; Cohen, Bevin; Alper, Paul; Larson, Elaine L

2014-09-01

Despite substantial evidence to support the effectiveness of hand hygiene for preventing health care-associated infections, hand hygiene practice is often inadequate. Hand hygiene product dispensers that can electronically capture hand hygiene events have the potential to improve hand hygiene performance. A study on an automated group monitoring and feedback system was implemented from January 2012 through March 2013 at a 140-bed community hospital. An electronic system that monitors the use of sanitizer and soap but does not identify individual health care personnel was used to calculate hand hygiene events per patient-hour for each of eight inpatient units and hand hygiene events per patient-visit for the six outpatient units. Hand hygiene was monitored but feedback was not provided during a six-month baseline period and three-month rollout period. During the rollout, focus groups were conducted to determine preferences for feedback frequency and format. During the six-month intervention period, graphical reports were e-mailed monthly to all managers and administrators, and focus groups were repeated. After the feedback began, hand hygiene increased on average by 0.17 events/patient-hour in inpatient units (interquartile range = 0.14, p = .008). In outpatient units, hand hygiene performance did not change significantly. A variety of challenges were encountered, including obtaining accurate census and staffing data, engendering confidence in the system, disseminating information in the reports, and using the data to drive improvement. Feedback via an automated system was associated with improved hand hygiene performance in the short-term.

Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey.

PubMed

Horng, L M; Unicomb, L; Alam, M-U; Halder, A K; Shoab, A K; Ghosh, P K; Opel, A; Islam, M K; Luby, S P

2016-11-01

Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions. To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy. The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities. More than 96% of facilities had 'improved' water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78-92% of handwashing locations for doctors and nurses, but just 4-30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%). Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi healthcare facilities. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Hand Hygiene Practices Among Indian Medical Undergraduates: A Questionnaire-Based Survey

PubMed Central

Modi, Pranav D; Solanki, Rajavi; Modi, Janhavi; Chandramani, Srinath; Gill, Niharika

2017-01-01

Background and objectives To prevent the spread of infections in all healthcare settings, hand hygiene must be routinely practiced. Appropriate hand hygiene techniques can go a long way in reducing nosocomial infections, cross-transmission of microorganisms and the risk of occupational exposure to infectious diseases. World Health Organisation (WHO) has taken an incredible approach called “My Five Moments for Hand Hygiene" which defines the key moments when health-care workers should perform hand hygiene. We thus carried out a survey to assess knowledge of hand hygiene practices among undergraduate medical students.  Materials and methods A cross-sectional survey was conducted among 523 Indian medical undergraduates. The questionnaire used was adapted from the WHO hand hygiene knowledge questionnaire for health-care workers and was distributed both, in print and online formats. The response to each question was examined using percentages. Results Nearly 57% (n=298) of medical students who participated in this study did not receive any formal training in hand hygiene. Only 27% (n=141) students knew that the most frequent source of germs responsible for health-care associated infections were the germs already present on or within the patient. Nearly 68.6% (n= 359) students were unaware of the sequence of hand washing and hand rubbing. Although 71.9% (n=376 ) students claimed that they use an alcohol-based hand rub routinely, only 36.1% (n=189 ) students knew the time required for a hand rub to kill the germs on the hands. Overall hand hygiene knowledge was low in 6.9% (n=36), moderate in 80.9% (n=423) and good in 12.2% (n=23) of respondents.  Conclusions The awareness about hand hygiene practices among medical students is low. Nearly 57% (n=298) of the respondents never received any formal training in hand hygiene throughout their course of medical undergraduate study. To prevent the spread of infections in healthcare settings, medical students should be given proper training in hand hygiene practices right from the first year of the medical curriculum. This should be done by running workshops and annual seminars on hand hygiene practices and making it a requisite for clinical skills assessment. PMID:28936375

Video observation of hand hygiene practices during routine companion animal appointments and the effect of a poster intervention on hand hygiene compliance

PubMed Central

2014-01-01

Background Hand hygiene is considered one of the most important infection control measures in human healthcare settings, but there is little information available regarding hand hygiene frequency and technique used in veterinary clinics. The objectives of this study were to describe hand hygiene practices associated with routine appointments in companion animal clinics in Ontario, and the effectiveness of a poster campaign to improve hand hygiene compliance. Results Observation of hand hygiene practices was performed in 51 clinics for approximately 3 weeks each using 2 small wireless surveillance cameras: one in an exam room, and one in the most likely location for hand hygiene to be performed outside the exam room following an appointment. Data from 38 clinics were included in the final analysis, including 449 individuals, 1139 appointments before and after the poster intervention, and 10894 hand hygiene opportunities. Overall hand hygiene compliance was 14% (1473/10894), while before and after patient contact compliance was 3% (123/4377) and 26% (1145/4377), respectively. Soap and water was used for 87% (1182/1353) of observed hand hygiene attempts with a mean contact time of 4 s (median 2 s, range 1-49 s), while alcohol-based hand rub (ABHR) was used for 7% (98/1353) of attempts with a mean contact time of 8 s (median 7 s, range 1-30 s). The presence of the posters had no significant effect on compliance, although some staff reported that they felt the posters did increase their personal awareness of the need to perform hand hygiene, and the posters had some effect on product contact times. Conclusions Overall hand hygiene compliance in veterinary clinics in this study was low, and contact time with hand hygiene products was frequently below current recommendations. Use of ABHR was low despite its advantages over hand washing and availability in the majority of clinics. The poster campaign had a limited effect on its own, but could still be used as a component of a multimodal hand hygiene campaign. Improving the infection control culture in veterinary medicine would facilitate future campaigns and studies in this area, as well as overall patient and staff safety. PMID:24885304

Video observation of hand hygiene practices during routine companion animal appointments and the effect of a poster intervention on hand hygiene compliance.

PubMed

Anderson, Maureen E C; Sargeant, Jan M; Weese, J Scott

2014-05-07

Hand hygiene is considered one of the most important infection control measures in human healthcare settings, but there is little information available regarding hand hygiene frequency and technique used in veterinary clinics. The objectives of this study were to describe hand hygiene practices associated with routine appointments in companion animal clinics in Ontario, and the effectiveness of a poster campaign to improve hand hygiene compliance. Observation of hand hygiene practices was performed in 51 clinics for approximately 3 weeks each using 2 small wireless surveillance cameras: one in an exam room, and one in the most likely location for hand hygiene to be performed outside the exam room following an appointment. Data from 38 clinics were included in the final analysis, including 449 individuals, 1139 appointments before and after the poster intervention, and 10894 hand hygiene opportunities. Overall hand hygiene compliance was 14% (1473/10894), while before and after patient contact compliance was 3% (123/4377) and 26% (1145/4377), respectively. Soap and water was used for 87% (1182/1353) of observed hand hygiene attempts with a mean contact time of 4 s (median 2 s, range 1-49 s), while alcohol-based hand rub (ABHR) was used for 7% (98/1353) of attempts with a mean contact time of 8 s (median 7 s, range 1-30 s). The presence of the posters had no significant effect on compliance, although some staff reported that they felt the posters did increase their personal awareness of the need to perform hand hygiene, and the posters had some effect on product contact times. Overall hand hygiene compliance in veterinary clinics in this study was low, and contact time with hand hygiene products was frequently below current recommendations. Use of ABHR was low despite its advantages over hand washing and availability in the majority of clinics. The poster campaign had a limited effect on its own, but could still be used as a component of a multimodal hand hygiene campaign. Improving the infection control culture in veterinary medicine would facilitate future campaigns and studies in this area, as well as overall patient and staff safety.

A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation.

PubMed

Dai, Ruoxi; Lam, Otto L T; Lo, Edward C M; Li, Leonard S W; McGrath, Colman

2017-06-01

The objectives of this study were to evaluate and compare the effectiveness of an advanced oral hygiene care programme (AOHCP) and a conventional oral hygiene care programme (COHCP) in improving oral hygiene, and reducing gingival bleeding among patients with stroke during outpatient rehabilitation. Subjects were randomized to receive (i) the COHCP comprising a manual toothbrush, toothpaste, and oral hygiene instruction, or (ii) the AOHCP comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, toothpaste, and oral hygiene instruction. Dental plaque, gingival bleeding, and other clinical oral health outcomes were assessed at baseline, the end of the clinical trial, and the end of observation period. Development of infectious complications was also monitored. Participants of both programmes had a significant reduction in the percentages of sites with moderate to abundant dental plaque (p<0.001) and with gingival bleeding (p<0.05). Those in the AOHCP had significantly less plaque and gingival bleeding than those in the COHCP controlling for other factors at the end of the clinical trial period (both p<0.001) and the observational period (plaque: p<0.05, gingival bleeding: p<0.01). Although both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control, the AOHCP was more effective than the COHCP in reducing dental plaque and gingival bleeding. This study highlighted the value of oral hygiene programmes within stroke outpatient rehabilitation and provides evidence to advocate for the inclusion of oral hygiene care programmes within stroke outpatient rehabilitation for patients with normal cognitive abilities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Impact of INICC Multidimensional Hand Hygiene Approach in ICUs in Four Cities in Argentina.

PubMed

Rosenthal, Victor D; Viegas, Mónica; Sztokhamer, Daniel; Benchetrit, Guillermo; Santoro, Beatriz; Lastra, Carlos Esteban; Romani, Adriana; Di Núbila, Beatriz Marta Alicia; Lanzetta, Diana; Fernández, Leonardo J; Rossetti, María Adelaida; Migazzi, Claudia; Barolin, Clarisa; Martínez, Estela; Bonaventura, Claudio; Caridi, Maria de Los Ángeles; Messina, Adriana; Ricci, Beatriz; Soroka, Luisa C; Frías, María Laura

2015-01-01

We evaluated the impact of the International Nosocomial Infection Control Consortium multidimensional approach to hand hygiene in 11 intensive care units in 4 cities in Argentina and analyzed predictors of poor hand hygiene compliance. We had a baseline period and a follow-up period. We observed 21 100 hand hygiene opportunities. Hand hygiene compliance increased from 28.3% to 64.8% (P = .0001). Males versus females (56.8% vs 66.4%; P < .001) and physicians versus nurses (46.6% vs 67.8%; P < .001) were significantly associated with poor hand hygiene compliance.

The relationship between hand hygiene and health care-associated infection: it’s complicated

PubMed Central

McLaws, Mary-Louise

2015-01-01

The reasoning that improved hand hygiene compliance contributes to the prevention of health care-associated infections is widely accepted. It is also accepted that high hand hygiene alone cannot impact formidable risk factors, such as older age, immunosuppression, admission to the intensive care unit, longer length of stay, and indwelling devices. When hand hygiene interventions are concurrently undertaken with other routine or special preventive strategies, there is a potential for these concurrent strategies to confound the effect of the hand hygiene program. The result may be an overestimation of the hand hygiene intervention unless the design of the intervention or analysis controls the effect of the potential confounders. Other epidemiologic principles that may also impact the result of a hand hygiene program include failure to consider measurement error of the content of the hand hygiene program and the measurement error of compliance. Some epidemiological errors in hand hygiene programs aimed at reducing health care-associated infections are inherent and not easily controlled. Nevertheless, the inadvertent omission by authors to report these common epidemiological errors, including concurrent infection prevention strategies, suggests to readers that the effect of hand hygiene is greater than the sum of all infection prevention strategies. Worse still, this omission does not assist evidence-based practice. PMID:25678805

Implementation of the WHO multimodal Hand Hygiene Improvement Strategy in a University Hospital in Central Ethiopia.

PubMed

Pfäfflin, Frieder; Tufa, Tafese Beyene; Getachew, Million; Nigussie, Tsehaynesh; Schönfeld, Andreas; Häussinger, Dieter; Feldt, Torsten; Schmidt, Nicole

2017-01-01

The burden of health-care associated infections in low-income countries is high. Adequate hand hygiene is considered the most effective measure to reduce the transmission of nosocomial pathogens. We aimed to assess compliance with hand hygiene and perception and knowledge about hand hygiene before and after the implementation of a multimodal hand hygiene campaign designed by the World Health Organization. The study was carried out at Asella Teaching Hospital, a university hospital and referral centre for a population of about 3.5 million in Arsi Zone, Central Ethiopia. Compliance with hand hygiene during routine patient care was measured by direct observation before and starting from six weeks after the intervention, which consisted of a four day workshop accompanied by training sessions and the provision of locally produced alcohol-based handrub and posters emphasizing the importance of hand hygiene. A second follow up was conducted three months after handing over project responsibility to the Ethiopian partners. Health-care workers' perception and knowledge about hand hygiene were assessed before and after the intervention. At baseline, first, and second follow up we observed a total of 2888, 2865, and 2244 hand hygiene opportunities, respectively. Compliance with hand hygiene was 1.4% at baseline and increased to 11.7% and 13.1% in the first and second follow up, respectively (p < 0.001). The increase in compliance with hand hygiene was consistent across professional categories and all participating wards and was independently associated with the intervention (adjusted odds ratio, 9.18; 95% confidence interval 6.61-12.76; p < 0.001). After the training, locally produced alcohol-based handrub was used in 98.4% of all hand hygiene actions. The median hand hygiene knowledge score overall was 13 (interquartile range 11-15) at baseline and increased to 17 (15-18) after training (p < 0.001). Health-care workers' perception surveys revealed high appreciation of the different strategy components. Promotion of hand hygiene is feasible and sustainable in a resource-constrained setting using a multimodal improvement strategy. However, absolute compliance remained low. Strong and long-term commitment by hospital management and health-care workers may be needed for further improvement.

Role of a multimodal educational strategy on health care workers' handwashing.

PubMed

Watson, Jo Andrea

2016-04-01

Good hand hygiene is the single most important strategy used to prevent health care-associated infections (HAIs); however, health care workers' (HCWs') hand hygiene compliance rates range between 25% and 51%. This study aims to determine if a multimodal strategy using the World Health Organization's (WHO's) My 5 Moments for Hand Hygiene methodology increases HCWs' compliance with handwashing and awareness of the importance of good hand hygiene in the prevention of HAIs. A quasi-experimental, 1-group pre-post survey design was used to test awareness and knowledge. A simple interrupted time series methodology at baseline and 3 months was used to monitor hand hygiene compliance. Overall, HCWs' hand hygiene compliance increased from 51.3% to 98.6%, with an odds ratio of 71.10. The pre-post survey demonstrated HCWs were aware and knowledgeable of the importance of good hand hygiene. Eight postsurvey questions focusing on the strategies used to promote hand hygiene demonstrated statistical significance using a 1-sample t test, with P values ranging from .000-.024. A multimodal approach using the WHO's My 5 Moments for Hand Hygiene does increase HCWs' hand hygiene compliance and awareness and knowledge of the importance of hand hygiene in the prevention of HAIs. Using this approach can produce a positive social change by reducing preventable disease and decreasing HAIs not only within a facility but also in the community. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of a hand hygiene campaign in outpatient health care clinics.

PubMed

Kukanich, Kate Stenske; Kaur, Ramandeep; Freeman, Lisa C; Powell, Douglas A

2013-03-01

To improve hand hygiene in two outpatient health care clinics through the introduction of a gel sanitizer and an informational poster. In this interventional study, health care workers at two outpatient clinics were observed for frequency of hand hygiene (attempts versus opportunities). Gel sanitizer and informational posters were introduced together as an intervention. Direct observation of the frequency of hand hygiene was performed during baseline, intervention, and follow-up. A poststudy survey of health care workers was also distributed and collected. In both clinics, the frequency of hand hygiene was poor at baseline (11% and 21%) but improved significantly after intervention (36% and 54%) and was maintained through the follow-up period (32% and 51%). Throughout the study, postcontact hand hygiene was observed significantly more often than precontact hand hygiene. In both clinics, health care workers reported a preference for soap and water; yet observations showed that when the intervention made gel sanitizer available, sanitizer use predominated. Fifty percent of the surveyed health care workers considered the introduction of gel sanitizer to be an effective motivating tool for improving hand hygiene. Hand hygiene performance by health care workers in outpatient clinics may be improved through promoting the use of gel sanitizer and using informational posters. Compared with surveys, direct observation by trained observers may provide more accurate information about worker preferences for hand hygiene tools.

Safety in Serbian animal source food industry and the impact of hazard analysis and critical control points: A review

NASA Astrophysics Data System (ADS)

Tomašević, I.; Đekić, I.

2017-09-01

There is a significant lack of HACCP-educated and/or HACCP-highly trained personnel within the Serbian animal source food workforces and veterinary inspectors, and this can present problems, particularly in hazard identification and assessment activities. However, despite obvious difficulties, HACCP benefits to the Serbian dairy industry are widespread and significant. Improving prerequisite programmes on the farms, mainly through infrastructural investments in milk collectors and transportation vehicles on one hand, and increasing hygiene awareness of farmers through training on the other hand has improved the safety of milk. The decline in bacterial numbers on meat contact surfaces, meat handlers’ hands and cooling facilities presents strong evidence of improved process hygiene and justifies the adoption of HACCP in Serbian meat establishments. Apart from the absence of national food poisoning statistics or national foodborne disease databases, the main obstacle to fully recognising the impact of HACCP on the safety of animal source food in Serbia is the lack of research regarding the occurrence of chemical and/or physical hazards interrelated with its production.

Factors associated with hand hygiene practices in two neonatal intensive care units.

PubMed

Cohen, Bevin; Saiman, Lisa; Cimiotti, Jeannie; Larson, Elaine

2003-06-01

To determine whether hand hygiene practices differ between levels of contact with neonates; to characterize the hand hygiene practices of different types of personnel; and to compare hand hygiene practices in neonatal intensive care units (NICUs) using different products. Research assistants observed staff hand hygiene practices during 38 sessions in two NICUs. Patient touches were categorized as touching within the neonates' environment but only outside the Isolette (Level 1), touching within the Isolette but not the neonate directly (Level 2) or directly touching the neonate (Level 3). Hand hygiene practices for each touch were categorized into five groups: cleaned hands and new gloves; uncleaned hands and new gloves; used gloves; clean hands and no gloves; uncleaned hands and no gloves. Research assistants observed 1472 touches. On average each neonate or his or her immediate environment was touched 78 times per shift. Nurses (P = 0.001), attending physicians (P = 0.02) and physicians-in-training (P = 0.03) were more likely to use appropriate practices during Level 3 touches, but only 22.8% of all touches were with cleaned and/or newly gloved hands. The mean number of direct touches by staff members with cleaned hands was greater in the NICU using an alcohol-based hand rub than in the NICU using antimicrobial soap (P < 0.01). Hand hygiene was suboptimal in this high risk setting; administrative action and improved products may be needed to assure acceptable practice. In this study use of an alcohol-based product was associated with significantly improved hand hygiene and should be encouraged, as recommended in the new CDC hand hygiene guideline.

Relationship between Systems-Level Factors and Hand Hygiene Adherence

PubMed Central

Dunn-Navarra, Ann-Margaret; Cohen, Bevin; Stone, Patricia W.; Pogorzelska, Monika; Jordan, Sarah; Larson, Elaine

2010-01-01

This study was a cross sectional descriptive survey of acute care hospitals in California to describe staff hand hygiene compliance and related predictors, and explore the relationship between hand hygiene adherence to health care-associated infections. Although there was a relatively small sample size, institutions with morning huddles reported a significantly higher proportion of ≥95% hand hygiene compliance. Huddles are an organizational tool to improve teamwork and communication and may offer promise to influence hand hygiene adherence. PMID:20489659

Adherence to hand hygiene protocol by clinicians and medical students at Queen Elizabeth Central Hospital, Blantyre-Malawi.

PubMed

Kalata, N L; Kamange, L; Muula, A S

2013-06-01

While communicable diseases are the leading causes of morbidity and mortality in Malawi, the contribution of nosocomial or hospital-acquired infections (HAIs) is unknown but could be substantial. The single most important method of preventing nosocomial infections is hand hygiene. We report a study which was conducted in 2011 to investigate adherence to hand hygiene protocols by clinicians and medical students working at Queen Elizabeth Central Hospital in Blantyre, Malawi. There were two parts to the study: a single blinded arm in which participants were observed without their knowledge by trained nurses; and a second arm which included self-completion of questionnaire after participant consent was obtained. The 2009 World Health Organization hand hygiene technique and recommendations which were adopted by Queen Elizabeth Central Hospital were used to define an opportunity for hand washing and effectiveness of hand washing. Hand hygiene effectiveness was defined as adherence to at least 6 out of 7 steps (80%) of the hand hygiene technique when using alcohol-based formulation or at least 8 out of 10 steps (80%) of the hand hygiene technique when using water and soap formulation before and after having direct contact with patients or their immediate surroundings. Clinicians were found to have disinfected their hands more than medical students (p<0.05) but effectiveness was similar and very low between the two groups (p=0.2). No association was also found between having a personal hand sanitizer and hand hygiene practice (p=0.3). Adherence to hand hygiene was found to be 23%. Most of the participants mentioned infection transmission prevention as a reason for disinfecting their hands. Other reasons mentioned included: a routine personal hand hygiene behaviour and discomfort if not washing hands. The top three reasons why they did not disinfect hands were forgetfulness, unavailability of sanitizers and negligence. Adherence to hand hygiene practice was found to be low, with forgetfulness and negligence being the major contributing factors. A hospital-wide multifaceted program aiming at clinicians and students education, adoption of alcohol based hand rubs as a primary formulation, production of colored poster reminders and encouraging role modeling of junior practitioners by senior practitioners can help improve compliance to hand hygiene.

Baseline evaluation of hand hygiene compliance in three major hospitals, Isfahan, Iran.

PubMed

Ataei, B; Zahraei, S M; Pezeshki, Z; Babak, A; Nokhodian, Z; Mobasherizadeh, S; Hoseini, S G

2013-09-01

Hand hygiene is the mainstay of nosocomial infection prevention. This study was a baseline survey to assess hand hygiene compliance of healthcare workers by direct observation in three major hospitals of Isfahan, Iran. The use of different hand hygiene products was also evaluated. In 3078 potential opportunities hand hygiene products were available on 2653 occasions (86.2%). Overall compliance was 6.4% (teaching hospital: 7.4%; public hospital: 6.2%; private hospital: 1.4%). Nurses (8.4%) had the highest rates of compliance. Poor hand hygiene compliance in Isfahan hospitals necessitates urgent interventions to improve both hospital infrastructure and staff knowledge. © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran.

PubMed

Ghorbani, Azam; Sadeghi, Leila; Shahrokhi, Akram; Mohammadpour, Asghar; Addo, Mary; Khodadadi, Esmail

2016-11-01

Nosocomial infections are considered a major risk factor in hospital wards, and hand hygiene is the first step in their control. An observational study was conducted in 2015 with 200 nurses working in intensive care units in teaching hospitals of Tabriz, Iran. Data were collected by using the Hand Hygiene Observation Tool questionnaire. The researchers monitored nurses' opportunities for hand hygiene during the 8-week period from February 3-April 4, 2015. A total of 1,067 opportunities occurred for hand hygiene before and after wearing gloves. The results show that hand hygiene compliance before wearing gloves is poor among nurses who work in intensive care units (14.8%). Therefore it is necessary to conduct effective interventions through continuing education programs to improve hand hygiene compliance. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Influencing factors on hand hygiene behavior of nursing students based on theory of planned behavior: A descriptive survey study.

PubMed

Jeong, Sun Young; Kim, Kyung Mi

2016-01-01

Hand hygiene is the single most important measure to prevent transmission of infection, but the compliance rate of healthcare workers is relatively low. This study was conducted to identify the knowledge, beliefs, behavior, and affecting factors about hand hygiene among nursing students. A descriptive survey study. The study was carried out in two South Korean nursing schools. A total 208 nursing students participated in this study. Questionnaires were used to collect data. The percentage of correct answers in the survey section concerning hand hygiene knowledge was 68.1%. No significant difference in the knowledge, behavioral beliefs, normative beliefs, or control beliefs data was found related to general characteristics. Behavioral beliefs correlated with normative beliefs (r=.25, p<.001) and hand hygiene behavior (r=.17, p=.017), and control beliefs correlated with hand hygiene behavior (r=.18, p=.010). The results suggest that knowledge is not enough to change the beliefs related to hand hygiene; positive behavioral beliefs and strong control beliefs are also needed to increase hand hygiene compliance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Smartphone text message service to foster hand hygiene compliance in health care workers.

PubMed

Kerbaj, Jad; Toure, Youssoupha; Soto Aladro, Alberto; Boudjema, Sophia; Giorgi, Roch; Dufour, Jean Charles; Brouqui, Philippe

2017-03-01

Health care-associated infections are a major worldwide public health issue. Hand hygiene is a major component in the prevention of pathogen transmission in hospitals, and hand hygiene adherence by health care workers is low in many studies. We report an intervention using text messages as reminders and feedback to improve hand hygiene adherence. The study is a historical comparison proof-of-concept study. Eighteen health care workers were monitored during 12 months by a radiofrequency identification system. Afterward we sent 2 types of text messages, congratulation or encouragement, and we studied the evolution of hand hygiene adherence. We recorded 15,723 hand hygiene opportunities, 8,973 before intervention and 6,750 during and after the intervention. Using a multilevel logistic regression analysis, we found a significant increase in hand hygiene adherence during the intervention (odds ratio, 1.68) compared with the historical period. Despite limitations due to the type of study, a text message encouraging personnel to be more vigilant is effective in increasing hand hygiene adherence in health care workers. Text message feedback should be incorporated into multimodal approaches for improving hand hygiene compliance. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Determinants of success and sustainability of the WHO multimodal hand hygiene promotion campaign, Italy, 2007–2008 and 2014

PubMed Central

Moro, Maria Luisa; Morsillo, Filomena; Nascetti, Simona; Parenti, Mita; Allegranzi, Benedetta; Pompa, Maria Grazia; Pittet, Didier

2017-01-01

A national hand hygiene promotion campaign based on the World Health Organization (WHO) multimodal, Clean Care is Safer Care campaign was launched in Italy in 2007. One hundred seventy-five hospitals from 14 of 20 Italian regions participated. Data were collected using methods and tools provided by the WHO campaign, translated into Italian. Hand hygiene compliance, ward infrastructure, and healthcare workers’ knowledge and perception of healthcare-associated infections and hand hygiene were evaluated before and after campaign implementation. Compliance data from the 65 hospitals returning complete data for all implementation tools were analysed using a multilevel approach. Overall, hand hygiene compliance increased in the 65 hospitals from 40% to 63% (absolute increase: 23%, 95% confidence interval: 22–24%). A wide variation in hand hygiene compliance among wards was observed; inter-ward variability significantly decreased after campaign implementation and the level of perception was the only item associated with this. Long-term sustainability in 48 of these 65 hospitals was assessed in 2014 using the WHO Hand Hygiene Self-Assessment Framework tool. Of the 48 hospitals, 44 scored in the advanced/intermediate categories of hand hygiene implementation progress. The median hand hygiene compliance achieved at the end of the 2007–2008 campaign appeared to be sustained in 2014. PMID:28661390

Kaiser Permanente National Hand Hygiene Program

PubMed Central

Barnes, Sue; Barron, Dana; Becker, Linda; Canola, Teresa; Salemi, Charles

2004-01-01

Objective: Hand hygiene has historically been identified as an important intervention for preventing infection acquired in health care settings. Recently, the advent of waterless, alcohol-based skin degermer and elimination of artificial nails have been recognized as other important interventions for preventing infection. Supplied with this information, the National Infection Control Peer Group convened a KP Hand Hygiene Work Group, which, in August 2001, launched a National Hand Hygiene Program initiative titled “Infection Control: It’s In Our Hands” to increase compliance with hand hygiene throughout the Kaiser Permanente (KP) organization. Design: The infection control initiative was designed to include employee and physician education as well as to implement standard hand hygiene products (eg, alcohol degermers), eliminate use of artificial nails, and monitor outcomes. Results: From 2001 through September 2003, the National KP Hand Hygiene Work Group coordinated implementation of the Hand Hygiene initiative throughout the KP organization. To date, outcome monitoring has shown a 26% increase in compliance with hand hygiene as well as a decrease in the number of bloodstream infections and methycillin-resistant Staphylococcus aureus (MRSA) infections. As of May 2003, use of artificial nails had been reduced by 97% nationwide. Conclusions: Endorsement of this Hand Hygiene Program initiative by KP leadership has led to implementation of the initiative at all medical centers throughout the KP organization. Outcome indicators to date suggest that the initiative has been successful; final outcome monitoring will be completed in December 2003. PMID:26704605

Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach over 13 years in 51 cities of 19 limited-resource countries from Latin America, Asia, the Middle East, and Europe.

PubMed

Rosenthal, Victor D; Pawar, Mandakini; Leblebicioglu, Hakan; Navoa-Ng, Josephine Anne; Villamil-Gómez, Wilmer; Armas-Ruiz, Alberto; Cuéllar, Luis E; Medeiros, Eduardo A; Mitrev, Zan; Gikas, Achilleas; Yang, Yun; Ahmed, Altaf; Kanj, Souha S; Dueñas, Lourdes; Gurskis, Vaidotas; Mapp, Trudell; Guanche-Garcell, Humberto; Fernández-Hidalgo, Rosalía; Kübler, Andrzej

2013-04-01

To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance. An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period. Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey. Healthcare workers at 99 ICU members of the INICC. A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. Observations were made for hand hygiene compliance in each ICU, during randomly selected 30-minute periods. A total of 149,727 opportunities for hand hygiene were observed. Overall hand hygiene compliance increased from 48.3% to 71.4% ([Formula: see text]). Univariate analysis indicated that several variables were significantly associated with poor hand hygiene compliance, including males versus females (63% vs 70%; [Formula: see text]), physicians versus nurses (62% vs 72%; [Formula: see text]), and adult versus neonatal ICUs (67% vs 81%; [Formula: see text]), among others. Adherence to hand hygiene increased by 48% with the INICC approach. Specific programs directed to improve hand hygiene for variables found to be predictors of poor hand hygiene compliance should be implemented.

[Hand hygiene technique assessment using electronic equipment in 26 Hungarian healthcare institutions].

PubMed

Lehotsky, Ákos; Morvai, Júlia; Szilágyi, László; Bánsághi, Száva; Benkó, Alíz; Haidegger, Tamás

2017-07-01

Hand hygiene is probably the most effective tool of nosocomial infection prevention, however, proper feedback and control is needed to develop the individual hand hygiene practice. Assessing the efficiency of modern education tools, and digital demonstration and verification equipment during their wide-range deployment. 1269 healthcare workers took part in a training organized by our team. The training included the assessment of the participants' hand hygiene technique to identify the most often missed areas. The hand hygiene technique was examined by a digital device. 33% of the participants disinfected their hands incorrectly. The most often missed sites are the fingertips (33% on the left hand, 37% on the right hand) and the thumbs (42% on the left hand, 32% on the right hand). The feedback has a fundamental role in the development of the hand hygiene technique. With the usage of electronic devices feedback can be provided efficiently and simply. Orv Hetil. 2017; 158(29): 1143-1148.

Healthcare professionals' hand hygiene knowledge and beliefs in the United Arab Emirates.

PubMed

Ng, Wai Khuan; Shaban, Ramon Z; van de Mortel, Thea

2017-05-01

Hand hygiene at key moments during patient care is considered an important infection prevention and control measure to reduce healthcare-associated infections. While there is extensive research in Western settings, there is little in the United Arab Emirates where particular cultural and religious customs are thought to influence hand hygiene behaviour. To examine the hand hygiene knowledge and beliefs of health professionals at a tertiary care hospital in the United Arab Emirates. A mixed methods design employed a survey followed by focus groups with nurses and doctors. A total of 109 participants (13.6%) completed the survey: 96 nurses (88%) and 13 doctors (12%). Doctors' hand hygiene knowledge was slightly higher than that of nurses (78.5% versus 73.5%). There was no significant difference in scores on the hand hygiene beliefs scale between nurses (M = 103.06; SD = 8.0) and doctors (M = 99.00; SD = 10.53; t (80) = 1.55; p = 0.13, two-tailed). Seven categories emerged following transcript analysis. Hand hygiene knowledge scores suggest further hand hygiene education is required, especially on alcohol-based hand rub use. Addressing doctors' beliefs is particularly important given the leadership roles that doctors play in healthcare settings.

Changing the paradigm: messages for hand hygiene education and audit from cluster analysis.

PubMed

Gould, D J; Navaie, D; Purssell, E; Drey, N S; Creedon, S

2018-04-01

Hand hygiene is considered to be the foremost infection prevention measure. How healthcare workers accept and make sense of the hand hygiene message is likely to contribute to the success and sustainability of initiatives to improve performance, which is often poor. A survey of nurses in critical care units in three National Health Service trusts in England was undertaken to explore opinions about hand hygiene, use of alcohol hand rubs, audit with performance feedback, and other key hand-hygiene-related issues. Data were analysed descriptively and subjected to cluster analysis. Three main clusters of opinion were visualized, each forming a significant group: positive attitudes, pragmatism and scepticism. A smaller cluster suggested possible guilt about ability to perform hand hygiene. Cluster analysis identified previously unsuspected constellations of beliefs about hand hygiene that offer a plausible explanation for behaviour. Healthcare workers might respond to education and audit differently according to these beliefs. Those holding predominantly positive opinions might comply with hand hygiene policy and perform well as infection prevention link nurses and champions. Those holding pragmatic attitudes are likely to respond favourably to the need for professional behaviour and need to protect themselves from infection. Greater persuasion may be needed to encourage those who are sceptical about the importance of hand hygiene to comply with guidelines. Interventions to increase compliance should be sufficiently broad in scope to tackle different beliefs. Alternatively, cluster analysis of hand hygiene beliefs could be used to identify the most effective educational and monitoring strategies for a particular clinical setting. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Dirt and diarrhoea: formative research in hygiene promotion programmes.

PubMed

Curtis, V; Kanki, B; Cousens, S; Sanou, A; Diallo, I; Mertens, T

1997-06-01

Investment in the promotion of better hygiene for the prevention of diarrhoeal diseases and as a component of water and sanitation programmes is increasing. Before designing programmes capable of sustainably modifying hygiene behaviour in large populations, valid answers to a number of basic questions concerning the site and the intended beneficiaries have to be obtained. Such questions include 'what practices favour the transmission of enteric pathogens?', 'what advantages will be perceived by those who adopt safe practices?' and 'what channels of communication are currently employed by the target population?' A study of hygiene and diarrhoea in Bobo-Dioulasso, Burkina Faso, used a mixture of methods to address such questions. This paper draws on that experience to propose a plan of preliminary research using a variety of techniques which could be implemented over a period of a few months by planners of hygiene promotion programmes. The techniques discussed include structured observation, focus group discussions and behavioural trials. Modest investment in such systematic formative research with clear and limited goals is likely to be repaid many times over in the increased effectiveness of hygiene promotion programmes.

Use of a verbal electronic audio reminder with a patient hand hygiene bundle to increase independent patient hand hygiene practices of older adults in an acute care setting.

PubMed

Knighton, Shanina C; Dolansky, Mary; Donskey, Curtis; Warner, Camille; Rai, Herleen; Higgins, Patricia A

2018-06-01

We hypothesized that the addition of a novel verbal electronic audio reminder to an educational patient hand hygiene bundle would increase performance of self-managed patient hand hygiene. We conducted a 2-group comparative effectiveness study randomly assigning participants to patient hand hygiene bundle 1 (n = 41), which included a video, a handout, and a personalized verbal electronic audio reminder (EAR) that prompted hand cleansing at 3 meal times, or patient hand hygiene bundle 2 (n = 34), which included the identical video and handout, but not the EAR. The primary outcome was alcohol-based hand sanitizer use based on weighing bottles of hand sanitizer. Participants that received the EAR averaged significantly more use of hand sanitizer product over the 3 days of the study (mean ± SD, 29.97 ± 17.13 g) than participants with no EAR (mean ± SD, 10.88 ± 9.27 g; t 73  = 5.822; P ≤ .001). The addition of a novel verbal EAR to a patient hand hygiene bundle resulted in a significant increase in patient hand hygiene performance. Our results suggest that simple audio technology can be used to improve patient self-management of hand hygiene. Future research is needed to determine if the technology can be used to promote other healthy behaviors, reduce infections, and improve patient-centered care without increasing the workload of health care workers. Published by Elsevier Inc.

Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units.

PubMed

Eveillard, Matthieu; Raymond, Françoise; Guilloteau, Véronique; Pradelle, Marie-Thérèse; Kempf, Marie; Zilli-Dewaele, Marina; Joly-Guillou, Marie-Laure; Brunel, Patrick

2011-10-01

To assess the impact of a multi-faceted training program on the compliance with hand hygiene and gloving practices. Hand hygiene is considered as the cornerstone of the prevention of hospital-acquired infections. Several studies have enhanced the poor effectiveness of training programs in improving hand hygiene compliance. A before-after evaluation study. The study was conducted in four healthcare settings before and after an intervention program which included the performance feedback of the first evaluation phase, three six-h training sessions, the assessment of hand hygiene performance with teaching boxes and the organisation of one full-day session devoted to institutional communication around hand hygiene in each setting. Hand hygiene compliance and quality of hand rubbing were evaluated. Hand hygiene opportunities were differentiated into extra-series opportunities (before or after a single contact and before the first contact or after the last contact of a series of consecutive contacts) and intra-series opportunities (from the opportunity following the first contact to the opportunity preceding the last in the same series). Overall, 969 contacts corresponding to 1,470 hand hygiene opportunities (760 during the first phase and 710 during the second) were observed. A significant improvement of observed practices was recorded for the hand hygiene compliance in intra-series opportunities (39·0% vs. 19·0%; p < 10(-5) ), the proportion of gloves worn if indicated (71·4% vs. 52·0%; p < 0·001) and the quality of hand rubbing (85·0% vs. 71·9%; p < 10(-5) ). Some of the performances measured for both hand hygiene and gloving practices were improved. We plan to extend this investigation by performing a qualitative study with experts in behavioural sciences to try improving practices for which adherence was still weak after the training program such as hand hygiene in intra-series opportunities. This study underscored the usefulness of implementing contextualised training programs, while more traditional courses have shown little impact. © 2011 Blackwell Publishing Ltd.

Hand hygiene compliance in transplant and other special patient groups: an observational study.

PubMed

Graf, Karolin; Ott, Ella; Wolny, Michael; Tramp, Nadine; Vonberg, Ralf-Peter; Haverich, Axel; Chaberny, Iris Freya

2013-06-01

This study evaluates hand hygiene behavior of health care workers in a German university hospital stratified for treatment of special patient groups (eg, transplant patients). From 2008 to 2010, comprehensive education and training of all health care workers was implemented to improve hand hygiene compliance. Consumption rates of alcohol-based hand rub and gloves were collected and evaluated. Of the 5,647 opportunities of hand disinfection evaluated, 1,607 occurred during care for transplant patients. To our knowledge, this is the largest survey of hand hygiene compliance in special patient groups on intensive care units in a university hospital in Germany. Health care workers on surgical intensive care units showed lower hand hygiene compliance compared with health care workers on other types of intensive care units. Compliance toward hand hygiene was significantly higher on hemato-oncologic and pediatric wards. In general, hand disinfection was performed significantly more frequently after an intervention than before (P < .05, 95% confidence interval: 1.24-1.84). Overall, there was no significant difference in hand hygiene compliance when caring for transplant patients or other patients (odds ratio, 1.16; 95% confidence interval: 0.95-1.42). Nurse's and physician's hand hygiene compliance improved because of education. Hand hygiene compliance is not increased in the care for transplant patients (despite their predisposition for nosocomial infections) compared with other patients. Additional studies will be necessary to further investigate these findings. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Comparison of ethanol hand sanitizer versus moist towelette packets for mealtime patient hand hygiene.

PubMed

Rai, Herleen; Knighton, Shanina; Zabarsky, Trina F; Donskey, Curtis J

2017-09-01

To facilitate patient hand hygiene, there is a need for easy-to-use products. In a survey of 100 patients, a single-use ethanol hand sanitizer packet took less time to access than a single-use moist towelette packet (3 vs 23 seconds) and was preferred by 74% of patients for mealtime hand hygiene. Performance of patient hand hygiene increased when a reminder was provided at the time of meal tray delivery. Published by Elsevier Inc.

A framework for designing hand hygiene educational interventions in schools.

PubMed

Appiah-Brempong, Emmanuel; Harris, Muriel J; Newton, Samuel; Gulis, Gabriel

2018-03-01

Hygiene education appears to be the commonest school-based intervention for preventing infectious diseases, especially in the developing world. Nevertheless, there remains a gap in literature regarding a school-specific theory-based framework for designing a hand hygiene educational intervention in schools. We sought to suggest a framework underpinned by psychosocial theories towards bridging this knowledge gap. Furthermore, we sought to propound a more comprehensive definition of hand hygiene which could guide the conceptualisation of hand hygiene interventions in varied settings. Literature search was guided by a standardized tool and literature was retrieved on the basis of a predetermined inclusion criteria. Databases consulted include PubMed, ERIC, and EBSCO host (Medline, CINAHL, PsycINFO, etc.). Evidence bordering on a theoretical framework to aid the design of school-based hand hygiene educational interventions is summarized narratively. School-based hand hygiene educational interventions seeking to positively influence behavioural outcomes could consider enhancing psychosocial variables including behavioural capacity, attitudes and subjective norms (normative beliefs and motivation to comply). A framework underpinned by formalized psychosocial theories has relevance and could enhance the design of hand hygiene educational interventions, especially in schools.

How a smiley protects health: A pilot intervention to improve hand hygiene in hospitals by activating injunctive norms through emoticons

PubMed Central

Tsivrikos, Dimitrios; Dollinger, Daniel; Lermer, Eva

2018-01-01

Hand hygiene practice in hospitals is unfortunately still widely insufficient, even though it is known that transmitting pathogens via hands is the leading cause of healthcare-associated infections. Previous research has shown that improving knowledge, providing feedback on past behaviour and targeting social norms are promising approaches to improve hand hygiene practices. The present field experiment was designed to direct people on when to perform hand hygiene and prevent forgetfulness. This intervention is the first to examine the effect of inducing injunctive social norms via an emoticon-based feedback system on hand hygiene behaviour. Electronic monitoring and feedback devices were installed in hospital patient rooms on top of hand-rub dispensers, next to the doorway, for a period of 17 weeks. In the emoticon condition, screens at the devices activated whenever a person entered or exited the room. Before using the alcohol-based hand-rub dispenser, a frowny face was displayed, indicating that hand hygiene should be performed. If the dispenser was subsequently used, this picture changed to a smiley face to positively reinforce the correct behaviour. Hand hygiene behaviour in the emoticon rooms significantly outperformed the behaviour in three other tested conditions. The strong effect in this field experiment indicates that activating injunctive norms may be a promising approach to improve hand hygiene behaviour. Theoretical and practical implications of these findings are discussed. PMID:29782516

Determinants of success and sustainability of the WHO multimodal hand hygiene promotion campaign, Italy, 2007-2008 and 2014.

PubMed

Moro, Maria Luisa; Morsillo, Filomena; Nascetti, Simona; Parenti, Mita; Allegranzi, Benedetta; Pompa, Maria Grazia; Pittet, Didier

2017-06-08

A national hand hygiene promotion campaign based on the World Health Organization (WHO) multimodal, Clean Care is Safer Care campaign was launched in Italy in 2007. One hundred seventy-five hospitals from 14 of 20 Italian regions participated. Data were collected using methods and tools provided by the WHO campaign, translated into Italian. Hand hygiene compliance, ward infrastructure, and healthcare workers' knowledge and perception of healthcare-associated infections and hand hygiene were evaluated before and after campaign implementation. Compliance data from the 65 hospitals returning complete data for all implementation tools were analysed using a multilevel approach. Overall, hand hygiene compliance increased in the 65 hospitals from 40% to 63% (absolute increase: 23%, 95% confidence interval: 22-24%). A wide variation in hand hygiene compliance among wards was observed; inter-ward variability significantly decreased after campaign implementation and the level of perception was the only item associated with this. Long-term sustainability in 48 of these 65 hospitals was assessed in 2014 using the WHO Hand Hygiene Self-Assessment Framework tool. Of the 48 hospitals, 44 scored in the advanced/intermediate categories of hand hygiene implementation progress. The median hand hygiene compliance achieved at the end of the 2007-2008 campaign appeared to be sustained in 2014. This article is copyright of The Authors, 2017.

Understanding the Determinants of Australian Hospital Nurses' Hand Hygiene Decisions Following the Implementation of a National Hand Hygiene Initiative

ERIC Educational Resources Information Center

White, Katherine M.; Starfelt, Louise C.; Jimmieson, Nerina L.; Campbell, Megan; Graves, Nicholas; Barnett, Adrian G.; Cockshaw, Wendell; Gee, Phillip; Page, Katie; Martin, Elizabeth; Brain, David; Paterson, David

2015-01-01

Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The "5 critical moments" of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this…

Hand hygiene in the intensive care unit.

PubMed

Tschudin-Sutter, Sarah; Pargger, Hans; Widmer, Andreas F

2010-08-01

Healthcare-associated infections affect 1.4 million patients at any time worldwide, as estimated by the World Health Organization. In intensive care units, the burden of healthcare-associated infections is greatly increased, causing additional morbidity and mortality. Multidrug-resistant pathogens are commonly involved in such infections and render effective treatment challenging. Proper hand hygiene is the single most important, simplest, and least expensive means of preventing healthcare-associated infections. In addition, it is equally important to stop transmission of multidrug-resistant pathogens. According to the Centers for Disease Control and Prevention and World Health Organization guidelines on hand hygiene in health care, alcohol-based handrub should be used as the preferred means for routine hand antisepsis. Alcohols have excellent in vitro activity against Gram-positive and Gram-negative bacteria, including multidrug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, Mycobacterium tuberculosis, a variety of fungi, and most viruses. Some pathogens, however, such as Clostridium difficile, Bacillus anthracis, and noroviruses, may require special hand hygiene measures. Failure to provide user friendliness of hand hygiene equipment and shortage of staff are predictors for noncompliance, especially in the intensive care unit setting. Therefore, practical approaches to promote hand hygiene in the intensive care unit include provision of a minimal number of handrub dispensers per bed, monitoring of compliance, and choice of the most attractive product. Lack of knowledge of guidelines for hand hygiene, lack of recognition of hand hygiene opportunities during patient care, and lack of awareness of the risk of cross-transmission of pathogens are barriers to good hand hygiene practices. Multidisciplinary programs to promote increased use of alcoholic handrub lead to an increased compliance of healthcare workers with the recommended hand hygiene practices and a reduced prevalence of nosocomial infections.

Meta-analysis of food safety training on hand hygiene knowledge and attitudes among food handlers.

PubMed

Soon, Jan Mei; Baines, Richard; Seaman, Phillip

2012-04-01

Research has shown that traditional food safety training programs and strategies to promote hand hygiene increases knowledge of the subject. However, very few studies have been conducted to evaluate the impact of food safety training on food handlers' attitudes about good hand hygiene practices. The objective of this meta-analytical study was to assess the extent to which food safety training or intervention strategies increased knowledge of and attitudes about hand hygiene. A systematic review of food safety training articles was conducted. Additional studies were identified from abstracts from food safety conferences and food science education conferences. Search terms included combinations of "food safety," "food hygiene," "training," "education," "hand washing," "hand hygiene," "knowledge," "attitudes," "practices," "behavior," and "food handlers." Only before- and after-training approaches and cohort studies with training (intervention group) and without training (control group) in hand hygiene knowledge and including attitudes in food handlers were evaluated. All pooled analyses were based on a random effects model. Meta-analysis values for nine food safety training and intervention studies on hand hygiene knowledge among food handlers were significantly higher than those of the control (without training), with an effect size (Hedges' g) of 1.284 (95% confidence interval [CI] ∼ 0.830 to 1.738). Meta-analysis of five food safety training and intervention studies in which hand hygiene attitudes and self-reported practices were monitored produced a summary effect size of 0.683 (95% CI ∼ 0.523 to 0.843). Food safety training increased knowledge and improved attitudes about hand hygiene practices. Refresher training and long-term reinforcement of good food handling behaviors may also be beneficial for sustaining good hand washing practices.

Hand Hygiene Improvement and Sustainability: Assessing a Breakthrough Collaborative in Western Switzerland.

PubMed

Staines, Anthony; Amherdt, Isabelle; Lécureux, Estelle; Petignat, Christiane; Eggimann, Philippe; Schwab, Marcos; Pittet, Didier

2017-12-01

OBJECTIVE To assess hand hygiene improvement and sustainability associated with a Breakthrough Collaborative. DESIGN Multicenter analysis of hand hygiene compliance through direct observation by trained observers. SETTING A total of 5 publicly funded hospitals in 14 locations, with a total of 1,152 beds, in the County of Vaud, Switzerland. PARTICIPANTS Clinical staff. INTERVENTIONS In total, 59,272 opportunities for hand hygiene were monitored for the duration of the study, for an average of 5,921 per audit (range, 5,449-6,852). An 18-month Hand Hygiene Breakthrough Collaborative was conducted to implement the WHO multimodal promotional strategy including improved access to alcohol-based hand rub, education, performance measurement and feedback, reminders and communication, leadership engagement, and safety culture. RESULTS Overall hand hygiene compliance improved from 61.9% to 88.3% (P<.001) over 18 months and was sustained at 88.9% (P=.248) 12 months after the intervention. Hand hygiene compliance among physicians increased from 62% to 85% (P<.001) and finally 86% at follow-up (P=.492); for nursing staff, compliance improved from 64% to 90% (P<.001) and finally 90% at follow-up (P=.464); for physiotherapists compliance improved from 50% to 90% (P<.001) and finally 91% at follow-up (P=.619); for X-ray technicians compliance improved from 45% to 80% (P<.001) and finally 81% at follow-up (P=.686). Hand hygiene compliance also significantly increased with sustained improvement across all hand hygiene indications and all hospitals. CONCLUSIONS A rigorously conducted multicenter project combining the Breakthrough Collaborative method for its structure and the WHO multimodal strategy for content and measurement was associated with significant and substantial improvement in compliance across all professions, all hand hygiene indications, and all participating hospitals. Infect Control Hosp Epidemiol 2017;38:1420-1427.

Healthcare professionals’ hand hygiene knowledge and beliefs in the United Arab Emirates

PubMed Central

Ng, Wai Khuan; Shaban, Ramon Z.; van de Mortel, Thea

2016-01-01

Background: Hand hygiene at key moments during patient care is considered an important infection prevention and control measure to reduce healthcare-associated infections. While there is extensive research in Western settings, there is little in the United Arab Emirates where particular cultural and religious customs are thought to influence hand hygiene behaviour. Aim: To examine the hand hygiene knowledge and beliefs of health professionals at a tertiary care hospital in the United Arab Emirates. Methods: A mixed methods design employed a survey followed by focus groups with nurses and doctors. Findings: A total of 109 participants (13.6%) completed the survey: 96 nurses (88%) and 13 doctors (12%). Doctors’ hand hygiene knowledge was slightly higher than that of nurses (78.5% versus 73.5%). There was no significant difference in scores on the hand hygiene beliefs scale between nurses (M = 103.06; SD = 8.0) and doctors (M = 99.00; SD = 10.53; t (80) = 1.55; p = 0.13, two-tailed). Seven categories emerged following transcript analysis. Discussion: Hand hygiene knowledge scores suggest further hand hygiene education is required, especially on alcohol-based hand rub use. Addressing doctors’ beliefs is particularly important given the leadership roles that doctors play in healthcare settings. PMID:28989517

Hesitation and error: Does product placement in an emergency department influence hand hygiene performance?

PubMed

Stackelroth, Jenny; Sinnott, Michael; Shaban, Ramon Z

2015-09-01

Existing research has consistently demonstrated poor compliance by health care workers with hand hygiene standards. This study examined the extent to which incorrect hand hygiene occurred as a result of the inability to easily distinguish between different hand hygiene solutions placed at washbasins. A direct observational method was used using ceiling-mounted, motion-activated video camera surveillance in a tertiary referral emergency department in Australia. Data from a 24-hour period on day 10 of the recordings were collected into the Hand Hygiene-Technique Observation Tool based on Feldman's criteria as modified by Larson and Lusk. A total of 459 episodes of hand hygiene were recorded by 6 video cameras in the 24-hour period. The observed overall rate of error in this study was 6.2% (27 episodes). In addition an overall rate of hesitation was 5.8% (26 episodes). There was no statistically significant difference in error rates with the 2 hand washbasin configurations. The amelioration of causes of error and hesitation by standardization of the appearance and relative positioning of hand hygiene solutions at washbasins may translate in to improved hand hygiene behaviors. Placement of moisturizer at the washbasin may not be essential. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Job Burnout Reduces Hand Hygiene Compliance Among Nursing Staff.

PubMed

Manomenidis, Georgios; Panagopoulou, Efharis; Montgomery, Anthony

2017-10-13

Health professional burnout has been associated with suboptimal care and reduced patient safety. However, the extent to which burnout influences hand hygiene compliance among health professionals has yet to be explored. The aim of the study was to examine whether job burnout reduces hand washing compliance among nursing staff. A diary study was conducted. Forty registered nurses working in a general city hospital in Thessaloniki, Greece, completed a questionnaire, while they were monitored for hand hygiene compliance following the World Health Organization protocol for hand hygiene assessment. Burnout was measured using validated items from the Maslach Burnout Inventory. Data were collected from September to October 2015. Multiple regression analysis showed that controlling for years in practice, burnout was negatively associated with hand hygiene compliance (R = 0.322, F(3,36) = 5.704, P < 0.01). Nurses reporting higher levels of burnout were less likely to comply with hand hygiene opportunities (b = - 3.72, 95% confidence interval = -5.94 to -1.51). This study showed that burnout contributes to suboptimal care by reducing compliance to hand hygiene among nurses. Given the crucial role of hand hygiene compliance for the prevention of in-hospital infections, this study highlights the need for interventions targeting the prevention of burnout among nursing staff.

Waterless Hand Rub Versus Traditional Hand Scrub Methods for Preventing the Surgical Site Infection in Orthopedic Surgery.

PubMed

Iwakiri, Kentaro; Kobayashi, Akio; Seki, Masahiko; Ando, Yoshiyuki; Tsujio, Tadao; Hoshino, Masatoshi; Nakamura, Hiroaki

2017-11-15

MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. A retrospective cohort study with prospectively collected data. The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264 seconds with the traditional protocol and 160 seconds with the waterless protocol. Waterless hand rub with an alcohol based chlorhexidine gluconate solution can be a safe, quick, and cost-effective alternative to traditional hand scrub. 3.

Do WiFi-based hand hygiene dispenser systems increase hand hygiene compliance?

PubMed

Scheithauer, Simone; Bickenbach, Johannes; Heisel, Hans; Fehling, Patrick; Marx, Gernot; Lemmen, Sebastian

2018-05-17

Innovative methods to ensure better compliance in hand hygiene are urgently needed. The aim of this study was to determine if WiFi-based hand hygiene dispenser-driven self-assessment systems (Wireless Fidelity, WiFi-dispenser) can support the work of infection control teams. Our results suggest that the continuous monitoring of dispenser usage can be a valuable addition to infection prevention and control programs, when used in a bundle in combination with conventional hand hygiene training. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Hand hygiene instruction decreases illness-related absenteeism in elementary schools: a prospective cohort study

PubMed Central

2012-01-01

Background Illness-related absences have been shown to lead to negative educational and economic outcomes. Both hand washing and hand sanitizer interventions have been shown to be effective in reducing illness-related absences. However, while the importance of hand hygiene in schools is clear, the role of instruction in use is less obvious. The purpose of this study was to compare absenteeism rates among elementary students given access to hand hygiene facilities versus students given both access and short repetitive instruction in use, particularly during influenza season when illness-related absences are at a peak. Methods A hand hygiene intervention was implemented from October to May during the 2009/2010 academic year, including peak flu season, in two Chicago Public Elementary Schools among students grades pre-kindergarten to eighth grade (ages 4–14). Classrooms were systematically assigned to an intervention or control group by grade (cluster design). Hand hygiene facilities (sanitizer and soap) were made available to all students. Students in the intervention group also received short repetitive instruction in hand hygiene every 2 months. Only absences as a result of respiratory or gastrointestinal illness were used to establish illness-related absenteeism rates. Percent absent days were calculated and bivariate analyses were performed to compare percent absent days among students given access to hand hygiene facilities versus students given both access and instruction. Prior to the intervention, teachers’ perceptions of students’ hand hygiene were also evaluated. Teacher perceptions were analysed to describe attitudes and beliefs. Results Data were collected and analysed for 773 students reporting 1,886 absences during the study period (1.73% of total school days). Both the percent total absent days and percent illness-related absent days were significantly lower in the group receiving short instruction during flu season (P = 0.002, P < 0.001, respectively). This difference peaked during the influenza season (when intervention began) and declined in the following months. Teachers (n = 23) agreed that hand hygiene is not performed properly among students and reported time constraints as a barrier to frequent hand washing. Conclusions Adding hand hygiene instruction to existing hand hygiene practices improved attendance at public elementary schools during the flu season. Standardized and brief repetitive instruction in hand hygiene holds potential to significantly reduce absenteeism. PMID:22587432

Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection.

PubMed

Lam, Barbara C C; Lee, Josephine; Lau, Y L

2004-11-01

Health care-associated infections persist as a major problem in most neonatal intensive care units. Hand hygiene has been singled out as the most important measure in preventing hospital-acquired infection. However, hand hygiene compliance among health care workers (HCWs) remains low. The objective of this study was to assess the frequency and nature of patient contacts in neonatal intensive care units and observe the compliance and technique of hand hygiene among HCWs before and after the implementation of a multimodal intervention program. The nature and frequency of patient contacts, the hand hygiene compliance, and hand-washing techniques of HCWs were observed unobtrusively to reflect the baseline compliance and to investigate factors for noncompliance. The intervention consisted of problem-based and task-orientated hand hygiene education, enhancement of minimal handling protocol and clustering of nursing care, liberal provision of alcohol-based hand antiseptic, improvement in hand hygiene facilities, ongoing regular hand hygiene audit, and implementation of health care-associated infection surveillance. The observational study was repeated 6 months after the completion of the intervention program, which extended over 1-year period. Overall hand hygiene compliance increased from 40% to 53% before patient contact and 39% to 59% after patient contact. More marked improvement was observed for high-risk procedures (35%-60%). The average number of patient contacts also decreased from 2.8 to 1.8 per patient per hour. There was improvement in most aspects of hand-washing technique in the postintervention stage. The health care-associated infection rate decreased from 11.3 to 6.2 per 1000 patient-days. A problem-based and task-orientated education program can improve hand hygiene compliance. Enhancement of minimal handling and clustering of nursing procedures reduced the total patient contact episodes, which could help to overcome the major barrier of time constraints. A concurrent decrease in health care-associated infection rate and increase in hand hygiene compliance was observed in this study. The observational study could form part of an ongoing audit to provide regular feedback to HCWs to sustain the compliance.

Self-reported reasons for hand hygiene in 3 groups of health care workers.

PubMed

McLaughlin, Anne Collins; Walsh, Fran

2012-09-01

The hands of health care workers continue to be the main vector for nosocomial infection in hospitals. The purpose of the current research was to capture the health beliefs and self-reported behaviors of US health care workers to better understand why workers avoid hand hygiene and what prompts them to wash. An online survey of health care workers assessed their reasons for washing their hands, reasons for not washing, and what cues prompted the decision to wash or not wash in a variety of locations. The findings were that hand hygiene could be cued by an external situation but tended to be motivated internally. Hand hygiene was avoided because of situational barriers. The reasons for performing hand hygiene can be situated in the internally motivated Theory of Planned Behavior; however, the reasons for not performing hand hygiene tend to be situational and affected by the environment. The results may be used to design programs, products, and systems that promote appropriate hand hygiene practices. Principles for design of these programs and products are provided. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Factors Affecting Hand Hygiene Adherence at a Private Hospital in Turkey.

PubMed

Teker, Bahri; Ogutlu, Aziz; Gozdas, Hasan Tahsin; Ruayercan, Saliha; Hacialioglu, Gulizar; Karabay, Oguz

2015-10-01

Nosocomial infections are the main problems rising morbidity and mortality in health care settings. Hand hygiene is the most effective method for preventing these infections. In this study, we aimed to investigate the factors related with hand hygiene adherence at a private hospital in Turkey. This study was conducted between March and June 2010 at a private hospital in Turkey. During the observation period, employees were informed about training, then posters and images were hanged in specific places of the hospital. After the initial observation, training on nosocomial infections and hand hygiene was provided to the hospital staff in March 2010. Contacts were classified according to occupational groups and whether invasive or not. These observations were evaluated in terms of compatibility with hand hygiene guidelines. Hand hygiene adherence rate of trained doctors was higher than untrained ones before patient contact and after environment contact [48% (35/73) versus 82% (92/113) p<0.05 and 23% (5/22) versus 76% (37/49) p<0.05 respectively]. Hand hygiene adherence rate of trained nurses was higher than untrained ones before patient contact [63% (50/79) versus 76% (37/49) p<0.05]. Hand hygiene adherence rate of trained assistant health personnel was higher than untrained ones before asepsis [20% (2/10) versus 73% (16/22) p<0.05]. In addition, it was seen that hand antiseptics were used when hand washing was not possible. The increase at the rate of hand washing after training reveals the importance of feedback of the observations, as well as the training. One of the most important ways of preventing nosocomial infections is hand hygiene training that should be continued with feedbacks.

Improving hand hygiene compliance in healthcare settings using behavior change theories: reflections.

PubMed

Al-Tawfiq, Jaffar A; Pittet, Didier

2013-01-01

Although hand hygiene is the most effective method for preventing healthcare-associated infections, hand hygiene practice falls short in many healthcare facilities. The compliance rate is mostly linked to system design and easily accessible hand hygiene products. System change, healthcare worker motivation, and complex behavioral considerations seem to play a significant role. This article discusses the application of behavioral theories in hand hygiene promotion in a theoretical manner. The program relies on the transtheoretical model (TTM) of health behavior change, John Keller's (ARCS) Model of Motivational Design, and the theory of planned behavior (TPB). Thus, the program links attitudes and behavior to hand hygiene promotion. The TTM of health behavior change helps to tailor interventions to predict and motivate individual movement across the pathway to change. A program could be based on this theory with multiple intercalations with John Keller's ARCS and the TPB. Such a program could be strengthened by linking attitudes and behavior to promote hand hygiene. The program could utilize different strategies such as organization cultural change that may increase the attention as well as fostering the movement in the ARCS stages. In addition, modeling TPB by creating peer pressure, ability to overcome obstacles, and increasing knowledge of the role of hand hygiene may lead to the desired outcome. The understanding and application of behavior change theories may result in an effective program to improve awareness and raise intention and thus may increase the potential for success of hand hygiene promotion programs.

Qualitative findings from focus group discussions on hand hygiene compliance among health care workers in Vietnam.

PubMed

Salmon, Sharon; McLaws, Mary-Louise

2015-10-01

It is accepted by hospital clinical governance that every clinician's "duty of care" includes hand hygiene, yet globally, health care workers (HCWs) continue to struggle with compliance. Focus group discussions were conducted to explore HCWs' barriers to hand hygiene in Vietnam. Twelve focus group discussions were conducted with HCWs from 6 public hospitals across Hanoi, Vietnam. Discussions included participants' experiences with and perceptions concerning hand hygiene. Tape recordings were transcribed verbatim and then translated into English. Thematic analysis was conducted by 2 investigators. Expressed frustration with high workload, limited access to hand hygiene solutions, and complicated guidelines that are difficult to interpret in overcrowded settings were considered by participants to be bona fide reasons for noncompliance. No participant acknowledged hand hygiene as a duty of care practice for her or his patients. Justification for noncompliance was the observation that visitors did not perform hand hygiene. HCWs did acknowledge a personal duty of care when hand hygiene was perceived to benefit her or his own health, and then neither workload or environmental challenges influenced compliance. Limited resources in Vietnam are amplified by overcrowded conditions and dual bed occupancy. Yet without a systematic systemic duty of care to patient safety, changes to guidelines and resources might not immediately improve compliance. Thus, introducing routine hand hygiene must start with education programs focusing on duty of care. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The first step in infection control is hand hygiene.

PubMed

Canham, Leslie

2011-01-01

A dental health care worker (DHCW) has an obligation to prevent the spread of health care associated infections. Adhering to proper hand hygiene procedures, selecting appropriate hand hygiene products and the use of gloves are all important elements of infection control. The CDC Guidelines for Hand Hygiene state that improved hand hygiene practices can reduce transmission of pathogenic microorganisms to patients and personnel in health care settings. DHCWs must also protect themselves by recognizing pitfalls such as irritants or allergies that may pose obstacles to proper hand hygiene. Occupational irritants and allergies can be caused by frequent hand washing, exposure to hand hygiene products, exposure to chemicals and shear forces associated with wearing or removing gloves. Since the primary defense against infection and transmission of pathogens is healthy, unbroken skin, DHCWs must take steps to ensure that their skin remains healthy and intact. These steps include evaluating different types of hand hygiene products, lotions and gloves for the best compatibility. If the DHCW sees a breakdown of his or her skin barrier, steps should be taken to determine the cause and remedy. Remedies can include the use of alcohol-based hand sanitizers containing emollients and moisturizers and regular use of a medical grade hand lotion. The bottom line: healthy skin protects you at work and at home. Selection and use of appropriate hand hygiene products, including moisturizers, are an essential part ofa dental office infection control program. My coworker lost the use of her thumb for several months due to complications of a staph infection. She was unable to work and found even simple tasks such as closing a button hard to do. Think of how difficult your work would be if something happened to your hands. Injury, irritation or allergies could alter your ability to work or even perform routine tasks. Our hands provide us with the ability to work in clinical dentistry. It makes good sense to protect your hands, your most valuable tools.

A Survey of Nurses' Compliance with Hand Hygiene Guidelines in Caring for Patients with Cancer in a Selected Center of Isfahan, Iran, in 2016

PubMed Central

Mostafazadeh-Bora, Mostafa; Bahrami, Masoud; Hosseini, Abbas

2018-01-01

Background: Hand hygiene is one of the key ways of preventing healthcare-associated infections (HCAI), especially in patients with cancer. The aim of this study was to determine nurses' compliance with hand hygiene guidelines in caring for patients with cancer in a selected center in Isfahan, Iran, in 2016. Materials and Methods: The present observational study was conducted on nurses in a cancer center in Isfahan in 2016. The participants were selected via convenience sampling method. Nurses serving at bedsides and willing to participate were entered into the study. Data were collected through the direct observation of nurses during delivering routine care, using the standard checklist for direct observation of the “five moments for hand hygiene” approach. Results: In the present study, 94 nurses were studied at 500 clinical moments. The overall hand hygiene compliance rate was 12.80%. The highest hand hygiene compliance rate was observed in the after body fluid exposure moment (72.70%). In addition, hand hygiene compliance rate in preprocedure indications (before patient contact and before aseptic procedure) and postprocedure indications (after patient contact, after body fluid exposure, and after patient surrounding contact) were 3.40 and 21%, respectively, which had a significant correlation (p = 0.001). Conclusions: The findings indicate that the hand hygiene compliance rate among nurses was low. Further research in this regard is recommended in order to find the causes of low compliance with hand hygiene and design interventions for improvement in hand hygiene compliance rate among nurses. PMID:29628959

Reducing hospital associated infection: a role for social marketing.

PubMed

Conway, Tony; Langley, Sue

2013-01-01

Although hand hygiene is seen as the most important method to prevent the transmission of hospital associated infection in the UK, hand hygiene compliance rates appear to remain poor. This research aims to assess the degree to which social marketing methodology can be adopted by a particular organisation to promote hand hygiene compliance. The research design is based on a conceptual framework developed from analysis of social marketing literature. Data collection involved taped interviews given by nursing staff working within a specific Hospital Directorate in Manchester, England. Supplementary data were obtained from archival records of the hand hygiene compliance rates. Findings highlighted gaps in the Directorate's approach to the promotion of hand hygiene compared to what could be using social marketing methodology. Respondents highlighted how the Directorate failed to fully optimise resources required to endorse hand hygiene practice and this resulted in poorer compliance. From the experiences and events documented, the study suggests how the emergent phenomena could be utilised by the Directorate to apply a social marketing approach which could positively influence hand hygiene compliance. The paper seeks to explore the use of social marketing in nursing to promote hand hygiene compliance and offer a conceptual framework that provides a way of measuring the strength of the impact that social marketing methodology could have.

Evaluation of hand hygiene adherence in a tertiary hospital.

PubMed

Novoa, Ana M; Pi-Sunyer, Teresa; Sala, Maria; Molins, Eduard; Castells, Xavier

2007-12-01

Although hand hygiene is the most important measure in the prevention of nosocomial infection, adherence to recommendations among health care workers (HCW) is low. Evaluation of compliance with hand hygiene was carried out in a Spanish teaching hospital. In 2005, adherence to hand hygiene was evaluated hospital wide through direct observation, collecting data on hand hygiene carried out whenever indicated (opportunity for hand hygiene). Compliance was defined as handwashing/disinfection in an opportunity for hand hygiene according to hospital protocols. The results were analyzed using mixed effects models, with the HCW observed as the random effect. A total of 1254 opportunities for hand hygiene were observed in 247 HCWs. Mean compliance was 20%. Although few differences were observed among types of HCW, compliance varied according to hospital area (69% in the intensive care unit [ICU]) and timing with respect to patient contact (compliance after contact was twice that before contact). Multivariate analyses revealed a protective odds ratio (OR) for nonadherence in ICUs (OR, 0.04; 95% confidence interval (95% CI): 0.01-0.10) and after patient contact (OR, 0.25; 95% CI: 0.17-0.38). Low adherence observed suggests that new interventions should focus in modification of HCWs' habits and attitudes, working at several levels: individual and institutional.

Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting.

PubMed

Le-Abuyen, Sheila; Ng, Jessica; Kim, Susie; De La Franier, Anne; Khan, Bibi; Mosley, Jane; Gardam, Michael

2014-04-01

A survey pilot asked patients to observe the hand hygiene compliance of their health care providers. Patients returned 75.1% of the survey cards distributed, and the overall hand hygiene compliance was 96.8%. Survey results and patient commentary were used to motivate hand hygiene compliance. The patient-as-observer approach appeared to be a viable alternative for hand hygiene auditing in an ambulatory care setting because it educated, engaged, and empowered patients to play a more active role in their own health care. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices

PubMed Central

Arbogast, James W.; Moore-Schiltz, Laura; Jarvis, William R.; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert

2016-01-01

Objective: The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. Methods: A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Results: Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Conclusion: Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction. PMID:27281645

Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices.

PubMed

Arbogast, James W; Moore-Schiltz, Laura; Jarvis, William R; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert

2016-06-01

The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.

Effect of hand hygiene on infectious diseases in the office workplace: A systematic review.

PubMed

Zivich, Paul N; Gancz, Abigail S; Aiello, Allison E

2018-04-01

Extensive data suggests that hand hygiene is a critical intervention for reducing infectious disease transmission in the clinical setting. However, it is unclear whether hand hygiene is effective at cutting down on infectious illnesses in non-clinical workplaces. The aim of this review is to assess the current literature concerning the effects of hand-washing interventions on infectious disease prevention among employees in nonclinical, office-based workplaces. In compiling this review, PubMed, Scopus, and Business Source Premier were examined for studies published from 1960 through 2016. Eleven studies (eight experimental, two observational, one a simulation) were identified as eligible for inclusion. Hand-hygiene interventions at various levels of rigor were shown to reduce self-reported illness symptoms. Hand hygiene is thought to be more effective against gastrointestinal illness than it is against respiratory illness, but no clear consensus has been reached on this point. Minimal hand-hygiene interventions seem to be effective at reducing the incidence of employee illness. Along with reducing infections among employees, hand-hygiene programs in the workplace may provide additional benefits to employers by reducing the number of employee health insurance claims and improving employee morale. Future research should use objective measures of hand hygiene and illness, and explore economic impacts on employers more fully. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Clean Hands for Life: results of a large, multicentre, multifaceted, social marketing hand-hygiene campaign.

PubMed

Forrester, L A; Bryce, E A; Mediaa, A K

2010-03-01

A year-long multifaceted hand-hygiene campaign entitled Clean Hands for Life targeting individual, environmental and organisational factors that influence healthcare worker (HCW) hand-hygiene behaviour was implemented in 36 acute and long-term care facilities in Vancouver Coastal Health region. The campaign involved rotation of ten novel posters, two poster contests, and distribution of multiple promotional items. A social marketing approach was used to implement and monitor the effectiveness of the campaign. Evaluation included quality assurance surveys, staff surveys (baseline, mid- and post-campaign), and focus groups. A total of 141 poster contest submissions was received, 5452 staff surveys completed and 14 focus groups conducted. Overall knowledge of the importance of hand-hygiene and intention to clean hands was high at baseline. No significant differences were observed when mid- and post-campaign scores were compared to baseline. The majority (89.5%) of HCWs reported that they preferred soap and water over alcohol hand gel. A significant increase in the self-reported use of hand-hygiene products was observed particularly among HCWs not providing direct patient care. Barriers to hand-hygiene included inappropriate placement of sinks, traffic flow issues, inadequately stocked washrooms, workload and time constraints. Organisational support was visible throughout the campaign. The results showed that social marketing is an effective approach in engaging HCWs. Hand-hygiene campaigns that focus almost exclusively on increasing awareness among HCWs may not be as successful as multifaceted campaigns or campaigns that target identified barriers to hand-hygiene. Copyright 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit.

PubMed

Chhapola, Viswas; Brar, Rekha

2015-10-01

Nosocomial infections are a significant problem in neonatal intensive care units (NICUs) and hand hygiene (HH) has been stated as an effective mean to prevent spread of infections. The aim of study was to assess the baseline compliance HH practices and to evaluate the impact of hand washing educational programme on infection rate in a NICU. Continuous surveillance of nosocomial infections was done. A total of 15,797 and 12 ,29 opportunities for HH were observed in pre-intervention and postintervention phases, respectively. Compliance of health-care workers for all HH opportunities combined was 46% before intervention and improved significantly to 69% in postintervention (RR 1.49, CI 1.46-1.52, P < 0.0001). Compliance for nurses and doctors was similar. Nosocomial sepsis rate showed a significant decline from 96 per 1000 patient-days in pre-intervention to 47 per 1000 patient-days in postintervention phase (RR 0.44, CI 0.33-0.58, P < 0.0001). We conclude that effective HH practices can serve as an economical and effective nosocomial infection control approach especially important in developing nations. © 2014 Wiley Publishing Asia Pty Ltd.

Interventions to improve hand hygiene compliance in patient care.

PubMed

Gould, Dinah J; Moralejo, Donna; Drey, Nicholas; Chudleigh, Jane H

2010-09-08

Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. To update the review done in 2007, to assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection. We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. Originally searched to July 2006, for the update databases were searched from August 2006 until November 2009. Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group were eligible for inclusion. Studies reporting indicators of hand hygiene compliance and proxy indicators such as product use were considered. Self-reported data were not considered a valid measure of compliance. Studies to promote hand hygiene compliance as part of a care bundle approach were included, providing data relating specifically to hand hygiene were presented separately. Studies were excluded if hand hygiene was assessed in simulations, non-clinical settings or the operating theatre setting. Two reviewers independently extracted data and assessed data quality. Four studies met the criteria for the review: two from the original review and two from the update. Two studies evaluated simple education initiatives, one using a randomized clinical trial design and the other a controlled before and after design. Both measured hand hygiene compliance by direct observation. The other two studies were both interrupted times series studies. One study presented three separate interventions within the same paper: simple substitutions of product and two multifaceted campaigns, one of which included involving practitioners in making decisions about choice of hand hygiene products and the components of the hand hygiene program. The other study also presented two separate multifaceted campaigns, one of which involved application of social marketing theory. In these two studies follow-up data collection continued beyond twelve months, and a proxy measure of hand hygiene compliance (product use) was recorded. Microbiological data were recorded in one study. Hand hygiene compliance increased for one of the studies where it was measured by direct observation, but the results from the other study were not conclusive. Product use increased in the two studies in which it was reported, with inconsistent results reported for one initiative. MRSA incidence decreased in the one study reporting microbiological data. The quality of intervention studies intended to increase hand hygiene compliance remains disappointing. Although multifaceted campaigns with social marketing or staff involvement appear to have an effect, there is insufficient evidence to draw a firm conclusion. There remains an urgent need to undertake methodologically robust research to explore the effectiveness of soundly designed and implemented interventions to increase hand hygiene compliance.

An individually tailored treatment programme for improved oral hygiene: introduction of a new course of action in health education for patients with periodontitis.

PubMed

Jönsson, B; Ohrn, K; Oscarson, N; Lindberg, P

2009-08-01

To describe and evaluate an individually tailored treatment programme based on a behavioural medicine approach to oral hygiene self-care for patients with chronic periodontitis. Two experimental single-case studies with multiple-baseline design across different self-administered oral hygiene behaviours were conducted. Cognitive Behavioural techniques were used to organize the strategies for the intervention and the approach to counselling was inspired by and structured in accordance with Motivational Interviewing. The central features in the programme were the individual analysis of knowledge and oral hygiene habits, individually set goals for oral hygiene behaviour, practice of manual dexterity for oral hygiene aids, continuous self-monitoring of the behaviour and prevention of relapse. Both participants reached the predecided criteria for clinical significance in reducing plaque and bleeding on probing. Reductions of periodontal probing depth were achieved as well. The positive results remained stable throughout the 2-year study period. The successful application of this educational model suggests that it could be used as a method for tailoring interventions targeted to oral hygiene for patients with periodontal conditions. The programme will now be tested in a larger randomized controlled trial.

Hand hygiene: product preference and compliance.

PubMed

Tanner, Judith; Mistry, Neetesh

Hospitals are trying to improve patient hand hygiene by providing handwashing products at the bedside. Patients' compliance with handwashing depends on their satisfaction with hygiene products but no one has looked at which products patients prefer. Research on this will help hospitals target hand hygiene more appropriately and effectively. To explore patient satisfaction with hand hygiene products and identify those that are most popular. Two hundred patients were given five hand hygiene products to evaluate. These represent the interventions most widely used by patients in hospitals: alcohol foams, alcohol wipes, wet cloths with antiseptic solutions, bowls of soapy water and mobile sinks. Alcohol foam achieved the highest mean satisfaction score and was significantly more popular than the other products. Alcohol foam was the most popular choice regardless of age, sex, dexterity, mobility and religion.

Keep it clean: a visual approach to reinforce hand hygiene compliance in the emergency department.

PubMed

Wiles, Lynn L; Roberts, Chris; Schmidt, Kim

2015-03-01

Although hand hygiene strategies significantly reduce health care-associated infections, multiple studies have documented that hand hygiene is the most overlooked and poorly performed infection control intervention. Emergency nurses and technicians (n = 95) in a 41-bed emergency department in eastern Virginia completed pretests and posttests, an education module, and two experiential learning activities reinforcing hand hygiene and infection control protocols. Posttest scores were significantly higher than pretest scores (t (108) = -6.928, P = .048). Hand hygiene compliance rates improved at the conclusion of the project and 3 months after the study (F (2, 15) = 9.89, P = .002). Interfaces with staff as they completed the interactive exercise, as well as anecdotal notes collected during the study, identified key times when compliance suffered and offered opportunities to further improve hand hygiene and, ultimately, patient safety. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Self-reported hand hygiene perceptions and barriers among companion animal veterinary clinic personnel in Ontario, Canada

PubMed Central

Anderson, Maureen E.C.; Weese, J. Scott

2016-01-01

The objective of this study was to describe the perceived importance of and barriers to hand hygiene among companion animal clinic staff. An anonymous, voluntary written questionnaire was completed by 356 of approximately 578 individuals (62%) from 49/51 clinics. On a scale of 1 (not important) to 7 (very important), the percentage of respondents who rated hand hygiene as a 5 or higher was at least 82% in all clinical scenarios queried. The most frequently reported reason for not performing hand hygiene was forgetting to do so (40%, 141/353). Specific discussion of hand hygiene practices at work was recalled by 32% (114/354) of respondents. Although veterinary staff seem to recognize the importance of hand hygiene, it should be emphasized more during staff training. Other barriers including time constraints and skin irritation should also be addressed, possibly through increased access to and use of alcohol-based hand sanitizers. PMID:26933265

Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review.

PubMed

Srigley, J A; Corace, K; Hargadon, D P; Yu, D; MacDonald, T; Fabrigar, L; Garber, G

2015-11-01

Despite the importance of hand hygiene in preventing transmission of healthcare-associated infections, compliance rates are suboptimal. Hand hygiene is a complex behaviour and psychological frameworks are promising tools to influence healthcare worker (HCW) behaviour. (i) To review the effectiveness of interventions based on psychological theories of behaviour change to improve HCW hand hygiene compliance; (ii) to determine which frameworks have been used to predict HCW hand hygiene compliance. Multiple databases and reference lists of included studies were searched for studies that applied psychological theories to improve and/or predict HCW hand hygiene. All steps in selection, data extraction, and quality assessment were performed independently by two reviewers. The search yielded 918 citations; seven met eligibility criteria. Four studies evaluated hand hygiene interventions based on psychological frameworks. Interventions were informed by goal setting, control theory, operant learning, positive reinforcement, change theory, the theory of planned behaviour, and the transtheoretical model. Three predictive studies employed the theory of planned behaviour, the transtheoretical model, and the theoretical domains framework. Interventions to improve hand hygiene adherence demonstrated efficacy but studies were at moderate to high risk of bias. For many studies, it was unclear how theories of behaviour change were used to inform the interventions. Predictive studies had mixed results. Behaviour change theory is a promising tool for improving hand hygiene; however, these theories have not been extensively examined. Our review reveals a significant gap in the literature and indicates possible avenues for novel research. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study

PubMed Central

Srigley, Jocelyn A; Furness, Colin D; Baker, G Ross; Gardam, Michael

2014-01-01

Background The Hawthorne effect, or behaviour change due to awareness of being observed, is assumed to inflate hand hygiene compliance rates as measured by direct observation but there are limited data to support this. Objective To determine whether the presence of hand hygiene auditors was associated with an increase in hand hygiene events as measured by a real-time location system (RTLS). Methods The RTLS recorded all uses of alcohol-based hand rub and soap for 8 months in two units in an academic acute care hospital. The RTLS also tracked the movement of hospital hand hygiene auditors. Rates of hand hygiene events per dispenser per hour as measured by the RTLS were compared for dispensers within sight of auditors and those not exposed to auditors. Results The hand hygiene event rate in dispensers visible to auditors (3.75/dispenser/h) was significantly higher than in dispensers not visible to the auditors at the same time (1.48; p=0.001) and in the same dispensers during the week prior (1.07; p<0.001). The rate increased significantly when auditors were present compared with 1–5 min prior to the auditors’ arrival (1.50; p=0.009). There were no significant changes inside patient rooms. Conclusions Hand hygiene event rates were approximately threefold higher in hallways within eyesight of an auditor compared with when no auditor was visible and the increase occurred after the auditors’ arrival. This is consistent with the existence of a Hawthorne effect localised to areas where the auditor is visible and calls into question the accuracy of publicly reported hospital hand hygiene compliance rates. PMID:25002555

Understanding Healthcare Workers Self-Reported Practices, Knowledge and Attitude about Hand Hygiene in a Medical Setting in Rural India.

PubMed

Diwan, Vishal; Gustafsson, Charlotte; Rosales Klintz, Senia; Joshi, Sudhir Chandra; Joshi, Rita; Sharma, Megha; Shah, Harshada; Pathak, Ashish; Tamhankar, Ashok J; Stålsby Lundborg, Cecilia

2016-01-01

To describe self-reported practices and assess knowledge and attitudes regarding hand hygiene among healthcare workers in a rural Indian teaching hospital. A rural teaching hospital and its associated medical and nursing colleges in the district of Ujjain, India. The study population consisted of physicians, nurses, teaching staff, clinical instructors and nursing students. Self-administered questionnaires based on the World Health Organization Guidelines on Hand Hygiene in Healthcare were used. Out of 489 healthcare workers, 259 participated in the study (response rate = 53%). The proportion of healthcare workers that reported to 'always' practice hand hygiene in the selected situations varied from 40-96% amongst categories. Reported barriers to maintaining good hand hygiene were mainly related to high workload, scarcity of resources, lack of scientific information and the perception that priority is not given to hand hygiene, either on an individual or institutional level. Previous training on the topic had a statistically significant association with self-reported practice (p = 0.001). Ninety three per cent of the respondents were willing to attend training on hand hygiene in the near future. Self-reported knowledge and adherence varied between situations, but hand hygiene practices have the potential to improve if the identified constraints could be reduced. Future training should focus on enhancing healthcare workers' knowledge and understanding regarding the importance of persistent practice in all situations.

Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina.

PubMed

Rosenthal, Victor D; Guzman, Sandra; Safdar, Nasia

2005-09-01

Hand hygiene is a fundamental measure for the control of nosocomial infection. However, sustained compliance with hand hygiene in health care workers is poor. We attempted to enhance compliance with hand hygiene by implementing education, training, and performance feedback. We measured nosocomial infections in parallel. We monitored the overall compliance with hand hygiene during routine patient care in intensive care units (ICUs); 1 medical surgical ICU and 1 coronary ICU, of 1 hospital in Buenos Aires, Argentina, before and during implementation of a hand hygiene education, training, and performance feedback program. Observational surveys were done twice a week from September 2000 to May 2002. Nosocomial infections in the ICUs were identified using the National Nosocomial Infections Surveillance (NNIS) criteria, with prospective surveillance. We observed 4347 opportunities for hand hygiene in both ICUs. Compliance improved progressively (handwashing adherence, 23.1% (268/1160) to 64.5% (2056/3187) (RR, 2.79; 95% CI: 2.46-3.17; P < .0001). During the same period, overall nosocomial infection in both ICUs decreased from 47.55 per 1000 patient-days (104/2187) to 27.93 per 1000 patient days (207/7409) RR, 0.59; 95% CI: 0.46-0.74, P < .0001). A program consisting of focused education and frequent performance feedback produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction in nosocomial infection rates in the ICUs.

Outcomes of an infection prevention project focusing on hand hygiene and isolation practices.

PubMed

Aragon, Daleen; Sole, Mary Lou; Brown, Scott

2005-01-01

Nosocomial infections are a major health problem for hospitalized patients and their families. Since the 1800s, hand hygiene has been recognized as the single best method to prevent the spread of pathogens and nosocomial infections. Despite this fact, many healthcare workers do not adhere to hand hygiene policies. The Centers for Disease Control and Prevention issued a guideline for hand hygiene practices in 2002. Multifaceted approaches to improve hand hygiene have been shown to increase compliance among healthcare workers and subsequently reduce infections. A performance improvement project was initiated to implement this guideline and other strategies to prevent nosocomial infection. This article summarizes the performance improvement processes and the preliminary outcomes on adherence to infection prevention policies related to hand hygiene and isolation practices. Clinically and statistically significant increases were noted for hand hygiene prior to patient care and in wearing masks when indicated. Nurses and patient care technicians had the greatest increases in compliance. Increases in hand hygiene after patient contact and wearing of gown and gloves were also noted, but results were not statistically significant. Nosocomial infection rates from antibiotic-resistant organisms decreased in the first surveillance, but rates increased during the 1-year surveillance. Consumption of alcohol-based foam disinfectant doubled from baseline. Findings are consistent with other published studies. The project will continue with further reinforcement and education over the second year.

Monitoring Pharmacy Student Adherence to World Health Organization Hand Hygiene Indications Using Radio Frequency Identification

PubMed Central

Decker, Andrew S.; Cipriano, Gabriela C.; Tsouri, Gill

2016-01-01

Objective. To assess and improve student adherence to hand hygiene indications using radio frequency identification (RFID) enabled hand hygiene stations and performance report cards. Design. Students volunteered to wear RFID-enabled hospital employee nametags to monitor their adherence to hand-hygiene indications. After training in World Health Organization (WHO) hand hygiene methods and indications, student were instructed to treat the classroom as a patient care area. Report cards illustrating individual performance were distributed via e-mail to students at the middle and end of each 5-day observation period. Students were eligible for individual and team prizes consisting of Starbucks gift cards in $5 increments. Assessment. A hand hygiene station with an RFID reader and dispensing sensor recorded the nametag nearest to the station at the time of use. Mean frequency of use per student was 5.41 (range: 2-10). Distance between the student’s seat and the dispenser was the only variable significantly associated with adherence. Student satisfaction with the system was assessed by a self-administered survey at the end of the study. Most students reported that the system increased their motivation to perform hand hygiene as indicated. Conclusion. The RFID-enabled hand hygiene system and benchmarking reports with performance incentives was feasible, reliable, and affordable. Future studies should record video to monitor adherence to the WHO 8-step technique. PMID:27170822

Monitoring Pharmacy Student Adherence to World Health Organization Hand Hygiene Indications Using Radio Frequency Identification.

PubMed

Decker, Andrew S; Cipriano, Gabriela C; Tsouri, Gill; Lavigne, Jill E

2016-04-25

Objective. To assess and improve student adherence to hand hygiene indications using radio frequency identification (RFID) enabled hand hygiene stations and performance report cards. Design. Students volunteered to wear RFID-enabled hospital employee nametags to monitor their adherence to hand-hygiene indications. After training in World Health Organization (WHO) hand hygiene methods and indications, student were instructed to treat the classroom as a patient care area. Report cards illustrating individual performance were distributed via e-mail to students at the middle and end of each 5-day observation period. Students were eligible for individual and team prizes consisting of Starbucks gift cards in $5 increments. Assessment. A hand hygiene station with an RFID reader and dispensing sensor recorded the nametag nearest to the station at the time of use. Mean frequency of use per student was 5.41 (range: 2-10). Distance between the student's seat and the dispenser was the only variable significantly associated with adherence. Student satisfaction with the system was assessed by a self-administered survey at the end of the study. Most students reported that the system increased their motivation to perform hand hygiene as indicated. Conclusion. The RFID-enabled hand hygiene system and benchmarking reports with performance incentives was feasible, reliable, and affordable. Future studies should record video to monitor adherence to the WHO 8-step technique.

Hand hygiene monitoring technology: protocol for a systematic review

PubMed Central

2013-01-01

Background Healthcare worker hand hygiene is thought to be one of the most important strategies to prevent healthcare-associated infections, but compliance is generally poor. Hand hygiene improvement interventions must include audits of compliance (almost always with feedback), which are most often done by direct observation - a method that is expensive, subjective, and prone to bias. New technologies, including electronic and video hand hygiene monitoring systems, have the potential to provide continuous and objective monitoring of hand hygiene, regular feedback, and for some systems, real-time reminders. We propose a systematic review of the evidence supporting the effectiveness of these systems. The primary objective is to determine whether hand hygiene monitoring systems yield sustainable improvements in hand hygiene compliance when compared to usual care. Methods/Design MEDLINE, EMBASE, CINAHL, and other relevant databases will be searched for randomized control studies and quasi-experimental studies evaluating a video or electronic hand hygiene monitoring system. A standard data collection form will be used to abstract relevant information from included studies. Bias will be assessed using the Cochrane Effective Practice and Organization of Care Group Risk of Bias Assessment Tool. Studies will be reviewed independently by two reviewers, with disputes resolved by a third reviewer. The primary outcome is directly observed hand hygiene compliance. Secondary outcomes include healthcare-associated infection incidence and improvements in hand hygiene compliance as measured by alternative metrics. Results will be qualitatively summarized with comparisons made between study quality, the measured outcome, and study-specific factors that may be expected to affect outcome (for example, study duration, frequency of feedback, use of real-time reminders). Meta-analysis will be performed if there is more than one study of similar systems with comparable outcome definitions. Discussion Electronic and video monitoring systems have the potential to improve hand hygiene compliance and prevent healthcare-associated infection, but are expensive, difficult to install and maintain, and may not be accepted by all healthcare workers. This review will assess the current evidence of effectiveness of these systems before their widespread adoption. Study registration PROSPERO registration number: CRD42013004519 PMID:24219817

Hand hygiene monitoring technology: protocol for a systematic review.

PubMed

Srigley, Jocelyn A; Lightfoot, David; Fernie, Geoff; Gardam, Michael; Muller, Matthew P

2013-11-12

Healthcare worker hand hygiene is thought to be one of the most important strategies to prevent healthcare-associated infections, but compliance is generally poor. Hand hygiene improvement interventions must include audits of compliance (almost always with feedback), which are most often done by direct observation - a method that is expensive, subjective, and prone to bias. New technologies, including electronic and video hand hygiene monitoring systems, have the potential to provide continuous and objective monitoring of hand hygiene, regular feedback, and for some systems, real-time reminders. We propose a systematic review of the evidence supporting the effectiveness of these systems. The primary objective is to determine whether hand hygiene monitoring systems yield sustainable improvements in hand hygiene compliance when compared to usual care. MEDLINE, EMBASE, CINAHL, and other relevant databases will be searched for randomized control studies and quasi-experimental studies evaluating a video or electronic hand hygiene monitoring system. A standard data collection form will be used to abstract relevant information from included studies. Bias will be assessed using the Cochrane Effective Practice and Organization of Care Group Risk of Bias Assessment Tool. Studies will be reviewed independently by two reviewers, with disputes resolved by a third reviewer. The primary outcome is directly observed hand hygiene compliance. Secondary outcomes include healthcare-associated infection incidence and improvements in hand hygiene compliance as measured by alternative metrics. Results will be qualitatively summarized with comparisons made between study quality, the measured outcome, and study-specific factors that may be expected to affect outcome (for example, study duration, frequency of feedback, use of real-time reminders). Meta-analysis will be performed if there is more than one study of similar systems with comparable outcome definitions. Electronic and video monitoring systems have the potential to improve hand hygiene compliance and prevent healthcare-associated infection, but are expensive, difficult to install and maintain, and may not be accepted by all healthcare workers. This review will assess the current evidence of effectiveness of these systems before their widespread adoption. PROSPERO registration number: CRD42013004519.

Hand hygiene and healthcare system change within multi-modal promotion: a narrative review.

PubMed

Allegranzi, B; Sax, H; Pittet, D

2013-02-01

Many factors may influence the level of compliance with hand hygiene recommendations by healthcare workers. Lack of products and facilities as well as their inappropriate and non-ergonomic location represent important barriers. Targeted actions aimed at making hand hygiene practices feasible during healthcare delivery by ensuring that the necessary infrastructure is in place, defined as 'system change', are essential to improve hand hygiene in healthcare. In particular, access to alcohol-based hand rubs (AHRs) enables appropriate and timely hand hygiene performance at the point of care. The feasibility and impact of system change within multi-modal strategies have been demonstrated both at institutional level and on a large scale. The introduction of AHRs overcomes some important barriers to best hand hygiene practices and is associated with higher compliance, especially when integrated within multi-modal strategies. Several studies demonstrated the association between AHR consumption and reduction in healthcare-associated infection, in particular, meticillin-resistant Staphylococcus aureus bacteraemia. Recent reports demonstrate the feasibility and success of system change implementation on a large scale. The World Health Organization and other investigators have reported the challenges and encouraging results of implementing hand hygiene improvement strategies, including AHR introduction, in settings with limited resources. This review summarizes the available evidence demonstrating the need for system change and its importance within multi-modal hand hygiene improvement strategies. This topic is also discussed in a global perspective and highlights some controversial issues. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Hand Hygiene: Knowledge and Attitudes of Fourth-Year Clerkship Medical Students at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.

PubMed

Hamadah, Reem; Kharraz, Razan; Alshanqity, Airabab; AlFawaz, Danah; Eshaq, Abdulaziz M; Abu-Zaid, Ahmed

2015-08-24

Little is known about the clerkship (clinical) medical students' knowledge of hand hygiene as the single most important precautionary measure to reduce nosocomial healthcare-associated infections. The aim of this study is to explore the knowledge of, and attitudes towards, hand hygiene practices among fourth-year clerkship medical students at Alfaisal University, College of Medicine, Riyadh, Saudi Arabia. A cross-sectional, paper-based, Yes/No formatted questionnaire was administered to explore the students' knowledge of, and attitudes towards, hand hygiene practices. Data were decoded in Microsoft Excel sheet and presented as numbers and percentages. One hundred and eleven students (n=111/147) participated in the questionnaire (response rate: 76%). Although the majority of students had a fair knowledge of hand hygiene practices, a number of them had some misconceptions. Only 14% of students correctly agreed to the statement: "Traditional hand washing (water, plus regular soap) decreases the number of germs." Furthermore, only 32% of students correctly answered that "hand washing with a regular soap, instead of an antiseptic soap, is better in limiting the transmission of clostridium difficile infections". Almost all students (93%) agreed to the importance of hand hygiene education in medical curricula and its awareness in healthcare centers. Despite the importance of hand hygiene, only 13% of students reviewed the respective WHO and CDC guidelines before starting their clinical training in the teaching hospital. The students' inadequate knowledge about hand hygiene needs to be enriched by well-structured curricular and extra-curricular programs as well as more positive attitudes by healthcare workers.

An evaluation of hand hygiene in an intensive care unit: Are visitors a potential vector for pathogens?

PubMed

Birnbach, David J; Rosen, Lisa F; Fitzpatrick, Maureen; Arheart, Kristopher L; Munoz-Price, L Silvia

2015-01-01

Patients in an intensive care unit (ICU) are frequently immunocompromised and might be highly susceptible to infection. Visitors to an ICU who do not adequately clean their hands could carry pathogenic organisms, resulting in risk to a vulnerable patient population. This observational study identifies pathogens carried on the hands of visitors into an ICU and investigates the effect of hand hygiene. Two observers, one stationed outside and one inside the ICU, evaluated whether visitors performed hand hygiene at any of the wall-mounted alcohol-based hand sanitizer dispensers prior to reaching a patient's room. Upon reaching a patient's room, the dominant hand of all of the participants was cultured. Of the 55 participating visitors, 35 did not disinfect their hands. Among the cultures of those who failed to perform hand hygiene, eight cultures grew Gram-negative rods and one grew methicillin-resistant Staphylococcus aureus. Of the cultures of the 20 individuals who performed hand hygiene, 14 (70%) had no growth on the cultures, and the remaining six (30%) showed only the usual skin flora. The visitors who do not perform hand hygiene might carry pathogens that pose a risk to ICU patients. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Randomized crossover study evaluating the effect of a hand sanitizer dispenser on the frequency of hand hygiene among anesthesiology staff in the operating room.

PubMed

Munoz-Price, L Silvia; Patel, Zalak; Banks, Shawn; Arheart, Kristopher; Eber, Scott; Lubarsky, David A; Birnbach, David J

2014-06-01

Forty anesthesia providers were evaluated with and without hand sanitizer dispensers present on the anesthesia machine. Having a dispenser increased the frequency of hand hygiene only from 0.5 to 0.8 events per hour (P = .01). Other concomitant interventions are needed to further increase hand hygiene frequency among anesthesia providers.

[The effectiveness of hand hygiene products on MRSA colonization of health care workers by using CHROMagar MRSA].

PubMed

Koçak Tufan, Zeliha; Irmak, Hasan; Bulut, Cemal; Cesur, Salih; Kınıklı, Sami; Demiröz, Ali Pekcan

2012-04-01

The aims of this study were; to investigate the hand hygiene compliance of the health care workers (HCWs) during their routine patient care, to determine the methicillin-resistant Staphylococcus aureus (MRSA) hand colonization of the HCWs, to investigate the effect of different hand hygiene products on MRSA colonization and to evaluate the effectiveness of chromogenic agar for detecting MRSA. HCWs were investigated during their routine patient care and hand cultures were taken before and after hand wash/hygiene. Two different techniques were used to obtain the hand cultures: fingertip method (CHROMagar MRSA containing HygiSlide); and direct swab method and then inoculation to CHROMagar MRSA media. MRSA strains grown on those cultures were confirmed with conventional methods. A total of 100 HCWs (of them 61 were female; mean age: 32.7 ± 5.2 years; age range: 25-51 years) involving physicians (n= 33), nurses (n= 38) and health care assistants (n= 29), were included in the study. MRSA was detected in 39% and 11% before hand hygiene and in 13% and 6% after hand hygiene, with HygiSlide CHROMagar media and with CHROMagar in plate media, respectively. No difference were found regarding clinics, occupations, or the type of patient handling in those HCWs who were positive (n= 13) for MRSA colonization following hand hygiene, and those who were negative (n= 26). However, the type of the hand hygiene product used exhibited a statistical difference. None of the seven HCWs who used alcohol based hand rub revealed growth in the second culture while 10 of 19 (53%) HCWs who used soap and three of 13 (23%) HCWs who used chlorhexidine were still colonized with MRSA. In terms of reduction in the MRSA counts, the most effective one was the alcohol based hand rub while the soap was the least, since seven of 19 (37%) HCWs who used soap showed no reduction at all in the MRSA counts. A high ratio of hand colonization with MRSA was detected in our hospital staff (39%). It was shown that the colonization could be reduced significantly (with a rate of 66%) with hand hygiene. Alcohol based hand rub was found to be the most effective method in hand hygiene. The fingertip technique was found to be superior to inoculation to plate media for obtaining hand cultures and CHROMagar MRSA media was found to be rapid, effective and practical for detecting the MRSA hand colonization.

Effect of the Intelligent Health Messenger Box on health care professionals' knowledge, attitudes, and practice related to hand hygiene and hand bacteria counts.

PubMed

Saffari, Mohsen; Ghanizadeh, Ghader; Fattahipour, Rasoul; Khalaji, Kazem; Pakpour, Amir H; Koenig, Harold G

2016-12-01

We assessed the effectiveness of the Intelligent Health Messenger Box in promoting hand hygiene using a quasiexperimental design. Knowledge, attitudes, and self-reported practices related to hand hygiene as well as hand bacteria counts and amount of liquid soap used were measured. The intervention involved broadcasting preventive audio messages. All outcomes showed significant change after the intervention compared with before. The Intelligent Health Messenger Box can serve as a practical way to improve hand hygiene. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Ability of Hand Hygiene Interventions Using Alcohol-Based Hand Sanitizers and Soap To Reduce Microbial Load on Farmworker Hands Soiled during Harvest.

PubMed

de Aceituno, Anna Fabiszewski; Bartz, Faith E; Hodge, Domonique Watson; Shumaker, David J; Grubb, James E; Arbogast, James W; Dávila-Aviña, Jorgé; Venegas, Fabiola; Heredia, Norma; García, Santos; Leon, Juan S

2015-11-01

Effective hand hygiene is essential to prevent the spread of pathogens on produce farms and reduce foodborne illness. The U.S. Food and Drug Administration Food Safety Modernization Act Proposed Rule for Produce Safety recommends the use of soap and running water for hand hygiene of produce handlers. The use of alcohol-based hand sanitizer (ABHS) may be an effective alternative hygiene intervention where access to water is limited. There are no published data on the efficacy of either soap or ABHS-based interventions to reduce microbial contamination in agricultural settings. The goal of this study was to assess the ability of two soap-based (traditional or pumice) and two ABHS-based (label-use or two-step) hygiene interventions to reduce microbes (coliforms, Escherichia coli, and Enterococcus spp.) and soil (absorbance of hand rinsate at 600 nm [A600]) on farmworker hands after harvesting produce, compared with the results for a no-hand-hygiene control. With no hand hygiene, farmworker hands were soiled (median A600, 0.48) and had high concentrations of coliforms (geometric mean, 3.4 log CFU per hand) and Enterococcus spp. (geometric mean, 5.3 log CFU per hand) after 1 to 2 h of harvesting tomatoes. Differences in microbial loads in comparison to the loads in the control group varied by indicator organism and hygiene intervention (0 to 2.3 log CFU per hand). All interventions yielded lower concentrations of Enterococcus spp. and E. coli (P < 0.05), but not of coliforms, than were found in the control group. The two-step ABHS intervention led to significantly lower concentrations of coliforms and Enterococcus spp. than the pumice soap and label-use ABHS interventions (P < 0.05) and was the only intervention to yield significantly fewer samples with E. coli than were found in the control group (P < 0.05). All interventions removed soil from hands (P < 0.05), soap-based interventions more so than ABHS-based interventions (P < 0.05). ABHS-based interventions were equally as effective as hand washing with soap at reducing indicator organisms on farmworker hands. Based on these results, ABHS is an efficacious hand hygiene solution for produce handlers, even on soiled hands.

Personal hand gel for improved hand hygiene compliance on the regional anesthesia team.

PubMed

Parks, Colby L; Schroeder, Kristopher M; Galgon, Richard E

2015-12-01

Hand hygiene reduces healthcare-associated infections, and several recent publications have examined hand hygiene in the perioperative period. Our institution's policy is to perform hand hygiene before and after patient contact. However, observation suggests poor compliance. This is a retrospective review of a quality improvement database showing the effect of personal gel dispensers on perioperative hand hygiene compliance on a regional anesthesia team. Healthcare providers assigned to the Acute Pain Service were observed for compliance with hand hygiene policy during a quality improvement initiative. Provider type and compliance were prospectively recorded in a database. Team members were then given a personal gel dispensing device and again observed for compliance. We have retrospectively reviewed this database to determine the effects of this intervention. Of the 307 encounters observed, 146 were prior to implementing personal gel dispensers. Compliance was 34%. Pre- and post-patient contact compliances were 23 and 43%, respectively. For 161 encounters after individual gel dispensers were provided, compliance was 63%. Pre- and post-patient contact compliances were 53 and 72%, respectively. Improvement in overall compliance from 34 to 63% was significant. On the Acute Pain Service, compliance with hand hygiene policy improves when individual sanitation gel dispensing devices are worn on the person.

A Goal Unrealized: Patient Empowerment on Hand Hygiene- A Web-Based Survey from India.

PubMed

Vijayalakshmi, S; Ramkumar, S; Narayan, K A; Vaithiyanathan, P

2017-04-01

Each year, millions of patients around the world are affected by Health Care Associated Infections (HCAIs). Understanding and assessing the global burden of HCAI is one of the key areas of work to improve the hand hygiene. To assess the patient empowerment and awareness on hand hygiene among online users. A web-based cross-sectional survey was conducted during September 2013 to December 2013 among adults. A predesigned questionnaire to assess the awareness on hand hygiene was sent to volunteers through emails and social networking sites. The data were transferred to excel sheet and analyzed in Epi info and represented in proportions and percentages. Total 94 (57%) participants responded to the survey among which 51.1% were males and 48.9% were females. Majority of them belongs to the age group of 20 to 35 years. Only 28.7% of them said they will ever ask health care worker to wash their hands before they examine. A 27.7% of the participants reported that their country/community have a program that educates/communicates with patients about the importance of hand hygiene. Adherence and compliance to hand hygiene practices is suboptimal among people. There seems to be a lack of knowledge regarding hand hygiene.

Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System.

PubMed

Koff, Matthew D; Brown, Jeremiah R; Marshall, Emily J; O'Malley, A James; Jensen, Jens T; Heard, Stephen O; Longtine, Karen; O'Neill, Melissa; Longtine, Jaclyn; Houston, Donna; Robison, Cindy; Moulton, Eric; Patel, Hetal M; Loftus, Randy W

2016-08-01

BACKGROUND Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development. OBJECTIVE To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events. DESIGN Randomized, prospective study. SETTING Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts. PATIENTS Patients undergoing surgery. METHODS Operating room environments were randomly assigned to usual intraoperative hand hygiene or to a personalized, body-worn hand hygiene system. Anesthesia and circulating nurse provider hourly hand decontamination events were continuously monitored and reported. All patients were followed prospectively for the development of 30-day postoperative healthcare-associated infections. RESULTS A total of 3,256 operating room environments and patients (1,620 control and 1,636 treatment) were enrolled. The mean (SD) provider hand decontamination event rate achieved was 4.3 (2.9) events per hour, an approximate 8-fold increase in hand decontamination events above that of conventional wall-mounted devices (0.57 events/hour); P<.001. Use of the hand hygiene system was not associated with a reduction in healthcare-associated infections (odds ratio, 1.07 [95% CI, 0.82-1.40], P=.626). CONCLUSIONS The hand hygiene system evaluated in this study increased the frequency of hand decontamination events without reducing 30-day postoperative healthcare-associated infections. Future work is indicated to optimize the efficacy of this hand hygiene improvement strategy. Infect Control Hosp Epidemiol 2016;37:888-895.

Hand Washing Practices Among Emergency Medical Services Providers.

PubMed

Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

2015-09-01

Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

Hand Washing Practices Among Emergency Medical Services Providers

PubMed Central

Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

2015-01-01

Introduction Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. Methods We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. Results There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Conclusion Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing. PMID:26587098

Reflection on observation: A qualitative study using practice development methods to explore the experience of being a hand hygiene auditor in Australia.

PubMed

Jain, Susan; Edgar, Denise; Bothe, Janine; Newman, Helen; Wilson, Annmaree; Bint, Beth; Brown, Megan; Alexander, Suzanne; Harris, Joanna

2015-12-01

Within the Australian public health care system, an observation model is used to assess hand hygiene practice in health care workers, culminating in a publicly available healthcare service performance indicator. The intent of this study was for the results to inform the development of a strategy to support individual auditors and local sustainability of the hand hygiene auditing program. This qualitative study used a values clarification tool to gain an understanding of the experiences of hand hygiene auditors. The methodology involved qualitative interpretation of focus group discussions to identify the enablers and barriers to successful performance of the auditors' role. Twenty-five participants identified congruous themes of the need for peer and managerial support, improved communication and feedback, and consideration for succession planning. There was consistency in the participants' most frequently identified significant barriers in undertaking the role. Hand hygiene auditors take pride in their role and work toward the goal of reducing health care-associated infections by having a part to play in improving hand hygiene practices of all staff members. Important themes, barriers, and enablers were identified in this study. This research will be of interest nationally and globally, considering the dearth of published information on the experience of hand hygiene auditors. This study provides evidence of the need to support individual hand hygiene auditors. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

[Infection control and hand hygiene in nursing homes in Oslo].

PubMed

Sie, Ingrid; Thorstad, Margrete; Andersen, Bjørg Marit

2008-06-26

Nosocomial infections and transmission can be substantially reduced by good infection control. The laws and regulations for infection control in heath care institutions emphasize establishment of infection control programs and improved hand hygiene. Our study reviews some factors that are important for practicing adequate hand hygiene (knowledge about infection control and hand-washing facilities). Health care workers (HCW) in nursing homes in Oslo participated in this study in 2006-2007. A questionnaire was made and SPSS was used to analyse the data . 70.7% of 324 HCW (in 42 nursing homes) answered the questionnaires. Nearly all of the respondents (95.6%) knew about the written procedures for hygiene and infection control; 88.5% knew that an infection control program was in place and about 50% had received information through internal education. Three of four had read the National guidelines for hand hygiene, 77.5% thought that hand disinfection was more effective than hand washing, and 97% reported hand hygiene after contact with a patient having an infection. Dispensers for hand disinfection were situated at central work places. At the same time, 17.9% informed that they worked in more than one place at the same time. This study confirms that most nursing homes in Oslo have an infection control program and training that improves the knowledge and awareness of hand hygiene among HCWs. However, the fact that nursing homes in Oslo have the resources, knowledge and education, is not the same as compliance.

Evaluation of hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system.

PubMed

Dufour, J-C; Reynier, P; Boudjema, S; Soto Aladro, A; Giorgi, R; Brouqui, P

2017-04-01

Hand hygiene is a major means for preventing healthcare-associated infections. One critical point in understanding poor compliance is the lack of relevant markers used to monitor practices systematically. This study analysed hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system in an infectious disease ward with 17 single bedrooms. Healthcare workers (HCWs) were tracked while performing routine care over 171 days. A multi-level multi-variate logistics model was used for data analysis. The main outcome measures were hand disinfection before entering the bedroom (outside use) and before entering the patient care zone, defined as the zone surrounding the patient's bed (inside/bedside use). Variables analysed included HCWs' characteristics and behaviour, patients, room layouts, path chains and duration of HCWs' paths. In total, 4629 paths with initial hand hygiene opportunities when entering the patient care zone were selected, of which 763 (16.5%), 285 (6.1%) and 3581 (77.4%) were associated with outside use, inside/bedside use and no use, respectively. Hand hygiene is caregiver-dependent. The shorter the duration of the HCW's path, the worse the bedside hand hygiene. Bedside hand hygiene is improved when one or two extra HCWs are present in the room. Hand hygiene compliance at the bedside, as analysed using the continuous monitoring system, depended upon the HCW's occupation and personal behaviour, number of HCWs, time spent in the room and (potentially) dispenser location. Meal tray distribution was a possible factor in the case of failure to disinfect hands. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Public health campaign to promote hand hygiene before meals in a college of veterinary medicine.

PubMed

Heinrich, Ellen R E; KuKanich, Kate S; Davis, Elizabeth; White, Brad J

2014-01-01

Veterinary students can be exposed to environmental infectious agents in school that may include zoonotic pathogens. Encouraging effective hand hygiene can minimize the spread of zoonoses and promote public health and the One Health concept among veterinary students. The purpose of this study was to determine if a campaign could improve hand hygiene among veterinary students at extracurricular meetings serving meals. Nine Kansas State University College of Veterinary Medicine (KSU-CVM) extracurricular organizations participated in the study, sanitizer was provided at each meeting, and baseline hand-hygiene data were observed. A hand-hygiene opportunity was defined as any student observed to approach the buffet food line. Sanitizer use (yes/no) and gender (male/female) were recorded. Campaign interventions included a 3.5-minute educational video and a novel motivational poster. The video was presented to all first-year, second-year, and third-year veterinary students. Posters encouraging hand sanitization were displayed on doors and tables alongside sanitizers at each meeting. Observational hand-hygiene data were collected immediately after introduction of interventions and again 3 months later. Environmental sampling for presence of bacteria in and around meeting locations was also performed. Observed hand hygiene was lowest during baseline (11.0% ± 1.7), improved significantly post-intervention (48.8% ± 3.2), and remained improved at 3-month follow-up (33.5% ± 4.0). Females had higher probability of hand sanitizing (35.9% ± 2.2) than males (21.4% ± 2.4) (p<.01). Clostridium perfringens was isolated from 2/42 samples, and Salmonella spp. were isolated from 4/42 samples. A short-term public health campaign targeting veterinary students successfully improved hand hygiene before meals.

Health care worker hand hygiene in the pediatric special care unit at Mulago National Referral Hospital in Uganda: a best practice implementation project.

PubMed

Muhumuza, Christine; Gomersall, Judith Streak; Fredrick, Makumbi E; Atuyambe, Lynn; Okiira, Christopher; Mukose, Aggrey; Ssempebwa, John

2015-03-01

The hands of a health care worker are a common vehicle of pathogen transmission in hospital settings. Health care worker hand hygiene is therefore critical for patients' well being. Whilst failure of health care workers to comply with the best hand hygiene practice is a problem in all health care settings, issues of lack of access to adequate cleaning equipment and in some cases even running water make practicing good hand hygiene particularly difficult in low-resource developing country settings. This study reports an audit and feedback project that focused on the hand hygiene of the health care worker in the pediatric special care unit of the Mulago National Referral Hospital, which is a low-resource setting in Uganda. To improve hand hygiene among health care workers in the pediatric special care unit and thereby contribute to reducing transmission of health care worker-associated pathogens. The Joanna Briggs Institute three-phase Practical Application of Clinical Evidence System audit and feedback tool for promoting evidence utilization and change in health care was used. In phase one of the project, stakeholders were engaged and seven evidence-based audit criteria were developed. A baseline audit was then conducted. In phase two, barriers underpinning areas of noncompliance found in the baseline audit were identified and three strategies - education, reminders and provision of hand cleaning equipment - were implemented to overcome them. In phase three, a follow-up audit was conducted. Compliance with best practice hygiene was found to be poor in the baseline audit for all but one of the audit criteria. Following the implementation of the strategies, hand hygiene improved. The compliance rate increased substantially across all criteria. Staff education achieved 100%, whilst criterion 4 increased to 70%. However, use of alcohol-based hand-rub for hand hygiene only improved to 66%, and for six of the seven audit criteria, compliance remained below 74%. The project provides another example of how audit can be used as a tool to improve health practice, even in a low-resource setting. At the same time, it showed how difficult it is to achieve compliance with best hand hygiene practice in a low-resource hospital. The project highlights the importance of continued education/awareness raising on the importance of good hand hygiene practice as well as investment in infrastructure and cleaning supplies for achieving and sustaining good hand hygiene among workers in a low-resource hospital setting. A key contribution of the project was the legacy it left in the form of knowledge about how to use audit and feedback as a tool to promote the best practice. A similar project has been implemented in the maternity ward at the hospital and further audits are planned.

Hand hygiene knowledge and perceptions among anesthesia providers.

PubMed

Fernandez, Patrick G; Loftus, Randy W; Dodds, Thomas M; Koff, Matthew D; Reddy, Sundara; Heard, Stephen O; Beach, Michael L; Yeager, Mark P; Brown, Jeremiah R

2015-04-01

Health care worker compliance with hand hygiene guidelines is an important measure for health care-associated infection prevention, yet overall compliance across all health care arenas remains low. A correct answer to 4 of 4 structured questions pertaining to indications for hand decontamination (according to types of contact) has been associated with improved health care provider hand hygiene compliance when compared to those health care providers answering incorrectly for 1 or more questions. A better understanding of knowledge deficits among anesthesia providers may lead to hand hygiene improvement strategies. In this study, our primary aims were to characterize and identify predictors for hand hygiene knowledge deficits among anesthesia providers. We modified this previously tested survey instrument to measure anesthesia provider hand hygiene knowledge regarding the 5 moments of hand hygiene across national and multicenter groups. Complete knowledge was defined by correct answers to 5 questions addressing the 5 moments for hand hygiene and received a score of 1. Incomplete knowledge was defined by an incorrect answer to 1 or more of the 5 questions and received a score of 0. We used a multilevel random-effects XTMELOGIT logistic model clustering at the respondent and geographic location for insufficient knowledge and forward/backward stepwise logistic regression analysis to identify predictors for incomplete knowledge. The survey response rates were 55.8% and 18.2% for the multicenter and national survey study groups, respectively. One or more knowledge deficits occurred with 81.6% of survey respondents, with the mean number of correct answers 2.89 (95% confidence interval, 2.78- 2.99). Failure of providers to recognize prior contact with the environment and prior contact with the patient as hand hygiene opportunities contributed to the low mean. Several cognitive factors were associated with a reduced risk of incomplete knowledge including providers responding positively to washing their hands after contact with the environment (odds ratio [OR] 0.23, 0.14-0.37, P < 0.001), disinfecting their environment during patient care (OR 0.54, 0.35-0.82, P = 0.004), believing that they can influence their colleagues (OR 0.43, 0.27-0.68, P < 0.001), and intending to adhere to guidelines (OR 0.56, 0.36-0.86, P = 0.008). These covariates were associated with an area under receiver operator characteristics curve of 0.79 (95% confidence interval, 0.74-0.83). Anesthesia provider knowledge deficits around to hand hygiene guidelines occur frequently and are often due to failure to recognize opportunities for hand hygiene after prior contact with contaminated patient and environmental reservoirs. Intraoperative hand hygiene improvement programs should address these knowledge deficits. Predictors for incomplete knowledge as identified in this study should be validated in future studies.

Hand hygiene and the use of personal protective equipment.

PubMed

Wyeth, Jenny

Infection prevention and control nurses (IPCNs) have an extremely wide remit in relation to the facilitation of appropriate infection prevention and control practice within healthcare environments. In order to be effective IPCNs need to be involved at all stages of healthcare service delivery and need to form close working relationships with staff at all levels and in all departments within their organisation. The provision of the necessary facilities within the clinical environment, along with the ongoing training and support of staff are essential prerequisites to changing the behaviour of staff in order to consistently deliver effective hand hygiene and other infection prevention and control practices. Auditing of practice and the investigation of incidents enable the identification of areas of practice requiring improvement, which subsequently informs the continual development of training programmes and initiatives with a view to improving patient and staff safety. IPCNs need to be able to react swiftly to the emergence of new infectious organisms and/or evidence to identify what is required in order to ensure that staff are compliant with anticipated practice to maintain the safety of the patients in their care, themselves and their colleagues.

Comparison of hand hygiene procedures for removing Bacillus cereus spores.

PubMed

Sasahara, Teppei; Hayashi, Shunji; Hosoda, Kouichi; Morisawa, Yuji; Hirai, Yoshikazu

2014-01-01

Bacillus cereus is a spore-forming bacterium. B. cereus occasionally causes nosocomial infections, in which hand contamination with the spores plays an important role. Therefore, hand hygiene is the most important practice for controlling nosocomial B. cereus infections. This study aimed to determine the appropriate hand hygiene procedure for removing B. cereus spores. Thirty volunteers' hands were experimentally contaminated with B. cereus spores, after which they performed 6 different hand hygiene procedures. We compared the efficacy of the procedures in removing the spores from hands. The alcohol-based hand-rubbing procedures scarcely removed them. The soap washing procedures reduced the number of spores by more than 2 log10. Extending the washing time increased the spore-removing efficacy of the washing procedures. There was no significant difference in efficacy between the use of plain soap and antiseptic soap. Handwashing with soap is appropriate for removing B. cereus spores from hands. Alcohol-based hand-rubbing is not effective.

Routine hand hygiene audit by direct observation: has nemesis arrived?

PubMed

Gould, D J; Drey, N S; Creedon, S

2011-04-01

Infection prevention and control experts have expended valuable health service time developing and implementing tools to audit health workers' hand hygiene compliance by direct observation. Although described as the 'gold standard' approach to hand hygiene audit, this method is labour intensive and may be inaccurate unless performed by trained personnel who are regularly monitored to ensure quality control. New technological devices have been developed to generate 'real time' data, but the cost of installing them and using them during routine patient care has not been evaluated. Moreover, they do not provide as much information about the hand hygiene episode or the context in which hand hygiene has been performed as direct observation. Uptake of hand hygiene products offers an inexpensive alternative to direct observation. Although product uptake would not provide detailed information about the hand hygiene episode or local barriers to compliance, it could be used as a continuous monitoring tool. Regular inspection of the data by infection prevention and control teams and clinical staff would indicate when and where direct investigation of practice by direct observation and questioning of staff should be targeted by highly trained personnel to identify local problems and improve practice. Copyright © 2011 the Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Use of a simulation intervention to examine differences in nursing students' hand hygiene knowledge, beliefs, and behaviors.

PubMed

Konicki, Tara; Miller, Elaine

2016-10-01

Although hand hygiene remains an essential aspect of quality care, adherence to best patient safety practices continues to pose major challenges. The objectives of this study are to examine hand hygiene knowledge, beliefs, practices, perceived importance and behaviors using Social Cognitive Theory and simulation-based intervention. Participants were taken from a convenience sample of 131 undergraduate nursing students enrolled in a nursing fundamentals course at an urban university in the midwestern United States, and then randomly assigned to their respective groups. Using an experimental pretest-posttest design, control and intervention groups received the same lecture pertaining to hand hygiene and 3 data collection points where van de Mortel's Hand Hygiene Questionnaire (HHQ) was administered. In addition, the intervention group viewed a 6.5min video related to healthcare acquired infection and participated in 4 simulated situations requiring hand hygiene, based on World Health Organization guidelines. For all students, the hand hygiene technique was assessed through the use of Glo Germ, followed by handwashing and photography under ultraviolet light (posttest only). Image illumination was analyzed using image processing software. Microbiological sampling plates (pretest-posttest) were assessed quantitatively by colony counting. Study findings did not support differences in the intervention group for the 5 hypothesized relationships. Social desirability responding and negative item confusion were found to occur with the HHQ in the student population. There was a significant difference in the UV hand photographs, with students in the afternoon having lower values than students in the morning. Given the study results, there were no definitive educational recommendations to teach hand hygiene to nursing students. Future research should continue to further examine multi-focal modalities to enhance adherence to hand hygiene practices, as well as control for extraneous mediating or moderating variables found in educational settings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study.

PubMed

Srigley, Jocelyn A; Furness, Colin D; Baker, G Ross; Gardam, Michael

2014-12-01

The Hawthorne effect, or behaviour change due to awareness of being observed, is assumed to inflate hand hygiene compliance rates as measured by direct observation but there are limited data to support this. To determine whether the presence of hand hygiene auditors was associated with an increase in hand hygiene events as measured by a real-time location system (RTLS). The RTLS recorded all uses of alcohol-based hand rub and soap for 8 months in two units in an academic acute care hospital. The RTLS also tracked the movement of hospital hand hygiene auditors. Rates of hand hygiene events per dispenser per hour as measured by the RTLS were compared for dispensers within sight of auditors and those not exposed to auditors. The hand hygiene event rate in dispensers visible to auditors (3.75/dispenser/h) was significantly higher than in dispensers not visible to the auditors at the same time (1.48; p=0.001) and in the same dispensers during the week prior (1.07; p<0.001). The rate increased significantly when auditors were present compared with 1-5 min prior to the auditors' arrival (1.50; p=0.009). There were no significant changes inside patient rooms. Hand hygiene event rates were approximately threefold higher in hallways within eyesight of an auditor compared with when no auditor was visible and the increase occurred after the auditors' arrival. This is consistent with the existence of a Hawthorne effect localised to areas where the auditor is visible and calls into question the accuracy of publicly reported hospital hand hygiene compliance rates. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A multimodal intervention to improve hand hygiene in ICUs in Buenos Aires, Argentina: a stepped wedge trial.

PubMed

Rodriguez, Viviana; Giuffre, Carolina; Villa, Silvia; Almada, Griselda; Prasopa-Plaizier, Nittita; Gogna, Monica; Gibbons, Luz; García Elorrio, Ezequiel

2015-10-01

Hand hygiene is a cost-effective measure to reduce microbial transmission (Teare EL, Cookson B, French GL, et al. UK handwashing initiative. J Hosp Infect. 1999;43:1-3.) and is considered to be the most important measure to prevent healthcare-associated infections (Pittet D, Allegranzi B, Sax H, Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641-52). Unfortunately, the compliance rate of healthcare workers (HCWs) with recommended hand hygiene procedures is less than expected. In order to estimate the effect of a multimodal intervention on improving healthcare workers' compliance with hand hygiene in eleven intensive care units (ICUs) from 11 hospitals of Buenos Aires, a randomized cluster-stepped wedge trial was designed. A multimodal intervention was designed based on practices characterized by being evidence-based, low cost and suggested by qualitative research: (i) leadership commitment, (ii) surveillance of materials needed to comply with hand hygiene and alcohol consumption, (iii) utilization of reminders, (iv) a storyboard of the project and (v) feedback (hand hygiene compliance rate). The study enrolled 705 participants, comprising nurses (66.4%), physicians (25.8%) and other HCW (7.8%) along 9 months of observation. Compliance with hand hygiene in the control group was 66.0% (2354/3565) vs. 75.6% (5190/6864) in the intervention group. Univariate analysis showed an association between the intervention and hand hygiene compliance (odds ratio, OR 1.17; 95% confidence interval (CI), 1.13-1.22). The effect was still present after adjustment by calendar's time and providers' characteristics-age, gender and profession (OR 1.08; 95% CI, 1.03-1.14). His study supports that a multimodal intervention was effective to improve compliance with hand hygiene in ICUs. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

World Health Organization Framework: Multimodal Hand Hygiene Strategy in Piedmont (Italy) Health Care Facilities.

PubMed

Bert, Fabrizio; Giacomelli, Sebastian; Ceresetti, Daniela; Zotti, Carla Maria

2017-01-10

In 2009, the World Health Organization (WHO) introduced the "Hand Hygiene Self-Assessment Framework" (HHSAF) to evaluate the level of the application of the Multimodal Hand Hygiene Improvement Strategy (MHHIS), which defines preventive interventions, standards, and tools conceived to improve hand hygiene in healthcare facilities. The aim of our study was to evaluate the implementation of the MHHIS in Piedmont healthcare units in 2014 using the HHSAF document. Our surveillance was performed through collection and analysis of the data from 50 Piedmont healthcare facilities recorded through the HHSAF in 2014. The HHSAF describes the hand hygiene level evaluating the following 5 parameters: system changes, education/staff training, evaluation and feedback, reminders in the workplace, and promotion of an institutional safety climate. We reported that 70.4% of the healthcare facilities involved in the study achieved the intermediate hand hygiene level, 19% the advanced level, and 11% the basic level. No facility exhibited an inadequate level of WHO multimodal implementation. Only 55% of the healthcare units provided information about hand hygiene to patients, and only 15% actively involved patients and their families. The implementation of the MHHIS has achieved important results all over the world in terms of hand hygiene. Piedmont has reached an overall good level, particularly in terms of the supply and availability of hand washing products and staff education. Our results revealed, however, some critical issues related to direct and indirect monitoring of hand hygiene, providing reminders and the active involvement of patients, family members, and caregivers.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Promoting action control and coping planning to improve hand hygiene.

PubMed

Reyes Fernández, Benjamín; Lippke, Sonia; Knoll, Nina; Blanca Moya, Emanuel; Schwarzer, Ralf

2015-09-25

We examined a brief educational intervention addressing hand hygiene self-regulatory mechanisms, and evaluated which psychological mechanisms may lead to hand hygiene behaviours. Two hundred forty two students (mean age = 21 years, SD = 3.9) received either an experimental (n = 149) or a control condition on action control and planning (n = 93). Hand hygiene, coping planning, and action control were measured at baseline and six weeks later. By applying repeated measures ANOVA, we compared the experimental condition addressing planning to perform hand hygiene with a control condition. Additionally, working mechanisms were evaluated by means of mediation analysis. The intervention had an effect on action control, as reflected by a time by treatment interaction. The direct effect of the intervention on behaviour was, however, non-significant. Changes in action control led to changes in coping planning. These social-cognitive changes mediated the effect of intervention on behaviour, after controlling for gender, baseline behaviour, and classroom membership. In spite of the associations between the intervention and self-regulatory strategies, no direct effect was found of the intervention on behaviour. Further research on how to increase hand sanitizing, involving enviromental characteristics, is required. The intervention led only indirectly to an improvement of hand hygiene via changes in self-regulatory factors. Results indicate the importance of promoting action control and coping planning to initiate changes in hand hygienic behaviours.

Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare.

PubMed

Armellino, Donna; Hussain, Erfan; Schilling, Mary Ellen; Senicola, William; Eichorn, Ann; Dlugacz, Yosef; Farber, Bruce F

2012-01-01

Hand hygiene is a key measure in preventing infections. We evaluated healthcare worker (HCW) hand hygiene with the use of remote video auditing with and without feedback. The study was conducted in an 17-bed intensive care unit from June 2008 through June 2010. We placed cameras with views of every sink and hand sanitizer dispenser to record hand hygiene of HCWs. Sensors in doorways identified when an individual(s) entered/exited. When video auditors observed a HCW performing hand hygiene upon entering/exiting, they assigned a pass; if not, a fail was assigned. Hand hygiene was measured during a 16-week period of remote video auditing without feedback and a 91-week period with feedback of data. Performance feedback was continuously displayed on electronic boards mounted within the hallways, and summary reports were delivered to supervisors by electronic mail. During the 16-week prefeedback period, hand hygiene rates were less than 10% (3933/60 542) and in the 16-week postfeedback period it was 81.6% (59 627/73 080). The increase was maintained through 75 weeks at 87.9% (262 826/298 860). The data suggest that remote video auditing combined with feedback produced a significant and sustained improvement in hand hygiene.

Four multifaceted countrywide campaigns to promote hand hygiene in Belgian hospitals between 2005 and 2011: impact on compliance to hand hygiene.

PubMed

Costers, M; Viseur, N; Catry, B; Simon, A

2012-05-03

Four consecutive one-month campaigns were organised to promote hand hygiene in Belgian hospitals between 2005 and 2011. The campaigns included a combination of reminders in wards, educational sessions for healthcare workers, promotion of alcohol-based hand rub use, increasing patient awareness, and audits with performance feedback. Prior and after each one month intervention period, the infection control teams measured hand hygiene compliance of healthcare workers by direct observation using a standardised observation roster. A total of 738,367 opportunities for hand hygiene were observed over the four campaigns. Compliance with hand hygiene significantly increased from 49.6% before to 68.6% after the intervention period for the first, from 53.2% to 69.5% for the second, from 58.0% to 69.1% for the third, and from 62.3% to 72.9% for the fourth campaign. The highest compliance rates were consistently observed in paediatric units. Compliance rates were always markedly lower among physicians than nurses. After patient contact and body fluid exposure risk, compliance rates were noticeably higher than before patient contact and performing aseptic procedures. We conclude that repeated countrywide campaigns to promote hand hygiene result in positive long-term outcomes. However, lower compliance rates among physicians compared with nurses, before patient contact, and before performing aseptic procedures remain challenges for future campaigns.

Hand disinfection in a neonatal intensive care unit: continuous electronic monitoring over a one-year period.

PubMed

Helder, Onno K; van Goudoever, Johannes B; Hop, Wim C J; Brug, Johannes; Kornelisse, René F

2012-10-08

Good hand hygiene compliance is essential to prevent nosocomial infections in healthcare settings. Direct observation of hand hygiene compliance is the gold standard but is time consuming. An electronic dispenser with built-in wireless recording equipment allows continuous monitoring of its usage. The purpose of this study was to monitor the use of alcohol-based hand rub dispensers with a built-in electronic counter in a neonatal intensive care unit (NICU) setting and to determine compliance with hand hygiene protocols by direct observation. A one-year observational study was conducted at a 27 bed level III NICU at a university hospital. All healthcare workers employed at the NICU participated in the study. The use of bedside dispensers was continuously monitored and compliance with hand hygiene was determined by random direct observations. A total of 258,436 hand disinfection events were recorded; i.e. a median (interquartile range) of 697 (559-840) per day. The median (interquartile range) number of hand disinfection events performed per healthcare worker during the day, evening, and night shifts was 13.5 (10.8 - 16.7), 19.8 (16.3 - 24.1), and 16.6 (14.2 - 19.3), respectively. In 65.8% of the 1,168 observations of patient contacts requiring hand hygiene, healthcare workers fully complied with the protocol. We conclude that the electronic devices provide useful information on frequency, time, and location of its use, and also reveal trends in hand disinfection events over time. Direct observations offer essential data on compliance with the hand hygiene protocol. In future research, data generated by the electronic devices can be supplementary used to evaluate the effectiveness of hand hygiene promotion campaigns.

Going Dotty: a practical guide for installing new hand hygiene products.

PubMed

Bush, Kathryn; Mah, Manuel W; Meyers, Gwyneth; Armstrong, Pamela; Stoesz, Janice; Strople, Sally

2007-12-01

This report distills our experiences coordinating the installation of a new commercial line of hand hygiene products in a large, integrated health care region in Western Canada into a practical guide that can benefit infection control professionals. Some key considerations while managing such a large hand hygiene products installation are stakeholder collaboration, management of occupational hand dermatitis, housekeeping support, and communication.

Prevention of meticillin-resistant Staphylococcus aureus bloodstream infections in European hospitals: moving beyond policies.

PubMed

Borg, M A; Hulscher, M; Scicluna, E A; Richards, J; Azanowsky, J-M; Xuereb, D; Huis, A; Moro, M L; Maltezou, H C; Frank, U

2014-08-01

There is evidence that meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia can be reduced with improved infection control and antibiotic stewardship. To survey infection control and antibiotic stewardship practices within European hospitals and to identify initiatives that correlate with reduced MRSA prevalence. Online questionnaires were sent to European hospitals about their surveillance, hand hygiene, intravenous device management, admission screening, isolation, antibiotic prescribing, hospital demographics and MRSA blood culture isolates during 2010. In all, 269 replies were received from hospitals in 29 European countries. Lower MRSA prevalence showed significant association with presence of incidence surveillance, performance of root cause analysis, mandatory training requirements for hand hygiene, accountability measures for persistent non-compliance, and multi-stakeholder teamwork in antibiotic prescribing. Presence of policies on intravenous catheter insertion and management showed no variation between different MRSA prevalence groups. However, low-prevalence hospitals reported more competency assessment programmes in insertion and maintenance of peripheral and central venous catheters. Hospitals from the UK and Ireland reported the highest uptake of infection control and antibiotic stewardship practices that were significantly associated with low MRSA prevalence, whereas Southern European hospitals exhibited the lowest. In multiple regression analysis, isolation of high-risk patients, performance of root cause analysis, obligatory training for nurses in hand hygiene, and undertaking joint ward rounds including microbiologists and infectious disease physicians remained significantly associated with lower MRSA prevalence. Proactive infection control and antibiotic stewardship initiatives that instilled accountability, ownership, teamwork, and validated competence among healthcare workers were associated with improved MRSA outcomes. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Burnout, depression and suicidal ideation in dental and dental hygiene students.

PubMed

Deeb, George R; Braun, Sarah; Carrico, Caroline; Kinser, Patricia; Laskin, Daniel; Golob Deeb, Janina

2018-02-01

The aim of this study was to assess the relationship between burnout, depressive symptoms and suicidal ideation in dental and dental hygiene students and to evaluate the influence of gender, programme type and year of study. Third- and fourth-year dental (DS) and first- and second-year hygiene students (DHS) completed the Patient Health Questionnaire (PHQ-9) and an abbreviated Maslach Burnout Inventory online as measures of depressive symptoms/suicidality and burnout, respectively. The statistical analyses included summary statistics and tests for intergroup comparisons (chi-square) to evaluate the influence of gender, programme type (DHS or DS) and year of study. Correlations between depression, suicidality and burnout were also conducted. A total of 32 dental hygiene and 119 dental students participated. 40% of the dental and 38% of the hygiene students met criteria for burnout. No differences were found between years or between programmes. Nine per cent of both dental and hygiene students were above the cut-off for moderate depressive symptoms, but there were no statistical differences between the third- and fourth-year dental and the first- and second-year hygiene students. Six per cent of the dental and 9% of the dental hygiene students were above the cut-off for clinically significant suicidal ideation, but there were no statistical differences between dental and hygiene students. There were no differences noted in the dental students based on gender for any of the measures. Depression was significantly associated with all three subscales of burnout. Suicidal ideation was only significantly related to the lack of personal accomplishment subscale of burnout. These findings suggest the need for introducing preventive measures for such affective states in dental and dental hygiene training programmes. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Quantifying the Hawthorne Effect in Hand Hygiene Compliance Through Comparing Direct Observation With Automated Hand Hygiene Monitoring.

PubMed

Hagel, Stefan; Reischke, Jana; Kesselmeier, Miriam; Winning, Johannes; Gastmeier, Petra; Brunkhorst, Frank M; Scherag, André; Pletz, Mathias W

2015-08-01

To quantify the Hawthorne effect of hand hygiene performance among healthcare workers using direct observation. Prospective observational study. Intensive care unit, university hospital. Direct observation of hand hygiene compliance over 48 audits of 2 hours each. Simultaneously, hand hygiene events (HHEs) were recorded using electronic alcohol-based handrub dispensers. Directly observed and electronically recorded HHEs during the 2 hours of direct observation were compared using Spearman correlations and Bland-Altman plots. To quantify the Hawthorne effect, we compared the number of electronically recorded HHEs during the direct observation periods with the re-scaled electronically recorded HHEs in the 6 remaining hours of the 8-hour working shift. A total of 3,978 opportunities for hand hygiene were observed during the 96 hours of direct observation. Hand hygiene compliance was 51% (95% CI, 49%-53%). There was a strong positive correlation between directly observed compliance and electronically recorded HHEs (ρ=0.68 [95% CI, 0.49-0.81], P<.0001). In the 384 hours under surveillance, 4,180 HHEs were recorded by the electronic dispensers. Of those, 2,029 HHEs were recorded during the 96 hours in which direct observation was also performed, and 2,151 HHEs were performed in the remaining 288 hours of the same working shift that were not under direct observation. Healthcare workers performed 8 HHEs per hour when not under observation compared with 21 HHEs per hour during observation. Directly and electronically observed HHEs were in agreement. We observed a marked influence of the Hawthorne effect on hand hygiene performance.

Hand hygiene prior to contact lens handling is problematical.

PubMed

McMonnies, Charles W

2012-04-01

To establish guidelines for contact lens wearers' hand hygiene practices which achieve a balance between minimising risk of infection and reasonable expectations on the ability of patients to follow them. Evidence has been obtained from publications via PubMed, Advanced Medline Search, Cochrane Reviews, Google Scholar and using the key words hand hygiene, washing and contact lens. Guidelines for effective hand washing and the bother involved vary according to the level of hygiene required. High levels of non-compliance with hand hygiene practices, even among healthcare workers, gives an indication of how important the level of bother involved when following guidelines can be in contributing to non-compliance. Better patient education to improve hand washing techniques as well as patient attitudes toward hand hygiene are needed to reduce high non-compliance levels. Better hand hygiene techniques and higher frequency of their application give the prospect of reduced risk of infection and of any discomfort that arises from increased lens and ocular bioburden. In order that adoption rates might be maximised, the guidelines which have been distilled from this review attempt to strike a balance between technique redundancy and the associated higher levels of hygiene achieved and the possibility that the perception of too much bother involved could reduce participation rates. The guidelines have been expanded by the inclusion of suggested explanatory information in the expectation that helping patients to understand why the recommendations are made will have the effect of increasing their adoption. Copyright © 2011 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Microbial Characteristics of Nosocomial Infections and Their Association with the Utilization of Hand Hygiene Products: A Hospital-Wide Analysis of 78,344 Cases.

PubMed

Liu, Song; Wang, Meng; Wang, Gefei; Wu, Xiuwen; Guan, Wenxian; Ren, Jianan

Nosocomial infections are the main adverse events during health care delivery. Hand hygiene is the fundamental strategy for the prevention of nosocomial infections. Microbial characteristics of nosocomial infections in the Asia-Pacific region have not been investigated fully. Correlation between the use of hand hygiene products and the incidence of nosocomial infections is still unknown. This study investigates the microbial characteristics of nosocomial infections in the Asia-Pacific region and analyzes the association between the utilization of hand hygiene products and the incidence of nosocomial infections. A total of 78,344 patients were recruited from a major tertiary hospital in China. Microbial characteristics of major types of nosocomial infections were described. The association between the utilization of hand hygiene products and the incidence of nosocomial infections was analyzed using correlation and regression models. The overall incidence of nosocomial infections was 3.04%, in which the incidence of surgical site infection was 1%. Multi-drug resistance was found in 22.8% of all pathogens, in which multi-drug-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus were 56.6% and 54.9%, respectively. The utilization of hand hygiene products (including hand sanitizer, soap and paper towel) was associated negatively with the incidence of surgical site infection in surgical departments and the incidence of nosocomial infections in non-intensive care unit (ICU) departments (especially in surgical departments). Regression analysis further identified that higher utilization of hand hygiene products correlated with decreased incidence of major types of nosocomial infections. Multi-drug-resistant organisms are emerging in Asia-Pacific health care facilities. Utilization of hand hygiene products is associated with the incidence of nosocomial infections.

Using the Six Sigma Process to Implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 Intensive Care Units

PubMed Central

Eldridge, Noel E; Woods, Susan S; Bonello, Robert S; Clutter, Kay; Ellingson, LeAnn; Harris, Mary Ann; Livingston, Barbara K; Bagian, James P; Danko, Linda H; Dunn, Edward J; Parlier, Renee L; Pederson, Cheryl; Reichling, Kim J; Roselle, Gary A; Wright, Steven M

2006-01-01

BACKGROUND The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings was issued in 2002. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established complying with the CDC Guideline as a National Patient Safety Goal for 2004. This goal has been maintained through 2006. The CDC's emphasis on the use of alcohol-based hand rubs (ABHRs) rather than soap and water was an opportunity to improve compliance, but the Guideline contained over 40 specific recommendations to implement. OBJECTIVE To use the Six Sigma process to examine hand hygiene practices and increase compliance with the CDC hand hygiene recommendations required by JCAHO. DESIGN Six Sigma Project with pre-post design. PARTICIPANTS Physicians, nurses, and other staff working in 4 intensive care units at 3 hospitals. MEASUREMENTS Observed compliance with 10 required hand hygiene practices, mass of ABHR used per month per 100 patient-days, and staff attitudes and perceptions regarding hand hygiene reported by questionnaire. RESULTS Observed compliance increased from 47% to 80%, based on over 4,000 total observations. The mass of ABHR used per 100 patient-days in 3 intensive care units (ICUs) increased by 97%, 94%, and 70%; increases were sustained for 9 months. Self-reported compliance using the questionnaire did not change. Staff reported increased use of ABHR and increased satisfaction with hand hygiene practices and products. CONCLUSIONS The Six Sigma process was effective for organizing the knowledge, opinions, and actions of a group of professionals to implement the CDC's evidence-based hand hygiene practices in 4 ICUs. Several tools were developed for widespread use. PMID:16637959

Using the six sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units.

PubMed

Eldridge, Noel E; Woods, Susan S; Bonello, Robert S; Clutter, Kay; Ellingson, Leann; Harris, Mary Ann; Livingston, Barbara K; Bagian, James P; Danko, Linda H; Dunn, Edward J; Parlier, Renee L; Pederson, Cheryl; Reichling, Kim J; Roselle, Gary A; Wright, Steven M

2006-02-01

The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings was issued in 2002. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established complying with the CDC Guideline as a National Patient Safety Goal for 2004. This goal has been maintained through 2006. The CDC's emphasis on the use of alcohol-based hand rubs (ABHRs) rather than soap and water was an opportunity to improve compliance, but the Guideline contained over 40 specific recommendations to implement. To use the Six Sigma process to examine hand hygiene practices and increase compliance with the CDC hand hygiene recommendations required by JCAHO. Six Sigma Project with pre-post design. Physicians, nurses, and other staff working in 4 intensive care units at 3 hospitals. Observed compliance with 10 required hand hygiene practices, mass of ABHR used per month per 100 patient-days, and staff attitudes and perceptions regarding hand hygiene reported by questionnaire. Observed compliance increased from 47% to 80%, based on over 4,000 total observations. The mass of ABHR used per 100 patient-days in 3 intensive care units (ICUs) increased by 97%, 94%, and 70%; increases were sustained for 9 months. Self-reported compliance using the questionnaire did not change. Staff reported increased use of ABHR and increased satisfaction with hand hygiene practices and products. The Six Sigma process was effective for organizing the knowledge, opinions, and actions of a group of professionals to implement the CDC's evidence-based hand hygiene practices in 4 ICUs. Several tools were developed for widespread use.

The epidemiology of soil-transmitted helminths in Bihar State, India.

PubMed

Greenland, Katie; Dixon, Ruth; Khan, Shabbir Ali; Gunawardena, Kithsiri; Kihara, Jimmy H; Smith, Jennifer L; Drake, Lesley; Makkar, Prerna; Raman, Sri; Singh, Sarman; Kumar, Sanjay

2015-05-01

Soil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions. A cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored. In January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection. STH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases.

The Epidemiology of Soil-Transmitted Helminths in Bihar State, India

PubMed Central

Greenland, Katie; Dixon, Ruth; Khan, Shabbir Ali; Gunawardena, Kithsiri; Kihara, Jimmy H.; Smith, Jennifer L.; Drake, Lesley; Makkar, Prerna; Singh, Sarman; Kumar, Sanjay

2015-01-01

Background Soil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions. Methods A cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored. Results In January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection. Conclusions STH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases. PMID:25993697

Use of hand hygiene agents as a surrogate marker of compliance in Hungarian long-term care facilities: first nationwide survey.

PubMed

Szabó, Rita; Morvai, Júlia; Bellissimo-Rodrigues, Fernando; Pittet, Didier

2015-01-01

Hand hygiene practice is an important measure for preventing infections in long-term care facilities (LTCFs). However, low compliance with hand hygiene has been reported in a number of studies. The purpose of this study was to provide an overview of the first reference data collected on alcohol-based handrub (ABHR) and antiseptic soap consumption, as surrogate markers for hand hygiene compliance by healthcare workers (HCWs) in Hungarian LTCFs. The objective was to inform stakeholders on the need of hand hygiene improvement in these settings. Between 5 May and 30 September 2014, we conducted a nationwide, cross-sectional survey using a standardized self-administered questionnaire; all Hungarian LTCFs were eligible. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for data analysis. The questionnaire was completed by 354 LTCFs, representing 24 % of all Hungarian LTCFs. In total, the median consumption of ABHR and antimicrobial soap was 15.5 L (IQR, 0-800 L) and 60 L (IQR, 0-1,680 L) per LTCFs, and 2.2 mL (IQR, 0.4-9.1 mL) and 12.1 mL (IQR, 0.7-32.8 mL) per HCWs in 2013, respectively. The estimated number of hand hygiene actions was 0.6 hygienic handrub/HCW per day (IQR, 0-12.8/HCWs) and 2.4 hygienic handwashing/HCW per day (IQR, 0-21.9/HCWs; P = .001), respectively. This study suggests that non-compliance with hand hygiene is a significant problem in Hungarian LTCFs. Based on our results, there is an urgent need for a nationwide multimodal hand hygiene promotion strategy including education and performance monitoring and feedback in all LTCFs. Furthermore, monitoring of ABHR consumption constitute an additional component of the existing National Nosocomial Surveillance system.

A point prevalence survey on hand hygiene, with a special focus on Candida species.

PubMed

Brühwasser, Christina; Hinterberger, Guido; Mutschlechner, Wolfgang; Kaltseis, Josef; Lass-Flörl, Cornelia; Mayr, Astrid

2016-01-01

A 1-day point prevalence study evaluated hand hygiene compliance, yeast colonization, and contamination, focusing on the hands of health care workers (HCWs) and patient-oriented surfaces. Hand hygiene compliance was evaluated by applying the direct observation technique and the World Health Organization's compliance program, "My Five Moments for Hand Hygiene." A total of 128 samples from HCWs working in intensive care (n = 11) and intermediate care (n = 2) units and 65 environmental samples from Innsbruck Medical University Hospital were investigated. Hand hygiene compliance was superior for nurses (83.5%) and moderate for medical doctors (45.2%). In general, fungal growth was unique; only 9 of 128 HCW samples and only 4 of 65 environmental samples yielded positive results. The genetic relatedness of yeasts from the same species was investigated by random amplified polymorphic DNA (RAPD) typing. RAPD profiles exhibited the potential for cross-transmission of yeasts. In general, the fungal colonization and contamination rate was low, but a high level of hand hygiene compliance was lacking. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance.

PubMed

Trick, William E; Vernon, Michael O; Welbel, Sharon F; Demarais, Patricia; Hayden, Mary K; Weinstein, Robert A

2007-01-01

To determine whether a multimodal intervention could improve adherence to hand hygiene and glove use recommendations and decrease the incidence of antimicrobial resistance in different types of healthcare facilities. Prospective, observational study performed from October 1, 1999, through December 31, 2002. We monitored adherence to hand hygiene and glove use recommendations and the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures. We evaluated trends in and predictors for adherence and preferential use of alcohol-based hand rubs, using multivariable analyses. Three intervention hospitals (a 660-bed acute and long-term care hospital, a 120-bed community hospital, and a 600-bed public teaching hospital) and a control hospital (a 700-bed university teaching hospital).Intervention. At the intervention hospitals, we introduced or increased the availability of alcohol-based hand rub, initiated an interactive education program, and developed a poster campaign; at the control hospital, we only increased the availability of alcohol-based hand rub. We observed 6,948 hand hygiene opportunities. The frequency of hand hygiene performance or glove use significantly increased during the study period at the intervention hospitals but not at the control hospital; the maximum quarterly frequency of hand hygiene performance or glove use at intervention hospitals (74%, 80%, and 77%) was higher than that at the control hospital (59%). By multivariable analysis, preferential use of alcohol-based hand rubs rather than soap and water for hand hygiene was more likely among workers at intervention hospitals compared with nonintervention hospitals (adjusted odds ratio, 4.6 [95% confidence interval, 3.3-6.4]) and more likely among physicians (adjusted odds ratio, 1.4 [95% confidence interval, 1.2-1.8]) than among nurses at intervention hospitals. A significantly reduced incidence of antimicrobial-resistant bacteria among isolates from clinical culture was found at a single intervention hospital, which had the greatest increase in the frequency of hand hygiene performance. During a 3-year period, a multimodal intervention program increased adherence to hand hygiene recommendations, especially to the use of alcohol-based hand rubs. In one hospital, a concomitant reduction was found in the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures.

Implementation of an innovative hands-on training to improve adherence to hygiene rules: A feasibility Study.

PubMed

Stock, Stephanie; Tebest, Ralf; Westermann, Kristina; Samel, Christina; Strohbücker, Barbara; Stosch, Christoph; Wenchel, Hans-Martin; Redaèlli, Marcus

2016-01-01

Hospital-acquired infections (HAI) still pose a major problem in inpatient care. The single most important measure for preventing HAIs is to improve adherence to hand hygiene among health care professionals. To assess the feasibility of an innovative hands-on training to improve adherence to hygiene rules under standardized and under real life conditions. Before-after controlled cohort trial to assess the feasibility of implementing an innovative hands-on training to improve hand hygiene adherence. Large university hospital in Germany. Fifty trained nurses from three wards with an average age of 32years (±10.22years) and an average vocational experience of 6.85years (±7.54years). The intervention consisted of a hands-on training in the skills lab of the University of Cologne complemented by a 12-week observation period before and after the training on participating wards. The training comprised important skills with respect to hand hygiene, venipuncture, dressing changes of central venous catheters, preparation of IV infusions, and donning of gloves using sterile technique. A communication training was included to enable nurses to enforce hygiene rules in their collaboration with peers and physicians. The intervention was taught in small groups with a wide array of interactive teaching methods. It was evaluated using the objective structured clinical examination (OSCE) format. Observations were conducted by a trained infection control nurse. Before (after) the intervention 622 (612) occasions of hand hygiene were documented. A highly significant improvement in hygiene compliance was observed pre- and post-intervention (64.3% vs. 79.2%; p≤0.0001). The OSCE evaluation showed significant improvements in all subscales. The developed and conducted hands-on training seems feasible and is successful in significantly improving adherence to hygiene rules under standardized and real life conditions. Whether the effect is stable over time is subject to further investigation. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Impact of a Health Campaign on Hand Hygiene and Upper Respiratory Illness among College Students Living in Residence Halls.

ERIC Educational Resources Information Center

White, Cindy; Kolble, Robin; Carlson, Rebecca; Lipson, Natasha

2005-01-01

Hand hygiene is a key element in preventing the transmission of cold and flu viruses. The authors conducted an experimental-control design study in 4 campus residence halls to determine whether a message campaign about hand hygiene and the availability of gel hand sanitizer could decrease cold and flu illness and school and work absenteeism. Their…

Comparison of Standard Culture-Based Method to Culture-Independent Method for Evaluation of Hygiene Effects on the Hand Microbiome.

PubMed

Zapka, C; Leff, J; Henley, J; Tittl, J; De Nardo, E; Butler, M; Griggs, R; Fierer, N; Edmonds-Wilson, S

2017-03-28

Hands play a critical role in the transmission of microbiota on one's own body, between individuals, and on environmental surfaces. Effectively measuring the composition of the hand microbiome is important to hand hygiene science, which has implications for human health. Hand hygiene products are evaluated using standard culture-based methods, but standard test methods for culture-independent microbiome characterization are lacking. We sampled the hands of 50 participants using swab-based and glove-based methods prior to and following four hand hygiene treatments (using a nonantimicrobial hand wash, alcohol-based hand sanitizer [ABHS], a 70% ethanol solution, or tap water). We compared results among culture plate counts, 16S rRNA gene sequencing of DNA extracted directly from hands, and sequencing of DNA extracted from culture plates. Glove-based sampling yielded higher numbers of unique operational taxonomic units (OTUs) but had less diversity in bacterial community composition than swab-based sampling. We detected treatment-induced changes in diversity only by using swab-based samples ( P < 0.001); we were unable to detect changes with glove-based samples. Bacterial cell counts significantly decreased with use of the ABHS ( P < 0.05) and ethanol control ( P < 0.05). Skin hydration at baseline correlated with bacterial abundances, bacterial community composition, pH, and redness across subjects. The importance of the method choice was substantial. These findings are important to ensure improvement of hand hygiene industry methods and for future hand microbiome studies. On the basis of our results and previously published studies, we propose recommendations for best practices in hand microbiome research. IMPORTANCE The hand microbiome is a critical area of research for diverse fields, such as public health and forensics. The suitability of culture-independent methods for assessing effects of hygiene products on microbiota has not been demonstrated. This is the first controlled laboratory clinical hand study to have compared traditional hand hygiene test methods with newer culture-independent characterization methods typically used by skin microbiologists. This study resulted in recommendations for hand hygiene product testing, development of methods, and future hand skin microbiome research. It also demonstrated the importance of inclusion of skin physiological metadata in skin microbiome research, which is atypical for skin microbiome studies. Copyright © 2017 Zapka et al.

An assessment of oral cancer curricula in dental hygiene programmes: implications for cancer control.

PubMed

Thacker, K K; Kaste, L M; Homsi, K D; LeHew, C W

2016-11-01

To assess oral cancer prevention and early detection curricula in Illinois associate-degree dental hygiene programmes and highlight global health applications. An email invitation was sent to each Illinois associate-degree granting dental hygiene programme's oral cancer contact to participate in a survey via a SurveyMonkey™ link to a 21-item questionnaire. Questions elicited background information on each programme and inquired about curriculum and methods used for teaching oral cancer prevention and early detection. Eight of the 12 (67%) programmes responded. Three (37.5%) reported having a specific oral cancer curriculum. Five (62.5%) require students to perform examinations for signs and symptoms of oral cancer at each clinic visit. Variations exist across the programmes in the number of patients each student sees annually and the number of oral cancer examinations each student performs before graduation. Seven programmes (87.5%) conduct early detection screening in community settings. All programmes included risk assessment associated with tobacco. All other risk factors measured were treated inconsistently. Significant differences in training and experience were reported across Illinois dental hygiene programmes. Training is neither standardized nor uniformly comprehensive. Students' preparation for delivering prevention and early detection services to their patients could be strengthened to ensure competence including reflection of risk factors and behaviours in a global context. Regular review of curricular guidelines and programme content would help dental hygienists meet the expectations of the Crete Declaration on Oral Cancer Prevention. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Hand hygiene for the prevention of nosocomial infections.

PubMed

Kampf, Günter; Löffler, Harald; Gastmeier, Petra

2009-10-01

The WHO regards hand hygiene as an essential tool for the prevention of nosocomial infection, but compliance in clinical practice is often low. The relevant scientific literature and national and international evidence-based recommendations (Robert Koch Institute [Germany], WHO) were evaluated. Hygienic hand disinfection has better antimicrobial efficacy than hand-washing and is the procedure of choice to be performed before and after manual contact with patients. The hands should be washed, rather than disinfected, only when they are visibly soiled. Skin irritation is quite common among healthcare workers and is mainly caused by water, soap, and prolonged wearing of gloves. Compliance can be improved by training, by placing hand-rub dispensers at the sites where they are needed, and by physicians setting a good example for others. Improved compliance in hand hygiene, with proper use of alcohol-based hand rubs, can reduce the nosocomial infection rate by as much as 40%.

Effect of hand sanitizer location on hand hygiene compliance.

PubMed

Cure, Laila; Van Enk, Richard

2015-09-01

Hand hygiene is the most important intervention to prevent infection in hospitals. Health care workers should clean their hands at least before and after contact with patients. Hand sanitizer dispensers are important to support hand hygiene because they can be made available throughout hospital units. The aim of this study was to determine whether the usability of sanitizer dispensers correlates with compliance of staff in using the sanitizer in a hospital. This study took place in a Midwest, 404-bed, private, nonprofit community hospital with 15 inpatient care units in addition to several ambulatory units. The usability and standardization of sanitizers in 12 participating inpatient units were evaluated. The hospital measured compliance of staff with hand hygiene as part of their quality improvement program. Data from 2010-2012 were analyzed to measure the relationship between compliance and usability using mixed-effects logistic regression models. The total usability score (P = .0046), visibility (P = .003), and accessibility of the sanitizer on entrance to the patient room (P = .00055) were statistically associated with higher observed compliance rates. Standardization alone showed no significant impact on observed compliance (P = .37). Hand hygiene compliance can be influenced by visibility and accessibility of dispensers. The sanitizer location should be part of multifaceted interventions to improve hand hygiene. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices.

PubMed

Sickbert-Bennett, Emily E; DiBiase, Lauren M; Willis, Tina M Schade; Wolak, Eric S; Weber, David J; Rutala, William A

2016-09-01

Improving hand hygiene from high to very high compliance has not been documented to decrease healthcare-associated infections. We conducted longitudinal analyses during 2013-2015 in an 853-bed hospital and observed a significantly increased hand hygiene compliance rate (p<0.001) and a significantly decreased healthcare-associated infection rate (p = 0.0066).

Efficacy of Waterless Hand Hygiene Compared with Handwashing with Soap: A Field Study in Dar es Salaam, Tanzania

PubMed Central

Pickering, Amy J.; Boehm, Alexandria B.; Mwanjali, Mathew; Davis, Jennifer

2010-01-01

Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field conditions in Dar es Salaam, Tanzania. Hand sanitizer use by mothers resulted in 0.66 and 0.64 log reductions per hand of Escherichia coli and fecal streptococci, respectively. In comparison, handwashing with soap resulted in 0.50 and 0.25 log reductions per hand of E. coli and fecal streptococci, respectively. Hand sanitizer was significantly better than handwashing with respect to reduction in levels of fecal streptococci (P = 0.01). The feasibility and health impacts of promoting hand sanitizer as an alternative hand hygiene option for water-constrained environments should be assessed. PMID:20134005

Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia

PubMed Central

Graves, Nicholas; Page, Katie; Martin, Elizabeth; Brain, David; Hall, Lisa; Campbell, Megan; Fulop, Naomi; Jimmeison, Nerina; White, Katherine; Paterson, David; Barnett, Adrian G.

2016-01-01

Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained. The return on investment varied among the states and territories of Australia. PMID:26859688

Hand hygiene noncompliance and the cost of hospital-acquired methicillin-resistant Staphylococcus aureus infection.

PubMed

Cummings, Keith L; Anderson, Deverick J; Kaye, Keith S

2010-04-01

Hand hygiene noncompliance is a major cause of nosocomial infection. Nosocomial infection cost data exist, but the effect of hand hygiene noncompliance is unknown. To estimate methicillin-resistant Staphylococcus aureus (MRSA)-related cost of an incident of hand hygiene noncompliance by a healthcare worker during patient care. Two models were created to simulate sequential patient contacts by a hand hygiene-noncompliant healthcare worker. Model 1 involved encounters with patients of unknown MRSA status. Model 2 involved an encounter with an MRSA-colonized patient followed by an encounter with a patient of unknown MRSA status. The probability of new MRSA infection for the second patient was calculated using published data. A simulation of 1 million noncompliant events was performed. Total costs of resulting infections were aggregated and amortized over all events. Duke University Medical Center, a 750-bed tertiary medical center in Durham, North Carolina. Model 1 was associated with 42 MRSA infections (infection rate, 0.0042%). Mean infection cost was $47,092 (95% confidence interval [CI], $26,040-$68,146); mean cost per noncompliant event was $1.98 (95% CI, $0.91-$3.04). Model 2 was associated with 980 MRSA infections (0.098%). Mean infection cost was $53,598 (95% CI, $50,098-$57,097); mean cost per noncompliant event was $52.53 (95% CI, $47.73-$57.32). A 200-bed hospital incurs $1,779,283 in annual MRSA infection-related expenses attributable to hand hygiene noncompliance. A 1.0% increase in hand hygiene compliance resulted in annual savings of $39,650 to a 200-bed hospital. Hand hygiene noncompliance is associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings.

Observation of practices at petting zoos and the potential impact on zoonotic disease transmission.

PubMed

Weese, J Scott; McCarthy, Lisa; Mossop, Michael; Martin, Hayley; Lefebvre, Sandi

2007-07-01

Although petting zoos are common at public events and allow the public to interact with animals, there has been minimal evaluation of practices at petting zoos. Unannounced observation was performed at 36 petting zoos in Ontario, Canada. Observers recorded information, including physical layout, animal species, animal health, types of animal contact permitted, animal sources, hand hygiene facilities, signage, sale of food for human consumption, and hand hygiene compliance. The majority of petting zoos (24 [67%] of 36 petting zoos) were part of temporary events, particularly agricultural fairs (21 [58%] of 36 petting zoos). A variety of animal species were present, including some animals that are considered to be at particularly high risk for disease transmission (neonatal calves and baby chicks). The following items that would come into contact with the mouths of infants and children were carried into the petting zoos: baby bottles (at 17 petting zoos; 50%), pacifiers (at 24 petting zoos; 71%), spill-proofs cups (at 19 petting zoos; 56%), and infant toys (at 22 petting zoos; 65%). Hand hygiene facilities were provided at 34 (94%) of 36 events, and hand hygiene compliance ranged from 0% through 77% (mean compliance [+/-SD], 30.9%+/-22.1%; median compliance, 26.5%). Predictors for increased hand hygiene compliance included the location of a hand hygiene station on an exit route, the presence of hand hygiene reminder signs, and the availability of running water. Numerous deficiencies were encountered. Better education of petting zoo operators and the general public is needed. Provision of hand hygiene stations with running water that are placed near exits is one effective way to encourage compliance.

Hand hygiene to reduce community transmission of influenza and acute respiratory tract infection: a systematic review

PubMed Central

Warren‐Gash, Charlotte; Fragaszy, Ellen; Hayward, Andrew C.

2012-01-01

Please cite this paper as: Warren‐Gash et al. (2012) Hand hygiene to reduce community transmission of influenza and acute respiratory tract infection: a systematic review. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12015. Hand hygiene may be associated with modest protection against some acute respiratory tract infections, but its specific role in influenza transmission in different settings is unclear. We aimed to review evidence that improving hand hygiene reduces primary and secondary transmission of (i) influenza and (ii) acute respiratory tract infections in community settings. We searched Medline, Embase, Global Health and Cochrane databases up to 13 February 2012 for reports in any language of original research investigating the effect of hand hygiene on influenza or acute respiratory tract infection where aetiology was unspecified in community settings including institutions such as schools, and domestic residences. Data were presented and quality rated across outcomes according to the Grading of Recommendations Assessment, Development and Evaluation system. Sixteen articles met inclusion criteria. There was moderate to low‐quality evidence of a reduction in both influenza and respiratory tract infection with hand hygiene interventions in schools, greatest in a lower–middle‐income setting. There was high‐quality evidence of a small reduction in respiratory infection in childcare settings. There was high‐quality evidence for a large reduction in respiratory infection with a hand hygiene intervention in squatter settlements in a low‐income setting. There was moderate‐ to high‐quality evidence of no effect on secondary transmission of influenza in households that had already experienced an index case. While hand hygiene interventions have potential to reduce transmission of influenza and acute respiratory tract infections, their effectiveness varies depending on setting, context and compliance. PMID:23043518

Formative research on the feasibility of hygiene interventions for influenza control in UK primary schools.

PubMed

Schmidt, Wolf-Peter; Wloch, Catherine; Biran, Adam; Curtis, Val; Mangtani, Punam

2009-10-15

Interventions to increase hand washing in schools have been advocated as a means to reduce the transmission of pandemic influenza and other infections. However, the feasibility and acceptability of effective school-based hygiene interventions is not clear. A pilot study in four primary schools in East London was conducted to establish the current need for enhanced hand hygiene interventions, identify barriers to their implementation and to test their acceptability and feasibility. The pilot study included key informant interviews with teachers and school nurses, interviews, group discussions and essay questions with the children, and testing of organised classroom hand hygiene activities. In all schools, basic issues of personal hygiene were taught especially in the younger age groups. However, we identified many barriers to implementing intensive hygiene interventions, in particular time constraints and competing health issues. Teachers' motivation to teach hygiene and enforce hygienic behaviour was primarily educational rather than immediate infection control. Children of all age groups had good knowledge of hygiene practices and germ transmission. The pilot study showed that intensive hand hygiene interventions are feasible and acceptable but only temporarily during a period of a particular health threat such as an influenza pandemic, and only if rinse-free hand sanitisers are used. However, in many settings there may be logistical issues in providing all schools with an adequate supply. In the absence of evidence on effectiveness, the scope for enhanced hygiene interventions in schools in high income countries aiming at infection control appears to be limited in the absence of a severe public health threat.

Formative research on the feasibility of hygiene interventions for influenza control in UK primary schools

PubMed Central

Schmidt, Wolf-Peter; Wloch, Catherine; Biran, Adam; Curtis, Val; Mangtani, Punam

2009-01-01

Background Interventions to increase hand washing in schools have been advocated as a means to reduce the transmission of pandemic influenza and other infections. However, the feasibility and acceptability of effective school-based hygiene interventions is not clear. Methods A pilot study in four primary schools in East London was conducted to establish the current need for enhanced hand hygiene interventions, identify barriers to their implementation and to test their acceptability and feasibility. The pilot study included key informant interviews with teachers and school nurses, interviews, group discussions and essay questions with the children, and testing of organised classroom hand hygiene activities. Results In all schools, basic issues of personal hygiene were taught especially in the younger age groups. However, we identified many barriers to implementing intensive hygiene interventions, in particular time constraints and competing health issues. Teachers' motivation to teach hygiene and enforce hygienic behaviour was primarily educational rather than immediate infection control. Children of all age groups had good knowledge of hygiene practices and germ transmission. Conclusion The pilot study showed that intensive hand hygiene interventions are feasible and acceptable but only temporarily during a period of a particular health threat such as an influenza pandemic, and only if rinse-free hand sanitisers are used. However, in many settings there may be logistical issues in providing all schools with an adequate supply. In the absence of evidence on effectiveness, the scope for enhanced hygiene interventions in schools in high income countries aiming at infection control appears to be limited in the absence of a severe public health threat. PMID:19832971

An evaluation of hospital hand hygiene practice and glove use in Hong Kong.

PubMed

Chau, Janita P-C; Thompson, David R; Twinn, Sheila; Lee, Diana T F; Pang, Sharon W M

2011-05-01

To identify omissions in hand hygiene practice and glove use among hospital workers in Hong Kong. Hospital-acquired infection is the commonest complication affecting hospitalised patients. Even though research evidence suggests that hand hygiene and proper glove use are the most important ways to prevent the spread of disease and infection, compliance with both are reported to be unacceptably low. An observational study of hospital workers in one acute and two convalescence and rehabilitation hospitals in Hong Kong was conducted. The participating clinical areas included the medical and surgical wards, accident and emergency department and intensive care unit. Hand hygiene practice and glove use amongst 206 hospital health and support workers, stratified according to years of working experience, were observed. The number of observed episodes for hand hygiene was 1037 and for glove use 304. Compliance with hand hygiene was 74.7% and with glove use 72.4%. In approximately two-third of episodes, participants washed their hands after each patient contact; though, 78.5% failed to rub their hands together vigorously for at least 15 seconds. The major break in compliance with glove use was failure to change gloves between procedures on the same patient. In 28.6% of observed glove use episodes, participants did not wear gloves during procedures that exposed them to blood, body fluids, excretion, non-intact skin or mucous membranes. Significant differences in performance scores on antiseptic hand rub were found between the two types of hospital and on glove use between the three groups of work experience: ≤ 5, 6-10, >10 years. Education and reinforcement of proper hand hygiene practice and glove use among hospital health and support workers is needed. © 2011 Blackwell Publishing Ltd.

Hand hygiene knowledge and practice among university students: evidence from Private Universities of Bangladesh

PubMed Central

Sultana, Marufa; Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Hossain, Sarder Mahmud

2016-01-01

Hand hygiene has achieved the reputation of being a convenient means of preventing communicable diseases. Although causal links between hand hygiene and rates of infectious disease have also been established earlier, studies focusing on hand hygiene among university-going students are not adequate in number. This study evaluated handwashing knowledge, practice, and other related factors among the selected university students in the city of Dhaka, Bangladesh. A cross-sectional study was conducted among 200 undergraduate students from four selected universities. A pretested, semistructured questionnaire, that included a checklist associated with handwashing practice, was applied to capture all relevant data. The mean (± SD) age of the participants was 20.4 (±1.8) years. The majority of the students washed their hands with water, but only 22.5% washed their hands effectively by maintaining the correct steps and frequency of handwashing with water, and soap or hand sanitizer. The mean (± SD) score of the participants’ hand hygiene practice was 50.81 (±4.79), while the total score with all perfect answers was considered as 66. Regression coefficient demonstrated that age has a negative influence on hand hygiene practice, as older students have lower scores compared to the younger ones (P<0.01). However, the unmarried students were a significant predictor for influencing the incensement of handwashing practice compared to the married ones (P<0.01). Findings of this study designate widespread insufficient hand hygiene practice in the university-going students and indicate a need for an extensive public health education program on this topic. Furthermore, availability of soap and sufficient water supply is needed within the university setting to facilitate handwashing. Therefore, supporting quantity and quality of available campus-based public health education programs along with providing health-washing equipment is suggested. PMID:26929673

Hand hygiene knowledge and practice among university students: evidence from Private Universities of Bangladesh.

PubMed

Sultana, Marufa; Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Hossain, Sarder Mahmud

2016-01-01

Hand hygiene has achieved the reputation of being a convenient means of preventing communicable diseases. Although causal links between hand hygiene and rates of infectious disease have also been established earlier, studies focusing on hand hygiene among university-going students are not adequate in number. This study evaluated handwashing knowledge, practice, and other related factors among the selected university students in the city of Dhaka, Bangladesh. A cross-sectional study was conducted among 200 undergraduate students from four selected universities. A pretested, semistructured questionnaire, that included a checklist associated with handwashing practice, was applied to capture all relevant data. The mean (± SD) age of the participants was 20.4 (±1.8) years. The majority of the students washed their hands with water, but only 22.5% washed their hands effectively by maintaining the correct steps and frequency of handwashing with water, and soap or hand sanitizer. The mean (± SD) score of the participants' hand hygiene practice was 50.81 (±4.79), while the total score with all perfect answers was considered as 66. Regression coefficient demonstrated that age has a negative influence on hand hygiene practice, as older students have lower scores compared to the younger ones (P<0.01). However, the unmarried students were a significant predictor for influencing the incensement of handwashing practice compared to the married ones (P<0.01). Findings of this study designate widespread insufficient hand hygiene practice in the university-going students and indicate a need for an extensive public health education program on this topic. Furthermore, availability of soap and sufficient water supply is needed within the university setting to facilitate handwashing. Therefore, supporting quantity and quality of available campus-based public health education programs along with providing health-washing equipment is suggested.

Interventions to improve hand hygiene compliance in patient care.

PubMed

Gould, Dinah J; Moralejo, Donna; Drey, Nicholas; Chudleigh, Jane H; Taljaard, Monica

2017-09-01

Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. To assess the short- and long-term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care-associated infection. We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol-based hand rub (ABHR), or both. Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta-analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. This review includes 26 studies: 14 randomised trials, two non-randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long-term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention.Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes.Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low.Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence).Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence.Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence.Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence.Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context.

Hand hygiene in the nursery during diaper changing.

PubMed

Phang, Koh Ni; Maznin, Nur Liyanna; Yip, Wai Kin

2012-12-01

This project aimed to improve hand hygiene practice during diaper changing among nurses working in the nursery. This project was conducted in one of the nurseries in a 935-bed acute care hospital with a sample of 15 nurses. A pre- and post-intervention audit was conducted utilising the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice module. A revised written workflow, which specified the occasions and process for hand hygiene during diaper changing, was introduced. Modifications to the baby bassinets and nursery were made after barriers to good hand hygiene were identified. The project was carried out over 4 months, from March to June 2011. The post-intervention audit results show an improvement in performing hand washing after changing diapers (20%) and performing the correct steps of hand rubbing (25%). However, the compliance rates decreased for the other criteria that measured whether hand rubbing or hand washing was performed prior to contacting the infant and after wrapping the infant, and whether hand washing was performed correctly. The improvement in compliance with hand washing--the main focus of the new workflow--after changing diapers was especially significant. The results indicated that having a workflow on the occasions and process for hand hygiene during diaper changing was useful in standardising practice. Pre- and post-implementation audits were effective methods for evaluating the effect of translating evidence into practice. However, this project had limited success in improving compliance with hand hygiene. This suggested that more effort is needed to reinforce the importance of hand hygiene and compliance to the proposed workflow. In addition, this project showed that for change to take place successfully, environmental modifications, increased awareness and adequate communication to every staff member are essential. © 2012 The Authors. International Journal of Evidence-Based Healthcare © 2012 The Joanna Briggs Institute.

Sustainable hand hygiene efforts; a review of a successful campaign.

PubMed

Ferrelli, Juliet; DiCuccio, Marge Hardt

2013-06-01

The aim of this paper is to provide a review of the hand hygiene literature and to give an example of the use of this literature to create a multimodal sustainable hand hygiene program. The literature describes six key ingredients to consider when designing a hand hygiene program. These ingredients include leadership engagement, environmental assessment, education, a tight feedback loop, communication and routine revitalization. Programs tend to be more successful when several of these ingredients are utilized. The multimodal program created and implemented at one academic medical center is described. This program is an example of using the six key ingredients found in the literature with an interesting marketing and revitalization strategy. The literature offers strategies that have led to successful programs in the past. The multimodal use of these strategies was demonstrated in the creation of a successful hand hygiene program at one academic medical center.

Implementing AORN recommended practices for hand hygiene.

PubMed

Patrick, Marcia; Van Wicklin, Sharon A

2012-04-01

This article focuses on implementing the revised AORN "Recommended practices for hand hygiene in the perioperative setting." The content of the document has been expanded and reorganized from the previous iteration and now includes specific activity statements about water temperature, water and soap dispensing controls, the type of dispensers to use, paper towel dispenser requirements, placement of soap and rub dispensers, and regulatory requirements for products and recommendations for hand hygiene practices. A successful hand hygiene program allows end users to have input into the selection and evaluation of products and should include educating personnel about proper hand hygiene, product composition and safety, and how and when to use specific products. Measures for competency evaluation and compliance monitoring include observations, quizzes, skills labs, electronic monitoring systems, handheld device applications, and data collection forms. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Survey of attitudes and practices of Irish nursing students towards hand hygiene, including handrubbing with alcohol-based hand rub.

PubMed

Kingston, Liz M; O'Connell, Nuala H; Dunne, Colum P

2017-05-01

Hand hygiene is widely recognised as the most important measure a healthcare worker can take in preventing the spread of healthcare associated infections. As a member of the healthcare team, nursing students have direct patient contact during clinical practice; hence, good hand hygiene practice among nursing students is essential. Low to moderate levels of hand hygiene knowledge and poor attitudes and practices are reported among nursing students. However, less is known about their attitudes and practices of handrubbing with ABHR, even though handrubbing is the recommended optimum practice in most situations. The aim of this study was to explore attitudes and practices of hand hygiene, in particular handrubbing with alcohol-based hand rub, among nursing students in Ireland. This survey employed a descriptive, self-report design using a questionnaire to gather data. It was administered electronically to all undergraduate nursing students (n=342) in the Department of Nursing and Midwifery at the University of Limerick, Ireland in March and April 2015. Response rate was 66%. Attitudes towards hand hygiene were generally positive. Compliance with hand hygiene after contact with body fluid was high (99.5%) and before a clean or aseptic procedure (98.5%). However, suboptimal practices emerged, before touching a patient (85%), after touching a patient (87%) and after touching patients' surroundings (61%), with first year students more compliant than fourth year students. 16% of students were not aware of the clinical contraindications for using alcohol-based hand rub and 9% did not know when to use soap and water and when to use alcohol-based hand rub. Educators and practitioners play an important role in ensuring that nursing students develop appropriate attitudes towards hand hygiene and engage in optimal handrubbing practices. Raising awareness among nursing students of their responsibility in preventing the occurrence and reducing the transmission of HCAI as an on-going endeavour is required, with the laudable aim of preventing complacency and ultimately improving patient outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Association between use of hand hygiene products and rates of health care-associated infections in a large university hospital in Norway.

PubMed

Herud, Trine; Nilsen, Roy M; Svendheim, Kjersti; Harthug, Stig

2009-05-01

An association between use of hand hygiene products and health care-associated infection rates was investigated in a large Norwegian university hospital. We conducted an ecologic study by combining data from purchasing and admission systems with data from 32 point prevalence surveys (27,248 patients) in 1998-2005. Data on purchase of hand disinfectants and soap, and patient-days, were collected for 20 bed wards similar to those of the prevalence surveys. The prevalence of infections was 7.1%. We found no significant decline in overall infections (P = .19), but use of hand hygiene products significantly increased from 28.5 L per 1000 patients-days in 1998 to 43.3 L per 1000 patient-days in 2005 (P < .001). After examining a linear dose-response relation between use and infection rates, we observed a borderline significant decline in infections from 8% to 6% with increased use of hand hygiene products (P = .05). This association appeared stronger for wards that were registered with infections >9% at study start in 1998 (P < .001). These data suggests that infection rates may be reflected by amount of hand hygiene products used. Quantification of such products over time may serve as an indicator for hand hygiene performance in hospitals.

Automated and electronically assisted hand hygiene monitoring systems: a systematic review.

PubMed

Ward, Melissa A; Schweizer, Marin L; Polgreen, Philip M; Gupta, Kalpana; Reisinger, Heather S; Perencevich, Eli N

2014-05-01

Hand hygiene is one of the most effective ways to prevent transmission of health care-associated infections. Electronic systems and tools are being developed to enhance hand hygiene compliance monitoring. Our systematic review assesses the existing evidence surrounding the adoption and accuracy of automated systems or electronically enhanced direct observations and also reviews the effectiveness of such systems in health care settings. We systematically reviewed PubMed for articles published between January 1, 2000, and March 31, 2013, containing the terms hand AND hygiene or hand AND disinfection or handwashing. Resulting articles were reviewed to determine if an electronic system was used. We identified 42 articles for inclusion. Four types of systems were identified: electronically assisted/enhanced direct observation, video-monitored direct observation systems, electronic dispenser counters, and automated hand hygiene monitoring networks. Fewer than 20% of articles identified included calculations for efficiency or accuracy. Limited data are currently available to recommend adoption of specific automatic or electronically assisted hand hygiene surveillance systems. Future studies should be undertaken that assess the accuracy, effectiveness, and cost-effectiveness of such systems. Given the restricted clinical and infection prevention budgets of most facilities, cost-effectiveness analysis of specific systems will be required before these systems are widely adopted. Published by Mosby, Inc.

Back to basics: hand hygiene and isolation

PubMed Central

Lin Huang, G. Khai; Stewardson, Andrew J.; Lindsay Grayson, M.

2014-01-01

Purpose of review Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions. Recent findings Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission. Summary Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation. PMID:24945613

The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: an intervention study with before and after comparison.

PubMed

Helder, Onno K; Brug, Johannes; Looman, Caspar W N; van Goudoever, Johannes B; Kornelisse, René F

2010-10-01

Nosocomial bloodstream infections are a major cause of morbidity and mortality in neonatal intensive care units. Appropriate hand hygiene is singled out as the most important measure in preventing these infections. However, hand hygiene compliance among healthcare professionals remains low despite the well-known effect on infection reduction. We studied the effectiveness of a hand hygiene education program on the incidence of nosocomial bloodstream infections. Observational study with two pretests and two posttest measurements and interrupted time series analysis. A 27 bed level IIID neonatal intensive care unit in a teaching hospital in the Netherlands. Healthcare professionals who had physical contact with very low birth weight (VLBW) infants. The study was conducted during a period of 4 years. Medical and nursing staff followed a problem-based education program on hand hygiene. Hand hygiene practices before and after the education program were compared by guided observations. The incidence of nosocomial infections in VLBW infants was compared. In addition, numbers of nosocomial bloodstream infections per day-at-risk in very low birth weight infants were analyzed by a segmented loglinear regression analysis. During 1201 observations hand hygiene compliance before patient contact increased from 65% to 88% (p<0.001). Median (interquartile range) drying time increased from 4s (4-10) to 10s (7-14) (p<0.001). The proportion of very low birth weight infants with one or more bloodstream infections and the infection rate per 1000 patient days (relative risk reduction) before and after the education program on hand hygiene intervention decreased from 44.5% to 36.1% (18.9%, p=0.03) and from 17.3% to 13.5% (22.0%, p=0.03), respectively. At the baseline the nosocomial bloodstream infections per day-at-risk decreased by +0.07% (95% CI -1.41 to +1.60) per month and decreased with -1.25% (95% CI -4.67 to +2.44) after the intervention (p=0.51). The level of instant change was -14.8% (p=0.48). The results are consistent with relevant improvement of hand hygiene practices among healthcare professionals due to an education program. Improved hand hygiene resulted in a reduction in nosocomial bloodstream infections. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Hand Hygiene and Tuberculosis Risk in Korea: An Ecological Association.

PubMed

Han, Mi Ah

2018-01-01

Hand hygiene is a basic but effective strategy against infectious disease. This study investigated an ecological association between hand hygiene and tuberculosis (TB) risk in Korea. Hand hygiene data were obtained from the 2015 Community Health Survey. Information on TB incidence and mortality in 2015 were obtained from the National Infectious Diseases Surveillance System and death monitoring database, respectively. In multiple linear regression analysis, frequent hand washing rates after using the restroom (B = -0.78, P = .037), after returning from the outdoors (B = -0.28, P = .049), and with soap or hand sanitizer (B = -0.54, P = .018) were negatively associated with TB incidence. TB mortality were associated with frequent hand washing rates after returning from the outdoors (B = -0.05, P = .035), and with soap or hand sanitizer (B = -0.10, P = .010), respectively. Hand washing was associated with lower TB incidence and mortality at the community level. These results could contribute to develop community-based health promotion strategies.

What are school children in Europe being taught about hygiene and antibiotic use?

PubMed

Lecky, Donna M; McNulty, Cliodna A M; Adriaenssens, Niels; Koprivová Herotová, Tereza; Holt, Jette; Touboul, Pia; Merakou, Kyriakoula; Koncan, Raffaella; Olczak-Pienkowska, Anna; Avô, António Brito; Campos, José; Farrell, David; Kostkova, Patty; Weinberg, Julius

2011-06-01

e-Bug is a pan-European antibiotic and hygiene teaching resource that aims to reinforce awareness in school children of microbes, prudent antibiotic use, hygiene and the transmission of infection. Prior to the production of the resource, it was essential to examine the educational structure across each partner country and assess what school children were being taught on these topics. A questionnaire was devised for distribution to each European partner (Belgium, Czech Republic, Denmark, England, France, Greece, Italy, Poland, Portugal and Spain), exploring their educational structure and examining educational resources or campaigns currently available. From the data collected it was evident that the majority of European schools have structured hand hygiene practices in place from a young age. The curricula in all countries cover the topic of human health and hygiene, but limited information is provided on antibiotics and their prudent use. School educational resources that link to the national curriculum and implement National Advice to the Public campaigns in the classroom are limited. The Microbes en question mobile health education campaign in France is an example of a successful children's education campaign and an innovative programme. Evaluation of the impact of school education on attitude and change of behaviour is also limited throughout many European countries. Not enough is currently being done across Europe to educate school children on the importance of appropriate antibiotic use and antibiotic resistance. The data from this research were used to develop e-Bug, a European Union-funded antibiotic and hygiene teaching resource.

Hand hygiene in rural Indonesian healthcare workers: barriers beyond sinks, hand rubs and in-service training.

PubMed

Marjadi, B; McLaws, M-L

2010-11-01

Few attempts to increase healthcare workers' hand hygiene compliance have included an in-depth analysis of the social and behavioural context in which hand hygiene is not undertaken. We used a mixed method approach to explore hand hygiene barriers in rural Indonesian healthcare facilities to develop a resource-appropriate adoption of international guidelines. Two hospitals and eight clinics (private and public) in a rural Indonesian district were studied for three months each. Hand hygiene compliance was covertly observed for two shifts each in three adult wards at two hospitals. Qualitative data were collected from direct observation, focus group discussions and semistructured in-depth and informal interviews within healthcare facilities and the community. Major barriers to compliance included longstanding water scarcity, tolerance of dirtiness by the community and the healthcare organisational culture. Hand hygiene compliance was poor (20%; 57/281; 95% CI: 16-25%) and was more likely to be undertaken after patient contact (34% after-patient contact vs 5% before-patient contact, P<0.001) and 'inherent' opportunities associated with contacts perceived to be dirty (49% 'inherent' vs 11% 'elective' opportunities associated with clean contacts, P<0.001). Clinicians frequently touched patients without hand hygiene, and some clinicians avoided touching patients altogether. The provision of clean soap and water and in-service training will not overcome strong social and behavioural barriers unless interventions focus on long term community education and managerial commitment to the provision of supportive working conditions. Copyright © 2010 The Hospital Infection Society. All rights reserved.

The Hygienic Efficacy of Different Hand-Drying Methods: A Review of the Evidence

PubMed Central

Huang, Cunrui; Ma, Wenjun; Stack, Susan

2012-01-01

The transmission of bacteria is more likely to occur from wet skin than from dry skin; therefore, the proper drying of hands after washing should be an integral part of the hand hygiene process in health care. This article systematically reviews the research on the hygienic efficacy of different hand-drying methods. A literature search was conducted in April 2011 using the electronic databases PubMed, Scopus, and Web of Science. Search terms used were hand dryer and hand drying. The search was limited to articles published in English from January 1970 through March 2011. Twelve studies were included in the review. Hand-drying effectiveness includes the speed of drying, degree of dryness, effective removal of bacteria, and prevention of cross-contamination. This review found little agreement regarding the relative effectiveness of electric air dryers. However, most studies suggest that paper towels can dry hands efficiently, remove bacteria effectively, and cause less contamination of the washroom environment. From a hygiene viewpoint, paper towels are superior to electric air dryers. Paper towels should be recommended in locations where hygiene is paramount, such as hospitals and clinics. PMID:22656243

Googling your hand hygiene data: Using Google Forms, Google Sheets, and R to collect and automate analysis of hand hygiene compliance monitoring.

PubMed

Wiemken, Timothy L; Furmanek, Stephen P; Mattingly, William A; Haas, Janet; Ramirez, Julio A; Carrico, Ruth M

2018-06-01

Hand hygiene is one of the most important interventions in the quest to eliminate healthcare-associated infections, and rates in healthcare facilities are markedly low. Since hand hygiene observation and feedback are critical to improve adherence, we created an easy-to-use, platform-independent hand hygiene data collection process and an automated, on-demand reporting engine. A 3-step approach was used for this project: 1) creation of a data collection form using Google Forms, 2) transfer of data from the form to a spreadsheet using Google Spreadsheets, and 3) creation of an automated, cloud-based analytics platform for report generation using R and RStudio Shiny software. A video tutorial of all steps in the creation and use of this free tool can be found on our YouTube channel: https://www.youtube.com/watch?v=uFatMR1rXqU&t. The on-demand reporting tool can be accessed at: https://crsp.louisville.edu/shiny/handhygiene. This data collection and automated analytics engine provides an easy-to-use environment for evaluating hand hygiene data; it also provides rapid feedback to healthcare workers. By reducing some of the data management workload required of the infection preventionist, more focused interventions may be instituted to increase global hand hygiene rates and reduce infection. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Hand hygiene compliance by health care workers at a teaching hospital, Kingston, Jamaica.

PubMed

Nicholson, Alison M; Tennant, Ingrid A; Martin, Allie C; Ehikhametalor, Kelvin; Reynolds, Glendee; Thoms-Rodriguez, Camille-Ann; Nagassar, Rajeev; Hoilett, Tena-Kim; Allen, Roxanne; Redwood, Tahira; Crandon, Ivor

2016-10-31

Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.

Implementing hygiene monitoring systems in hospital laundries in order to reduce microbial contamination of hospital textiles.

PubMed

Fijan, S; Sostar-Turk, S; Cencic, A

2005-09-01

As textiles sent to hospital laundries contain many types of pathogenic organisms, it is important that laundering not only has an appropriate cleaning effect but also has a satisfactory disinfecting effect. Critical to this process is the maintenance of an appropriate hygiene level in the clean area of laundries in order to prevent recontamination of textiles from manual handling when ironing, folding, packing etc. The aims of this study were to evaluate the hygienic state of a hospital laundry, to introduce continuous sanitary measures, and to introduce a continuous hygiene monitoring system with an infection control programme. Two systems for evaluating hospital laundry hygiene were combined: HACCP principles (hazard analysis and critical control points) and RAL-GZ 992 standards (quality assurance standard for textile care of hospital laundry). Evaluation of the hygienic state of the hospital laundry was carried out by evaluating the number and types of micro-organisms present at the critical control points throughout the whole laundering process, using RODAC agar plates for surface sampling and the pour plate method for investigating water samples. The initial examination showed that the sanitary condition of the laundry did not reach the required hygiene level. Therefore, fundamental sanitation measures were instituted and the examination was repeated. Results were then satisfactory. The most important critical control point was the chemothermal laundering efficiency of the laundering process. To prevent micro-organisms spreading into the entire clean working area, it is important that, in addition to regular sanitary measures such as cleaning/disinfecting all working areas, technical equipment and storage shelves etc., regular education sessions for laundry employees on proper hand hygiene is undertaken and effective separation of the clean and dirty working areas is achieved.

Can a school-based hand hygiene program reduce asthma exacerbations among elementary school children?

PubMed Central

Gerald, Joe K.; Zhang, Bin; McClure, Leslie A.; Bailey, William C.; Harrington, Kathy F.

2012-01-01

Background Viral upper respiratory infections have been implicated as a major cause of asthma exacerbations among school age children. Regular hand washing is the most effective method to prevent the spread of viral respiratory infections but, effective hand washing practices are difficult to establish in schools. Objectives This randomized controlled trial evaluated whether a standardized regimen of hand washing plus alcohol-based hand sanitizer could reduce asthma exacerbations more than schools’ usual hand hygiene practices. Methods This was a two year, community-based, randomized controlled crossover trial. Schools were randomized to usual care then intervention (Sequence 1) or intervention then usual care (Sequence 2). Intervention schools were provided with alcohol-based hand sanitizer, hand soap, and hand hygiene education. The primary outcome was the proportion of students experiencing an asthma exacerbation each month. Generalized estimating equations were used to model the difference in the marginal rate of exacerbations between sequences while controlling for individual demographic factors and the correlation within each student and between students within each school. Results 527 students with asthma were enrolled among 31 schools. The hand hygiene intervention did not reduce the number of asthma exacerbations as compared to the schools’ usual hand hygiene practices (p=0.132). There was a strong temporal trend as both sequences experienced fewer exacerbations during Year 2 as compared to Year 1 (p<0.001). Conclusions While the intervention was not found to be effective, the results were confounded by the H1N1 influenza pandemic that resulted in substantially increased hand hygiene behaviors and resources in usual care schools. Therefore, these results should be viewed cautiously. PMID:23069487

[Oral health hygiene education programme for nursing personnel to improve oral health of residents in long-term care facilities 2010 in Frankfurt/Main, Germany].

PubMed

Czarkowski, G; Allroggen, S; Köster-Schmidt, A; Bausback-Schomakers, S; Frank, M; Heudorf, U

2013-06-01

Many studies have shown the urgent need for improving oral health hygiene in nursing home residents. Deficits in the knowledge of the personnel about dental and oral hygiene are often cited as one of the causes. Therefore, an oral health education programme was provided to the personnel of 20 nursing homes in Frankfurt/Main. Here the results of the assessment of the impact of the education programme on knowledge and attitudes of the personnel as well as on oral health of the residents are presented. In May/June 2010, 471 nurses in 20 nursing homes in the Frankfurt/Main, Germany, received a two-hour education programme on oral health. The lessons were held by dentists with special education in geriatric dentistry. The personnel were asked to complete a questionnaire regarding knowledge and attitudes on oral health care before the education programme and 4-6 months afterwards. The oral health status of 313 residents (i. e., about 10% of the total residents) was examined by two dentists. Before and 4-6 months after education of the caregivers, the following data were recorded in the residents: number of teeth, caries, plaque index (PI), sulcus bleeding index (SBI), community periodontal index of treatment needs (CPITN) and denture hygiene index (DHI). By attending the lessons, good improvements in knowledge of the caregivers could be obtained. The education programme was rated as very good/good by 85% of the nurses, having reduced their fear of oral care in the seniors and having gained more competence in practical oral hygiene procedures. Mean age of the residents was 80±13 years. About 32% of the residents were edentulous. Teeth were carious in 53% of the residents. Initially, one half of the residents exhibited plaque index>2, in 29% of the residents a severe and in 59% of them a very severe parodontitis was found (CPITN 3 or, respectively, 4). At 4-6 months after the education programme, an improvement in oral and dental hygiene of the residents could be demonstrated, significant for plaque index, cleanliness of the tongue and denture hygiene index. The positive assessment of the nursing personnel as well as the positive effects on oral hygiene in the residents are in agreement with the results of many other studies in many countries. Therefore, these education programmes will be continued in the long-term care facilities in Frankfurt/Main, Germany.· © Georg Thieme Verlag KG Stuttgart · New York.

Sustained meticillin-resistant Staphylococcus aureus control in a hyper-endemic tertiary acute care hospital with infrastructure challenges in Singapore.

PubMed

Fisher, D; Tambyah, P A; Lin, R T P; Jureen, R; Cook, A R; Lim, A; Ong, B; Balm, M; Ng, T M; Hsu, L Y

2013-10-01

Meticillin-resistant Staphylococcus aureus (MRSA) has been entrenched in Singapore hospitals since the 1980s, with an excess of 600 non-duplicate cases of infections (120 bacteraemia episodes) each year in our 995-bed university hospital. Approximately 5% of our hospital beds are used as isolation facilities. To study the impact of an MRSA control bundle that was implemented via gradual geographic extension across hospital wards. The bundle included active surveillance on admission and transfer/discharge to identify ward-based acquisition of MRSA, isolation and cohorting of MRSA-infected patients, enhanced hand hygiene initiatives, and publicly displayed feedback of MRSA acquisition and hand hygiene compliance rates. Implementation was between October 2006 and June 2010 in order to provide lead-time for the incremental development of infrastructural capacity, and to develop an ethic of infection prevention among staff. Results were analysed via interrupted time-series analysis. MRSA infections fell midway through the implementation, with MRSA bacteraemia declining from 0.26 [95% confidence interval (CI): 0.18-0.34] cases per 1000 inpatient-days in the first quarter of 2004 to 0.11 (95% CI: 0.07-0.19) cases per 1000 inpatient-days in the first quarter of 2012. MRSA acquisition rates fell a year after the programme had been fully implemented, whereas hand hygiene compliance rose significantly from 47% (95% CI: 44-49) in the first quarter of 2009 to 69% (95% CI: 68-71) in the first quarter of 2012. Successful staged implementation of an MRSA bundle in a hyper-endemic setting is sustainable and represents a model that may be adapted for similar settings. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

The effect of hand-hygiene interventions on infectious disease-associated absenteeism in elementary schools: A systematic literature review.

PubMed

Wang, Zhangqi; Lapinski, Maria; Quilliam, Elizabeth; Jaykus, Lee-Ann; Fraser, Angela

2017-06-01

Hand-hygiene interventions are widely used in schools but their effect on reducing absenteeism is not well known. The aim of our literature review was to determine whether implementation of a hand-hygiene intervention reduced infectious disease-associated absenteeism in elementary schools. The eligible studies (N = 19), published between 1996 and 2014, were summarized and the methodologic quality of each was assessed. Our review indicated evidence is available to show hand-hygiene interventions had an effect on reducing acute gastrointestinal illness-associated absenteeism but inadequate evidence is available to show an effect on respiratory illness-associated absenteeism. The methodologic quality assessment of eligible studies revealed common design flaws, such as lack of randomization, blinding, and attrition, which must be addressed in future studies to strengthen the evidence base on the effect of hand-hygiene interventions on school absenteeism. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Knowledge, awareness and practice of the importance of hand-washing amongst children attending state run primary schools in rural Malawi.

PubMed

Grimason, Anthony Martin; Masangwi, Salule Joseph; Morse, Tracy Dawn; Jabu, George Christopher; Beattie, Tara Kate; Taulo, Steven Elias; Lungu, Kingsley

2014-01-01

A study was undertaken to determine the efficacy of hygiene practices in 2 primary schools in Malawi. The study determined: (1) presence of Escherichia coli on the hands of 126 primary school pupils, (2) knowledge, awareness and hygiene practices amongst pupils and teachers and (3) the school environment through observation. Pupil appreciation of hygiene issues was reasonable; however, the high percentage presence of E. coli on hands (71%) and the evidence of large-scale open defaecation in school grounds revealed that apparent knowledge was not put into practice. The standard of facilities for sanitation and hygiene did not significantly impact on the level of knowledge or percentage of school children's hands harbouring faecal bacteria. Evidence from pupils and teachers indicated a poor understanding of principles of disease transmission. Latrines and hand-washing facilities constructed were not child friendly. This study identifies a multidisciplinary approach to improve sanitation and hygiene practices within schools.

A helping hand for infection control.

PubMed

Allen, Mike

2004-09-01

Despite considerable awareness amongst the healthcare community about the importance of hand hygiene in controlling Healthcare Acquired Infections (HAIs), the problem persists. Mike Allen of Dart Valley Systems explores the issues surrounding good hand hygiene practice in UK hospitals.

Effectiveness of an extended period of flashing lights and strategic signage to increase the salience of alcohol-gel dispensers for improving hand hygiene compliance.

PubMed

Rashidi, Babak; Li, Aimee; Patel, Rakesh; Harmsen, Irene E; Sabri, Elham; Kyeremanteng, Kwadwo; D'Egidio, Gianni

2016-07-01

Multiple factors affect compliance with hand hygiene, including conspicuity of alcohol-gel dispensers. Previous studies have shown that flashing lights increase hand hygiene compliance; however, the durability of this effect has not been studied. We affixed flashing lights to hand sanitizer dispensers for a total of 6 weeks. Regression analysis was used to compare compliance rates between the beginning and end of the intervention. Our secondary objective was to determine whether compliance rates in cold weather could be improved by adding a sign separated in time and space from the dispensers. Flashing lights improved hand hygiene compliance from 11.8% to 20.7%, and this effect was unchanged over the 6-week study period. Fully charged lights resulted in a greater compliance increase. A preemptive sign did not have a significant effect on hand hygiene rates nor did absolute temperatures. Flashing lights are a simple, inexpensive way of improving hand hygiene. Brighter lights appear to have a greater effect; however, this must be balanced with annoyance in specific settings. Temperature did not have a significant effect; however, this may be because the relationship does not fit a linear model. Other interventions, such as signs, may need to be tailored specifically to individual hospital environments. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

A ubiquitous but ineffective intervention: Signs do not increase hand hygiene compliance.

PubMed

Birnbach, David J; Rosen, Lisa F; Fitzpatrick, Maureen; Everett-Thomas, Ruth; Arheart, Kristopher L

Proper hand hygiene is critical for preventing healthcare-associated infection, but provider compliance remains suboptimal. While signs are commonly used to remind physicians and nurses to perform hand hygiene, the content of these signs is rarely based on specific, validated health behavior theories. This observational study assessed the efficacy of a hand hygiene sign disseminated by the Centers for Disease Control and Prevention in an intensive care unit compared to an optimized evidence-based sign designed by a team of patient safety experts. The optimized sign was developed by four patient safety experts to include known evidence-based components and was subsequently validated by surveying ten physicians and ten nurses using a 10 point Likert scale. Eighty-two physicians and 98 nurses (102 females; 78 males) were observed for hand hygiene (HH) compliance, and the total HH compliance rate was 16%. HH compliance was not significantly different among the signs (Baseline 10% vs. CDC 18% vs. OIS 20%; p=0.280). The findings of this study suggest that even when the content and design of a hand hygiene reminder sign incorporates evidence-based constructs, healthcare providers comply only a fraction of the time. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Impact of a hospital-wide hand hygiene promotion strategy on healthcare-associated infections.

PubMed

Ling, Moi Lin; How, Kue Bien

2012-03-23

During the Severe Acute Respiratory Syndrome (SARS) outbreak, high compliance in healthcare workers to hand hygiene was primarily driven by fear. However, the post-SARS period confirmed that this practice was not sustainable. At the Singapore General Hospital, a 1,600-bedded acute tertiary care hospital, the hand hygiene program was revised in early 2007 following Singapore's signing of the pledge to the World Health Organization (WHO) "Clean Care is Safer Care" program. A multi-prong approach was used in designing the hand hygiene program. This included system change; training and education; evaluation and feedback; reminders in the workplace; and institutional safety climate. Hand hygiene compliance rate improved from 20% (in January 2007) to 61% (2010). Improvement was also seen annually in the compliance to each of the 5 moments as well as in all staff categories. Healthcare-associated MRSA infections were reduced from 0.6 (2007) to 0.3 (2010) per 1000 patient-days. Leadership's support of the program evidenced through visible leadership presence, messaging and release of resources is the key factor in helping to make the program a true success. The hospital was recognised as a Global Hand Hygiene Expert Centre in January 2011. The WHO multi-prong interventions work in improving compliance and reducing healthcare associated infections.

Hand hygiene to reduce community transmission of influenza and acute respiratory tract infection: a systematic review.

PubMed

Warren-Gash, Charlotte; Fragaszy, Ellen; Hayward, Andrew C

2013-09-01

Hand hygiene may be associated with modest protection against some acute respiratory tract infections, but its specific role in influenza transmission in different settings is unclear. We aimed to review evidence that improving hand hygiene reduces primary and secondary transmission of (i) influenza and (ii) acute respiratory tract infections in community settings. We searched Medline, Embase, Global Health and Cochrane databases up to 13 February 2012 for reports in any language of original research investigating the effect of hand hygiene on influenza or acute respiratory tract infection where aetiology was unspecified in community settings including institutions such as schools, and domestic residences. Data were presented and quality rated across outcomes according to the Grading of Recommendations Assessment, Development and Evaluation system. Sixteen articles met inclusion criteria. There was moderate to low-quality evidence of a reduction in both influenza and respiratory tract infection with hand hygiene interventions in schools, greatest in a lower-middle-income setting. There was high-quality evidence of a small reduction in respiratory infection in childcare settings. There was high-quality evidence for a large reduction in respiratory infection with a hand hygiene intervention in squatter settlements in a low-income setting. There was moderate- to high-quality evidence of no effect on secondary transmission of influenza in households that had already experienced an index case. While hand hygiene interventions have potential to reduce transmission of influenza and acute respiratory tract infections, their effectiveness varies depending on setting, context and compliance. © 2012 John Wiley & Sons Ltd.

Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities.

PubMed

Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier

2014-03-01

The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. Copyright © 2014 World Health Organization. Published by Mosby, Inc. All rights reserved.

Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities

PubMed Central

Allegranzi, Benedetta; Conway, Laurie; Larson, Elaine; Pittet, Didier

2014-01-01

Background The World Health Organization (WHO) launched a multimodal strategy and campaign in 2009 to improve hand hygiene practices worldwide. Our objective was to evaluate the implementation of the strategy in United States health care facilities. Methods From July through December 2011, US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online, a validated tool based on the WHO multimodal strategy. Results Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002). Conclusion Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign. PMID:24581011

Association of hand and arm disinfection with asthma control in US nurses.

PubMed

Dumas, Orianne; Varraso, Raphäelle; Boggs, Krislyn M; Descatha, Alexis; Henneberger, Paul K; Quinot, Catherine; Speizer, Frank E; Zock, Jan-Paul; Le Moual, Nicole; Camargo, Carlos A

2018-05-01

To investigate the association between occupational exposure to disinfectants/antiseptics used for hand hygiene and asthma control in nurses. In 2014, we invited female nurses with asthma drawn from the Nurses' Health Study II to complete two supplemental questionnaires on their occupation and asthma (cross-sectional study, response rate: 80%). Among 4055 nurses (mean age: 59 years) with physician-diagnosed asthma and asthma medication use in the past year, we examined asthma control, as defined by the Asthma Control Test (ACT). Nurses were asked about the daily frequency of hand hygiene tasks: 'wash/scrub hands with disinfectants/hand sanitizers' (hand hygiene) and 'wash/scrub arms with disinfecting products' (surrogate of surgical hand/arm antisepsis). Analyses were adjusted for age, race, ethnicity, smoking status and body mass index. Nurses with partly controlled asthma (ACT: 20-24, 50%) and poorly controlled asthma (ACT ≤19, 18%) were compared with nurses with controlled asthma (ACT=25, 32%). In separate models, both hand and arm hygiene were associated with poorly controlled asthma. After mutual adjustment, only arm hygiene was associated with poorly controlled asthma: OR (95% CI) for <1 time/day, 1.38 (1.06 to 1.80); ≥1 time/day, 1.96 (1.52 to 2.51), versus never. We observed a consistent dose-response relationship between frequency of arm hygiene tasks (never to >10 times/day) and poor asthma control. Associations persisted after further adjustment for surfaces/instruments disinfection tasks. Frequency of hand/arm hygiene tasks in nurses was associated with poor asthma control. The results suggest an adverse effect of products used for surgical hand/arm antisepsis. This potential new occupational risk factor for asthma warrants further study. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Validation of a questionnaire on hand hygiene in the construction industry.

PubMed

Timmerman, Johan G; Zilaout, Hicham; Heederik, Dick; Spee, Ton; Smit, Lidwien A M

2014-10-01

Construction workers are at risk of developing occupational contact dermatitis. Gloves, when used properly, may protect against chemicals and coarse materials. We investigated the prevalence and determinants of contact dermatitis in a population of Dutch construction workers and aimed at validating questionnaire items on hand hygiene. A cross-sectional study was conducted at 13 construction sites, yielding data of 177 subjects (95% response rate). A questionnaire covering questions on hand hygiene and contact dermatitis symptoms was used. Agreement between workplace observations and a number of questionnaire items was assessed by calculating Cohen's kappa. Log-binomial regression analysis was used to assess the association between contact dermatitis and various hand hygiene-related determinants. The 1-year prevalence of self-reported contact dermatitis in our study sample was 46.9%. Multiple regression analysis showed a positive association with difficulties with hand cleaning (prevalence ratio [PR]: 1.26, 95% confidence interval [CI]: 1.05-1.52), hand contamination at the end of the working day (PR: 2.30, 95% CI: 1.14-4.65), and intensive hand cream use (PR: 2.07, 95% CI: 1.42-3.01). Observations of hand contamination, glove use, and glove types were found to agree well with the self-reported data from the questionnaire (Cohen's kappa's 0.75, 0.97, and 0.88). Self-reported contact dermatitis prevalence in construction workers was high and related to hand hygiene. A strong agreement was found between workplace observations and self-reported questionnaire data. © The Author 2014. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Theoretical and practical considerations for the development of online international collaborative learning for dental hygiene students.

PubMed

Gussy, M G; Knevel, R J M; Sigurdson, V; Karlberg, G

2006-08-01

Globalization and concurrent development in computer and communication technology has increased interest in collaborative online teaching and learning for students in higher education institutions. Many institutions and teachers have introduced computer-supported programmes in areas including dental hygiene. The potential for the use of this technology is exciting; however, its introduction should be careful and considered. We suggest that educators wanting to introduce computer-supported programmes make explicit their pedagogical principles and then select technologies that support and exploit these principles. This paper describes this process as it was applied to the development of an international web-based collaborative learning programme for dental hygiene students.

Video surveillance captures student hand hygiene behavior, reactivity to observation, and peer influence in Kenyan primary schools.

PubMed

Pickering, Amy J; Blum, Annalise G; Breiman, Robert F; Ram, Pavani K; Davis, Jennifer

2014-01-01

In-person structured observation is considered the best approach for measuring hand hygiene behavior, yet is expensive, time consuming, and may alter behavior. Video surveillance could be a useful tool for objectively monitoring hand hygiene behavior if validated against current methods. Student hand cleaning behavior was monitored with video surveillance and in-person structured observation, both simultaneously and separately, at four primary schools in urban Kenya over a study period of 8 weeks. Video surveillance and in-person observation captured similar rates of hand cleaning (absolute difference <5%, p = 0.74). Video surveillance documented higher hand cleaning rates (71%) when at least one other person was present at the hand cleaning station, compared to when a student was alone (48%; rate ratio  = 1.14 [95% CI 1.01-1.28]). Students increased hand cleaning rates during simultaneous video and in-person monitoring as compared to single-method monitoring, suggesting reactivity to each method of monitoring. This trend was documented at schools receiving a handwashing with soap intervention, but not at schools receiving a sanitizer intervention. Video surveillance of hand hygiene behavior yields results comparable to in-person observation among schools in a resource-constrained setting. Video surveillance also has certain advantages over in-person observation, including rapid data processing and the capability to capture new behavioral insights. Peer influence can significantly improve student hand cleaning behavior and, when possible, should be exploited in the design and implementation of school hand hygiene programs.

[Products for hand hygiene and antisepsis: use by health professionals and relationship with hand eczema].

PubMed

Batalla, A; García-Doval, I; de la Torre, C

2012-04-01

Hand hygiene is the most important measure for the prevention of nosocomial infection. We describe the different products available for hygiene and antisepsis of the hands and the use of these products in daily practice. Hand hygiene products such as soaps and detergents are a cause of irritant dermatitis in health professionals. This irritation is one of the principal factors affecting their use in clinical practice. Alcohol-based products are better tolerated and less irritant than soap and water; irritation should not therefore be a limiting factor in the use of these products and they are to be recommended in place of soap and water. Informative and continued education programs could increase their use. Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.

Hand Hygiene – Evaluation of Three Disinfectant Hand Sanitizers in a Community Setting

PubMed Central

Babeluk, Rita; Jutz, Sabrina; Mertlitz, Sarah; Matiasek, Johannes; Klaus, Christoph

2014-01-01

Hand hygiene is acknowledged as the single most important measure to prevent nosocomial infections in the healthcare setting. Similarly, in non-clinical settings, hand hygiene is recognised as a key element in helping prevent the spread of infectious diseases. The aim of this study was to evaluate the efficacy of three different disinfectant hand sanitizers in reducing the burden of bacterial hand contamination in 60 healthy volunteers in a community setting, both before and after education about the correct use of hand sanitizers. The study is the first to evaluate the efficacy and ease of use of different formulations of hand rubs used by the general population. The products tested were: Sterillium (perfumed, liquid), desderman pure gel (odorless, gel) and Lavit (perfumed, spray). Sterillium and desderman are EN1500 (hygienic hand rub) certified products (available in pharmacy) and Lavit is non EN1500 certified and available in supermarkets. The two EN1500 certified products were found to be significantly superior in terms of reducing bacterial load. desderman pure gel, Sterillium and Lavit reduced the bacterial count to 6.4%, 8.2% and 28.0% respectively. After education in the correct use of each hand rub, the bacterial load was reduced even further, demonstrating the value of education in improving hand hygiene. Information about the testers' perceptions of the three sanitizers, together with their expectations of a hand sanitizer was obtained through a questionnaire. Efficacy, followed by skin compatibility were found to be the two most important attributes of a hand disinfectant in our target group. PMID:25379773

Antiseptic technology: access, affordability, and acceptance.

PubMed Central

Boyce, J. M.

2001-01-01

Factors other than antimicrobial activity of soaps and antiseptic agents used for hand hygiene by health personnel play a role in compliance with recommendations. Hand hygiene products differ considerably in acceptance by hospital personnel. If switching from a nonmedicated soap to an antiseptic agent or increased use of an existing antiseptic agent for hand hygiene prevented a few more infections per year, additional expenditures for antiseptic agents would be offset by cost savings. PMID:11294713

Impact of environmental olfactory cues on hand hygiene behaviour in a simulated hospital environment: a randomized study.

PubMed

Birnbach, D J; King, D; Vlaev, I; Rosen, L F; Harvey, P D

2013-09-01

This study investigated the impact of a fresh scent on the rate of hand hygiene compliance (HHC) among novice healthcare providers. In all, 165 participants examined a standardized patient with one sample exposed to fresh scent (N = 79) and the other exposed to the standard environment (N = 86). Hand hygiene behaviours were tracked before patient contact using video surveillance. The standard environment group had an HHC rate of 51% whereas participants in the fresh scent group had a higher HHC rate of 80% (P < 0.001). These data demonstrate that hand hygiene behaviour may be subconsciously influenced by cues in the environment. © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Quantitative impact of direct, personal feedback on hand hygiene technique.

PubMed

Lehotsky, Á; Szilágyi, L; Ferenci, T; Kovács, L; Pethes, R; Wéber, G; Haidegger, T

2015-09-01

This study investigated the effectiveness of targeting hand hygiene technique using a new training device that provides objective, personal and quantitative feedback. One hundred and thirty-six healthcare workers in three Hungarian hospitals participated in a repetitive hand hygiene technique assessment study. Ultraviolet (UV)-labelled hand rub was used at each event, and digital images of the hands were subsequently taken under UV light. Immediate objective visual feedback was given to participants, showing missed areas on their hands. The rate of inadequate hand rubbing reduced from 50% to 15% (P < 0.001). However, maintenance of this reduced rate is likely to require continuous use of the electronic equipment. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Hand hygiene with alcohol hand rub and gloves reduces the incidence of late onset sepsis in preterm neonates.

PubMed

Janota, Jan; Šebková, Sylva; Višňovská, Magda; Kudláčková, Jana; Hamplová, Drahomíra; Zach, Jiří

2014-10-01

To assess the impact of a hand hygiene protocol, using hand washing, alcohol hand rub and gloves when caring for preterm infants born after 31 weeks of gestation, on the incidence of neonatal late onset sepsis (LOS). All babies delivered between 32 + 0 and 36 + 6 weeks gestation and admitted to the neonatal intensive care unit during a 14-month period were included. We followed a hand hygiene protocol with hand washing and alcohol hand rub (hand rub period) for the first 7 months and a protocol of hand washing, alcohol hand rub and gloves (gloves period) for the second 7 months. The hand rub and gloves groups consisted of 111 and 89 patients, respectively. Five patients were diagnosed with a total of six episodes of LOS in the hand rub group, and the incidence of LOS during the hand rub period was 2.99/1000 hospital days and 54.1/1000 admissions. There were no patients diagnosed with LOS during the gloves period (significant decrease, p = 0.028). Using a hand hygiene protocol with hand washing, hand rub and gloves significantly reduced the incidence of LOS in preterm newborns, and the results suggest that it may produce a sustained improvement in the infection rate. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Knowledge, attitudes and practices (KAP) of hygiene among school children in Angolela, Ethiopia.

PubMed

Vivas, A P; Gelaye, B; Aboset, N; Kumie, A; Berhane, Y; Williams, M A

2010-06-01

Poor hygiene practices and inadequate sanitary conditions play major roles in the increased burden of communicable diseases within developing countries. This study evaluated the KAP of hygiene among rural school children in Ethiopia and assessed the extent to which proper knowledge of hygiene was associated with personal hygiene characteristics. This cross-sectional study was comprised of 669 students who were interviewed by trained staff Participants were in grades 1-6 at Angolela Primary School, located in rural Ethiopia. Data consisted of hygiene and hand washing practices, knowledge about sanitation, personal hygiene characteristics, and presence of gastrointestinal parasitic infection. Results. Approximately 52% of students were classified as having adequate knowledge of proper hygiene. Most students reported hand washing before meals (99.0%), but only 36.2% reported using soap. Although 76.7% of students reported that washing hands after defecation was important, only 14.8% reported actually following this practice. Students with adequate knowledge of proper hygiene were more likely to have clean clothes (AOR 1.62, CI 1.14-2.29) and to have a lower risk of parasitic infection (AOR 0.78, CI 0.56-1.09) although statistical significance was not achieved for the latter Study findings underscore the need for more hand washing and hygiene education in schools; and provide objective evidence that may guide the development of comprehensive health and hygiene intervention programs in rural Ethiopian schools. Successful implementation of these programs is likely to substantially attenuate the transmissible disease burden borne by school children in rural settings.

A Study to Assess Knowledge and Attitude Regarding Hand Hygiene amongst Residents and Nursing Staff in a Tertiary Health Care Setting of Bhopal City.

PubMed

Maheshwari, Veena; Kaore, Navin Chandra M; Ramnani, Vijay Kumar; Gupta, Sanjay Kumar; Borle, Amod; Kaushal, Rituja

2014-08-01

Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in health care settings. Most nosocomial infections are thought to be transmitted by the hands of health care workers.The application of hand hygiene is effective in reducing infection rates. To assess the level of knowledge and attitude regarding hand hygiene practices amongst the health care professionals and to identify areas of gaps in their knowledge and attitude. A cross-sectional study. A total 160 respondents were studied about their knowledge and attitude towards hand hygiene practices and significant difference with a p-value of 0.0025 was observed regarding most frequent source of germs responsible for health care associated infections among resident and nurses. A significant difference with p-value of 0.0001 & 0.04 was observed in colonization due to jewellery and artificial nail among the study groups. The attitude regarding correct hand hygiene practices to be followed at all times was found to be better among nurses (62.5%) as compared to residents (21.3%) which was found to be highly significant with p-value <0.001. Present study highlights the need of repeated training sessions regarding hand hygiene practices among the health care workers to provide the current knowledge in the area with a behavioral change in attitudes and practices leading to reduction of nosocomial infections.

An automated hand hygiene training system improves hand hygiene technique but not compliance.

PubMed

Kwok, Yen Lee Angela; Callard, Michelle; McLaws, Mary-Louise

2015-08-01

The hand hygiene technique that the World Health Organization recommends for cleansing hands with soap and water or alcohol-based handrub consists of 7 poses. We used an automated training system to improve clinicians' hand hygiene technique and test whether this affected hospitalwide hand hygiene compliance. Seven hundred eighty-nine medical and nursing staff volunteered to participate in a self-directed training session using the automated training system. The proportion of successful first attempts was reported for each of the 7 poses. Hand hygiene compliance was collected according to the national requirement and rates for 2011-2014 were used to determine the effect of the training system on compliance. The highest pass rate was for pose 1 (palm to palm) at 77% (606 out of 789), whereas pose 6 (clean thumbs) had the lowest pass rate at 27% (216 out of 789). One hundred volunteers provided feedback to 8 items related to satisfaction with the automated training system and most (86%) expressed a high degree of satisfaction and all reported that this method was time-efficient. There was no significant change in compliance rates after the introduction of the automated training system. Observed compliance during the posttraining period declined but increased to 82% in response to other strategies. Technology for training clinicians in the 7 poses played an important education role but did not affect compliance rates. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Point of care hand hygiene-where's the rub? A survey of US and Canadian health care workers' knowledge, attitudes, and practices.

PubMed

Kirk, Jane; Kendall, Anson; Marx, James F; Pincock, Ted; Young, Elizabeth; Hughes, Jillian M; Landers, Timothy

2016-10-01

Hand hygiene at the point of care is recognized as a best practice for promoting compliance at the moments when hand hygiene is most critical. The objective of this study was to compare knowledge, attitudes, and practices of US and Canadian frontline health care personnel regarding hand hygiene at the point of care. Physicians and nurses in US and Canadian hospitals were invited to complete a 32-question online survey based on evidence supporting point of care hand hygiene. Eligible health care personnel were in direct clinical practice at least 50% of the time. Three hundred fifty frontline caregivers completed the survey. Among respondents, 57.1% were from the United States and 42.9% were from Canada. Respondents were evenly distributed between physician and nurses. The US and Canadian respondents gave identical ranking to their perceived barriers to hand hygiene compliance. More than half of the respondents from both the United States and Canada agreed or strongly agreed that they would be more likely to clean their hands when recommended if alcohol-based handrub was closer to the patient. This survey demonstrates that similarities between Canada and the United States were more common than not, and the survey raises, or suggests, potential knowledge gaps that require further illumination. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative.

PubMed

Barnett, Adrian G; Page, Katie; Campbell, Megan; Brain, David; Martin, Elizabeth; Rashleigh-Rolls, Rebecca; Halton, Kate; Hall, Lisa; Jimmieson, Nerina; White, Katherine; Paterson, David; Graves, Nicholas

2014-08-01

Interventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infection. We examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associated Staphylococcus aureus bloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time. The National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates. The intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative's introduction or because infection rates were already low and could not be further reduced.

Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study.

PubMed

Erichsen Andersson, Annette; Frödin, Maria; Dellenborg, Lisen; Wallin, Lars; Hök, Jesper; Gillespie, Brigid M; Wikström, Ewa

2018-01-04

Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room. The study was set in an operating department of a university hospital. The intervention was underpinned by theories on organizational learning, culture and person centeredness. Qualitative process data were collected via participant observations and analyzed using a thematic approach. Doubts that hand-hygiene practices are effective in preventing hospital acquired infections, strong boundaries and distrust between professional groups and a lack of psychological safety were identified as barriers towards change. Facilitated interprofessional dialogue and learning in "safe spaces" worked as mechanisms for motivation and engagement. Allowing for the free expression of different opinions, doubts and viewing resistance as a natural part of any change was effective in engaging all professional categories in co-creation of clinical relevant solutions to improve hand hygiene. Enabling nurses and physicians to think and talk differently about hospital acquired infections and hand hygiene requires a shift from the concept of one-way directed compliance towards change and learning as the result of a participatory and meaning-making process. The present study is a part of the Safe Hands project, and is registered with ClinicalTrials.gov (ID: NCT02983136 ). Date of registration 2016/11/28, retrospectively registered.

Dissemination of the CDC's Hand Hygiene Guideline and impact on infection rates

PubMed Central

Larson, Elaine L.; Quiros, Dave; Lin, Susan X.

2007-01-01

Background The diffusion of national evidence-based practice guidelines and their impact on patient outcomes often go unmeasured. Methods Our objectives were to (1) evaluate implementation and compliance with clinical practices recommended in the new Centers for Disease Control and Prevention (CDC) Hand Hygiene Guideline, (2) compare rates of health care-associated infections (HAI) before and after implementation of the Guideline recommendations, and (3) examine the patterns and correlates of changes in rates of HAI. We used pre- and post-Guideline implementation site visits and surveys in the setting of 40 US hospitals—members of the National Nosocomial Infections Surveillance System—and measured HAI rates 1 year before and after publication of the CDC Guideline and used direct observation of hand hygiene compliance and Guideline implementation scores. Results All study hospitals had changed their policies and procedures and provided products in compliance with Guideline recommendations; 89.8% of 1359 staff members surveyed anonymously reported that they were familiar with the Guideline. However, in 44.2% of the hospitals (19/40), there was no evidence of a multidisciplinary program to improve compliance. Hand hygiene rates remained low (mean, 56.6%). Rates of central line-associated bloodstream infections were significantly lower in hospitals with higher rates of hand hygiene (P < .001). No impact of Guideline implementation or hand hygiene compliance on other HAI rates was identified. Other factors occurring over time could affect rates of HAI. Observed hand hygiene compliance rates were likely to overestimate rates in actual practice. The study may have been of too short duration to detect the impact of a practice guideline. Conclusion Wide dissemination of this Guideline was not sufficient to change practice. Only some hospitals had initiated multidisciplinary programs; practice change is unlikely without such multidisciplinary efforts and explicit administrative support. PMID:18063132

Dissemination of the CDC's Hand Hygiene Guideline and impact on infection rates.

PubMed

Larson, Elaine L; Quiros, Dave; Lin, Susan X

2007-12-01

The diffusion of national evidence-based practice guidelines and their impact on patient outcomes often go unmeasured. Our objectives were to (1) evaluate implementation and compliance with clinical practices recommended in the new Centers for Disease Control and Prevention (CDC) Hand Hygiene Guideline, (2) compare rates of health care-associated infections (HAI) before and after implementation of the Guideline recommendations, and (3) examine the patterns and correlates of changes in rates of HAI. We used pre- and post-Guideline implementation site visits and surveys in the setting of 40 US hospitals--members of the National Nosocomial Infections Surveillance System--and measured HAI rates 1 year before and after publication of the CDC Guideline and used direct observation of hand hygiene compliance and Guideline implementation scores. All study hospitals had changed their policies and procedures and provided products in compliance with Guideline recommendations; 89.8% of 1359 staff members surveyed anonymously reported that they were familiar with the Guideline. However, in 44.2% of the hospitals (19/40), there was no evidence of a multidisciplinary program to improve compliance. Hand hygiene rates remained low (mean, 56.6%). Rates of central line-associated bloodstream infections were significantly lower in hospitals with higher rates of hand hygiene (P < .001). No impact of Guideline implementation or hand hygiene compliance on other HAI rates was identified. Other factors occurring over time could affect rates of HAI. Observed hand hygiene compliance rates were likely to overestimate rates in actual practice. The study may have been of too short duration to detect the impact of a practice guideline. Wide dissemination of this Guideline was not sufficient to change practice. Only some hospitals had initiated multidisciplinary programs; practice change is unlikely without such multidisciplinary efforts and explicit administrative support.

Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: validation of the HOW2 Benchmark Study.

PubMed

Diller, Thomas; Kelly, J William; Blackhurst, Dawn; Steed, Connie; Boeker, Sue; McElveen, Danielle C

2014-06-01

We previously published a formula to estimate the number of hand hygiene opportunities (HHOs) per patient-day using the World Health Organization's "Five Moments for Hand Hygiene" methodology (HOW2 Benchmark Study). HHOs can be used as a denominator for calculating hand hygiene compliance rates when product utilization data are available. This study validates the previously derived HHO estimate using 24-hour video surveillance of health care worker hand hygiene activity. The validation study utilized 24-hour video surveillance recordings of 26 patients' hospital stays to measure the actual number of HHOs per patient-day on a medicine ward in a large teaching hospital. Statistical methods were used to compare these results to those obtained by episodic observation of patient activity in the original derivation study. Total hours of data collection were 81.3 and 1,510.8, resulting in 1,740 and 4,522 HHOs in the derivation and validation studies, respectively. Comparisons of the mean and median HHOs per 24-hour period did not differ significantly. HHOs were 71.6 (95% confidence interval: 64.9-78.3) and 73.9 (95% confidence interval: 69.1-84.1), respectively. This study validates the HOW2 Benchmark Study and confirms that expected numbers of HHOs can be estimated from the unit's patient census and patient-to-nurse ratio. These data can be used as denominators in calculations of hand hygiene compliance rates from electronic monitoring using the "Five Moments for Hand Hygiene" methodology. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Dental hygiene work in a clinical trial.

PubMed

Luís, H S; Morgado, I; Assunção, V; Bernardo, M F; Leroux, B; Martin, M D; DeRouen, T A; Leitão, J

2008-08-01

Dental hygiene activities were developed as part of a randomized clinical trial designed to assess the safety of low-level mercury exposure from dental amalgam restorations. Along with dental-hygiene clinical work, a community programme was implemented after investigators noticed the poor oral hygiene habits of participants, and the need for urgent action to minimize oral health problems in the study population. Clinical and community activity goal was to promote oral health and prevent new disease. Community activities involved participants and their fellow students and were aimed at providing education on oral health in a school environment. Dental hygienists developed clinical work with prophylaxis, sealants application and topical fluoride and implemented the community programme with in-class sessions on oral health themes. Twice a month fluoride mouthrinses and bi-annual tooth brushing instructional activity took place. Participation at dental-hygiene activities, sealed teeth with no need of restoration and dental-plaque-index were measures used to evaluate success of the programme for the participants. Improvement in dental hygiene is shown by the decrease in dental plaque index scores (P < 0.0001); also sealants integrity is achieved in 86.3% of teeth. 888 (13.7%) teeth with sealants had to be restored or were lost. Children participated actively on dental hygiene activities. Teachers became aware of the problem and included oral-health in school curricula. Dental hygiene activities have shown to be helpful to promote dental hygiene, promote oral health and to provide school-age children with education on habits that will be important for their future good health.

Comparison of human and electronic observation for the measurement of compliance with hand hygiene.

PubMed

Filho, Miguel Almeida O; Marra, Alexandre R; Magnus, Thyago Pereira; Rodrigues, Rodrigo Dias; Prado, Marcelo; de Souza Santini, Tales Roberto; da Silva Victor, Elivane; Ishibe, Eder Issao; Pavão Dos Santos, Oscar Fernando; Edmond, Michael B

2014-11-01

Monitoring of hand hygiene is an important part of the improvement of hospital quality indicators. This study was prospectively performed over a 14-week (electronic observer) period from December 3, 2013-March 9, 2014, to evaluate hand hygiene compliance in an adult step-down unit. We compared electronic handwash counters with the application of radiofrequency identification (RFID - ZigBee; i-Healthsys, São Carlos, Brazil) (electronic observer), which counts each activation of the alcohol gel dispenser to direct observation (human observer) using the iScrub application. For the overall time period of simultaneous electronic and human observation, we found that the electronic observer identified 414 hand hygiene episodes, whereas the human observers identified 448 episodes. Therefore, we found 92% (95% confidence interval [CI], 90%-95%) overall concordance (414/448), with an intraclass correlation coefficient of .87 (95% CI, 0.77-0.92). Our RFID (ZigBee) system showed good accuracy (92%) and is a useful method to monitor hand hygiene compliance. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Hand hygiene posters: motivators or mixed messages?

PubMed

Jenner, E A; Jones, F; Fletcher, B C; Miller, L; Scott, G M

2005-07-01

Poster campaigns regarding hand hygiene are commonly used by infection control teams to improve practice, yet little is known of the extent to which they are based on established theory or research. This study reports on the content analysis of hand hygiene posters (N=69) and their messages (N=75) using message-framing theory. The results showed that posters seldom drew on knowledge about effective ways to frame messages. Frequently, they simply conveyed information 'telling' rather than 'selling' and some of this was confusing. Most posters were not designed to motivate, and some conveyed mixed messages. Few used fear appeals. Hand hygiene posters could have a greater impact if principles of message framing were utilized in their design. Suggestions for gain-framed messages are offered, but these need to be tested empirically.

Video Surveillance Captures Student Hand Hygiene Behavior, Reactivity to Observation, and Peer Influence in Kenyan Primary Schools

PubMed Central

Pickering, Amy J.; Blum, Annalise G.; Breiman, Robert F.; Ram, Pavani K.; Davis, Jennifer

2014-01-01

Background In-person structured observation is considered the best approach for measuring hand hygiene behavior, yet is expensive, time consuming, and may alter behavior. Video surveillance could be a useful tool for objectively monitoring hand hygiene behavior if validated against current methods. Methods Student hand cleaning behavior was monitored with video surveillance and in-person structured observation, both simultaneously and separately, at four primary schools in urban Kenya over a study period of 8 weeks. Findings Video surveillance and in-person observation captured similar rates of hand cleaning (absolute difference <5%, p = 0.74). Video surveillance documented higher hand cleaning rates (71%) when at least one other person was present at the hand cleaning station, compared to when a student was alone (48%; rate ratio  = 1.14 [95% CI 1.01–1.28]). Students increased hand cleaning rates during simultaneous video and in-person monitoring as compared to single-method monitoring, suggesting reactivity to each method of monitoring. This trend was documented at schools receiving a handwashing with soap intervention, but not at schools receiving a sanitizer intervention. Conclusion Video surveillance of hand hygiene behavior yields results comparable to in-person observation among schools in a resource-constrained setting. Video surveillance also has certain advantages over in-person observation, including rapid data processing and the capability to capture new behavioral insights. Peer influence can significantly improve student hand cleaning behavior and, when possible, should be exploited in the design and implementation of school hand hygiene programs. PMID:24676389

Comparison of Standard Culture-Based Method to Culture-Independent Method for Evaluation of Hygiene Effects on the Hand Microbiome

PubMed Central

Leff, J.; Henley, J.; Tittl, J.; De Nardo, E.; Butler, M.; Griggs, R.; Fierer, N.

2017-01-01

ABSTRACT Hands play a critical role in the transmission of microbiota on one’s own body, between individuals, and on environmental surfaces. Effectively measuring the composition of the hand microbiome is important to hand hygiene science, which has implications for human health. Hand hygiene products are evaluated using standard culture-based methods, but standard test methods for culture-independent microbiome characterization are lacking. We sampled the hands of 50 participants using swab-based and glove-based methods prior to and following four hand hygiene treatments (using a nonantimicrobial hand wash, alcohol-based hand sanitizer [ABHS], a 70% ethanol solution, or tap water). We compared results among culture plate counts, 16S rRNA gene sequencing of DNA extracted directly from hands, and sequencing of DNA extracted from culture plates. Glove-based sampling yielded higher numbers of unique operational taxonomic units (OTUs) but had less diversity in bacterial community composition than swab-based sampling. We detected treatment-induced changes in diversity only by using swab-based samples (P < 0.001); we were unable to detect changes with glove-based samples. Bacterial cell counts significantly decreased with use of the ABHS (P < 0.05) and ethanol control (P < 0.05). Skin hydration at baseline correlated with bacterial abundances, bacterial community composition, pH, and redness across subjects. The importance of the method choice was substantial. These findings are important to ensure improvement of hand hygiene industry methods and for future hand microbiome studies. On the basis of our results and previously published studies, we propose recommendations for best practices in hand microbiome research. PMID:28351915

The effect of hand hygiene on illness rate among students in university residence halls.

PubMed

White, Cindy; Kolble, Robin; Carlson, Rebecca; Lipson, Natasha; Dolan, Mike; Ali, Yusuf; Cline, Mojee

2003-10-01

Several studies have indicated a connection between hand sanitization and infection control in numerous settings such as extended care facilities, schools, and hospitals. The purpose of this study was to assess the effectiveness of both a hand-hygiene message campaign and the use of an alcohol gel hand sanitizer in decreasing the incidence of upper-respiratory illness among students living in university residence halls. This study involved a total of 430 students recruited from 4 residence halls during the fall semester at the University of Colorado at the Boulder campus. Dormitories were paired into control and product groups. In the product groups, alcohol gel hand-sanitizer dispensers were installed in every room, bathroom, and dining hall. The data were statistically analyzed for the differences between product and control groups in reported symptoms, illness rates, and absenteeism from classes. The overall increase in hand-hygiene behavior and reduction in symptoms, illness rates, and absenteeism between the product group and control group was statistically significant. Reductions in upper respiratory-illness symptoms ranged from 14.8% to 39.9%. Total improvement in illness rate was 20%. The product group had 43% less missed school/work days. Hand-hygiene practices were improved with increased frequency of handwashing through increasing awareness of the importance of hand hygiene, and the use of alcohol gel hand sanitizer in university dormitories. This resulted in fewer upper respiratory-illness symptoms, lower illness rates, and lower absenteeism.

Experiences of hand hygiene among acute care nurses: An interpretative phenomenological analysis

PubMed Central

Chatfield, Sheryl L; Nolan, Rachael; Crawford, Hannah; Hallam, Jeffrey S

2016-01-01

Objective: Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals’ perceptions of hygiene might drive practices. Methods: We conducted qualitative interview research with eight nurses in the United States who were employed in various patient-care roles. We analyzed the data using an interpretative phenomenological analysis methodology to explore how nurses described their perceptions of, and experiences with, hygiene. We developed themes that explored individual, workplace, and management influences on perception of hygiene. Results: Developed themes include practical hygiene, risky business, and hygiene on trial; the latter theme described the conflict between how nurses perceived their own hygiene practices and how they felt hospital management perceived these practices. Other findings included that participants distinguished between policy-mandated use of sanitizer and a personal sense of cleanliness; the latter was more likely to be associated with scrubbing or removal of contaminants than with use of protectants. Conclusion: While participants asserted support for facility hand hygiene policies, their behavior in certain instances might be mediated by broadly defined emergent situations and a belief that it is not currently possible to establish a causal link between an healthcare-associated infections and a specific individual or occurrence. Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions, to encourage ownership, and emphasizing detailed cases as training content to take advantage of individuals’ sensory responses to hygiene. PMID:27803809

The effect of random voice hand hygiene messages delivered by medical, nursing, and infection control staff on hand hygiene compliance in intensive care.

PubMed

McGuckin, Maryanne; Shubin, Arlene; McBride, Patricia; Lane, Stephen; Strauss, Kevin; Butler, Donna; Pitman, Andrew

2006-12-01

Hand hygiene (HH) compliance in the intensive care unit has been studied extensively, with short-term, nonsustained compliance often because of lack of ongoing reinforcement. HH messages delivered by health care workers responsible for overseeing staff in the intensive care unit provided continuous reinforcement of HH. Compliance measured through product usage and reported as HH/bed-days increased by 60% for soap and sanitizer combined and 25% for sanitizer usage (P < 001).

Hand hygiene technique quality evaluation in nursing and medicine students of two academic courses 1

PubMed Central

Škodová, Manuela; Gimeno-Benítez, Alfredo; Martínez-Redondo, Elena; Morán-Cortés, Juan Francisco; Jiménez-Romano, Ramona; Gimeno-Ortiz, Alfredo

2015-01-01

Abstract Objective: because they are health professionals, nursing and medical students' hands during internships can function as a transmission vehicle for hospital-acquired infections. Method: a descriptive study with nursing and medical degree students on the quality of the hand hygiene technique, which was assessed via a visual test using a hydroalcoholic solution marked with fluorescence and an ultraviolet lamp. Results: 546 students were assessed, 73.8% from medicine and 26.2% from nursing. The area of the hand with a proper antiseptic distribution was the palm (92.9%); areas not properly scrubbed were the thumbs (55.1%). 24.7% was very good in both hands, 29.8% was good, 25.1% was fair, and 20.3% was poor. The worst assessed were the male, nursing and first year students. There were no significant differences in the age groups. Conclusions: hand hygiene technique is not applied efficiently. Education plays a key role in setting a good practice base in hand hygiene, theoretical knowledge, and in skill development, as well as good practice reinforcement. PMID:26444174

Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities

PubMed Central

Løyland, Borghild; Wilmont, Sibyl; Hessels, Amanda J.; Larson, Elaine

2016-01-01

Background The burden of healthcare-associated infection worldwide is considerable, and there is a need to improve surveillance and infection control practices such as hand hygiene. Objectives The aims of this study were to explore direct care providers’ knowledge about infection prevention and hand hygiene, their attitudes regarding their own and others’ hand hygiene practices, and their ideas and advice for improving infection prevention efforts. Methods This exploratory study included interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers conducted semistructured interviews using an interview guide with open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted a thematic analysis using a strategy adapted from the systematic text condensation approach. Results From 31 interviews, four major thematic categories with subthemes emerged from the analysis: (a) hand hygiene products; (b) knowledge, awareness, perceptions, and beliefs; (c) barriers to infection prevention practices; and (d) suggested improvements. There was confusion regarding hand hygiene recommendations, use of soap or sanitizer, and isolation precaution policies. There was a robust “us” and “them” mentality between professionals. Discussion One essential driver of staff behavior change is having expectations that are meaningful to staff, and many staff members stated that they wanted more in-person staff meetings with education and hands-on, practical advice. Workflow patterns and/or the physical environment need to be carefully evaluated to identify systems and methods to minimize cross-contamination. Further studies need to evaluate if personal sized containers of hand sanitizer (e.g., for the pocket, attached to a belt or lanyard) would facilitate improvement of hand hygiene in these facilities. PMID:26938362

Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 11. Use of antiseptics and sanitizers in community settings and issues of hand hygiene compliance in health care and food industries.

PubMed

Todd, Ewen C D; Greig, Judy D; Michaels, Barry S; Bartleson, Charles A; Smith, Debra; Holah, John

2010-12-01

Hand washing with soap is a practice that has long been recognized as a major barrier to the spread of disease in food production, preparation, and service and in health care settings, including hospitals, child care centers, and elder care facilities. Many of these settings present multiple opportunities for spread of pathogens within at-risk populations, and extra vigilance must be applied. Unfortunately, hand hygiene is not always carried out effectively, and both enteric and respiratory diseases are easily spread in these environments. Where water is limited or frequent hand hygiene is required on a daily basis, such as for many patients in hospitals and astronauts in space travel, instant sanitizers or sanitary wipes are thought to be an effective way of preventing contamination and spread of organisms among coworkers and others. Most concerns regarding compliance are associated with the health care field, but the food industry also must be considered. Specific reasons for not washing hands at appropriate times are laziness, time pressure, inadequate facilities and supplies, lack of accountability, and lack of involvement by companies, managers, and workers in supporting proper hand washing. To facilitate improvements in hand hygiene, measurement of compliant and noncompliant actions is necessary before implementing any procedural changes. Training alone is not sufficient for long-lasting improvement. Multiactivity strategies also must include modification of the organization culture to encourage safe hygienic practices, motivation of employees willing to use peer pressure on noncompliant coworkers, a reward and/or penalty system, and an operational design that facilitates regular hand hygiene.

A Study to Assess Knowledge and Attitude Regarding Hand Hygiene amongst Residents and Nursing Staff in a Tertiary Health Care Setting of Bhopal City

PubMed Central

kaore, Navin Chandra M; Ramnani, Vijay Kumar; Gupta, Sanjay Kumar; Borle, Amod; Kaushal, Rituja

2014-01-01

Background: Infection due to hospital-acquired microbes is an evolving problem worldwide, and horizontal transmission of bacterial organism continues to cause a high nosocomial infection rate in health care settings. Most nosocomial infections are thought to be transmitted by the hands of health care workers.The application of hand hygiene is effective in reducing infection rates. Objectives: To assess the level of knowledge and attitude regarding hand hygiene practices amongst the health care professionals and to identify areas of gaps in their knowledge and attitude. Materials and Methods: A cross-sectional study. Result: A total 160 respondents were studied about their knowledge and attitude towards hand hygiene practices and significant difference with a p-value of 0.0025 was observed regarding most frequent source of germs responsible for health care associated infections among resident and nurses. A significant difference with p-value of 0.0001 & 0.04 was observed in colonization due to jewellery and artificial nail among the study groups. The attitude regarding correct hand hygiene practices to be followed at all times was found to be better among nurses (62.5%) as compared to residents (21.3%) which was found to be highly significant with p-value <0.001. Conclusion: Present study highlights the need of repeated training sessions regarding hand hygiene practices among the health care workers to provide the current knowledge in the area with a behavioral change in attitudes and practices leading to reduction of nosocomial infections. PMID:25302193

An observational study of the hand hygiene initiative: a comparison of preintervention and postintervention outcomes

PubMed Central

Mukerji, Amit; Narciso, Janet; Moore, Christine; McGeer, Allison; Kelly, Edmond; Shah, Vibhuti

2013-01-01

Objectives To evaluate the impact of implementing a simple, user-friendly eLearning module on hand hygiene (HH) compliance and infection rates. Design Preintervention and postintervention observational study. Participants All neonates admitted to the neonatal intensive care unit (NICU) over the study period were eligible for participation and were included in the analyses. A total of 3422 patients were admitted over a 36-month span (July 2009 to June 2012). Interventions In the preintervention and postintervention periods (phases I and II), all healthcare providers were trained on HH practices using an eLearning module. The principles of the ‘4 moments of HH’ and definition of ‘baby space’ were incorporated using interactive tools. The intervention then extended into a long-term sustainability programme (phase III), including the requirement of an annual recertification of the module and introduction of posters and screensavers throughout the NICU. Primary and secondary outcome measures The primary outcome was HH compliance rates among healthcare providers in the three phases. The secondary outcome was healthcare-associated infection rates in the NICU. Results HH compliance rates declined initially in phase II then improved in phase III with the addition of a long-term sustainability programme (76%, 67% and 76% in phases I, II and III, respectively (p<0.01). Infection rates showed an opposing, but concomitant trend in the overall population as well as in infants <1500 g and were 4%, 6% and 4% (p=0.02), and 11%, 21% and 16% (p<0.01), respectively, during the three phases. Conclusions Interventions to improve HH compliance are challenging to implement and sustain with the need for ongoing reinforcement and education. PMID:23793705

Feasibility of a real-time hand hygiene notification machine learning system in outpatient clinics.

PubMed

Geilleit, R; Hen, Z Q; Chong, C Y; Loh, A P; Pang, N L; Peterson, G M; Ng, K C; Huis, A; de Korne, D F

2018-04-09

Various technologies have been developed to improve hand hygiene (HH) compliance in inpatient settings; however, little is known about the feasibility of machine learning technology for this purpose in outpatient clinics. To assess the effectiveness, user experiences, and costs of implementing a real-time HH notification machine learning system in outpatient clinics. In our mixed methods study, a multi-disciplinary team co-created an infrared guided sensor system to automatically notify clinicians to perform HH just before first patient contact. Notification technology effects were measured by comparing HH compliance at baseline (without notifications) with real-time auditory notifications that continued till HH was performed (intervention I) or notifications lasting 15 s (intervention II). User experiences were collected during daily briefings and semi-structured interviews. Costs of implementation of the system were calculated and compared to the current observational auditing programme. Average baseline HH performance before first patient contact was 53.8%. With real-time auditory notifications that continued till HH was performed, overall HH performance increased to 100% (P < 0.001). With auditory notifications of a maximum duration of 15 s, HH performance was 80.4% (P < 0.001). Users emphasized the relevance of real-time notification and contributed to technical feasibility improvements that were implemented in the prototype. Annual running costs for the machine learning system were estimated to be 46% lower than the observational auditing programme. Machine learning technology that enables real-time HH notification provides a promising cost-effective approach to both improving and monitoring HH, and deserves further development in outpatient settings. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses' hand washing.

PubMed

Fox, Cherie; Wavra, Teresa; Drake, Diane Ash; Mulligan, Debbie; Bennett, Yvonne Pacheco; Nelson, Carla; Kirkwood, Peggy; Jones, Louise; Bader, Mary Kay

2015-05-01

Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not significantly. A hand hygiene protocol for patients in the intensive care unit was associated with reductions in hospital-acquired infections and improvements in nurses' hand-washing compliance. Prevention of such infections requires continuous quality improvement efforts to monitor lasting effectiveness as well as investigation of strategies to eliminate these infections. ©2015 American Association of Critical-Care Nurses.

Interventions to Improve Hand Hygiene Compliance in the ICU: A Systematic Review.

PubMed

Lydon, Sinéad; Power, Michael; McSharry, Jennifer; Byrne, Molly; Madden, Caoimhe; Squires, Janet Elaine; O'Connor, Paul

2017-11-01

To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened. English language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included. Data were extracted on the setting, participant characteristics, experimental design, hand hygiene measurement, intervention characteristics, and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist. Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 of 24 (SD= 2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were education (78.9%), enablement (71.1%), training (68.4%), environmental restructuring (65.8%), and persuasion (65.8%). Intervention outcomes were variable, with a mean relative percentage change of 94.7% (SD= 195.7; range, 4.3-1155.4%) from pre to post intervention. This review demonstrates that best practice for improving hand hygiene in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.

Promoting Hand Hygiene With a Lighting Prompt.

PubMed

Diegel-Vacek, Lauren; Ryan, Catherine

2016-10-01

The objective of this pilot study was to assess an automatic sink light design intervention as a prompt for clinician hand hygiene (as defined by World Health Organization [WHO]). Healthcare-associated infections (HAIs) are still leading causes of morbidity and mortality and contribute to burdens on our healthcare system. Hand hygiene has been related to reducing the rate of HAIs and positively impacting both patient and hospital outcomes. This pilot study was a prospective, longitudinal observational study of a convenience sample of healthcare clinicians. In one inpatient room, clinicians were exposed to a hand hygiene reminder that consisted of a light turning on over the sink as they entered. A control room (the adjacent inpatient room) did not have the intervention. A total of 88 clinician encounters were monitored during the study. On the first observation day at the initial activation of the signal light system, the percentage of clinicians performing hand hygiene upon entering a room was only 7% in the control room and 23% in the intervention room. During the second observation (Day 14), those percentages were 16% in the control room and 30% in the intervention room. During the third observation (Day 21), those percentages were 23% in the control room and 23% in the intervention room. The healthcare system frequently relies on expensive technology to improve healthcare delivery, but implementation of low-cost, low-technology methods such as this light may be effective in prompting hand hygiene. © The Author(s) 2016.

Effectiveness of an electronic hand hygiene monitoring system on healthcare workers' compliance to guidelines.

PubMed

Al Salman, J M; Hani, S; de Marcellis-Warin, N; Isa, Sister Fatima

2015-01-01

Hand hygiene is a growing concern among populations and is a crucial element in ensuring patient safety in a healthcare environment. Numerous management efforts have been conducted in that regard, including education, awareness and observations. To better evaluate the possible impact of technology on a healthcare setting, we observed the impact of a particular niche technology developed as an answer to the growing hand hygiene concerns. A study was conducted at Salmaniya Medical Complex (SMC) in Bahrain on a total of 16 Coronary Care Unit (CCU) beds where the system was installed, and the hand hygiene activity of healthcare workers (HCWs) in this area was monitored for a total period of 28 days. Comments, remarks and suggestions were noted, and improvements were made to the technology during the course of the trial. While resistance to change was significant, overall results were satisfactory. Compliance with hand hygiene techniques went from 38-42% to 60% at the beginning of the trial and then increased to an average of 75% at the end of the 28-day trial. In some cases, compliance peaked at 85% or even at 100%. Our case study demonstrates that technology can be used effectively in promoting and improving hand hygiene compliance in hospitals, which is one way to prevent cross-infections, especially in critical care areas. Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home.

PubMed

Sandora, Thomas J; Taveras, Elsie M; Shih, Mei-Chiung; Resnick, Elissa A; Lee, Grace M; Ross-Degnan, Dennis; Goldmann, Donald A

2005-09-01

Good hand hygiene may reduce the spread of infections in families with children who are in out-of-home child care. Alcohol-based hand sanitizers rapidly kill viruses that are commonly associated with respiratory and gastrointestinal (GI) infections. The objective of this study was to determine whether a multifactorial campaign centered on increasing alcohol-based hand sanitizer use and hand-hygiene education reduces illness transmission in the home. A cluster randomized, controlled trial was conducted of homes of 292 families with children who were enrolled in out-of-home child care in 26 child care centers. Eligible families had > or =1 child who was 6 months to 5 years of age and in child care for > or =10 hours/week. Intervention families received a supply of hand sanitizer and biweekly hand-hygiene educational materials for 5 months; control families received only materials promoting good nutrition. Primary caregivers were phoned biweekly and reported respiratory and GI illnesses in family members. Respiratory and GI-illness-transmission rates (measured as secondary illnesses per susceptible person-month) were compared between groups, adjusting for demographic variables, hand-hygiene practices, and previous experience using hand sanitizers. Baseline demographics were similar in the 2 groups. A total of 1802 respiratory illnesses occurred during the study; 443 (25%) were secondary illnesses. A total of 252 GI illnesses occurred during the study; 28 (11%) were secondary illnesses. The secondary GI-illness rate was significantly lower in intervention families compared with control families (incidence rate ratio [IRR]: 0.41; 95% confidence interval [CI]: 0.19-0.90). The overall rate of secondary respiratory illness was not significantly different between groups (IRR: 0.97; 95% CI: 0.72-1.30). However, families with higher sanitizer usage had a marginally lower secondary respiratory illness rate than those with less usage (IRR: 0.81; 95% CI: 0.65-1.09). A multifactorial intervention emphasizing alcohol-based hand sanitizer use in the home reduced transmission of GI illnesses within families with children in child care. Hand sanitizers and multifaceted educational messages may have a role in improving hand-hygiene practices within the home setting.

Impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants.

PubMed

Capretti, Maria Grazia; Sandri, Fabrizio; Tridapalli, Elisabetta; Galletti, Silvia; Petracci, Elisabetta; Faldella, Giacomo

2008-08-01

This study examined the effects of a standardized hand hygiene program on the rate of nosocomial infection (NI) in very low birth weight (VLBW) infants (birth weight < 1500 g) admitted to our neonatal intensive care unit (NICU). We compared the rate of NI in VLBW infants in 2 separate periods. In the first period, staff were encouraged to perform handwashing using a plain fluid detergent (0.5% triclosan). In the second period, a standardized hand hygiene program was implemented using antimicrobial soap (4% chlorhexidine gluconate) and alcohol-based hand rubs. NI after 72 hours of life was detected in 16 of the 85 VLBW infants in the first period and in 5 of the 80 VLBW infants in the second period. The rate of central venous catheter colonization was significantly lower in the second period (5.8%) than in the first period (16.6%). In our NICU, the incidence of NI in VLBW infants was significantly reduced after the introduction of a standardized handwashing protocol. In our experience, a proper hand hygiene program can save approximately 10 NI episodes/year, at a cost of $10,000 per episode. Therefore, improving hand hygiene practice is a cost-effective program in the NICU.

Feasibility: An important but neglected issue in patient hand hygiene.

PubMed

Knighton, Shanina C; McDowell, Cherese; Rai, Herleen; Higgins, Patricia; Burant, Christopher; Donskey, Curtis J

2017-06-01

Patient hand hygiene may be a useful strategy to prevent acquisition of pathogens and to reduce the risk for transmission by colonized patients. Several studies demonstrate that patients and long-term-care facility (LTCF) residents may have difficulty using hand hygiene products that are provided; however, none of them measure feasibility for patients to use different hand hygiene products. A convenience sample of 42 hospitalized patients and 46 LTCF residents was assessed for their ability to use 3 hand sanitizer products (8-oz pushdown pump bottle, 2-oz pocket-sized bottle with a reclosable lid, and alcohol-impregnated hand wipes). The time (seconds) required for accessing each product was compared among acute-care patients and LTCF residents. Participants provided feedback on which product they preferred and found easiest to use. Of 88 participants, 86 (97.7%) preferred the pushdown pump, 2 (2.3%) preferred the bottle with the reclosable lid, and none preferred the hand wipes. For both hospitalized patients and LTCF residents, the average time required to access the pushdown pump was significantly less than the time required to access the other products (pushdown pump, 0.45 seconds; bottle with reclosable lid, 3.86 seconds; and wipes, 5.66 seconds; P < .001). Feasibility and ease of use should be considered in the selection of hand hygiene products for patients and LTCF residents. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Personal Hygiene Practices among Urban Homeless Persons in Boston, MA.

PubMed

Leibler, Jessica H; Nguyen, Daniel D; León, Casey; Gaeta, Jessie M; Perez, Debora

2017-08-18

Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA ( n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population. Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink. Heavy drinking, injection drug use, and sleeping outdoors were identified as significant risk factors for reduced hygiene practices. People experiencing homelessness who also engage in these activities may be among the most difficult to reach for intervention, yet targeted efforts may decrease illness risk associated with reduced hygiene. Housed friends and family play a critical role in assisting homeless individuals maintain hygiene by providing showers and laundry facilities.

Personal Hygiene Practices among Urban Homeless Persons in Boston, MA

PubMed Central

Leibler, Jessica H.; León, Casey; Gaeta, Jessie M.; Perez, Debora

2017-01-01

Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA (n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population. Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink. Heavy drinking, injection drug use, and sleeping outdoors were identified as significant risk factors for reduced hygiene practices. People experiencing homelessness who also engage in these activities may be among the most difficult to reach for intervention, yet targeted efforts may decrease illness risk associated with reduced hygiene. Housed friends and family play a critical role in assisting homeless individuals maintain hygiene by providing showers and laundry facilities. PMID:28820454

Hand hygiene among healthcare workers: A qualitative meta summary using the GRADE-CERQual process

PubMed Central

Chatfield, Sheryl L.; DeBois, Kristen; Nolan, Rachael; Crawford, Hannah; Hallam, Jeffrey S.

2016-01-01

Background: Hand hygiene is considered an effective and potentially modifiable infection control behaviour among healthcare workers (HCW). Several meta-studies have been published that compare quantitatively expressed findings, but limited efforts have been made to synthesise qualitative research. Objectives: This paper provides the first report of integrated findings from qualitative research reports on hand hygiene compliance among HCW worldwide that employs the GRADE-CERQual process of quality assessment. Methods: We conducted database searches and identified 36 reports in which authors conducted qualitative or mixed methods research on hand hygiene compliance among HCW. We used Dedoose analysis software to facilitate extraction of relevant excerpts. We applied the GRADE-CERQual process to describe relative confidence as high, moderate or low for nine aggregate findings. Findings: Highest confidence findings included that HCW believe they have access to adequate training, and that management and resource support are sometimes lacking. Individual, subjective criteria also influence hand hygiene. Discussion: These results suggest the need for further investigation into healthcare cultures that are perceived as supportive for infection control. Surveillance processes have potential, especially if information is perceived by HCW as timely and relevant. PMID:28989515

Factors associated with personal protection equipment use and hand hygiene among hemodialysis staff.

PubMed

Shimokura, Gayle; Weber, David J; Miller, William C; Wurtzel, Heather; Alter, Miriam J

2006-04-01

Because exposure to blood by health care workers is frequent during hemodialysis, gloves are required for all contact with patients and their equipment, followed by hand hygiene. In this study, we investigated factors associated with performing these practices as recommended. Staff members from a sample of 45 US hemodialysis facilities were surveyed using an anonymous self-administered questionnaire. Factors independently associated with reporting increased compliance with recommended hand hygiene and glove use practices during patient care were identified with multivariate modeling. Of 605 eligible staff members, 420 (69%) responded: registered nurses, 41%; dialysis technicians, 51%; and licensed practical nurses, 8%. Only 35% reported that dialysis patients were at risk for bloodborne virus infections, and only 36% reported always following recommended hand hygiene and glove use practices. Independent factors associated with more frequent compliance were being a technician (versus a registered nurse) and reporting always doing what was needed to protect themselves from infection. Compliance with recommended hand hygiene and glove use practices by hemodialysis staff was low. The rationale for infection control practices specific to the hemodialysis setting was poorly understood by all staff. Infection control training should be tailored to this setting and should address misconceptions.

Poor hospital infection control practice in hand hygiene, glove utilization, and usage of tourniquets.

PubMed

Sacar, Suzan; Turgut, Huseyin; Kaleli, Ilknur; Cevahir, Nural; Asan, Ali; Sacar, Mustafa; Tekin, Koray

2006-11-01

Hospital-acquired infection often occurs because of lapses in accepted standards of practice on the part of health care personnel. The aim of this study is to attract attention on poor hospital infection control practice in venepuncture and use of tourniquets and emphasize the importance of hand hygiene. Overall compliance with hygiene during usage of tourniquets and routine patient care before and after implementation of a hospital infection control measures was evaluated. According to the questionnaire, only 26.9% of respondents always washed their hands both before and after venepuncture. In the second step of the study, based on direct observation, hands were washed both before and after venepuncture on only 41 (45.1%) occasions. Failure to remove gloves after patient contact was observed on 23.1% occasions. Our survey reveals poor infection control practice in hand hygiene, glove utilization, and usage of tourniquets and the implementation of infection control measures produced a moderate improvement in compliance with them.

Randomized Controlled Trial of Antiseptic Hand Hygiene Methods in an Outpatient Surgery Clinic.

PubMed

Therattil, Paul J; Yueh, Janet H; Kordahi, Anthony M; Cherla, Deepa V; Lee, Edward S; Granick, Mark S

2015-12-01

Outpatient wound care plays an integral part in any plastic surgery practice. However, compliance with hand hygiene measures has shown to be low, due to skin irritation and lack of time. The objective of this trial was to determine whether single-use, long-acting antiseptics can be as effective as standard multiple-use hand hygiene methods in an outpatient surgical setting. A prospective, randomized controlled trial was performed in the authors' outpatient plastic surgery clinic at Rutgers New Jersey Medical School, Newark, NJ to compare the efficacy of an ethyl alcohol-based sanitizer (Avagard D Instant Hand Aniseptic, 3M Health Care, St. Paul, MN), a benzalkonium chloride-based sanitizer (Soft & Shield, Bioderm Technologies, Inc, Trenton, NJ, distributed by NAPP Technologies, Hackensack, NJ ), and soap and- water handwashing. Subjects included clinic personnel, who were followed throughout the course of a 3-hour clinic session with hourly hand bacterial counts taken. During the course of the trial, 95 subjects completed the clinic session utilizing 1 of the hand hygiene methods (36 ethyl alcohol-based sanitizer, 38 benzalkonium chloride-based sanitizer, and 21 soap-and-water handwashing). There was no difference between hand bacterial counts using the different methods at 4 hourly time points (P greater than 0.05). Hand bacterial counts increased significantly over the 3-hour clinic session with the ethyl alcohol-based sanitizer (9.24 to 21.90 CFU, P less than 0.05), benzalkonium chloride-based sanitizer (6.69 to 21.59 CFU, P less than 0.05), and soap-and-water handwashing (8.43 to 22.75 CFU, P less than 0.05). There does not appear to be any difference in efficacy between single-use, long-acting sanitizer, and standard multiple-use hand hygiene methods. Hand bacterial counts increased significantly over the course of the 3-hour clinic session regardless of the hand hygiene measure used. Hand condition of subjects was improved with the ethyl alcohol-based sanitizer and the benzalkonium chloride-based sanitizer compared with soap-and-water handwashing.

[A photographic competition on hand hygiene in a nursing home].

PubMed

Guerre, Graziella; Aho-Glele, Ludwig-Serge; Astruc, Karine

2016-01-01

Hand hygiene is often considered as the attribute of caregivers. However, it is the patient who is increasingly targeted by improved communication around hygiene in care notably in the framework of the "Clean Hands Mission". In this sense, the French regional centres for the fight against nosocomial infections in Burgundy has proved itself innovative on two levels by organising a photo competition in nursing homes. The aim was to show residents how to prevent care-related infections through the simple act of handwashing. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Hand hygiene promotion and the participation of infection control link nurses: an effective innovation to overcome campaign fatigue.

PubMed

Seto, Wing Hong; Yuen, Shanny W S; Cheung, Christina W Y; Ching, Patricia T Y; Cowling, Benjamin J; Pittet, Didier

2013-12-01

Campaign fatigue was evident in a large hospital in Hong Kong when hand hygiene compliance remained just above 50% after 4 years of aggressive and varied promotional activities. A new innovative strategy was developed that directly involved the infection control link nurses both in formulating the strategy and in implementing the various proposed programs. The new strategy was successful in increasing hand hygiene compliance to 83%. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Evaluation of the Multimodal Strategy for Improvement of Hand Hygiene as Proposed by the World Health Organization.

PubMed

Pereira, Eliana B S; Jorge, Miguel T; Oliveira, Elias J; Júnior, Alberto Lopes Ribeiro; Santos, Lauro R L; Mendes-Rodrigues, Clesnan

Hand hygiene has the biggest impact and is the least expensive way to prevent and control health care-associated infections. In this study, we assessed the effectiveness of the multimodal strategy of the World Health Organization to improve health care-associated infection rates, hand hygiene compliance, and the related knowledge of health care professionals in a Brazilian university hospital. We observed the necessity for an alternative approach in hospitals with high staff turnover and low attendance of educational sessions.

Patient empowerment in a hand hygiene program: differing points of view between patients/family members and health care workers in Asian culture.

PubMed

Pan, Sung-Ching; Tien, Kuei-Lien; Hung, I-Chen; Lin, Yu-Jiun; Yang, Ya-Ling; Yang, Ming-Chin; Wang, Ming-Jiuh; Chang, Shan-Chwen; Chen, Yee-Chun

2013-11-01

"Patient empowerment" is an important component of World Health Organization hand hygiene program, but little is known about the intentions and attitude of patients/families and health care workers (HCWs) regarding this. A cross-sectional survey using questionnaires was conducted in a tertiary teaching hospital in Taiwan to assess hand hygiene knowledge and the attitudes and intentions regarding patient empowerment among patients/families and HCWs. Among patients/families, 95.4% (329/345) had positive attitudes regarding patient empowerment; however, only 67.2% (232/345) had the positive intention to remind HCWs about hand hygiene (P < .001). Risk factors for negative intention were being female (odds ratio [OR], 1.82; 95% confidence interval [CI]: 1.08-3.03), illiteracy (OR, 3.18; 95% CI: 0.86-11.7), and being patients/families in the pediatric department (OR, 1.86; 95% CI: 0.93-3.64). Among HCWs, the difference between positive attitude (81.1%; 714/880) and positive intention regarding being reminded about hand hygiene (62.8%; 553/880) was significant (P < .001). Risk factors for negative intention were age > 25 years (OR, 3.20; 95% CI: 1.51-6.81) and a negative attitude toward patient empowerment (OR, 10.00; 95% CI: 5.88-16.67). There were significant gaps between attitude and intention regarding patient empowerment both among patients/families and HCWs. Special strategies targeting women, the pediatric population, or illiterate people may help improve patient/family participation. Additionally, hand hygiene education should be incorporated into early-stage medical/nursing education to create a facilitating environment. Patients/families and HCWs cooperation is needed to promote the hand hygiene program further. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Breath alcohol of anesthesiologists using alcohol hand gel and the "five moments for hand hygiene" in routine practice.

PubMed

Lindsay, Helen A; Hannam, Jacqueline A; Bradfield, Charles N; Mitchell, Simon J

2016-08-01

Appropriate hand hygiene reduces hospital-acquired infections. Anesthesiologists work in environments with numerous hand hygiene opportunities (HHOs). In a prospective observational study, we investigated the potential for an anesthesiologist to return a positive alcohol breath test during routine practice when using alcohol hand gel. We observed ten volunteer anesthesiologists over four hours while they implemented the World Health Organization (WHO) "five moments for hand hygiene" using our hospital's adopted standard 70% ethanol hand gel. We measured the expired alcohol concentration at shift start and every fifteen minutes thereafter with a fuel cell breathalyzer calibrated to measure the percentage of blood alcohol concentration (BAC). Blood alcohol specimens (analyzed with gas chromatography) were collected at shift start and, when possible, immediately after a participant's first positive breathalyzer test. Of the 130 breathalyzer tests obtained, there were eight (6.2%) positive breath alcohol results from six of the ten participants, all within two minutes of a HHO. The highest value breathalyzer BAC recorded was 0.064%, with an overall mean (SD) of 0.023 (0.017)%. Five (62.5%) of the positive breathalyzer tests returned to zero in less than seven minutes. All of three blood specimens obtained immediately after a positive breathalyzer reading tested negative for alcohol. Anesthesia practitioners using alcohol hand gel in a manner that conforms with recommended hand hygiene can test positive for alcohol on a breathalyzer assay. Positive tests probably arose from inhalation of alcohol vapour into the respiratory dead space following gel application. If workplace breath testing for alcohol is implemented, it should be completed more than 15 min after applying alcohol hand gel. Positive results should be verified with a BAC test.

Assessment of Self-Contamination During Removal of Personal Protective Equipment for Ebola Patient Care.

PubMed

Casanova, Lisa M; Teal, Lisa J; Sickbert-Bennett, Emily E; Anderson, Deverick J; Sexton, Daniel J; Rutala, William A; Weber, David J

2016-10-01

OBJECTIVE Ebola virus disease (EVD) places healthcare personnel (HCP) at high risk for infection during patient care, and personal protective equipment (PPE) is critical. Protocols for EVD PPE doffing have not been validated for prevention of viral self-contamination. Using surrogate viruses (non-enveloped MS2 and enveloped Φ6), we assessed self-contamination of skin and clothes when trained HCP doffed EVD PPE using a standardized protocol. METHODS A total of 15 HCP donned EVD PPE for this study. Virus was applied to PPE, and a trained monitor guided them through the doffing protocol. Of the 15 participants, 10 used alcohol-based hand rub (ABHR) for glove and hand hygiene and 5 used hypochlorite for glove hygiene and ABHR for hand hygiene. Inner gloves, hands, face, and scrubs were sampled after doffing. RESULTS After doffing, MS2 virus was detected on the inner glove worn on the dominant hand for 8 of 15 participants, on the non-dominant inner glove for 6 of 15 participants, and on scrubs for 2 of 15 participants. All MS2 on inner gloves was observed when ABHR was used for glove hygiene; none was observed when hypochlorite was used. When using hypochlorite for glove hygiene, 1 participant had MS2 on hands, and 1 had MS2 on scrubs. CONCLUSIONS A structured doffing protocol using a trained monitor and ABHR protects against enveloped virus self-contamination. Non-enveloped virus (MS2) contamination was detected on inner gloves, possibly due to higher resistance to ABHR. Doffing protocols protective against all viruses need to incorporate highly effective glove and hand hygiene agents. Infect Control Hosp Epidemiol 2016;1-6.

Assessment of hand hygiene techniques using the World Health Organization's six steps.

PubMed

Arias, Ariadna V; Garcell, Humberto G; Ochoa, Yagdeline R; Arias, Katiana F; Miranda, Fernando R

2016-01-01

The quality of hand hygiene was evaluated via direct observation for compliance with the six recommended World Health Organization steps. A total of 2497 HH opportunities, of which 1573 (63.0%) were hand rubs, were monitored over a five month period. Compliance was higher in nurses compared with physicians and auxiliaries and in steps 1 and 2 for hand rubs as well as the first three steps of hand washing, with lower rates after these steps. Rubbing of the thumbs and fingertips achieved the lowest rates of compliance in both HH types. A combination of the five recommended moments and six steps and staff education is recommended to improve the quality of hand hygiene. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Effect of electronic real-time prompting on hand hygiene behaviors in health care workers.

PubMed

Pong, Steven; Holliday, Pamela; Fernie, Geoff

2018-03-02

Poor hand hygiene by health care workers is a major cause of nosocomial infections. This research evaluated the ability of an electronic monitoring system with real-time prompting capability to change hand hygiene behaviors. Handwashing activity was measured by counting dispenser activations on a single nursing unit before, during, and after installation of the system. The effect of changing the prompt duration on hand hygiene performance was determined by a cluster-randomized trial on 3 nursing units with 1 acting as control. Sustainability of performance and participation was observed on 4 nursing units over a year. All staff were eligible to participate. Between June 2015 and December 2016, a total of 459,376 hand hygiene opportunities and 330,740 handwashing events from 511 staff members were recorded. Dispenser activation counts were significantly influenced by use of the system (χ 2 [3] = 75.76; P < .0001). Hand hygiene performance dropped from 62.61% to 24.94% (odds ratio, 0.36; 95% confidence interval, 0.34-0.38) when the prompting feature was removed. Staff participation had a negative trajectory of -0.72% (P < .001), whereas change in average performance was -0.18% (P < .001) per week for the year. Use of electronic monitoring with real-time prompts of 20 seconds' duration nearly doubles handwashing activity and causes handwashing to occur sooner after entering a patient room. These improvements are sustainable over a year. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Standard work for room entry: Linking lean, hand hygiene, and patient-centeredness.

PubMed

O'Reilly, Kristin; Ruokis, Samantha; Russell, Kristin; Teves, Tim; DiLibero, Justin; Yassa, David; Berry, Hannah; Howell, Michael D

2016-03-01

Healthcare-associated infections are costly and fatal. Substantial front-line, administrative, regulatory, and research efforts have focused on improving hand hygiene. While broad agreement exists that hand hygiene is the most important single approach to infection prevention, compliance with hand hygiene is typically only about 40%(1). Our aim was to develop a standard process for room entry in the intensive care unit that improved compliance with hand hygiene and allowed for maximum efficiency. We recognized that hand hygiene is a single step in a substantially more complicated process of room entry. We applied Lean engineering techniques to develop a standard process that included both physical steps and also standard communication elements from provider to patients and families and created a physical environment to support this. We observed meaningful improvement in the performance of the new standard as well as time savings for clinical providers with each room entry. We also observed an increase in room entries that included verbal communication and an explanation of what the clinician was entering the room to do. The design and implementation of a standardized room entry process and the creation of an environment that supports that new process has resulted in measurable positive outcomes on the medical intensive care unit, including quality, patient experience, efficiency, and staff satisfaction. Designing a process, rather than viewing tasks that need to happen in close proximity in time (either serially or in parallel) as unrelated, simplifies work for staff and results in higher compliance to individual tasks. Copyright © 2015 Elsevier Inc. All rights reserved.

[Left- or right-handed: the effect of a preferential use of one hand or the other on dental hygiene].

PubMed

Eleveld, C A; Schuller, A A

2016-02-01

A research project investigated the extent to which a preferential use of one hand or the other has an effect on dental hygiene on the left or right side of the mouth. The study made use of epidemiological dental-care data from the Netherlands Organisation for Applied Scientific Research and of data from a dental practice specifically collected for this project. The results revealed that among a population which is 85-90% right-handed, statistically significantly more dental plaque was found on the right side of the mouth than on the left. A separate study revealed the prevalence of statistically significantly more dental plaque on the right side than on the left among right-handed people and, among left-handed people, a non-statistically significant trend of more dental plaque on the left than the right. It is concluded that dental hygiene on the left side and the right side of the mouth is very likely to be dependent on the preferential use of one hand or the other. The differences between the left side of the mouth and right among left- and right-handed people are, however, so small that it is questionable whether these should be taken into consideration in giving instructions about dental hygiene.

Poor hand hygiene by college students linked to more occurrences of infectious diseases, medical visits, and absence from classes.

PubMed

Prater, Kayla J; Fortuna, Crystal A; McGill, Janis L; Brandeberry, Macey S; Stone, Abigail R; Lu, Xu

2016-01-01

Proper hand hygiene has been linked to lower susceptibility to infectious diseases in many types of communities, but it has not been well established on college campuses. This study investigated the hand hygiene statuses of college students and their occurrences in relation to infectious diseases, medical visits, and absence from classes or work. It also examined the effects of education on handwashing technique to improve hand hygiene. College students enrolled at a university in Northwestern Ohio were recruited as study subjects. Microbial samples were collected 3 times from each of the 220 valid volunteers before washing their hands, after washing with their own procedures, and after washing with a procedure recommended by the Centers for Disease Control and Prevention (CDC). Each volunteer also answered a survey including questions on their health conditions, medical visits, and absence from classes or work. Hands of 57.7% volunteers were colonized by an uncountable number of microbial colonies, which were significantly linked to more occurrences to infectious diseases (P < .05), medical visits (P < .05), and arguably more absence from classes or work (P = .09). The handwashing procedure provided by the CDC significantly improved hand hygiene. It is critical to promote education on proper handwashing in colleges, in grade schools, and at home to improve health and learning outcomes. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Can theoretical intervention improve hand hygiene behavior among nurses?

PubMed Central

Baghaei, Rahim; Sharifian, Elham; Kamran, Aziz

2016-01-01

Background Hand washing is the best strategy to prevent known nosocomial infections but the nurses’ hand hygiene is estimated to be poor in Iran. Objective This study aimed to determine the effectiveness of BASNEF (Behavior, Attitude, Subjective Norms, and Enabling Factors) model on hand hygiene adherence education. Methods This controlled quasi-experimental study was conducted on 70 hemodialysis unit nurses (35 case and 35 control) in the health and educational centers of the University of Medical Sciences of Urmia, Iran. To collect the data, a six-part validated and reliable questionnaire was used. The data were analyzed using SPSS version18, using Wilcoxon, Mann–Whitney, chi-square, and Fisher’s exact tests. The significance level was considered P<0.05. Results The mean age was 38.4±8.1 years for the intervention group and 40.2±8.0 years for the control group. There was no significant difference between the two groups for any demographic variables. Also, before the intervention, there was no significant difference between the two groups for any components of the BASNEF model. Post-intervention, the attitude, subjective norms, enabling factors, and intention improved significantly in the intervention group (P<0.001), but hand hygiene behavior did not show any significant change in the intervention group (P=0.16). Conclusion Despite the improving attitudes and intention, the intervention had no significant effect on hand hygiene behavior among the studied nurses. PMID:27366106

Can theoretical intervention improve hand hygiene behavior among nurses?

PubMed

Baghaei, Rahim; Sharifian, Elham; Kamran, Aziz

2016-01-01

Hand washing is the best strategy to prevent known nosocomial infections but the nurses' hand hygiene is estimated to be poor in Iran. This study aimed to determine the effectiveness of BASNEF (Behavior, Attitude, Subjective Norms, and Enabling Factors) model on hand hygiene adherence education. This controlled quasi-experimental study was conducted on 70 hemodialysis unit nurses (35 case and 35 control) in the health and educational centers of the University of Medical Sciences of Urmia, Iran. To collect the data, a six-part validated and reliable questionnaire was used. The data were analyzed using SPSS version18, using Wilcoxon, Mann-Whitney, chi-square, and Fisher's exact tests. The significance level was considered P<0.05. The mean age was 38.4±8.1 years for the intervention group and 40.2±8.0 years for the control group. There was no significant difference between the two groups for any demographic variables. Also, before the intervention, there was no significant difference between the two groups for any components of the BASNEF model. Post-intervention, the attitude, subjective norms, enabling factors, and intention improved significantly in the intervention group (P<0.001), but hand hygiene behavior did not show any significant change in the intervention group (P=0.16). Despite the improving attitudes and intention, the intervention had no significant effect on hand hygiene behavior among the studied nurses.

Reducing hospital-acquired infections and improving the rational use of antibiotics in a developing country: an effectiveness study

PubMed Central

Murni, Indah K; Duke, Trevor; Kinney, Sharon; Daley, Andrew J; Soenarto, Yati

2015-01-01

Background Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries. Aims To implement a multifaceted infection control and antibiotic stewardship programme and evaluate its effectiveness on HAIs and antibiotic use. Methods A before-and-after study was conducted over 27 months in a teaching hospital in Indonesia. All children admitted to the paediatric intensive care unit and paediatric wards were observed daily. Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of a hand hygiene campaign, antibiotic stewardship (using the WHO Pocket Book of Hospital Care for Children guidelines as standards of antibiotic prescribing for community-acquired infections), and other elementary infection control practices. Data were collected using an identical method in the preintervention and postintervention periods. Results We observed a major reduction in HAIs, from 22.6% (277/1227 patients) in the preintervention period to 8.6% (123/1419 patients) in the postintervention period (relative risk (RR) (95% CI) 0.38 (0.31 to 0.46)). Inappropriate antibiotic use declined from 43% (336 of 780 patients who were prescribed antibiotics) to 20.6% (182 of 882 patients) (RR 0.46 (0.40 to 0.55)). Hand hygiene compliance increased from 18.9% (319/1690) to 62.9% (1125/1789) (RR 3.33 (2.99 to 3.70)). In-hospital mortality decreased from 10.4% (127/1227) to 8% (114/1419) (RR 0.78 (0.61 to 0.97)). Conclusions Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised children in developing countries. PMID:25503715

A return to the basics; nurses' practices and knowledge about interventional patient hygiene in critical care units.

PubMed

El-Soussi, Azza H; Asfour, Hayam I

2017-06-01

The Nursing profession is struggling to return to basic nursing care to maintain patients' safety. "Interventional patient hygiene" (IPH) is a measurement model for reducing the bioburden of both the patient and health care worker, and its components are hand hygiene, oral care, skin care/antisepsis, and catheter site care. To identify the level of nurses' practice and knowledge about interventional patient hygiene and identify barriers for implementing interventional patient hygiene in critical care units. A descriptive research design was used and three tools were applied in this study: "The Interventional Patient Hygiene Observational Checklist", "The Interventional Patient Hygiene Knowledge Questionnaire" and "The Barriers for Implementing Interventional Patient Hygiene in Critical Care Units". The mean percentage nurses' knowledge score is higher than the mean percentage practice score in all items (hand hygiene (71.28±25.46, compared with 46.15±17.87), oral care (100.0±0.0, compared with 25.32±24.25), catheter care (75.76±9.40, compared with 8.97±24.14) and skin care (47.80±6.79, compared with 26.28±16.57). Barriers for implementing hand hygiene are workload (71.79%), insufficient resources (61.53%), and lack of knowledge (10.25%). The mean percentage IPH knowledge score is higher than the mean percentage IPH practice score of all IPH items. Barriers for implementing IPH include workload, insufficient resources, and lack of knowledge/training. Copyright © 2016 Elsevier Ltd. All rights reserved.

Impact of sink location on hand hygiene compliance for Clostridium difficile infection.

PubMed

Zellmer, Caroline; Blakney, Rebekah; Van Hoof, Sarah; Safdar, Nasia

2015-04-01

Hand hygiene with soap and water after the care of a patient with Clostridium difficile infection is essential to reduce nosocomial transmission in an outbreak situation. Factors that may pose barriers to user completion of infection prevention measures, such as hand hygiene, are of interest. We undertook a quantitative study to evaluate the relationship between sink location and compliance with handwashing among health care workers and visitors in a surgical transplant unit. We found that placement of 2 more easily visible sinks in a surgical transplant unit was associated with improved adherence to handwashing. Published by Elsevier Inc.

Electronic hand hygiene monitoring as a tool for reducing health care-associated methicillin-resistant Staphylococcus aureus infection.

PubMed

Kelly, J William; Blackhurst, Dawn; McAtee, Wendy; Steed, Connie

2016-08-01

Electronic monitoring of hand hygiene compliance using the World Health Organization's My 5 Moments for Hand Hygiene is a new innovation that has not yet been shown to reduce hospital infections. We analyzed existing data from 23 inpatient units over a 33-month period and found a significant correlation between unit-specific improvements in electronic monitoring compliance and reductions in methicillin-resistant Staphylococcus aureus infection rates (r = -0.37, P < .001). Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of an automated ultraviolet-C light disinfection device and patient hand hygiene for reduction of pathogen transfer from interactive touchscreen computer kiosks.

PubMed

Alhmidi, Heba; Cadnum, Jennifer L; Piedrahita, Christina T; John, Amrita R; Donskey, Curtis J

2018-04-01

Touchscreens are a potential source of pathogen transmission. In our facility, patients and visitors rarely perform hand hygiene after using interactive touchscreen computer kiosks. An automated ultraviolet-C touchscreen disinfection device was effective in reducing bacteriophage MS2, bacteriophage ϕX174, methicillin-resistant Staphylococcus aureus, and Clostridium difficile spores inoculated onto a touchscreen. In simulations, an automated ultraviolet-C touchscreen disinfection device alone or in combination with hand hygiene reduced transfer of the viruses from contaminated touchscreens to fingertips. Published by Elsevier Inc.

Effects of knowledge and internal locus of control in groups of health care workers judging likelihood of pathogen transfer.

PubMed

McLaughlin, Anne Collins; Walsh, Fran; Bryant, Michelle

2013-08-01

A study was conducted to measure the effects of attitudes and beliefs on the risk judgments of health care workers. Lack of hand hygiene compliance is a worldwide issue in health care, contributing to infections, fatalities, and increased health care costs. Human factors methods are a promising solution to the problem of compliance, although thus far, the concentration has been on process and engineering methods, such as the design of no-touch sinks. Factors internal to the health care worker, such as their attitudes and beliefs about hand hygiene, have received less attention. For this study, three groups of health care workers completed measures of attitudes, control beliefs, and hand hygiene knowledge. They then provided risk judgments of touching various surfaces via a factorial survey. Attitudes, knowledge, control beliefs, and surface type all predicted the risk judgments of the sample of health care workers, with differences between professional groups. Health care workers perceive less risk when touching surfaces,which may explain historically low rates of hand hygiene compliance after surface contact. Although more research is needed to directly connect risk judgments to failures of hand hygiene, the current results can inform interventions targeting the internal attitudes and beliefs of health care workers.

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

PubMed

Pelat, Camille; Kardaś-Słoma, Lidia; Birgand, Gabriel; Ruppé, Etienne; Schwarzinger, Michaël; Andremont, Antoine; Lucet, Jean-Christophe; Yazdanpanah, Yazdan

2016-03-01

The best strategy for controlling extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) transmission in intensive care units (ICUs) remains elusive. We developed a stochastic transmission model to quantify the effectiveness of interventions aimed at reducing the spread of ESBL-PE in an ICU. We 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. Improving 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. Our results suggest that hand hygiene is the most effective intervention to control ESBL-PE transmission in an ICU.

Social marketing analysis of 20 [corrected] years of hand hygiene promotion.

PubMed

Mah, Manuel W; Tam, Yat Cho; Deshpande, Sameer

2008-03-01

To assess published hand hygiene behavioral interventions that employed a social marketing framework and to recommend improvements to future interventions. We performed a systematic literature review by searching the PubMed database and the Cumulative Index to Nursing and Allied Health Literature for published articles about hand hygiene behavioral interventions in healthcare facilities, schools, and community settings. Our analysis included articles that describe multifaceted interventions and evaluated them with predefined social marketing benchmark criteria. Of 53 interventions analyzed in this review, 16 (30.2%) employed primary formative audience research, 5 (9.4%) incorporated social or behavioral theories, 27 (50.9%) employed segmentation and targeting of the audience, 44 (83.0%) used components of the "marketing mix," 3 (5.7%) considered the influence of competing behaviors, 7 (13.2%) cultivated relationships with the target audience, and 15 (28.3%) provided simple behavioral messages. Thirty-five (66.0%) of the interventions demonstrated a significant improvement in performance, but only 21 (39.6%) were considered to have a strong evaluative design. The median duration of the interventions was 8.0 months. From a social marketing perspective, the promotion of hand hygiene could be improved in several ways. The effectiveness of social marketing in hand hygiene promotion should be tested in future interventions.

Student-led intervention to inNOvate hand hygiene practice in Auckland Region's medical students (the No HHARMS study).

PubMed

Lucas, Nathanael Cc; Hume, Carl G; Al-Chanati, Abdal; Diprose, William; Roberts, Sally; Freeman, Josh; Mogol, Vernon; Hoskins, David; Hamblin, Richard; Frampton, Chris; Bagg, Warwick; Merry, Alan F

2017-01-13

Hand hygiene is important in reducing healthcare-associated infections. The World Health Organization has defined 'five moments' when hand hygiene compliance is required. During 2013, New Zealand national data showed poor compliance with these moments by medical students. To improve medical students' compliance with the five moments. In this prospective student-led quality improvement initiative, student investigators developed, implemented and evaluated a multi-modal intervention comprising a three-month social media campaign, a competition and an entertaining educational video. Data on individual patient-medical student interactions were collected covertly by observers at baseline and at one week, six weeks and three months after initiation of the intervention. During the campaign, compliance improved in moment 2, but not significantly in moments 1, 3, 4 or 5. Statistical analysis of amalgamated data was limited by non-independent data points-a consideration apparently not always addressed in previous studies. The initiative produced improvements in compliance by medical students with one hand hygiene moment. Statistical analysis of amalgamated data for all five moments should allow for the non-independence of each occasion in which clinicians interact with a patient. More work is needed to ensure excellent hand hygiene practices of future doctors.

Enhanced performance feedback and patient participation to improve hand hygiene compliance of health-care workers in the setting of established multimodal promotion: a single-centre, cluster randomised controlled trial.

PubMed

Stewardson, Andrew James; Sax, Hugo; Gayet-Ageron, Angèle; Touveneau, Sylvie; Longtin, Yves; Zingg, Walter; Pittet, Didier

2016-12-01

Hand hygiene compliance of health-care workers remains suboptimal despite standard multimodal promotion, and evidence for the effectiveness of novel interventions is urgently needed. We aimed to assess the effect of enhanced performance feedback and patient participation on hand hygiene compliance in the setting of multimodal promotion. We did a single-centre, cluster randomised controlled trial at University of Geneva Hospitals (Geneva, Switzerland). All wards hosting adult, lucid patients, and all health-care workers and patients in these wards, were eligible. After a 15-month baseline period, eligible wards were assigned by computer-generated block randomisation (1:1:1), stratified by the type of ward, to one of three groups: control, enhanced performance feedback, or enhanced performance feedback plus patient participation. Standard multimodal hand hygiene promotion was done hospital-wide throughout the study. The primary outcome was hand hygiene compliance of health-care workers (according to the WHO Five Moments of Hand Hygiene) at the opportunity level, measured by direct observation (20-min sessions) by 12 validated infection control nurses, with each ward audited at least once every 3 months. This trial is registered with ISRCTN, number ISRCTN43599478. We randomly assigned 67 wards to the control group (n=21), enhanced performance feedback (n=24), or enhanced performance feedback plus patient participation (n=22) on May 19, 2010. One ward in the control group became a high-dependency unit and was excluded from analysis. During 1367 observation sessions, 12 579 hand hygiene opportunities were recorded. Between the baseline period (April 1, 2009, to June 30, 2010) and the intervention period (July 1, 2010, to June 30, 2012), mean hand hygiene compliance increased from 66% (95% CI 62-70) to 73% (70-77) in the control group (odds ratio [OR] 1·41, 95% CI 1·21-1·63), from 65% (62-69) to 75% (72-77) in the enhanced performance feedback group (1·61, 1·41-1·84), and from 66% (62-70) to 77% (74-80) in the enhanced performance feedback plus patient participation group (1·73, 1·51-1·98). The absolute difference in compliance attributable to interventions was 3 percentage points (95% CI 0-7; p=0·19) for the enhanced performance feedback group and 4 percentage points (1-8; p=0·048) for the enhanced performance feedback plus patient participation group. Hand hygiene compliance remained significantly higher than baseline in all three groups (OR 1·21 [1·00-1·47] vs 1·38 [1·19-1·60] vs 1·36 [1·18-1·57]) during the post-intervention follow-up (Jan 1, 2013, to Dec 31, 2014). Hand hygiene compliance improved in all study groups, and neither intervention had a clinically significant effect compared with control. Improvement in control wards might reflect cross-contamination, highlighting challenges with randomised trials of behaviour change. Swiss National Science Foundation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Clinical Issues-October 2016.

PubMed

Wood, Amber

2016-10-01

Wearing nail polish Key words: nail, polish, UV-cured, gel nail, Shellac. Preventing dry skin Key words: dry skin, chapped, dermatitis, hand hygiene. Wearing rings Key words: ring, jewelry, wedding ring, band, hand hygiene. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Redesigning a large school-based clinical trial in response to changes in community practice

PubMed Central

Gerald, Lynn B; Gerald, Joe K; McClure, Leslie A; Harrington, Kathy; Erwin, Sue; Bailey, William C

2011-01-01

Background Asthma exacerbations are seasonal with the greatest risk in elementary-age students occurring shortly after returning to school following summer break. Recent research suggests that this seasonality in children is primarily related to viral respiratory tract infections. Regular hand washing is the most effective method to prevent the spread of viral respiratory infections; unfortunately, achieving hand washing recommendations in schools is difficult. Therefore, we designed a study to evaluate the effect of hand sanitizer use in elementary schools on exacerbations among children with asthma. Purpose To describe the process of redesigning the trial in response to changes in the safety profile of the hand sanitizer as well as changes in hand hygiene practice in the schools. Methods The original trial was a randomized, longitudinal, subject-blinded, placebo-controlled, community-based crossover trial. The primary aim was to evaluate the incremental effectiveness of hand sanitizer use in addition to usual hand hygiene practices to decrease asthma exacerbations in elementary-age children. Three events occurred that required major modifications to the original study protocol: (1) safety concerns arose regarding the hand sanitizer’s active ingredient; (2) no substitute placebo hand sanitizer was available; and (3) community preferences changed regarding hand hygiene practices in the schools. Results The revised protocol is a randomized, longitudinal, community-based crossover trial. The primary aim is to evaluate the incremental effectiveness of a two-step hand hygiene process (hand hygiene education plus institutionally provided alcohol-based hand sanitizer) versus usual care to decrease asthma exacerbations. Enrollment was completed in May 2009 with 527 students from 30 schools. The intervention began in August 2009 and will continue through May 2011. Study results should be available at the end of 2011. Limitations The changed design does not allow us to directly measure the effectiveness of hand sanitizer use as a supplement to traditional hand washing practices. Conclusions The need to balance a rigorous study design with one that is acceptable to the community requires investigators to be actively involved with community collaborators and able to adapt study protocols to fit changing community practices. PMID:21730079

Redesigning a large school-based clinical trial in response to changes in community practice.

PubMed

Gerald, Lynn B; Gerald, Joe K; McClure, Leslie A; Harrington, Kathy; Erwin, Sue; Bailey, William C

2011-06-01

Asthma exacerbations are seasonal with the greatest risk in elementary-age students occurring shortly after returning to school following summer break. Recent research suggests that this seasonality in children is primarily related to viral respiratory tract infections. Regular hand washing is the most effective method to prevent the spread of viral respiratory infections; unfortunately, achieving hand washing recommendations in schools is difficult. Therefore, we designed a study to evaluate the effect of hand sanitizer use in elementary schools on exacerbations among children with asthma. To describe the process of redesigning the trial in response to changes in the safety profile of the hand sanitizer as well as changes in hand hygiene practice in the schools. The original trial was a randomized, longitudinal, subject-blinded, placebo-controlled, community-based crossover trial. The primary aim was to evaluate the incremental effectiveness of hand sanitizer use in addition to usual hand hygiene practices to decrease asthma exacerbations in elementary-age children. Three events occurred that required major modifications to the original study protocol: (1) safety concerns arose regarding the hand sanitizer's active ingredient; (2) no substitute placebo hand sanitizer was available; and (3) community preferences changed regarding hand hygiene practices in the schools. The revised protocol is a randomized, longitudinal, community-based crossover trial. The primary aim is to evaluate the incremental effectiveness of a two-step hand hygiene process (hand hygiene education plus institutionally provided alcohol-based hand sanitizer) versus usual care to decrease asthma exacerbations. Enrollment was completed in May 2009 with 527 students from 30 schools. The intervention began in August 2009 and will continue through May 2011. Study results should be available at the end of 2011. The changed design does not allow us to directly measure the effectiveness of hand sanitizer use as a supplement to traditional hand washing practices. The need to balance a rigorous study design with one that is acceptable to the community requires investigators to be actively involved with community collaborators and able to adapt study protocols to fit changing community practices.

Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection.

PubMed

Johnson, Paul D R; Martin, Rhea; Burrell, Laurelle J; Grabsch, Elizabeth A; Kirsa, Susan W; O'Keeffe, Jason; Mayall, Barrie C; Edmonds, Deidre; Barr, Wendy; Bolger, Christopher; Naidoo, Humsha; Grayson, M Lindsay

2005-11-21

To assess the effect of a multifaceted hand hygiene culture-change program on health care worker behaviour, and to reduce the burden of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections. Timetabled introduction of interventions (alcohol/chlorhexidine hand hygiene solution [ACHRS], improved cleaning of shared ward equipment, targeted patient decolonisation, comprehensive "culture change" package) to five clinical areas of a large university teaching hospital that had high levels of MRSA. Health care worker hand hygiene compliance; volume of ACHRS used; prevalence of patient and health care worker MRSA colonisation; environmental MRSA contamination; rates of clinical MRSA infection; and rates of laboratory detection of ESBL-producing Escherichia coli and Klebsiella spp. In study wards, health care worker hand hygiene compliance improved from a pre-intervention mean of 21% (95% CI, 20.3%-22.9%) to 42% (95% CI, 40.2%-43.8%) 12 months post-intervention (P < 0.001). ACHRS use increased from 5.7 to 28.6 L/1000 bed-days. No change was observed in patient MRSA colonisation or environmental colonisation/contamination, and, except in the intensive care unit, colonisation of health care workers was unchanged. Thirty-six months post-intervention, there had been significant reductions in hospital-wide rates of total clinical MRSA isolates (40% reduction; P < 0.001), patient-episodes of MRSA bacteraemia (57% reduction; P = 0.01), and clinical isolates of ESBL-producing E. coli and Klebsiella spp (90% reduction; P < 0.001). Introduction of ACHRS and a detailed culture-change program was effective in improving hand hygiene compliance and reducing nosocomial MRSA infections, despite high-level MRSA endemicity.

Cytomegalovirus (CMV) and Pregnancy

MedlinePlus

... way to prevent infection is to practice good hygiene, particularly proper hand washing. An interventional study in ... a CMV infection found that teaching about good hygiene (and practicing good hygiene) reduced the risk of ...

Semmelweis revisited: hand hygiene and nosocomial disease transmission in the anesthesia workstation.

PubMed

Biddle, Chuck

2009-06-01

Hospital-acquired infections occur at an alarmingly high frequency, possibly affecting as many as 1 in 10 patients, resulting in a staggering morbidity and an annual mortality of many tens of thousands of patients. Appropriate hand hygiene is highly effective and represents the simplest approach that we have to preventing nosocomial infections. The Agency for Healthcare Research and Quality has targeted hand-washing compliance as a top research agenda item for patient safety. Recent research has identified inadequate hand washing and contaminated anesthesia workstation issues as likely contributors to nosocomial infections, finding aseptic practices highly variable among providers. It is vital that all healthcare providers, including anesthesia providers, appreciate the role of inadequate hand hygiene in nosocomial infection and meticulously follow the mandates of the American Association of Nurse Anesthetists and other professional healthcare organizations.

Nudging to improve hand hygiene.

PubMed

Caris, M G; Labuschagne, H A; Dekker, M; Kramer, M H H; van Agtmael, M A; Vandenbroucke-Grauls, C M J E

2018-04-01

Hand hygiene is paramount to prevent healthcare-associated infections, but improving compliance is challenging. When healthcare workers seldom encounter healthcare-associated infections, they will consider the odds of causing infections through poor hand hygiene negligible. Cognitive biases such as these may induce non-compliance. Nudging, 'a friendly push to encourage desired behaviour', could provide an easily implemented, inexpensive measure to address cognitive biases and thus support hand hygiene interventions. To investigate whether behavioural nudges, displayed as posters, can increase the use of alcohol-based hand rub. We developed nudges based on a systematic review of previously described cognitive biases, and tested these through a cross-sectional survey among the target audience. We then conducted a controlled before-after trial on two hospital wards, to assess the effect of these nudges on the use of alcohol-based hand rub, measured with electronic dispensers. Poisson regression analyses adjusted for workload showed that nudges displayed next to dispensers increased their overall use on one ward [poster 1: relative risk: 1.6 (95% confidence interval: 1.2-2.2); poster 2: 1.7 (1.2-2.5)] and during doctor's rounds on both wards [poster 1: ward A: 1.7 (1.1-2.6); ward B: 2.2 (1.3-3.8)]. Use of dispensers without adjacent nudges did not increase. Nudges based on cognitive biases that play a role in hand hygiene, and displayed as posters, could provide an easy, inexpensive measure to increase use of alcohol-based hand rub. When applying nudges to change behaviour, it is important to identify the right nudge for the right audience. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

PubMed Central

TATARELLI, P.; LORENZI, I.; CAVIGLIA, I.; SACCO, R.A.; LA MASA, D.

2016-01-01

Summary Introduction. Hand decontamination with alcohol-based antiseptic agents is considered the best practise to reduce healthcare associated infections. We present a new method to monitor hand hygiene, introduced in a tertiary care pediatric hospital in Northern Italy, which estimates the mean number of daily hand decontamination procedures performed per patient. Methods. The total amount of isopropyl alcohol and chlorhexidine solution supplied in a trimester to each hospital ward was put in relation with the number of hospitalization days, and expressed as litres/1000 hospitalization-days (World Health Organization standard method). Moreover, the ratio between the total volume of hand hygiene products supplied and the effective amount of hand disinfection product needed for a correct procedure was calculated. Then, this number was divided by 90 (days in a quarter) and then by the mean number of bed active in each day in a Unit, resulting in the mean estimated number of hand hygiene procedures per patient per day (new method). Results. The two methods had similar performance for estimating the adherence to correct hand disinfection procedures. The new method identified wards and/or periods with high or low adherence to the procedure and indicated where to perform interventions and their effectiveness. The new method could result easy-to understand also for non-infection control experts. Conclusions. This method can help non-infection control experts to understand adherence to correct hand-hygiene procedures and improve quality standards. PMID:28167854

Wearable Sensors for eLearning of Manual Tasks: Using Forearm EMG in Hand Hygiene Training

PubMed Central

Kutafina, Ekaterina; Laukamp, David; Bettermann, Ralf; Schroeder, Ulrik; Jonas, Stephan M.

2016-01-01

In this paper, we propose a novel approach to eLearning that makes use of smart wearable sensors. Traditional eLearning supports the remote and mobile learning of mostly theoretical knowledge. Here we discuss the possibilities of eLearning to support the training of manual skills. We employ forearm armbands with inertial measurement units and surface electromyography sensors to detect and analyse the user’s hand motions and evaluate their performance. Hand hygiene is chosen as the example activity, as it is a highly standardized manual task that is often not properly executed. The World Health Organization guidelines on hand hygiene are taken as a model of the optimal hygiene procedure, due to their algorithmic structure. Gesture recognition procedures based on artificial neural networks and hidden Markov modeling were developed, achieving recognition rates of 98.30% (±1.26%) for individual gestures. Our approach is shown to be promising for further research and application in the mobile eLearning of manual skills. PMID:27527167

Achieving Hand Hygiene Success With a Partnership Between Graduate Medical Education, Hospital Leadership, and Physicians.

PubMed

Rosenbluth, Glenn; Garritson, Susan; Green, Adrienne L; Milev, Dimiter; Vidyarthi, Arpana R; Auerbach, Andrew D; Baron, Robert B

2016-11-01

Engaging physicians in hand hygiene programs is a challenge faced by many academic medical centers. Partnerships between education and academic leaders present opportunities for effective collaboration and improvement. The authors developed a robust hand hygiene quality improvement program, with attention to rapid-cycle improvements, including all levels of staff and health care providers. The program included a defined governance structure, clear data collection process, educational interventions, rapid-cycle improvements, and financial incentive for staff and physicians (including residents and fellows). Outcomes were measured on patients in all clinical areas. Run charts were used to document compliance in aggregate and by subgroups throughout the project duration. Institutional targets were achieved and then exceeded, with sustained hand hygiene compliance >90%. Physician compliance lagged behind aggregate compliance but ultimately was sustained at a level exceeding the target. Successfully achieving the institutional goal required collaboration among all stakeholders. Physician-specific data and physician champions were essential to drive improvement. © The Author(s) 2015.

Wearable Sensors for eLearning of Manual Tasks: Using Forearm EMG in Hand Hygiene Training.

PubMed

Kutafina, Ekaterina; Laukamp, David; Bettermann, Ralf; Schroeder, Ulrik; Jonas, Stephan M

2016-08-03

In this paper, we propose a novel approach to eLearning that makes use of smart wearable sensors. Traditional eLearning supports the remote and mobile learning of mostly theoretical knowledge. Here we discuss the possibilities of eLearning to support the training of manual skills. We employ forearm armbands with inertial measurement units and surface electromyography sensors to detect and analyse the user's hand motions and evaluate their performance. Hand hygiene is chosen as the example activity, as it is a highly standardized manual task that is often not properly executed. The World Health Organization guidelines on hand hygiene are taken as a model of the optimal hygiene procedure, due to their algorithmic structure. Gesture recognition procedures based on artificial neural networks and hidden Markov modeling were developed, achieving recognition rates of 98 . 30 % ( ± 1 . 26 % ) for individual gestures. Our approach is shown to be promising for further research and application in the mobile eLearning of manual skills.

Conspicuous vs customary location of hand hygiene agent dispensers on alcohol-based hand hygiene product usage in an intensive care unit.

PubMed

Thomas, Bruce W; Berg-Copas, Gina M; Vasquez, Donald G; Jackson, Brandy L; Wetta-Hall, Ruth

2009-05-01

Hand washing is considered the single most important nosocomial infection-control strategy, yet compliance rarely meets levels recommended by infection control authorities. To determine whether placement of hand hygiene foam dispensers in more conspicuous positions and closer proximity to patients would increase use of infection control agents as measured by volume of product used. Further, to ascertain the influence of dispenser placement vs the number of dispensers available on usage by volume. This prospective, observational study conducted in an intensive care unit was composed of three observation periods. A control period with standard agent dispenser location (8 dispensers) was followed by two experimental periods: (1) "conspicuous and immediate proximity to patient" placement (16 dispensers) and (2) standard locations with a dramatic increase in the number of dispensers (36 dispensers). Volume of use for alcohol-based hand hygiene agent during the three observation periods revealed a statistically significant increase in daily consumption after conspicuous and proximate positioning of dispensers (P<.001). However, increasing the number of dispensers did not increase agent use (P=.196). More conspicuous placement of dispensers containing alcohol-based hand hygiene agent (ie, immediate proximity to patients) resulted in statistically and clinically significant increases in product usage. An increase in the number of dispensers did not increase usage. The impact of dispenser positioning on usage by volume for these highly effective products should be considered when planning and implementing intensive care unit infection-control policies.

Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit.

PubMed

Swoboda, Sandra M; Earsing, Karen; Strauss, Kevin; Lane, Stephen; Lipsett, Pamela A

2004-02-01

To determine whether electronic monitoring of hand hygiene and voice prompts can improve hand hygiene and decrease nosocomial infection rates in a surgical intermediate care unit. Three-phase quasi-experimental design. Phase I was electronic monitoring and direct observation; phase II was electronic monitoring and computerized voice prompts for failure to perform hand hygiene on room exit; and phase III was electronic monitoring only. Nine-room, 14-bed intermediate care unit in a university, tertiary-care institution. All patient rooms, utility room, and staff lavatory were monitored electronically. All healthcare personnel including physicians, nurses, nursing support personnel, ancillary staff, all visitors and family members, and any other personnel interacting with patients on the intermediate care unit. All patients with an intermediate care unit length of stay >48 hrs were followed for nosocomial infection. Electronic monitoring during all phases, computerized voice prompts during phase II only. We evaluated a total of 283,488 electronically monitored entries into a patient room with 251,526 exits for 420 days (10,080 hrs and 3,549 patient days). Compared with phase I, hand hygiene compliance in patient rooms improved 37% during phase II (odds ratio, 1.38; 95% confidence interval, 1.04-1.83) and 41% in phase III (odds ratio, 1.41; 95% confidence interval, 1.07-1.84). When adjusting for patient admissions during each phase, point estimates of nosocomial infections decreased by 22% during phase II and 48% during phase III; when adjusting for patient days, the number of infections decreased by 10% during phase II and 40% during phase III. Although the overall rate of nosocomial infections significantly decreased when combining phases II and III, the association between nosocomial infection and individual phase was not significant. Electronic monitoring provided effective ongoing feedback about hand hygiene compliance. During both the voice prompt phase and post-intervention phase, hand hygiene compliance and nosocomial infection rates improved suggesting that ongoing monitoring and feedback had both a short-term and, perhaps, a longer-term effect.

Efficacy of a new educational tool to improve Handrubbing technique amongst healthcare workers: a controlled, before-after study.

PubMed

Stewardson, Andrew J; Iten, Anne; Camus, Véronique; Gayet-Ageron, Angèle; Caulfield, Darren; Lacey, Gerard; Pittet, Didier

2014-01-01

Hand hygiene is a key component of infection control in healthcare. WHO recommends that healthcare workers perform six specific poses during each hand hygiene action. SureWash (Glanta Ltd, Dublin, Ireland) is a novel device that uses video-measurement technology and immediate feedback to teach this technique. We assessed the impact of self-directed SureWash use on healthcare worker hand hygiene technique and evaluated the device's diagnostic capacity. A controlled before-after study: subjects in Group A were exposed to the SureWash for four weeks followed by Group B for 12 weeks. Each subject's hand hygiene technique was assessed by blinded observers at baseline (T0) and following intervention periods (T1 and T2). Primary outcome was performance of a complete hand hygiene action, requiring all six poses during an action lasting ≥20 seconds. The number of poses per hand hygiene action (maximum 6) was assessed in a post-hoc analysis. SureWash's diagnostic capacity compared to human observers was assessed using ROC curve analysis. Thirty-four and 29 healthcare workers were recruited to groups A and B, respectively. No participants performed a complete action at baseline. At T1, one Group A participant and no Group B participants performed a complete action. At baseline, the median number of poses performed per action was 2.0 and 1.0 in Groups A and B, respectively (p = 0.12). At T1, the number of poses per action was greater in Group A (post-intervention) than Group B (control): median 3.8 and 2.0, respectively (p<0.001). In Group A, the number of poses performed twelve weeks post-intervention (median 3.0) remained higher than baseline (p<0.001). The area under the ROC curves for the 6 poses ranged from 0.59 to 0.88. While no impact on complete actions was demonstrated, SureWash significantly increased the number of poses per hand hygiene action and demonstrated good diagnostic capacity.

Can a school-based sleep education programme improve sleep knowledge, hygiene and behaviours using a randomised controlled trial.

PubMed

Rigney, Gabrielle; Blunden, Sarah; Maher, Carol; Dollman, James; Parvazian, Somayeh; Matricciani, Lisa; Olds, Timothy

2015-06-01

The present study investigated the effectiveness of a school-based sleep education programme in improving key sleep behaviours, sleep knowledge, and sleep hygiene. A cross-sectional cluster-randomised controlled trial with two groups (Intervention and Control) and three assessment time points [baseline, immediately post intervention (6 weeks post baseline) and follow-up (18 weeks post baseline)] was employed. A total of 296 students (mean age = 12.2 ± 0.6 years; 59% female) from 12 schools in Adelaide, South Australia, were recruited, with 149 participants in the Intervention group and 147 in the Control group. The intervention consisted of four classroom lessons delivered at weekly intervals, followed by a group project on sleep topics, which students presented at a parental information evening. Sleep patterns were assessed objectively (actigraphy, n = 175) and subjectively (time-use recall, n = 251) at three time points. Sleep knowledge and sleep hygiene (n = 296) were also measured. Generalised estimating equations were used to compare changes in the Intervention and Control groups. The programme increased time in bed by 10 min (p = 0.03) for the Intervention group relative to the Control group, due to a 10-min delay in wake time (p = 0.00). These changes were not sustained at follow-up. There was no impact on sleep knowledge or sleep hygiene. Investment in the sleep health of youth through sleep education is important but changes to sleep patterns are difficult to achieve. More intensive programmes, programmes with a different focus or programmes targeting different age groups may be more effective. Copyright © 2015 Elsevier B.V. All rights reserved.

Reduction in Acute Gastroenteritis among Military Trainees: Secondary Effects of a Hygiene-based Cluster-Randomized Trial for Skin and Soft Tissue Infection Prevention

PubMed Central

D’Onofrio, Michael J.; Schlett, Carey D.; Millar, Eugene V.; Cui, Tianyuan; Lanier, Jeffrey B.; Law, Natasha N.; Tribble, David R.; Ellis, Michael W.

2018-01-01

Military personnel in congregate settings are at increased risk for acute gastroenteritis.1,2 Personal hygiene (eg, frequent hand washing, hand sanitizers, etc.) remains a central strategy. A skin and soft tissue infection (SSTI) prevention trial was conducted among military trainees.3 Trainees were randomized to 1 of 3 groups with incrementally increasing education- and hygiene-based measures. The principal components were promotion of hand washing in addition to a once-weekly application of a chlorhexidine-based body wash. Herein, we report the trial’s impact on acute gastroenteritis. PMID:25695181

Introduction of an electronic monitoring system for monitoring compliance with Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" methodology

PubMed Central

2011-01-01

Background MedSense is an electronic hand hygiene compliance monitoring system that provides Infection Control Practitioners with continuous access to hand hygiene compliance information by monitoring Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" guidelines. Unlike previous electronic monitoring systems, MedSense operates in open cubicles with multiple beds and does not disrupt existing workflows. Methods This study was conducted in a 6-bed neurosurgical intensive care unit with technical development and evaluation phases. Healthcare workers (HCWs) wore an electronic device in the style of an identity badge to detect hand hygiene opportunities and compliance. We compared the compliance determined by the system and an infection control nurse. At the same time, the system assessed compliance by time of day, day of week, work shift, professional category of HCWs, and individual subject, while the workload of HCWs was monitored by measuring the amount of time they spent in patient zones. Results During the three-month evaluation phase, the system identified 13,694 hand hygiene opportunities from 17 nurses, 3 physiotherapists, and 1 healthcare assistant, resulting in an overall compliance of 35.1% for the unit. The per-indication compliance for Moment 1, 4, and simultaneous 1 and 4 were 21.3% (95%CI: 19.0, 23.6), 39.6% (95%CI: 37.3, 41.9), and 49.2% (95%CI: 46.6, 51.8), respectively, and were all statistically significantly different (p < 0.001). In the four 20-minute sessions when hand hygiene was monitored concurrently by the system and infection control nurse, the compliance were 88.9% and 95.6% respectively (p = 0.34), and the activity indices were 11.1 and 12.9 opportunities per hour, respectively. The hours from 12:00 to 14:00 had a notably lower compliance (21.3%, 95%CI: 17.2, 25.3) than nearly three quarters of the other periods of the day (p < 0.001). Nurses who used shared badges had significantly (p < 0.01) lower compliance (23.7%, 95%CI: 17.8, 29.6) than both the registered nurses (36.1%, 95%CI: 34.2, 37.9) and nursing officers (34.0%, 95%CI: 31.1, 36.9) who used named badges. Conclusion MedSense provides an unobtrusive and objective measurement of hand hygiene compliance. The information is important for staff training by the infection control team and allocation of manpower by hospital administration. PMID:21612666

Introduction of an electronic monitoring system for monitoring compliance with Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" methodology.

PubMed

Cheng, Vincent C C; Tai, Josepha W M; Ho, Sara K Y; Chan, Jasper F W; Hung, Kwan Ngai; Ho, Pak Leung; Yuen, Kwok Yung

2011-05-26

MedSense is an electronic hand hygiene compliance monitoring system that provides Infection Control Practitioners with continuous access to hand hygiene compliance information by monitoring Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" guidelines. Unlike previous electronic monitoring systems, MedSense operates in open cubicles with multiple beds and does not disrupt existing workflows. This study was conducted in a 6-bed neurosurgical intensive care unit with technical development and evaluation phases. Healthcare workers (HCWs) wore an electronic device in the style of an identity badge to detect hand hygiene opportunities and compliance. We compared the compliance determined by the system and an infection control nurse. At the same time, the system assessed compliance by time of day, day of week, work shift, professional category of HCWs, and individual subject, while the workload of HCWs was monitored by measuring the amount of time they spent in patient zones. During the three-month evaluation phase, the system identified 13,694 hand hygiene opportunities from 17 nurses, 3 physiotherapists, and 1 healthcare assistant, resulting in an overall compliance of 35.1% for the unit. The per-indication compliance for Moment 1, 4, and simultaneous 1 and 4 were 21.3% (95%CI: 19.0, 23.6), 39.6% (95%CI: 37.3, 41.9), and 49.2% (95%CI: 46.6, 51.8), respectively, and were all statistically significantly different (p < 0.001). In the four 20-minute sessions when hand hygiene was monitored concurrently by the system and infection control nurse, the compliance were 88.9% and 95.6% respectively (p = 0.34), and the activity indices were 11.1 and 12.9 opportunities per hour, respectively. The hours from 12:00 to 14:00 had a notably lower compliance (21.3%, 95%CI: 17.2, 25.3) than nearly three quarters of the other periods of the day (p < 0.001). Nurses who used shared badges had significantly (p < 0.01) lower compliance (23.7%, 95%CI: 17.8, 29.6) than both the registered nurses (36.1%, 95%CI: 34.2, 37.9) and nursing officers (34.0%, 95%CI: 31.1, 36.9) who used named badges. MedSense provides an unobtrusive and objective measurement of hand hygiene compliance. The information is important for staff training by the infection control team and allocation of manpower by hospital administration.

[Staphylococcus aureus nasal colonization in medical students: importance in nosocomial transmission].

PubMed

López-Aguilera, Sara; Goñi-Yeste, María Del Mar; Barrado, Laura; González-Rodríguez-Salinas, M Carmen; Otero, Joaquín R; Chaves, Fernando

2013-10-01

Staphylococcus aureus is the main pathogen causing nosocomial infections. Health professionals, including medical students, could be a source of transmission. The aims of the study were to determine the rate of nasal carriage of S.aureus susceptible and resistant to methicillin (MRSA) and evaluate the knowledge and adherence that students had about hand hygiene. The study included medical students attached to the Hospital Universitario 12 de Octubre (Madrid, Spain). We collected samples from both nasal vestibules, and the antimicrobial susceptibility was determined on all isolates. Data collection was performed using a self-administered questionnaire that included risk factors for colonization, hygiene habits and knowledge of hand hygiene protocols. Of the 140 students included, 55 (39.3%) were colonized by S.aureus, and 3 (2,1%) by MRSA. The exposure to antibiotics in the last 3 months was lower in colonized students (12.3% vs. 25.9%, P=.03). Self-assessment showed that 56.4% of students almost never washed their hands before to attending to the first patient, and only 38.6% always washed after examining patients. More than a third (35.7%) ignored the hand hygiene protocol, and 38.6% had not received specific formation. Medical students should be included in hospital infection control programs. Hand hygiene training should be given to students before they begin their practices in the hospital. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Pilot study of digital tools to support multimodal hand hygiene in a clinical setting.

PubMed

Thirkell, Gary; Chambers, Joanne; Gilbart, Wayne; Thornhill, Kerrill; Arbogast, James; Lacey, Gerard

2018-03-01

Digital tools for hand hygiene do not share data, limiting their potential to support multimodal programs. The Christie NHS Foundation Trust, United Kingdom, worked with GOJO (in the United States), MEG (in Ireland), and SureWash (in Ireland) to integrate their systems and pilot their combined use in a clinical setting. A 28-bed medical oncology unit piloted the system for 5 weeks. Live data from the tools were combined to create a novel combined risk status metric that was displayed publicly and via a management Web site. The combined risk status reduced over the pilot period. However, larger and longer duration studies are required to reach statistical significance. Staff and especially patient reaction was positive in that 70% of the hand hygiene training events were by patients. The digital tools did not negatively impact clinical workflow and received positive engagement from staff and patients. The combined risk status did not change significantly over the short pilot period because there was also no specific hand hygiene improvement campaign underway at the time of the pilot study. The results indicate that integrated digital tools can provide both rich data and novel tools that both measure impact and provide feedback to support the implementation of multimodal hand hygiene campaigns, reducing the need for significant additional personnel resources. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Determining next steps in a hand hygiene improvement initiative by examining variation in hand hygiene compliance rates.

PubMed

Homa, Karen; Kirkland, Kathryn B

2011-01-01

Health care worker hand hygiene (HH) is a major quality and safety concern since poor hand hygiene has been linked with hospital associated infections. Dartmouth-Hitchcock Medical Center has been involved in a 4-year initiative to improve hand hygiene. In 2006, HH compliance occurred 41% of the time and by 2009, it had improved to 91%. We wanted to understand some of the unexplained variability in HH to help determine where to target more specific strategies. To help determine where some of the variability in HH compliance rates occurred, an analysis of means chart was used to determine whether role type of the health care worker and hospital areas had significantly different HH rates compared with the overall HH rate. The overall HH rate between March 2008 and December 2009 was 87%. There was a wide and significant variation between the 16 groups of 2 types of health care workers in 8 hospital areas from the lowest rate of 64% to a high of 96%. Analysis of means revealed significant differences in HH rates relative to the type of worker and hospital areas. Although the method does not inform the organization of what type of intervention will work where and why, it allows high and low performing groups to be identified, so that organizations can learn from them to generate and test theories.

Healthcare personnel perceptions of hand hygiene monitoring technology.

PubMed

Ellingson, Katherine; Polgreen, Philip M; Schneider, Amy; Shinkunas, Laura; Kaldjian, Lauris C; Wright, Donald; Thomas, Geb W; Segre, Alberto M; Herman, Ted; McDonald, L Clifford; Sinkowitz-Cochran, Ronda

2011-11-01

To assess healthcare personnel (HCP) perceptions regarding implementation of sensor-based electronic systems for automated hand hygiene adherence monitoring. Using a mixed-methods approach, structured focus groups were designed to elicit quantitative and qualitative responses on familiarity, comfort level, and perceived impact of sensor-based hand hygiene adherence monitoring. A university hospital, a Veterans Affairs hospital, and a community hospital in the Midwest. Focus groups were homogenous by HCP type, with separate groups held for leadership, midlevel management, and frontline personnel at each hospital. Overall, 89 HCP participated in 10 focus groups. Levels of familiarity and comfort with electronic oversight technology varied by HCP type; when compared with frontline HCP, those in leadership positions were significantly more familiar with ([Formula: see text]) and more comfortable with ([Formula: see text]) the technology. The most common concerns cited by participants across groups included lack of accuracy in the data produced, such as the inability of the technology to assess the situational context of hand hygiene opportunities, and the potential punitive use of data produced. Across groups, HCP had decreased tolerance for electronic collection of spatial-temporal data, describing such oversight as Big Brother. While substantial concerns were expressed by all types of HCP, participants' recommendations for effective implementation of electronic oversight technologies for hand hygiene monitoring included addressing accuracy issues before implementation and transparent communication with frontline HCP about the intended use of the data.

Effects of alcohol-based hand hygiene solutions on breath alcohol detection in the emergency department.

PubMed

Emerson, Beth L; Whitfill, Travis; Baum, Carl R; Garlin-Kane, Katherine; Santucci, Karen

2016-12-01

This study aimed to investigate the effects of alcohol-based hand hygiene solution (ABHS) use by care providers on point-of-care alcohol breath analyzer interpretation under different clinically relevant conditions. Among each test condition (foam vehicle with immediate testing, gel vehicle with immediate testing, allowing hands to dry after the use of ABHS, and donning gloves after the use of ABHS), alcohol was detected in breath at 1 minute after use of ABHS. Because the use of ABHS by individuals administering breath alcohol detection may result in false-positive detection of alcohol, staff using these devices should consider traditional hand hygiene with soap and water. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Using Olfaction and Unpleasant Reminders to Reduce the Intention-behavior Gap in Hand Washing

PubMed Central

Pellegrino, Robert; Crandall, Philip G.; Seo, Han-Seok

2016-01-01

Lack of hand washing is a leading cause of food borne illnesses. To successfully increase hand hygiene compliance, interventions must have continual engagement with employees. This study used a real-time prospective memory (PM) scenario to measure the effectiveness of a control and sensory reminders of disgust to influence hand washing behavior and performance. First, a model of hand washing performance was built by having six participants’ hands contaminated with GermGlo (a florescent micro-particle) and then washed their hands using predetermined protocols while monitored by an electronic hand hygiene verification (HHV) system. Next, eighty Hispanic/Latino participants, in a between-group experimental design, performed a PM experiment while one of four reminders were present (hand washing poster, disgusting image, disgusting sound, and disgusting odor) as the HHV recorded their hand washing performance. Visual cues, typical of hand washing campaigns, were not as effective at increasing hand hygiene compliance as disgust-induced sensory cues. Furthermore, olfactory disgust showed a significantly higher probability that individuals would engage in hand washing behaviors than all other conditions. This study provides new insight into the effectiveness of different senses and emotion to reduce the intention-behavior gap associated with modifying behaviors, and broadens current PM research to a real-time application. PMID:26732033

Developing professional habits of hand hygiene in intensive care settings: An action-research intervention.

PubMed

Battistella, Giuseppe; Berto, Giuliana; Bazzo, Stefania

2017-02-01

To explore perceptions and unconscious psychological processes underlying handwashing behaviours of intensive care nurses, to implement organisational innovations for improving hand hygiene in clinical practice. An action-research intervention was performed in 2012 and 2013 in the intensive care unit of a public hospital in Italy, consisting of: structured interviews, semantic analysis, development and validation of a questionnaire, team discussion, project design and implementation. Five general workers, 16 staff nurses and 53 nurse students participated in the various stages. Social handwashing emerged as a structured and efficient habit, which follows automatically the pattern "cue/behaviour/gratification" when hands are perceived as "dirty". The perception of "dirt" starts unconsciously the process of social washing also in professional settings. Professional handwashing is perceived as goal-directed. The main concern identified is the fact that washing hands requires too much time to be performed in a setting of urgency. These findings addressed participants to develop a professional "habit-directed" hand hygiene procedure, to be implemented at beginning of workshifts. Handwashing is a ritualistic behaviour driven by deep and unconscious patterns, and social habits affect professional practice. Creating professional habits of hand hygiene could be a key solution to improve compliance in intensive care settings. Copyright © 2016. Published by Elsevier Ltd.

Factors influencing knowledge and practice of hygiene in Water, Sanitation and Hygiene (WASH) programme areas of Bangladesh Rural Advancement Committee.

PubMed

Akter, Tahera; Ali, Armm Mehrab

2014-01-01

Improved hygiene is one of the most effective means of reducing disease occurrence. However, a complete understanding of the factors that contribute to such improvement are not clear. This study explored factors that facilitate and/or impede hygiene behavior in water, sanitation and hygiene (WASH) intervention areas using qualitative research techniques. The Bangladesh Rural Advancement Committee (BRAC) has been providing WASH intervention to 150 rural upazilas (sub-districts) since 2006. For qualitative data collection, in-depth interviews were conducted with 144 purposively selected women from six upazilas across Bangladesh. A woman in the household was considered as a case and interviewed regarding various aspects of sanitation and hygiene, using a checklist. Some practices, such as cleanliness of latrines, and availability of soap, water, slippers in their designated place were physically verified. The respondents' hygiene behavior was mainly facilitated by improved knowledge and awareness of health and environment-related issues. Latrine ownership increased through financial assistance, resulting in improved privacy, social prestige, and a heightened sense of responsibility towards maintaining a healthy life. However, lack of interest in attending cluster meetings, traditional knowledge, poverty, and lack of will were some of the factors impeding knowledge and hygiene practice. In addition, attitude played a definitive role, with some respondents not practicing hygiene in spite of having the financial ability to do so. They expected full financial support for creating sanitation and hygiene facilities in their household despite BRAC's policy of providing such support only to the 'ultra-poor'. The identified impeding factors often act as barriers to transformation of hygiene-related knowledge into practice and practice into habit. More motivational cluster meetings with large-scale participation and periodic home visits by the programme organizers are imperative as they markedly improve hygiene behavior.

Delayed norovirus epidemic in the 2009-2010 season in Japan: potential relationship with intensive hand sanitizer use for pandemic influenza.

PubMed

Inaida, S; Shobugawa, Y; Matsuno, S; Saito, R; Suzuki, H

2016-09-01

Norovirus (NoV) epidemics normally peak in December in Japan; however, the peak in the 2009-2010 season was delayed until the fourth week of January 2010. We suspected intensive hand hygiene that was conducted for a previous pandemic influenza in 2009 as the cause of this delay. We analysed the NoV epidemic trend, based on national surveillance data, and its associations with monthly output data for hand hygiene products, including alcohol-based skin antiseptics and hand soap. The delayed peak in the NoV incidence in the 2009-2010 season had the lowest number of recorded cases of the five seasons studied (2006-2007 to 2010-2011). GII.4 was the most commonly occurring genotype. The monthly relative risk of NoV and monthly output of both alcohol-based skin antiseptics and hand soap were significantly and negatively correlated. Our findings suggest an association between hand hygiene using these products and prevention of NoV transmission.

Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial

PubMed Central

2012-01-01

Background Hand hygiene is considered as an important means of infection control. We explored whether guided hand hygiene together with transmission-limiting behaviour reduces infection episodes and lost days of work in a common work environment in an open cluster-randomized 3-arm intervention trial. Methods A total of 21 clusters (683 persons) were randomized to implement hand hygiene with soap and water (257 persons), with alcohol-based hand rub (202 persons), or to serve as a control (224 persons). Participants in both intervention arms also received standardized instructions on how to limit the transmission of infections. The intervention period (16 months) included the emergence of the 2009 influenza pandemic and the subsequent national hand hygiene campaign influencing also the control arm. Results In the total follow-up period there was a 6.7% reduction of infection episodes in the soap-and water arm (p = 0.04). Before the onset of the anti-pandemic campaign, a statistically significant (p = 0.002) difference in the mean occurrence of infection episodes was observed between the control (6.0 per year) and the soap-and-water arm (5.0 per year) but not between the control and the alcohol-rub arm (5.6 per year). Neither intervention had a decreasing effect on absence from work. Conclusions We conclude that intensified hand hygiene using water and soap together with behavioural recommendations can reduce the occurrence of self-reported acute illnesses in common work environment. Surprisingly, the occurrence of reported sick leaves also increased in the soap-and water-arm. Trial Registration ClinicalTrials.gov: NCT00981877 Source of funding The Finnish Work Environment Fund and the National Institute for Health and Welfare. PMID:22243622

Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial.

PubMed

Savolainen-Kopra, Carita; Haapakoski, Jaason; Peltola, Piia A; Ziegler, Thedi; Korpela, Terttu; Anttila, Pirjo; Amiryousefi, Ali; Huovinen, Pentti; Huvinen, Markku; Noronen, Heikki; Riikkala, Pia; Roivainen, Merja; Ruutu, Petri; Teirilä, Juha; Vartiainen, Erkki; Hovi, Tapani

2012-01-16

Hand hygiene is considered as an important means of infection control. We explored whether guided hand hygiene together with transmission-limiting behaviour reduces infection episodes and lost days of work in a common work environment in an open cluster-randomized 3-arm intervention trial. A total of 21 clusters (683 persons) were randomized to implement hand hygiene with soap and water (257 persons), with alcohol-based hand rub (202 persons), or to serve as a control (224 persons). Participants in both intervention arms also received standardized instructions on how to limit the transmission of infections. The intervention period (16 months) included the emergence of the 2009 influenza pandemic and the subsequent national hand hygiene campaign influencing also the control arm. In the total follow-up period there was a 6.7% reduction of infection episodes in the soap-and water arm (p = 0.04). Before the onset of the anti-pandemic campaign, a statistically significant (p = 0.002) difference in the mean occurrence of infection episodes was observed between the control (6.0 per year) and the soap-and-water arm (5.0 per year) but not between the control and the alcohol-rub arm (5.6 per year). Neither intervention had a decreasing effect on absence from work. We conclude that intensified hand hygiene using water and soap together with behavioural recommendations can reduce the occurrence of self-reported acute illnesses in common work environment. Surprisingly, the occurrence of reported sick leaves also increased in the soap-and water-arm. ClinicalTrials.gov: NCT00981877 The Finnish Work Environment Fund and the National Institute for Health and Welfare.

Assessment of two hand hygiene regimens for intensive care unit personnel.

PubMed

Larson, E L; Aiello, A E; Bastyr, J; Lyle, C; Stahl, J; Cronquist, A; Lai, L; Della-Latta, P

2001-05-01

To compare skin condition and skin microbiology among intensive care unit personnel using one of two randomly assigned hand hygiene regimens: a 2% chlorhexidine gluconate (CHG)-containing traditional antiseptic wash and a waterless handrub containing 61% ethanol with emollients (ALC). Prospective, randomized clinical trial. Two critical care units (medical and surgical) in a large, metropolitan academic health center in Manhattan. Fifty staff members (physicians, nurses, housekeepers, respiratory therapists) working full time in the intensive care unit. One of two hand hygiene regimens randomly assigned for four consecutive weeks. The two outcomes were skin condition (measured by two tools: Hand Skin Assessment form and Visual Skin Scaling form) and skin microbiology. Samples were obtained at baseline, on day 1, and at the end of wks 2 and 4. Participants in the ALC group had significant improvements in the Hand Skin Assessment scores at wk 4 (p = 0.04) and in Visual Skin Scaling scores at wks 3 (p = 0.01) and 4 (p = 0.0005). There were no significant differences in numbers of colony-forming units between participants in the CHG or ALC group at any time period. The ALC regimen required significantly less time than the CHG regimen (mean: 12.7 secs and 21.1 secs, respectively; p = 0.000) and resulted in a 50% reduction in material costs. Changes in hand hygiene practices in acute care settings from the traditional antiseptic wash to use of plain, mild soap and an alcohol-based product should be considered. Further research is needed to examine the association between use of antiseptic products for hand hygiene of staff and reductions in nosocomial infection rates among patients.

Hand hygiene posters: selling the message.

PubMed

Jenner, E A; Jones, F; Fletcher, B C; Miller, L; Scott, G M

2005-02-01

This literature review was undertaken to determine the established theory and research that might be utilized to inform the construction of persuasive messages on hand hygiene posters. It discusses the principles of message framing and the use of fear appeals. Current theory suggests that the most effective messages for health promotion behaviours should be framed in terms of gains rather than losses for the individual. However, as clinical hand hygiene is largely for the benefit of others (i.e. patients), messages should also invoke a sense of personal responsibility and appeal to altruistic behaviour. The use of repeated minimal fear appeals have their place. Posters that simply convey training messages are not effective persuaders.

[Preventive measures for avoiding transmission of microorganisms between hospitalised patients. Hand hygiene].

PubMed

Lupión, Carmen; López-Cortés, Luis Eduardo; Rodríguez-Baño, Jesús

2014-11-01

Health-care associated infections are an important public health problem worldwide. The rates of health-care associated infections are indicators of the quality of health care. The infection control activities related to prevention of transmission of hospital microorganisms can be grouped in 4 mayor areas: standard precautions, specific precautions (including isolation if appropriate), environmental cleaning and disinfection, and surveillance activities (including providing infection rates and monitoring procedures). Hand hygiene and the correct use of gloves are the most important measures to prevent health-care associated infections and to avoid the dissemination of multidrug-resistant microorganisms. Continuous educational activities aimed at improving adherence to hand hygiene are needed. Periodical assessment of adherence to hand hygiene recommendations with feed-back have been shown to provide sustained improvement. Several complementary activities are being evaluated, including skin decolonization prior to certain surgeries, a package of measures in patients with central venous catheters or mechanical ventilation, and universal body hygiene with chlorhexidine. The present area of discussion concerns in which situations and in which groups would such measures be effective and efficient. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Pilot study to evaluate 3 hygiene protocols on the reduction of bacterial load on the hands of veterinary staff performing routine equine physical examinations.

PubMed

Traub-Dargatz, Josie L; Weese, J Scott; Rousseau, Joyce D; Dunowska, Magdalena; Morley, Paul S; Dargatz, David A

2006-07-01

Reduction factors (RFs) for bacterial counts on examiners' hands were compared when performing a standardized equine physical examination, followed by the use of one of 3 hand-hygiene protocols (washing with soap, ethanol gel application, and chlorohexidine-ethanol application). The mean RFs were 1.29 log10 and 1.44 log10 at 2 study sites for the alcohol-gel (62% ethyl alcohol active ingredient) protocols and 1.47 log10 and 1.94 log10 at 2 study sites for the chlorhexidine-alcohol (61% ethyl alcohol plus 1% chlorhexidine active ingredients) protocols, respectively. The RFs were significantly different (P < 0.0001) between the hand-washing group and the other 2 treatment groups (the alcohol-gel and the chlorhexidine-alcohol lotion). The use of alcohol-based gels or chlorhexidine-alcohol hand hygiene protocols must still be proven effective in equine practice settings, but in this study, these protocols were equivalent or superior to hand washing for reduction in bacterial load on the hands of people after they perform routine physical examinations.

Pilot study to evaluate 3 hygiene protocols on the reduction of bacterial load on the hands of veterinary staff performing routine equine physical examinations

PubMed Central

Traub-Dargatz, Josie L.; Weese, J. Scott; Rousseau, Joyce D.; Dunowska, Magdalena; Morley, Paul S.; Dargatz, David A.

2006-01-01

Abstract Reduction factors (RFs) for bacterial counts on examiners’ hands were compared when performing a standardized equine physical examination, followed by the use of one of 3 hand-hygiene protocols (washing with soap, ethanol gel application, and chlorohexidine-ethanol application). The mean RFs were 1.29 log10 and 1.44 log10 at 2 study sites for the alcohol-gel (62% ethyl alcohol active ingredient) protocols and 1.47 log10 and 1.94 log10 at 2 study sites for the chlorhexidine-alcohol (61% ethyl alcohol plus 1% chlorhexidine active ingredients) protocols, respectively. The RFs were significantly different (P < 0.0001) between the hand-washing group and the other 2 treatment groups (the alcohol-gel and the chlorhexidine-alcohol lotion). The use of alcohol-based gels or chlorhexidine-alcohol hand hygiene protocols must still be proven effective in equine practice settings, but in this study, these protocols were equivalent or superior to hand washing for reduction in bacterial load on the hands of people after they perform routine physical examinations. PMID:16898109

The role of message strategy in improving hand hygiene compliance rates.

PubMed

Taylor, Ronald E

2015-11-01

Despite increased attention to hand hygiene over the past decade compliance rates remain relatively low. Although there have been a number of improvements in the science of hand hygiene, very little attention has been devoted to the messages that promote it. A total of 86 health care workers who are members of Association for Professionals in Infection Control and Epidemiology chapters participated in an online evaluation of 6 message strategies. The participants evaluated the strategies on ease of understanding, believability, and whether the message strategies were likely to lead to increased handwashing. Of the 6 strategies--ego, social, sensory, routine, acute need, and ration--the social strategy was rated the most likely to lead to action. The sensory strategy was seen as not only least likely but also counterproductive. ICPs should add a social message strategy to communication programs promoting hand hygiene. Although further testing is needed, ego, routine, and acute need strategies show promise for tapping into motivations that lead to improved compliance. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Cleanliness in context: reconciling hygiene with a modern microbial perspective.

PubMed

Vandegrift, Roo; Bateman, Ashley C; Siemens, Kyla N; Nguyen, May; Wilson, Hannah E; Green, Jessica L; Van Den Wymelenberg, Kevin G; Hickey, Roxana J

2017-07-14

The concept of hygiene is rooted in the relationship between cleanliness and the maintenance of good health. Since the widespread acceptance of the germ theory of disease, hygiene has become increasingly conflated with sterilization. In reviewing studies across the hygiene literature (most often hand hygiene), we found that nearly all studies of hand hygiene utilize bulk reduction in bacterial load as a proxy for reduced transmission of pathogenic organisms. This treatment of hygiene may be insufficient in light of recent microbial ecology research, which has demonstrated that humans have intimate and evolutionarily significant relationships with a diverse assemblage of microorganisms (our microbiota). The human skin is home to a diverse and specific community of microorganisms, which include members that exist across the ecological spectrum from pathogen through commensal to mutualist. Most evidence suggests that the skin microbiota is likely of direct benefit to the host and only rarely exhibits pathogenicity. This complex ecological context suggests that the conception of hygiene as a unilateral reduction or removal of microbes has outlived its usefulness. As such, we suggest the explicit definition of hygiene as "those actions and practices that reduce the spread or transmission of pathogenic microorganisms, and thus reduce the incidence of disease."

A unified framework for developing effective hygiene procedures for hands, environmental surfaces and laundry in healthcare, domestic, food handling and other settings

PubMed Central

Bloomfield, Sally F.; Carling, Philip C.; Exner, Martin

2017-01-01

Hygiene procedures for hands, surfaces and fabrics are central to preventing spread of infection in settings including healthcare, food production, catering, agriculture, public settings, and home and everyday life. They are used in situations including hand hygiene, clinical procedures, decontamination of environmental surfaces, respiratory hygiene, food handling, laundry hygiene, toilet hygiene and so on. Although the principles are common to all, approaches currently used in different settings are inconsistent. A concern is the use of inconsistent terminology which is misleading, especially to people we need to communicate with such as the public or cleaning professionals. This paper reviews the data on current approaches, alongside new insights to developing hygiene procedures. Using this data, we propose a more scientifically-grounded framework for developing procedures that maximize protection against infection, based on consistent principles and terminology, and applicable across all settings. A key feature is use of test models which assess the state of surfaces after treatment rather than product performance alone. This allows procedures that rely on removal of microbes to be compared with those employing chemical or thermal inactivation. This makes it possible to ensure that a consistent “safety target level” is achieved regardless of the type of procedure used, and allows us deliver maximum health benefit whilst ensuring prudent usage of antimicrobial agents, detergents, water and energy. PMID:28670508

Exploring the use of entertainment-education YouTube videos focused on infection prevention and control.

PubMed

Lim, Kathryn; Kilpatrick, Claire; Storr, Julie; Seale, Holly

2018-06-05

As a communications strategy, education entertainment has been used to inform, influence, and shift societal and individual behaviors. Recently, there has been an increasing number of entertainment-education YouTube videos focused on hand hygiene. However, there is currently no understanding about the quality of these videos; therefore, this study aimed to explore the social media content and user engagement with these videos. The search terms "hand hygiene" and "hand hygiene education" were used to query YouTube. Video content had to be directed at a health care professional audience. Using author designed checklists, each video was systematically evaluated and grouped according to educational usefulness and was subsequently evaluated against the categories of attractiveness, comprehension, and persuasiveness. A total of 400 videos were screened, with 70 videos retained for analysis. Of these, 55.7% (n = 39) were categorized as educationally useful. Overall, educationally useful videos scored higher than noneducationally useful videos across the categories of attractiveness, comprehension, and persuasiveness. Miscommunication of the concept of My 5 Moments for Hand Hygiene was observed in several of the YouTube videos. The availability of educationally useful videos in relation to hand hygiene is evident; however, it is clear that there are opportunities for contributors using this medium to strengthen their alignment with social media best practice principles to maximize the effectiveness, reach, and sustainability of their content. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Physician 'defiance' towards hand hygiene compliance: Is there a theory-practice-ethics gap?

PubMed

Mortell, Manfred; Balkhy, Hanan H; Tannous, Elias B; Jong, Mei Thiee

2013-07-01

The theory-practice gap has always existed [1,2]. This gap is often cited as a culmination of theory being idealistic and impractical, even if practical and beneficial, is often ignored. Most of the evidence relating to the non-integration of theory and practice assumes that environmental factors are responsible and will affect learning and practice outcomes, hence the gap. Therefore, the author believes that to 'bridge the gap' between theory and practice, an additional dimension is required: ethics. A moral duty and obligation ensuring theory and practice integrate. In order to effectively implement new practices, one must deem these practices as worthy and relevant to their role as healthcare providers (HCP). Hence, this introduces a new concept which the author refers to as the theory-practice-ethics gap. This theory-practice-ethics gap must be considered when reviewing some of the unacceptable outcomes in healthcare practice [3]. The literature suggests that there is a crisis of ethics where theory and practice integrate, and healthcare providers are failing to fulfill our duty as patient advocates. Physician hand hygiene practices and compliance at King Abdulaziz Cardiac Centre (KACC) are consistent with those of other physicians in the global healthcare arena. That is one of noncompliance to King Abdulaziz Medical City (KAMC) organizational expectations and the World Health Organization (WHO) requirements? An observational study was conducted on the compliance of cardiac surgeons, cardiologists and nurses in the authors' cardiac center from January 2010 to December 2011. The hand hygiene (HH) compliance elements that were evaluated pertained to the WHO's five moments of HH recommendations. The data was obtained through direct observation by KAMC infection prevention and control practitioners. Physician hand hygiene compliance at KACC was consistently less than 60%, with nurses regularly encouraging physicians to be diligent with hand hygiene practices in the clinical area. Hand hygiene compliance will not improve unless evidence-based recommendations are adopted and endorsed by all healthcare professionals and providers.

Epidemiologic Background of Hand Hygiene and Evaluation of the Most Important Agents for Scrubs and Rubs

PubMed Central

Kampf, Günter; Kramer, Axel

2004-01-01

The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product. PMID:15489352

Personal and household hygiene, environmental contamination, and health in undergraduate residence halls in New York City, 2011.

PubMed

Miko, Benjamin A; Cohen, Bevin; Haxall, Katharine; Conway, Laurie; Kelly, Nicole; Stare, Dianne; Tropiano, Christina; Gilman, Allan; Seward, Samuel L; Larson, Elaine

2013-01-01

While several studies have documented the importance of hand washing in the university setting, the added role of environmental hygiene remains poorly understood. The purpose of this study was to characterize the personal and environmental hygiene habits of college students, define the determinants of hygiene in this population, and assess the relationship between reported hygiene behaviors, environmental contamination, and health status. 501 undergraduate students completed a previously validated survey assessing baseline demographics, hygiene habits, determinants of hygiene, and health status. Sixty survey respondents had microbiological samples taken from eight standardized surfaces in their dormitory environment. Bacterial contamination was assessed using standard quantitative bacterial culture techniques. Additional culturing for coagulase-positive Staphylococcus and coliforms was performed using selective agar. While the vast majority of study participants (n = 461, 92%) believed that hand washing was important for infection prevention, there was a large amount of variation in reported personal hygiene practices. More women than men reported consistent hand washing before preparing food (p = .002) and after using the toilet (p = .001). Environmental hygiene showed similar variability although 73.3% (n = 367) of subjects reported dormitory cleaning at least once per month. Contamination of certain surfaces was common, with at least one third of all bookshelves, desks, refrigerator handles, toilet handles, and bathroom door handles positive for >10 CFU of bacteria per 4 cm(2) area. Coagulase-positive Staphylococcus was detected in three participants' rooms (5%) and coliforms were present in six students' rooms (10%). Surface contamination with any bacteria did not vary by frequency of cleaning or frequency of illness (p>.05). Our results suggest that surface contamination, while prevalent, is unrelated to reported hygiene or health in the university setting. Further research into environmental reservoirs of infectious diseases may delineate whether surface decontamination is an effective target of hygiene interventions in this population.

Personal and Household Hygiene, Environmental Contamination, and Health in Undergraduate Residence Halls in New York City, 2011

PubMed Central

Haxall, Katharine; Conway, Laurie; Kelly, Nicole; Stare, Dianne; Tropiano, Christina; Gilman, Allan; Seward, Samuel L.; Larson, Elaine

2013-01-01

Background While several studies have documented the importance of hand washing in the university setting, the added role of environmental hygiene remains poorly understood. The purpose of this study was to characterize the personal and environmental hygiene habits of college students, define the determinants of hygiene in this population, and assess the relationship between reported hygiene behaviors, environmental contamination, and health status. Methods 501 undergraduate students completed a previously validated survey assessing baseline demographics, hygiene habits, determinants of hygiene, and health status. Sixty survey respondents had microbiological samples taken from eight standardized surfaces in their dormitory environment. Bacterial contamination was assessed using standard quantitative bacterial culture techniques. Additional culturing for coagulase-positive Staphylococcus and coliforms was performed using selective agar. Results While the vast majority of study participants (n = 461, 92%) believed that hand washing was important for infection prevention, there was a large amount of variation in reported personal hygiene practices. More women than men reported consistent hand washing before preparing food (p = .002) and after using the toilet (p = .001). Environmental hygiene showed similar variability although 73.3% (n = 367) of subjects reported dormitory cleaning at least once per month. Contamination of certain surfaces was common, with at least one third of all bookshelves, desks, refrigerator handles, toilet handles, and bathroom door handles positive for >10 CFU of bacteria per 4 cm2 area. Coagulase-positive Staphylococcus was detected in three participants' rooms (5%) and coliforms were present in six students' rooms (10%). Surface contamination with any bacteria did not vary by frequency of cleaning or frequency of illness (p>.05). Conclusions Our results suggest that surface contamination, while prevalent, is unrelated to reported hygiene or health in the university setting. Further research into environmental reservoirs of infectious diseases may delineate whether surface decontamination is an effective target of hygiene interventions in this population. PMID:24312303

The impact of a school dental service on the periodontal health and oral hygiene status of 6-year-old Sowetan learners.

PubMed

Maraj, E; Kroon, J

2004-10-01

The public oral health sector offers essentially two types of services to learners viz, (i) clinical services, where curative and restorative treatment, and prophylactic care is provided, and (ii) school-based services which focus on a primary preventive approach to oral health that consists of health promotion and specific protection initiatives e.g. brushing programmes. Learners may be exposed to a combination of clinical and school-based services or to school-based services only. The objective of this study was to compare the impact of services delivered by the public oral health sector on periodontal health and oral hygiene status of 6-year-old Sowetan learners to a control group who were not exposed to any organised oral health programme. Follow-up visits were conducted every 6 months from baseline for a period of 18 months. A significant decrease in the percentage of learners with healthy periodontal tissues and a significant increase in the percentage of learners with gingival bleeding was observed for all three cohorts. Oral hygiene performance, assessed according to the Patient Hygiene Performance (PHP) index, demonstrated no improvement after 18 months, although the mean scores remained within the 'fair' interval. No significant benefit could be demonstrated in providing a clinical services component in combination with school-based services. No significant positive impact of the brushing programme on oral hygiene and periodontal health status of learners was observed after 18 months when compared to a control group.

The impact of national-level interventions to improve hygiene on the incidence of irritant contact dermatitis in healthcare workers: changes in incidence from 1996 to 2012 and interrupted times series analysis.

PubMed

Stocks, S J; McNamee, R; Turner, S; Carder, M; Agius, R M

2015-07-01

Reducing healthcare-associated infections (HCAI) has been a priority in the U.K. over recent decades and this has been reflected in interventions focusing on improving hygiene procedures. To evaluate whether these interventions coincided with an increased incidence of work-related irritant contact dermatitis (ICD) attributed to hand hygiene or/and other hygiene measures in healthcare workers (HCWs). A quasi-experimental (interrupted time series) design was used to compare trends in incidence of ICD in HCWs attributed to hygiene before and after interventions to reduce HCAI with trends in the same periods in control groups (ICD in other workers). Cases of ICD reported to a U.K. surveillance scheme from 1996 to 2012 were analysed. The time periods compared were defined objectively based on the dates of the publication of national evidence-based guidelines, the U.K. Health Act 2006 and the Cleanyourhands campaign. The reported incidence of ICD in HCWs attributed to hygiene has increased steadily from 1996 to 2012 [annual incidence rate ratio (95% confidence interval): hand hygiene only 1.10 (1.07-1.12); all hygiene 1.05 (1.03-1.07)], whereas the incidence in other workers is declining. An increase in incidence of ICD in HCWs attributed to hand hygiene was observed at the beginning of the Cleanyourhands campaign. The increasing incidence of ICD in HCWs combined with the popularity of interventions to reduce HCAI warrants increased efforts towards identifying products and implementing practices posing the least risk of ICD. © 2015 British Association of Dermatologists.

Health care workers' hand decontamination practices: an Irish study.

PubMed

Creedon, Sile A

2006-02-01

The primary purpose of this quasi-experimental research is to observe health care workers' compliance with hand-hygiene guidelines during patient care in an intensive care unit in Ireland before (pretest) and after (posttest) implementation of a multifaceted hand-hygiene program. Health care workers' attitudes, beliefs, and knowledge in relation to compliance with handwashing guidelines were also investigated. A convenience sample of nurses, doctors, physiotherapists, and care assistants (n = 73 observational participants, n = 62 questionnaire respondents) was used. Data (N = 314 observations, 62 questionnaires) were analyzed descriptively and cross-tabulated using chi-square (Pearson's) and Mann-Whitney statistical tests. Results revealed that a significant shift (32%) occurred in health care workers' compliance with handwashing guidelines (pretest 51%, posttest 83%, p < .001) following the interventional hand-hygiene program. Significant changes were also found in relation to health care workers' attitudes, beliefs, and knowledge (p < .05).

Outcomes of a pilot hand hygiene randomized cluster trial to reduce communicable infections among US office-based employees.

PubMed

Stedman-Smith, Maggie; DuBois, Cathy L Z; Grey, Scott F; Kingsbury, Diana M; Shakya, Sunita; Scofield, Jennifer; Slenkovich, Ken

2015-04-01

To determine the effectiveness of an office-based multimodal hand hygiene improvement intervention in reducing self-reported communicable infections and work-related absence. A randomized cluster trial including an electronic training video, hand sanitizer, and educational posters (n = 131, intervention; n = 193, control). Primary outcomes include (1) self-reported acute respiratory infections (ARIs)/influenza-like illness (ILI) and/or gastrointestinal (GI) infections during the prior 30 days; and (2) related lost work days. Incidence rate ratios calculated using generalized linear mixed models with a Poisson distribution, adjusted for confounders and random cluster effects. A 31% relative reduction in self-reported combined ARI-ILI/GI infections (incidence rate ratio: 0.69; 95% confidence interval, 0.49 to 0.98). A 21% nonsignificant relative reduction in lost work days. An office-based multimodal hand hygiene improvement intervention demonstrated a substantive reduction in self-reported combined ARI-ILI/GI infections.

Associations between school- and household-level water, sanitation and hygiene conditions and soil-transmitted helminth infection among Kenyan school children.

PubMed

Freeman, M C; Chard, A N; Nikolay, B; Garn, J V; Okoyo, C; Kihara, J; Njenga, S M; Pullan, R L; Brooker, S J; Mwandawiro, C S

2015-08-07

Soil-transmitted helminths, a class of parasitic intestinal worms, are pervasive in many low-income settings. Infection among children can lead to poor nutritional outcomes, anaemia, and reduced cognition. Mass treatment, typically administered through schools, with yearly or biannual drugs is inexpensive and can reduce worm burden, but reinfection can occur rapidly. Access to and use of sanitation facilities and proper hygiene can reduce infection, but rigorous data are scarce. Among school-age children, infection can occur at home or at school, but little is known about the relative importance of WASH in transmission in these two settings. We explored the relationships between school and household water, sanitation, and hygiene conditions and behaviours during the baseline of a large-scale mass drug administration programme in Kenya. We assessed several WASH measures to quantify the exposure of school children, and developed theory and empirically-based parsimonious models. Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection. No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean.

A pre- and post-intervention study of infection control in equine hospitals in Sweden

PubMed Central

2014-01-01

Background Detection of nosocomial methicillin-resistant Staphylococcus aureus infections in horses in Sweden has increased attention on infection control (IC) in equine hospitals. This study established baseline data on IC programmes within such settings, evaluated compliance with some IC procedures before and after an education intervention, and examined barriers to compliance. The study was carried out between 2008 and 2011 in four Swedish equine hospitals. Data on current IC of each hospital, purchase data on hand sanitisers and disposable gloves per patient, and direct observations of compliance with procedures were monitored pre- and post-intervention. The intervention comprised a lecture on common IC and a review of each hospital’s current procedures. For comparison, retrospective purchase data were reviewed. A questionnaire on individual compliance, experiences and opinions of IC was issued to employees. Results Three hospitals completed the study, while the fourth reported its IC procedures and completed the questionnaire. Actual numbers of procedures, content and level of documentation differed among the hospitals. Similarities were poor or absent IC implementation strategy, lack of active surveillance of compliance with procedures and no monitoring of such as nosocomial infections. Among the hospitals which completed the study, two reported pre-intervention observation of compliance, while all three reported post-intervention observations. The purchase data showed trends for changes over time, although not uniformly related to the intervention. One hospital demonstrated a significant post-intervention increase in compliance with glove procedures, accompanied by a non-significant post-intervention increase in purchases figures. Compliance with dress code and personal appearance was high in all three hospitals (92-100%), while compliance with hand hygiene procedures was generally poorer. Barriers to compliance cited in the questionnaire (data from four hospitals) included insufficient supplies of hygiene products, lack of readily accessible places for cleaning, insufficient knowledge and high workload. Conclusions Potential for easily attainable improvements in IC, such as traceability of documents, implementation strategies and surveillance of efficacy, was revealed. Attention to hand hygiene implementation and improvement of logistics appeared important. Data on purchases per patient were readily available and therefore applicable for intra-hospital surveillance of IC trends over time. PMID:25146752

Investigating the impact of a community-based geriatric dentistry rotation on oral health literacy and oral hygiene of older adults.

PubMed

Hjertstedt, Jadwiga; Barnes, Stacy L; Sjostedt, Jennifer M

2014-12-01

This study investigated the impact of a community-based geriatric dentistry rotation on older adults' oral health literacy and oral hygiene. A pre-post study design was used to assess the impact of the educational intervention. The study sample consisted of 67 older adults, who resided in independent or assisted living apartments (age: M = 84, SD = 7.3). Over the course of the programme, participants received patient education pertaining to oral health and oral hygiene. Oral health literacy was assessed using the Rapid Estimation of Adult Literacy in Dentistry (REALD-30) test at baseline and on the final visit. Oral hygiene was measured on four visits using the O'Leary, Drake and Naylor Plaque Control Record (PI). REALD-30 scores significantly increased, and PI scores significantly decreased for all subjects following participation in the programme (p < 0.001, and p < 0.01, respectively). Hierarchical multiple regression demonstrated that neither study subjects' individual characteristics nor their health literacy significantly predicted the change in oral hygiene. This study demonstrated that a community-based geriatric dentistry rotation involving multiple interactions with dental students can in the short term significantly and positively impact older adults' oral health literacy and oral hygiene status. © 2013 The Gerodontology Society and John Wiley & Sons A/S.

[Street food: analysis of hygienic and sanitary conditions of food handlers].

PubMed

de Souza, Giovanna Carbonera; dos Santos, Celso Tadeu Barbosa; Andrade, Anderson Assunção; Alves, Luciene

2015-08-01

The consumption of street food is an economical and practical alternative for the population. However, concerns regarding the safety of these foods are increasing. Thus, this study aimed to analyze the hygienic and sanitary conditions of the street food trade in Uberaba in the State of Minas Gerais. For this purpose, 30 street vending sites were evaluated using a structured questionnaire and microbiological analysis of food handlers' hands and food contact recipients and surfaces. The findings showed low adequacy of street food regarding hand hygiene and food contact surfaces. With respect to surfaces, the results for mesophilic aerobic microorganisms revealed that only 23.3% had satisfactory sanitary conditions. The level of contamination of hands by fecal thermotolerant coliforms and/or Coagulase positive Staphylococci was unsatisfactory in approximately 47% of food handlers. The conclusion drawn is that the hygienic and sanitary conditions of food handlers in Uberaba are poor. It is therefore necessary to adopt effective and permanent training programs on food safety for food handlers urgently.

Rate of Compliance with Hand Hygiene by Dental Healthcare Personnel (DHCP) within a Dentistry Healthcare First Aid Facility.

PubMed

de Amorim-Finzi, Marcília Batista; Cury, Mauro Vieira Cezar; Costa, Cláudio Rodrigues R; Dos Santos, Angelis Costa; de Melo, Geraldo Batista

2010-07-01

To evaluate the compliance with the opportunities of hand hygiene by dentistry school healthcare professionals, as well as the higher choice products. Through direct observation, the oral healthcare team-professors, oral and maxillofacial surgery residents, graduation students-for daily care were monitored: before performing the first treatment of the shift, after snacks and meals, and after going to the bathroom (initial opportunities) as well as between patients' care, and after ending the shift (following opportunities). The professors' category profited 78.4% of all opportunities while residents and graduation students did not reach 50.0% of compliance. Statistically significant data (P

Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review

PubMed Central

Musuuza, Jackson S.; Barker, Anna; Ngam, Caitlyn; Vellardita, Lia; Safdar, Nasia

2016-01-01

OBJECTIVE Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3) quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation. DESIGN Systematic review METHODS A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and assessment of study quality was conducted for each study reviewed. RESULTS A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100 (20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most frequently reported measure. CONCLUSIONS Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To facilitate replication and effective implementation, reporting fidelity should be standard practice when describing results of complex behavioral interventions such as hand hygiene. PMID:26861117

Enhancing the evaluation of pathogen transmission risk in a hospital by merging hand-hygiene compliance and contact data: a proof-of-concept study.

PubMed

Mastrandrea, Rossana; Soto-Aladro, Alberto; Brouqui, Philippe; Barrat, Alain

2015-09-10

Hand-hygiene compliance and contacts of health-care workers largely determine the potential paths of pathogen transmission in hospital wards. We explored how the combination of data collected by two automated infrastructures based on wearable sensors and recording (1) use of hydro-alcoholic solution and (2) contacts of health-care workers provide an enhanced view of the risk of transmission events in the ward. We perform a proof-of-concept observational study. Detailed data on contact patterns and hand-hygiene compliance of health-care workers were collected by wearable sensors over 12 days in an infectious disease unit of a hospital in Marseilles, France. 10,837 contact events among 10 doctors, 4 nurses, 4 nurses' aids and 4 housekeeping staff were recorded during the study. Most contacts took place among medical doctors. Aggregate contact durations were highly heterogeneous and the resulting contact network was highly structured. 510 visits of health-care workers to patients' rooms were recorded, with a low rate of hand-hygiene compliance. Both data sets were used to construct histories and statistics of contacts informed by the use of hydro-alcoholic solution, or lack thereof, of the involved health-care workers. Hand-hygiene compliance data strongly enrich the information concerning contacts among health-care workers, by assigning a 'safe' or 'at-risk' value to each contact. The global contact network can thus be divided into 'at-risk' and 'safe' contact networks. The combined data could be of high relevance for outbreak investigation and to inform data-driven models of nosocomial disease spread.

An Assessment of Basic Patient Safety Skills in Residents Entering the First Year of Clinical Training.

PubMed

Comunale, Mark E; Sandoval, Mathew; Broussard, La Toya

2018-06-01

During safety rounds, we observed few residents demonstrating hand hygiene and patient identification as they began their postgraduate clinical training. We assessed baseline performance of these 2 basic safety skills in residents entering the first year of postgraduate clinical training (PGY1). PGY1 residents beginning training on July 1, 2013, and July 1, 2014, at our institution were examined using a simulated scenario testing for hand hygiene and patient identification. Nurse volunteers posed as patients and evaluated each resident using a standardized scoring tool. Residents were observed for the following behaviors when interacting: (1) hand hygiene before or upon entry into the patient's room (HHE); (2) resident introducing himself or herself (INTRO); (3) resident identifying patient (IDNB); (4) resident comparing patient's stated name and date of birth to patient's ID band (IDC); (5) resident explaining procedure to patient (EXP); and (6) resident performing hand hygiene upon exiting patient's room (HHL). A total of 114 residents were examined. Compliance results were as follows: HHE at 66% (75); INTRO at 96% (110); IDNB at 52% (59); IDC at 42% (48); EXP at 90% (103); and HHL at 58% (66). Developing and hardwiring basic patient safety skills is essential for creating an institutional culture of safety. We used a simulated patient scenario to provide a baseline assessment of 2 important safety skills.The results obtained demonstrate poor compliance with hand hygiene and patient identification. Our results suggest that there is a need for additional training and perhaps new methods of training and reinforcement in medical school and beyond, to hardwire these basic patient safety skills.

Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos--2010-2011.

PubMed

Erdozain, G; KuKanich, K; Chapman, B; Powell, D

2013-06-01

Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This study details an observational study of hand hygiene tool availability and recommendations; frequency of risky behaviour; and handwashing attempts by visitors in Kansas (9) and Missouri (4), USA, petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos, respectively. Risky behaviours were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviours were as follows: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children's and adults' hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n = 214) of individuals attempted some type of hand hygiene, with male adults, female adults and children attempting at similar rates (32%, 40% and 37%, respectively). Visitors were 4.8× more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; P < 0.001, OR = 4.863, 95% CI = 3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3× more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals' yard for contact (26/114, 22.8%; P < 0.001, OR = 2.339, 95% CI = 1.454-3.763). Inconsistencies existed in tool availability, signage and supervision of animal contact. Risk communication was poor, with few petting zoos outlining risks associated with animal contact, or providing recommendations for precautions to be taken to reduce these risks. © 2012 Blackwell Verlag GmbH.

Handwashing behaviour among Chinese adults: a cross-sectional study in five provinces.

PubMed

Tao, S Y; Cheng, Y L; Lu, Y; Hu, Y H; Chen, D F

2013-07-01

To describe the patterns of handwashing behaviour among Chinese adults, and assess their associations with sociodemographic factors and knowledge of hand hygiene. A representative sample (n = 6159) of Chinese adults aged 18-60 years in five provinces was attained by multiple-stage, stratified sampling mainly based on geographical location and economic status. Data on handwashing behaviour, knowledge of hand hygiene and sociodemographic factors were collected through self-administrated questionnaires. Associations between handwashing behaviour and sociodemographic factors were tested in logistic models. Path analysis was applied to examine the associations between sociodemographic factors, knowledge of hand hygiene and proper handwashing behaviour in order to evaluate the relative magnitude of these determinants and internal relationships. This study found that 52.7% (rural vs urban: 44.6% vs 56.8%) and 67.3% (rural vs urban: 59.7% vs 71.1%) of Chinese adults reported they always washed hands before eating and after defaecation, and 30.0% (rural vs urban: 25.1% vs 32.8%) of adults always used soap or other sanitizers during washing. Using the criteria of 'always or very often washing hands with soap before eating and after defaecation without sharing a towel with family members after washing', only 47.2% (rural vs urban: 23.8% vs 59.1%) of the adults were graded to practice proper handwashing behaviour. Urban area, high level of education level, high level of knowledge about diseases, female gender and older age were protective factors for good hand hygiene; of these, area was found to be associated most strongly with handwashing behaviour. Adherence to an appropriate handwashing method and duration of handwashing are critical problems among Chinese adults. Area difference, level of education and level of knowledge of hand hygiene were most strongly associated with handwashing behaviour, and should be targeted in future health education. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

A lean Six Sigma team increases hand hygiene compliance and reduces hospital-acquired MRSA infections by 51%.

PubMed

Carboneau, Clark; Benge, Eddie; Jaco, Mary T; Robinson, Mary

2010-01-01

A low hand hygiene compliance rate by healthcare workers increases hospital-acquired infections to patients. At Presbyterian Healthcare Services in Albuquerque, New Mexico a Lean Six Sigma team identified the reasons for noncompliance were multifaceted. The team followed the DMAIC process and completed the methodology in 12 months. They implemented multiple solutions in the three areas: Education, Culture, and Environment. Based on methicillin-resistant Staphylococcus aureus (MRSA) mortality research the team's results included an estimated 2.5 lives saved by reducing MRSA infections by 51%. Subsequently this 51% decrease in MRSA saved the hospital US$276,500. For those readers tasked with increasing hand hygiene compliance this article will provide the knowledge and insight needed to overcome multifaceted barriers to noncompliance.

Provoking "Eureka" moments for effective infection control strategies.

PubMed

Pittet, Didier

2014-01-01

Safety is now a fundamental principle of patient care and a critical component of quality management. Health care-associated infection prevention strategies need to be constantly revisited and updated to be effective. The "Geneva hand hygiene model" is a typical example of a breakthrough innovatory campaign that caught fire and went viral worldwide, thanks to its adoption by the World Health Organization (WHO) as the First Global Patient Safety Challenge. The campaign remains an inspiration for further innovation. To encourage new and disruptive technologies with the potential to improve patient safety through the successful implementation of the WHO multimodal strategy, the University of Geneva Hospitals/WHO Collaborating Centre on Patient Safety, together with the Aesculap Academy, have created a series of "Hand Hygiene Excellence Awards" and "Hand Hygiene Innovation Awards" worldwide.

Organization of infection control in European hospitals.

PubMed

Hansen, S; Zingg, W; Ahmad, R; Kyratsis, Y; Behnke, M; Schwab, F; Pittet, D; Gastmeier, P

2015-12-01

The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) survey was initiated to investigate the status of healthcare-associated infection (HCAI) prevention across Europe. This paper presents the methodology of the quantitative PROHIBIT survey and outlines the findings on infection control (IC) structure and organization including management's support at the hospital level. Hospitals in 34 countries were invited to participate between September 2011 and March 2012. Respondents included IC personnel and hospital management. Data from 309 hospitals in 24 countries were analysed. Hospitals had a median (interquartile range) of four IC nurses (2-6) and one IC doctor (0-2) per 1000 beds. Almost all hospitals (96%) had defined IC objectives, which mainly addressed hand hygiene (87%), healthcare-associated infection reduction (84%), and antibiotic stewardship (66%). Senior management provided leadership walk rounds in about half of hospitals, most often in Eastern and Northern Europe, 65% and 64%, respectively. In the majority of hospitals (71%), sanctions were not employed for repeated violations of IC practices. Use of sanctions varied significantly by region (P < 0.001), but not by countries' healthcare expenditure. There is great variance in IC staffing and policies across Europe. Some areas of practice, such as hand hygiene, seem to receive considerably more attention than others that are equally important, such as antibiotic stewardship. Programmes in IC suffer from deficiencies in human resources and local policies, ubiquitous factors that negatively impact on IC effectiveness. Strengthening of IC policies in European hospitals should be a public health priority. Copyright © 2015. Published by Elsevier Ltd.

Evaluation of infectious diseases and clinical microbiology specialists' preferences for hand hygiene: analysis using the multi-attribute utility theory and the analytic hierarchy process methods.

PubMed

Suner, Aslı; Oruc, Ozlem Ege; Buke, Cagri; Ozkaya, Hacer Deniz; Kitapcioglu, Gul

2017-08-31

Hand hygiene is one of the most effective attempts to control nosocomial infections, and it is an important measure to avoid the transmission of pathogens. However, the compliance of healthcare workers (HCWs) with hand washing is still poor worldwide. Herein, we aimed to determine the best hand hygiene preference of the infectious diseases and clinical microbiology (IDCM) specialists to prevent transmission of microorganisms from one patient to another. Expert opinions regarding the criteria that influence the best hand hygiene preference were collected through a questionnaire via face-to-face interviews. Afterwards, these opinions were examined with two widely used multi-criteria decision analysis (MCDA) methods, the Multi-Attribute Utility Theory (MAUT) and the Analytic Hierarchy Process (AHP). A total of 15 IDCM specialist opinions were collected from diverse private and public hospitals located in İzmir, Turkey. The mean age of the participants was 49.73 ± 8.46, and the mean experience year of the participants in their fields was 17.67 ± 11.98. The findings that we obtained through two distinct decision making methods, the MAUT and the AHP, suggest that alcohol-based antiseptic solution (ABAS) has the highest utility (0.86) and priority (0.69) among the experts' choices. In conclusion, the MAUT and the AHP, decision models developed here indicate that rubbing the hands with ABAS is the most favorable choice for IDCM specialists to prevent nosocomial infection.

The needs of denture-brushing in geriatrics: clinical aspects and perspectives.

PubMed

Berteretche, Marie-Violaine; Mastari, Fatima; Nicolas, Emmanuel; Hüe, Olivier

2012-06-01

Oral and denture hygiene are often defective in particular with dependent persons such as geriatric subjects. The reasons are the lack of hygiene education of the subjects or those caring for them. Consequently, oral hygiene is often neglected, resulting in poor oral health and an increase in the presence of local or general infections. This paper is a report of brushing effectiveness on microbial biofilm deposits on dentures of subjects participating in a specific oral hygiene programme. Thirty-nine dentures of 30 subjects were assessed for 2 weeks following an educational brushing programme. Microbial biofilm was recovered using fluoresceine and then scanned and quantified by 'Mesurim' software three times: before study, after 1 and 2 weeks. The repeated measurement procedures showed a decrease in the percentage of biofilm present (F = 15, p < 0.001) whatever the type of denture (partial or complete) and for all biomaterials. Regular denture-brushing can improve local hygiene. Consequently, decreasing the biofilm surface can reduce the prevalence of oral pathogens, thereby contributing to the general prevention of the risks of infections such as pneumotisis. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis

PubMed Central

Hongsuwan, Maliwan; Limmathurotsakul, Direk; Lubell, Yoel; Lee, Andie S; Harbarth, Stephan; Day, Nicholas P J; Graves, Nicholas; Cooper, Ben S

2015-01-01

Objective To evaluate the relative efficacy of the World Health Organization 2005 campaign (WHO-5) and other interventions to promote hand hygiene among healthcare workers in hospital settings and to summarize associated information on use of resources. Design Systematic review and network meta-analysis. Data sources Medline, Embase, CINAHL, NHS Economic Evaluation Database, NHS Centre for Reviews and Dissemination, Cochrane Library, and the EPOC register (December 2009 to February 2014); studies selected by the same search terms in previous systematic reviews (1980-2009). Review methods Included studies were randomised controlled trials, non-randomised trials, controlled before-after trials, and interrupted time series studies implementing an intervention to improve compliance with hand hygiene among healthcare workers in hospital settings and measuring compliance or appropriate proxies that met predefined quality inclusion criteria. When studies had not used appropriate analytical methods, primary data were re-analysed. Random effects and network meta-analyses were performed on studies reporting directly observed compliance with hand hygiene when they were considered sufficiently homogeneous with regard to interventions and participants. Information on resources required for interventions was extracted and graded into three levels. Results Of 3639 studies retrieved, 41 met the inclusion criteria (six randomised controlled trials, 32 interrupted time series, one non-randomised trial, and two controlled before-after studies). Meta-analysis of two randomised controlled trials showed the addition of goal setting to WHO-5 was associated with improved compliance (pooled odds ratio 1.35, 95% confidence interval 1.04 to 1.76; I2=81%). Of 22 pairwise comparisons from interrupted time series, 18 showed stepwise increases in compliance with hand hygiene, and all but four showed a trend for increasing compliance after the intervention. Network meta-analysis indicated considerable uncertainty in the relative effectiveness of interventions, but nonetheless provided evidence that WHO-5 is effective and that compliance can be further improved by adding interventions including goal setting, reward incentives, and accountability. Nineteen studies reported clinical outcomes; data from these were consistent with clinically important reductions in rates of infection resulting from improved hand hygiene for some but not all important hospital pathogens. Reported costs of interventions ranged from $225 to $4669 (£146-£3035; €204-€4229) per 1000 bed days. Conclusion Promotion of hand hygiene with WHO-5 is effective at increasing compliance in healthcare workers. Addition of goal setting, reward incentives, and accountability strategies can lead to further improvements. Reporting of resources required for such interventions remains inadequate. PMID:26220070

Nutrition education for illiterate children in southern Madagascar--addressing their needs, perceptions and capabilities.

PubMed

Mahr, Johanna; Wuestefeld, Marzella; Ten Haaf, Joep; Krawinkel, Michael B

2005-06-01

A Knowledge, Attitudes and Practices (KAP) study was conducted in three villages of Bekily District in southern Madagascar prior to the implementation of a health education programme with children. The participatory learning concept of the Child-to-Child approach was followed to involve the children in the planning and implementation of the programme, which was covered by the German Agency for Technical Cooperation. To this effect, qualitative research methods such as Participatory Learning and Action techniques (focus group discussions, mapping and matrix ranking, etc.) were applied. The survey was conducted between August and December 1999. It involved a total of 55 school-aged children (6-14 years) along with 21 mothers and 34 fathers, representing different ethnic groups and educational backgrounds. The results show that children's KAP related to health and nutrition strongly reflect those of adults. They are not aware of a possible link between bad hygiene and the occurrence of diseases. According to them, diarrhoea or malaria is caused by consuming too large amounts of certain foods. Even if they know about certain elementary hygiene behaviours, they do not practise this in their everyday life. A major objective of the health education programme for children should be to tackle the discrepancy between hygiene-related knowledge and behaviour. Through the participatory study approach the children revealed their ability to contribute to the programme development. In using appropriate communication channels, the Child-to-Child health education programme is expected to influence the health behaviours of both adults and children. The health education programme should be combined with a literacy programme to address the children's desire to learn reading and writing.

Optimizing Health Care Environmental Hygiene.

PubMed

Carling, Philip C

2016-09-01

This article presents a review and perspectives on aspects of optimizing health care environmental hygiene. The topics covered include the epidemiology of environmental surface contamination, a discussion of cleaning health care patient area surfaces, an overview of disinfecting health care surfaces, an overview of challenges in monitoring cleaning versus cleanliness, a description of an integrated approach to environmental hygiene and hand hygiene as interrelated disciplines, and an overview of the research opportunities and challenges related to health care environmental hygiene. Copyright © 2016 Elsevier Inc. All rights reserved.

An organized approach to the control of hazards to health at work.

PubMed

Molyneux, M K; Wilson, H G

1990-04-01

Shell U.K. has an approach which facilitates the implementation of its occupational hygiene programme in its many locations. The main elements of the system are Company Policy, Standards, Methods and Management. The Policy sets the scene and is rigorous in its aims. The new COSHH legislation has emphasized particular duties which have influenced the approach. The Company Occupational Health Guidelines [Guidelines on Health at Work for Shell in the U.K. Shell U.K. Ltd, London (1989)] set the standards for control of exposure, among other things, and the Company adopts appropriate methods to achieve them. Of particular note is the Company's COSHH Programme [Implementation of the Shell U.K. Policy on the Control of Substances Hazardous to Health. Shell U.K. Ltd, London (1989)] which applies to all hazards to health (including physical and biological agents) in the workplace. Its introduction has been given full corporate support and is in the process of implementation. Appropriate procedures have been introduced for assessments of risk and for work histories. Guidance has been given on competence, reflecting a philosphy based on a team approach using local resources to the full, supported by corporate resources as required. The awards of the British Examining and Registration Board in Occupational Hygiene (1987) are used as the professional standard. Because of difficulties in obtaining basic hazard data, an internal core hazard data system (CHADS) [Core Hazard Data System. Shell U.K Ltd, London (1989)] has been introduced. The whole programme is managed through Occupational Hygiene Focal Points (OHFP) which represent local activities but also participate in corporate strategy. Through them the multidisciplinary approach is promoted, working in conjunction with local and sector Medical Advisers. Work done by the central Occupational Hygiene Unit is recorded and the reports are used for time management and recovery of costs. In its entirety, the approach is being used successfully to implement a comprehensive occupational hygiene programme in a diversified and dispersed industrial organization.

Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries

PubMed Central

Prüss-Ustün, Annette; Bartram, Jamie; Clasen, Thomas; Colford, John M; Cumming, Oliver; Curtis, Valerie; Bonjour, Sophie; Dangour, Alan D; De France, Jennifer; Fewtrell, Lorna; Freeman, Matthew C; Gordon, Bruce; Hunter, Paul R; Johnston, Richard B; Mathers, Colin; Mäusezahl, Daniel; Medlicott, Kate; Neira, Maria; Stocks, Meredith; Wolf, Jennyfer; Cairncross, Sandy

2014-01-01

Objective To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. Methods For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Results In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group. Conclusions This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene. PMID:24779548

Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries.

PubMed

Prüss-Ustün, Annette; Bartram, Jamie; Clasen, Thomas; Colford, John M; Cumming, Oliver; Curtis, Valerie; Bonjour, Sophie; Dangour, Alan D; De France, Jennifer; Fewtrell, Lorna; Freeman, Matthew C; Gordon, Bruce; Hunter, Paul R; Johnston, Richard B; Mathers, Colin; Mäusezahl, Daniel; Medlicott, Kate; Neira, Maria; Stocks, Meredith; Wolf, Jennyfer; Cairncross, Sandy

2014-08-01

To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. In 2012, 502,000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280,000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297,000 deaths. In total, 842,000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361,000 deaths could be prevented, representing 5.5% of deaths in that age group. This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene. © 2014 The Authors. Tropical Medicine and International Health published by John Wiley & Sons Ltd.

Evaluation of the efficacy of a dental plaque control program in autistic patients.

PubMed

Dias, Guilherme G; Prado, Eliane F G B; Vadasz, Estevão; Siqueira, José Tadeu T

2010-06-01

The aim of this study was to verify the efficacy of a programme for dental plaque control in autistics. Patients were evaluated on five occasions over a period of 180 days using the following instruments: OHI-S, DMF-T, the Fonnes brushing technique and diet questionnaire. Participants were divided into two groups according to level of co-operation on the programme: Group A (co-operative) and Group B (non-cooperative). A statistically significant improvement (p < 0.001) in Oral Hygiene was attained, with 84.2% showing regular or satisfactory hygiene at study end-point. Groups A and B both showed improvement in hygiene (p < 0.001 and p = 0.004), but improvement was significantly higher among co-operative patients (p < 0.001 at 180 days), who also had a higher mean age (p = 0.02).

STOPFLU: is it possible to reduce the number of days off in office work by improved hand-hygiene?

PubMed Central

2010-01-01

Background Acute infectious diseases are major causes of short periods of days off from work, day care and school. These diseases are mainly caused by viruses and hands have a key role in their transmission. Thus, hypothetically, they can be controlled with means of intensified hand hygiene. In this study we aim to elucidate the effect of acute infectious diseases on the work contribution in common office work and study the influence of improved hand hygiene on possible reduction of infectious disease episodes and days off from work due to acute infectious diseases. Design The voluntary participants have been recruited from six companies in the Helsinki region. The designated 21 study clusters were identified as operationally distinct working units each containing at least 50 people. The clusters were matched and randomized based on results of a pre-trial contagion risk survey. Improved hand hygiene is being executed with guided hand-washing with soap and water in one intervention arm and with alcohol based hand rubbing disinfectant in the other. Participants in both arms have received guidance on how to avoid infections and how to implement contagion stopping habits. A control arm is acting as before regarding hand hygiene. Data collection for evaluation of the efficacy of the interventions is based on self-reporting through weekly electronic reports. The questionnaire is enquiring about possible respiratory or gastrointestinal symptoms during the preceding week, and requests a daily report of presence of symptoms and working capacity. Etiology of the symptoms is not searched for individually, but contribution of different viruses is evaluated by sentinel surveillance, where occupational health clinics located in the premises of the participating companies collect specimens from employees visiting the clinic. Common causative agents of the diseases are being searched for using real-time PCR techniques. The duration of the intervention will be 16 months. Primary endpoints of the study are the number of reported infection episodes in a cluster within a time frame of 100 reporting weeks and the number of reported sick leave episodes in a cluster within a time frame of 100 reporting weeks. Trial Registration ClinicalTrials.gov Identifier: NCT00821509 PMID:20525328

Access to water and sanitation facilities in primary schools: A neglected educational crisis in Ngamiland district in Botswana

NASA Astrophysics Data System (ADS)

Ngwenya, B. N.; Thakadu, O. T.; Phaladze, N. A.; Bolaane, B.

2018-06-01

In developing countries, the sanitation and hygiene provision often receives limited resources compared to the water supply. However, water supply benefits tend to diminish if improved sanitation and hygiene are neglected. This paper presents findings of a situational analysis of water supply, sanitation and hygiene infrastructure and their utilization in three primary schools in north-western Botswana. The overall objective of the paper is to determine access and functionality of water supply, sanitation and hygiene infrastructure in three primary schools. The specific objectives are: a) Learners' perspective of their water and sanitation facilities and b) gendered utilization of sanitation and hygiene facilities. Data were collected through a face-to-face administered social survey tool to 286 learners selected through proportionate stratified random sampling from three purposively selected villages in the middle and lower Okavango Delta. Findings indicate that standpipes provide 96% of potable water supply. However, the majority (65% of leaners) indicated that they 'sometimes' experienced water shortage due to dry/nonfunctioning taps/pumps and leaks/wastage. Overall, schools have relatively sufficient sanitation facilities consisting of both water borne toilets and VIP latrines. The major sanitation gap identified was that 80% flush toilets hardly work, while 77% of VIP toilets were in disrepair. Furthermore, poor water supply compromised hand washing with 65.7% learners "always" washing their hands if school standpipes had water, while the majority did not wash hands if standpipes were dry. The study concluded that availability of sanitation infrastructure does not necessarily translate into utilization in the study area due to multiple problems, such as lack of personal hygiene supplies (regular toilet paper and hand washing detergents), privacy issues and recurring water problems. The chronicity of inadequate water, sanitation and hygiene infrastructure in primary schools is critical and there is urgent need to address these challenges in order to create a conducive learning environment in primary schools in the district.

Can education influence stethoscope hygiene?

PubMed

Holleck, Jürgen L; Merchant, Naseema; Lin, Shin; Gupta, Shaili

2017-07-01

The importance of stethoscope hygiene has been demonstrated in prior studies, and is acknowledged by guidelines, yet it is rarely done. We implemented a pilot project consisting of provider education, reminder flyers and provision of cleaning supplies at the start of clinical rotations for housestaff, medical students, and attending physicians. Hand hygiene rates did not change significantly with rates between 58% and 63% while stethoscope hygiene remained at zero. Published by Elsevier Inc.

Surveillance of nosocomial infections: a preliminary study on hand hygiene compliance of healthcare workers.

PubMed

Brunetti, L; Santoro, E; De Caro, F; Cavallo, P; Boccia, G; Capunzo, M; Motta, O

2006-06-01

The observance of hand hygiene compliance is important to reduce cross-infection by micro-organisms. The aim of this preliminary study was to evaluate the level of hand hygiene in healthcare workers from different departments, with particular emphasis on transient flora. The study was conducted in three departments (Surgery, Intensive Care Unit, Obstetrics and Gynecology) of a hospital in Campania, southern Italy. Over a six-month period, 50 healthcare workers were randomly tested. Imprints of palms and fingertips were taken monthly during the morning shift. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Total flora was found in the following CFU means per palm and per five fingertips (95% CI): Obstetrics and Gynecology [palms 130 CFUs (95% CI 85-180); fingertips 125 CFUs (95% CI 92-160)]; ICU [palms 80 CFUs (95% CI 58-99); fingertips 62 CFUs (95% CI 45-82)]; Surgery [palms 75 CFUs (95% CI 41-120); fingertips 70 CFUs (95% CI 52-90)] Transient flora was found on 39% of healthcare workers' hands. The only factor associated with hand contamination by transient flora was the absence of gloving during healthcare procedure (P = 0.02).

[Health behavior of medical students. Introduction of mental hygienic skills in the medical education in Hungary].

PubMed

Rosta, Eszter; Almási, Zsuzsanna; Karácsony, István; Konkolÿ Thege, Barna; Hegedűs, Katalin

2012-07-22

HuMania Training Programme is a voluntary peer training course. to measure the efficiency of HuMania Training Programme and to analyse social relations of medical students. WHO Well-being Index, Bergen Social Relationship Scale, Lazarus's Ways of Coping Questionnaire and the Maslach Burnout Inventory for undergraduate students were used. The results of HuMania Training Programme established in 2009 were compared with those obtained from controls and HuMania Training Programme of the forthcoming year. At the beginning, participants of the HuMania Training Programme had fewer well-being scores (p = 0.01), whereas their social anxiety (p = 0.01) and emotion-based coping (p = 0.05) were greater as compared to controls. After the HuMania Training Programme course, well-being showed an increasing tendency (p = 0.072), and burnout-level decreased (p = 0.040). Fifty percent of medical students had a minimum of three stressors, and 57% of them said that there was a person in their environment, who needed help, but they cannot provide it. Medical students display poor mental hygienic state. and HuMania Training Programme tries to fight this situation.

Environmental challenges of identifying a patient zone and the healthcare zone in a crowded Vietnamese hospital.

PubMed

Salmon, S; McLaws, M L

2015-09-01

The application of the World Health Organization (WHO) 'My five moments for hand hygiene' was designed for a healthcare environment with levels of bed spacing and occupancy normally present in developed countries. However, overcrowded healthcare facilities in Vietnam and other challenged settings require strategies to adapt 'My five moments for hand hygiene' in order to meet their situational needs. To identify the environmental challenges to compliance with the 'My five moments' indications. Overt observation using the WHO hand hygiene audit tool was conducted in two clinical departments at a large teaching hospital in Vietnam. Clinical practice movements and the 'My five moments' indications were detailed diagrammatically. Sharing a bed is widely practised outside the intensive care unit in this country, which makes visualizing a patient zone according to the WHO instructions difficult. In addition, decreased spacing between shared beds in overcrowded conditions results in the close proximity of patients to the shared healthcare zone. These two barriers prevent attempts to apply the 'My five moments' correctly. Undertaking hand hygiene and conducting audits in accordance with the 'My five moments for hand hygiene' assumes a separation of patients and individual healthcare zones. The barriers to applying 'My five moments' include the lack of distinct zones between patients and their shared healthcare zone, and amelioration requires resources beyond current chronic resource challenges. Until environmental resources can meet the western standards required for application of the 'Five moments' principle, healthcare workers urgently need detailed clarification of modifications that would empower them to comply. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Attitudes Toward Practice Guidelines Among ICU Personnel: A Cross-Sectional Anonymous Survey

PubMed Central

Quiros, Dave; Lin, Susan; Larson, Elaine L

2007-01-01

Objectives To assess attitudes of ICU staff members toward practice guidelines in general and toward a specific guideline, CDC's Guideline for Hand Hygiene in Healthcare Settings; to correlate these attitudes with staff and hospital characteristics; and to examine the impact of staff attitudes toward the Hand Hygiene Guideline on self reported implementation of the Guideline. Methods A cross-sectional survey of staff in 70 ICUs in 39 U.S. hospitals, members of The National Nosocomial Infection Surveillance (NNIS) System. A survey, “Attitudes Regarding Practice Guidelines”, was administered anonymously to all willing staff during a site visit at each hospital; 1,359 ICU personnel: 1,003 nurses (74%), 228 physicians (17%), and 128 others (10%) responded. Results Significantly more positive attitudes toward practice guidelines were found among staff in pediatric as compared with adult ICUs (p<0.001). Nurses and other staff when compared with physicians had more positive attitudes toward guidelines in general but not toward the specific Hand Hygiene Guideline. Those with more positive attitudes were significantly more likely to report that they had implemented recommendations of the Guideline (p<0.001) and used an alcohol product for hand hygiene (p=0.002). Conclusions The majority of staff members were familiar with the CDC Hand Hygiene Guideline. Staff attitudes toward practice guidelines varied by type of ICU and by profession, and more positive attitudes were associated with significantly better self-reported guideline implementation. Because differences in staff attitudes might hinder or facilitate their acceptance and adoption of evidence-based practice guidelines, these results may have important implications for the education and/or socialization of ICU staff. PMID:17628198

Compliance of hospital staff with guidelines for the active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) and its impact on rates of nosocomial MRSA bacteremia.

PubMed

Zoabi, Marwan; Keness, Yoram; Titler, Nava; Bisharat, Naiel

2011-12-01

The compliance of hospital staff with guidelines for the active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in Israel has not been determined. To evaluate the compliance of hospital staff with guidelines for the active surveillance of MRSA and assess its impact on the incidence of nosocomial MRSA bacteremia. We assessed compliance with MRSA surveillance guidelines by assessing adherence to the screening protocol and reviewing medical and nursing charts of patients colonized with MRSA, and observed hand hygiene opportunities among health care workers and colonized patients. Rates of nosocomial MRSA bacteremia and of adherence with hand hygiene among overall hospital staff were obtained from archived data for the period 2001-2010. Only 32.4% of eligible patients were screened for MRSA carriage on admission, and 69.9% of MRSA carriers did not receive any eradication treatment. The mean rate of adherence to glove use among nurses and doctors was 69% and 31% respectively (P<0.01) and to hand hygiene 59% and 41% respectively (P<0.01). The hospital overall rate of adherence to hand hygiene increased from 42.3% in 2005 to 68.1% in 2010. Rates of nosocomial MRSA bacteremia decreased by 79.2%, from 0.48 (in 2001) to 0.1 (in 2010) per 1000 admissions (P<0.001). The compliance of medical and nursing staff with guidelines for active MRSA surveillance was poor. The encouraging increase in adherence to hand hygiene and concomitant decrease in nosocomial MRSA bacteremia is gratifying. The deficiencies in compliance with MRSA infection control policy warrant an adjusted strategy based on the hospital resources.

Using an Analysis of Behavior Change to Inform Effective Digital Intervention Design: How Did the PRIMIT Website Change Hand Hygiene Behavior Across 8993 Users?

PubMed

Ainsworth, B; Steele, M; Stuart, B; Joseph, J; Miller, S; Morrison, L; Little, P; Yardley, L

2017-06-01

In designing digital interventions for healthcare, it is important to understand not just whether interventions work but also how and for whom-including whether individual intervention components have different effects, whether a certain usage threshold is required to change behavior in each intervention and whether usage differs across population subgroups. We investigated these questions using data from a large trial of the digital PRimary care trial of a website based Infection control intervention to Modify Influenza-like illness and respiratory tract infection Transmission) (PRIMIT) intervention, which aimed to reduce respiratory tract infections (RTIs) by increasing hand hygiene behavior. Baseline and follow-up questionnaires measured behaviors, intentions and attitudes in hand hygiene. In conjunction with objective measures of usage of the four PRIMIT sessions, we analysed these observational data to examine mechanisms of behavior change in 8993 intervention users. We found that the PRIMIT intervention changed behavior, intentions and attitudes, and this change was associated with reduced RTIs. The largest hand hygiene change occurred after the first session, with incrementally smaller changes after each subsequent session, suggesting that engagement with the core behavior change techniques included in the first session was necessary and sufficient for behavior change. The intervention was equally effective for men and women, older and younger people and was particularly effective for those with lower levels of education. Our well-powered analysis has implications for intervention development. We were able to determine a 'minimum threshold' of intervention engagement that is required for hand hygiene change, and we discuss the potential implications this (and other analyses of this type) may have for further intervention development. We also discuss the application of similar analyses to other interventions.

An Assessment of Diarrhea Among Long-Distance Backpackers in the Sierra Nevada.

PubMed

Meyer, Derek J; Costantino, Amber; Spano, Susanne

2017-03-01

Diarrhea is a common problem among long-distance backpackers, ranging in overall incidence from 11-56% as reported by previous studies on the Appalachian Trail and Long Trail. Differences in age, sex, and regularity of standard backcountry hygiene recommendations and practices have been shown to significantly affect the incidence of diarrhea. No study to date has investigated these trends among long-distance backpackers on the John Muir Trail (JMT) in the Sierra Nevada mountain range of California. Retrospective analysis of online survey data gathered from long-distance backpackers who attempted a JMT trek in 2014. Data were assessed for the significance of variables that might contribute to the incidence and severity of on-trail diarrhea. Of 737 valid responders, 16.4% reported experiencing diarrhea (82% with minimal/mild severity; 18% with significant severity). Regular hand sanitizer use was significantly correlated with more severe diarrhea (P < .05), but had no effect on incidence. Regular hand sanitizer users followed all other recommended hygiene practices as frequently as or better than those not using hand sanitizer regularly. Of all backpackers, 88% filtered or treated their drinking water regularly, with 18% of those reporting diarrhea of any severity. JMT backpackers have a comparatively lower incidence of diarrhea than backpackers on other major long-distance backpacking routes in the United States. Most JMT backpackers follow standard backcountry hygiene recommendations, including regular filtration or treatment of drinking water. No statistical significance was found between the incidence of diarrhea and compliance with standard hygiene recommendations. Regular hand sanitizer use was significantly correlated with more severe diarrhea but was not associated with incidence. There was no significant difference in compliance with standard backcountry hygiene practices between regular and infrequent hand sanitizer users. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Outcomes of a Pilot Hand Hygiene Randomized Cluster Trial to Reduce Communicable Infections Among US Office-Based Employees

PubMed Central

DuBois, Cathy L.Z.; Grey, Scott F.; Kingsbury, Diana M.; Shakya, Sunita; Scofield, Jennifer; Slenkovich, Ken

2015-01-01

Objective: To determine the effectiveness of an office-based multimodal hand hygiene improvement intervention in reducing self-reported communicable infections and work-related absence. Methods: A randomized cluster trial including an electronic training video, hand sanitizer, and educational posters (n = 131, intervention; n = 193, control). Primary outcomes include (1) self-reported acute respiratory infections (ARIs)/influenza-like illness (ILI) and/or gastrointestinal (GI) infections during the prior 30 days; and (2) related lost work days. Incidence rate ratios calculated using generalized linear mixed models with a Poisson distribution, adjusted for confounders and random cluster effects. Results: A 31% relative reduction in self-reported combined ARI-ILI/GI infections (incidence rate ratio: 0.69; 95% confidence interval, 0.49 to 0.98). A 21% nonsignificant relative reduction in lost work days. Conclusions: An office-based multimodal hand hygiene improvement intervention demonstrated a substantive reduction in self-reported combined ARI-ILI/GI infections. PMID:25719534

Oral health-related quality of life in patients with stroke: a randomized clinical trial of oral hygiene care during outpatient rehabilitation.

PubMed

Dai, Ruoxi; Lam, Otto L T; Lo, Edward C M; Li, Leonard S W; McGrath, Colman

2017-08-09

This study was to evaluate the effectiveness of oral hygiene care in improving oral health- and health-related quality of life (OHRQoL and HRQoL) among patients receiving outpatient stroke rehabilitation. Subjects were randomized to: (1) a conventional oral hygiene care programme (COHCP) comprising a manual toothbrush, and oral hygiene instruction, or (2) an advanced oral hygiene care programme (AOHCP) comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, and oral hygiene instruction. The interventional period lasted for 3 months, followed by a 3-month observational period. HRQoL was assessed by SF-12, and OHRQoL was assessed by Oral Health Impact Profile-14 (OHIP-14), General Oral Health Assessment Index (GOHAI), and Oral Health Transitional Scale (OHTS). Participants in AOHCP group had significantly better OHRQoL at the end of clinical trial as assessed by OHTS (p < 0.01), and at the end of observational study as assessed by GOHAI (p < 0.05) than those in the COHCP. Participants in the AOHCP group had significantly better HRQoL as assessed by physical component summary score (PCS) the end of both 3 and 6 months (both p < 0.05). This study provided the evidence that the AOHCP was more effective than the COHCP within stroke rehabilitation in improving subjective health.

Mental models: a basic concept for human factors design in infection prevention.

PubMed

Sax, H; Clack, L

2015-04-01

Much of the effort devoted to promoting better hand hygiene is based on the belief that poor hand hygiene reflects poor motivation. We argue, however, that automatic unconscious behaviour driven by 'mental models' is an important contributor to what actually happens. Mental models are concepts of reality--imaginary, often blurred, and sometimes unstable. Human beings use them to reduce mental load and free up capacity in the conscious mind to focus on deliberate activities. They are pragmatic solutions to the complexity of life. Knowledge of such mental processes helps healthcare designers and clinicians overcome barriers to behavioural change. This article reviews the concept of mental models and considers how it can be used to improve hand hygiene and patient safety. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

User Centred Design and Nosocomials in Surgical ICUs: A Mobile Application for Peer Monitoring and Training in Hand Hygiene.

PubMed

Kariyawasam, Nadish; Wong, Ming Chao; Turner, Paul

2017-01-01

Nosocomial infections are a global public health risk. In low and middle-income countries the problem is acute with very high infection rates commonly contributing to poor patient outcomes including mortality. Organisational, cultural, and individual factors have been identified in these high rates, with poor hand hygiene compliance amongst clinicians a major risk factor. New approaches to achieving clinician behaviour change are required. User-centred approaches have proven effective to engage and support changes in clinician behaviours through the use of electronic tools. This paper reports on the experience of co-designing and implementing a mobile application with clinicians to enhance hand hygiene compliance. The peer monitoring and training supported by the application aims to directly contribute to evidence on reductions in infection rates in two surgical ICUs in Sri Lanka.

An update on oral hygiene products and techniques.

PubMed

Laing, Emma; Ashley, Paul; Gill, Daljit; Naini, Farhad

2008-05-01

The aim of this article is to update the reader on oral hygiene products and techniques. The evidence relating to the range of toothbrushing, interdental cleaning products and chemotherapeutic agents currently on the market will be discussed. It will be seen that choice of many of the oral hygiene products currently on the market is still largely a matter of personal preference. An inadequate oral hygiene regime may lead to caries and periodontal disease. It is important for clinicians to be able to recommend a preventive programme for dental and periodontal health that is supported by high quality, evidence-based clinical research.

Towards objective hand hygiene technique assessment: validation of the ultraviolet-dye-based hand-rubbing quality assessment procedure.

PubMed

Lehotsky, Á; Szilágyi, L; Bánsághi, S; Szerémy, P; Wéber, G; Haidegger, T

2017-09-01

Ultraviolet spectrum markers are widely used for hand hygiene quality assessment, although their microbiological validation has not been established. A microbiology-based assessment of the procedure was conducted. Twenty-five artificial hand models underwent initial full contamination, then disinfection with UV-dyed hand-rub solution, digital imaging under UV-light, microbiological sampling and cultivation, and digital imaging of the cultivated flora were performed. Paired images of each hand model were registered by a software tool, then the UV-marked regions were compared with the pathogen-free sites pixel by pixel. Statistical evaluation revealed that the method indicates correctly disinfected areas with 95.05% sensitivity and 98.01% specificity. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Using Workflow Diagrams to Address Hand Hygiene in Pediatric Long-Term Care Facilities1

PubMed Central

Carter, Eileen J.; Cohen, Bevin; Murray, Meghan T.; Saiman, Lisa; Larson, Elaine L.

2015-01-01

Hand hygiene (HH) in pediatric long-term care settings has been found to be sub-optimal. Multidisciplinary teams at three pediatric long-term care facilities developed step-by-step workflow diagrams of commonly performed tasks highlighting HH opportunities. Diagrams were validated through observation of tasks and concurrent diagram assessment. Facility teams developed six workflow diagrams that underwent 22 validation observations. Four main themes emerged: 1) diagram specificity, 2) wording and layout, 3) timing of HH indications, and 4) environmental hygiene. The development of workflow diagrams is an opportunity to identify and address the complexity of HH in pediatric long-term care facilities. PMID:25773517

Rate of Compliance with Hand Hygiene by Dental Healthcare Personnel (DHCP) within a Dentistry Healthcare First Aid Facility

PubMed Central

de Amorim-Finzi, Marcília Batista; Cury, Mauro Vieira Cezar; Costa, Cláudio Rodrigues R.; dos Santos, Angelis Costa; de Melo, Geraldo Batista

2010-01-01

Objectives: To evaluate the compliance with the opportunities of hand hygiene by dentistry school healthcare professionals, as well as the higher choice products. Methods: Through direct observation, the oral healthcare team-professors, oral and maxillofacial surgery residents, graduation students-for daily care were monitored: before performing the first treatment of the shift, after snacks and meals, and after going to the bathroom (initial opportunities) as well as between patients’ care, and after ending the shift (following opportunities). Results: The professors’ category profited 78.4% of all opportunities while residents and graduation students did not reach 50.0% of compliance. Statistically significant data (P≤.05) were seen between categories: professors and residents, professors and graduation students, and between genders within the residents’ category. When opportunities were profited, the preferred choice for hand hygiene was water and soap (82.2%), followed by 70% alcohol (10.2%), and both (7.6%). Conclusions: Although gloves were worn in all procedures, we concluded that the hygiene compliance by these professionals was under the expectation. PMID:20613909

An Inverse Problem Formulation Methodology for Stochastic Models

DTIC Science & Technology

2010-05-02

form the surveillance data Infection control measures were implemented in the form of health care worker hand - hygiene before and after patients contact...manuscript derives from our interest in understanding the spread of infectious diseases in particular, nosocomial infections , in order to prevent major...given by the inverse of the parameter of the exponential distribution. A hand - hygiene policy applied to health care workers on isolated VRE colonized

Clostridium difficile infections in patients with severe burns

DTIC Science & Technology

2011-01-01

placards indicating that hand hygiene should involve soap and water. Periodic hand hygiene compliance surveys have indicated relatively consistent...care unit: epidemiology, costs, and colonization pressure. Infect Control Hosp Epidemiol 2007;28:123–30. [6] Marcon AP, Gamba MA, Vianna LA. Nosocomial ...Clostridium difficile infections in patients with severe burns§ Scott J. Crabtree a, Janelle L. Robertson a,b, Kevin K. Chung c, Evan M. Renz b,c

Infection control best practices in clinical research in resource-limited settings.

PubMed

Godfrey, Catherine; Schouten, Jeffrey T

2014-01-01

Infection control activities in the international research setting include the development of meaningful and effective policies on specific topics such as hand and respiratory hygiene. Prevention of infection in health care workers and management of occupational exposure to transmissible agents are important aspects of the role of an infection control practitioner. Hand hygiene reduces health care associated infections and practices may be implemented in the research setting.

Access to waterless hand sanitizer improves student hand hygiene behavior in primary schools in Nairobi, Kenya.

PubMed

Pickering, Amy J; Davis, Jennifer; Blum, Annalise G; Scalmanini, Jenna; Oyier, Beryl; Okoth, George; Breiman, Robert F; Ram, Pavani K

2013-09-01

Handwashing is difficult in settings with limited resources and water access. In primary schools within urban Kibera, Kenya, we investigated the impact of providing waterless hand sanitizer on student hand hygiene behavior. Two schools received a waterless hand sanitizer intervention, two schools received a handwashing with soap intervention, and two schools received no intervention. Hand cleaning behavior after toilet use was monitored for 2 months using structured observation. Hand cleaning after toileting was 82% at sanitizer schools (N = 2,507 toileting events), 38% at soap schools (N = 3,429), and 37% at control schools (N = 2,797). Students at sanitizer schools were 23% less likely to have observed rhinorrhea than control students (P = 0.02); reductions in student-reported gastrointestinal and respiratory illness symptoms were not statistically significant. Providing waterless hand sanitizer markedly increased student hand cleaning after toilet use, whereas the soap intervention did not. Waterless hand sanitizer may be a promising option to improve student hand cleansing behavior, particularly in schools with limited water access.

Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department.

PubMed

Arntz, P R H; Hopman, J; Nillesen, M; Yalcin, E; Bleeker-Rovers, C P; Voss, A; Edwards, M; Wei, A

2016-11-01

Hand hygiene (HH) is essential in preventing nosocomial infection. The emergency department (ED) is an open portal of entry for pathogens into the hospital system, hence the important sentinel function of the ED personnel. The main objective of this study was to assess the effect of a multimodal improvement strategy on hand hygiene compliance in the ED. Our study was a prospective before-and-after study to determine the effect of a multimodal improvement strategy on the compliance of HH in the ED according to the My 5 Moments of Hand Hygiene defined by the World Health Organization. Interventions such as education, reminders, and regular feedback on HH performance and role models were planned during the 3 intervention weeks. In total, 57 ED nurses and ED physicians were observed in this study, and approximately 1,000 opportunities for handrubs were evaluated during the 3 intervention periods. HH compliance increased significantly from baseline from 18% (74/407) to 41% (77/190) after the first intervention and stabilized to 50% (99/200) and 46% (96/210) after the second and third interventions, respectively. Implementing a multimodal HH improvement program significantly improved the HH compliance of ED personnel. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Social and moral norm differences among Portuguese 1st and 6th year medical students towards their intention to comply with hand hygiene.

PubMed

Roberto, Magda S; Mearns, Kathryn; Silva, Silvia A

2012-01-01

This study examines social and moral norms towards the intention to comply with hand hygiene among Portuguese medical students from 1st and 6th years (N = 175; 121 from the 1st year, 54 from the 6th year). The study extended the theory of planned behaviour theoretical principles and hypothesised that both subjective and moral norms will be the best predictors of 1st and 6th year medical students' intention to comply with hand hygiene; however, these predictors ability to explain intention variance will change according to medical students' school year. Results indicated that the subjective norm, whose referent focuses on professors, is a relevant predictor of 1st year medical students' intention, while the subjective norm that emphasises the relevance of colleagues predicts the intentions of medical students from the 6th year. In terms of the moral norm, 6th year students' intention is better predicted by a norm that interferes with compliance; whereas intentions from 1st year students are better predicted by a norm that favours compliance. Implications of the findings highlight the importance of role models and mentors as key factors in teaching hand hygiene in medical undergraduate curricula.

Access to Safe Water and Personal Hygiene Practices in the Kulandia Refugee Camp (Jerusalem).

PubMed

Issa, Mohamad; McHenry, Michael; Issa, Abdul Aziz; Blackwood, R Alexander

2015-12-22

Diarrheal illness, frequently associated with fecal-oral transmission, is one of the leading causes of death worldwide. It is commonly preventable through the implementation of safe water practices. This experiment concerns how to best implement safe water practices in a quasi-permanent refugee camp setting with limited ability for structural changes. Specifically, we explore how health promotion activities that help identify target groups for hygiene interventions can play a role in disease prevention. An anonymous survey was conducted at the United Nations Relief and Works Agency Health Clinic in the Kulandia refugee camp to assess the safe water and personal hygiene practices. Demographic and social characteristics, accessible water and personal hygiene characteristics, and gastrointestinal (GI) burden for individuals and their households were assessed. A total of 96 individuals were enrolled; 62 females and 34 males. Approximately 58% of the sample had soap available and washed hands before and after eating and when preparing food. Piped water was the main source of drinking water (62%), while 31% of our sample utilized tanker-trucks. 93% of participants had access to toilet facilities, with 86% of these facilities being private households. 55% practice extra water hygiene measures on their household drinking water source. 51.3% considered vendor cleanliness when they were buying food. 51% had received formal health education. 68.8% had been taught by their parents, but only 55.2% were teaching their children and 15.6% had consistent access to a health professional for hygiene inquiries. Individual variables and hygiene practices associated with lower rates of diarrheal illnesses included having water piped into the home, proper hand washing, adequate soap availability, proper consideration of vendor cleanliness, higher income, levels of education, health hygiene education, and having access to healthcare professions to discuss hygiene related matters. This is the first study to assess the water and personal hygiene practices at the Kulandia refugee ramp. This study demonstrates that hygiene education and better practices are closely associated with the rate at which individuals and households suffer from diarrheal illnesses within the Kulandia refugee camp. There are significant hygiene deficits in the camp, which likely result from a lack of formal hygiene education and a lack of awareness concerning the connection between diarrheal illness and hygiene. With respect to practices, our results elucidate several areas where basic, communal programming - including lessons on appropriate hand washing and food preparation - will likely improve hygiene practices and decrease overall GI burden.

Hygiene and mental health among middle school students in India and 11 other countries.

PubMed

Ranasinghe, Shamika; Ramesh, Swathi; Jacobsen, Kathryn H

2016-01-01

The Global School-based Student Health Survey (GSHS) collects data from early adolescents who are approximately 13-15 years old and enrolled in middle schools (also known as junior secondary schools). We used logistic regression models to examine the associations between self-reported hygiene practices and mental health status as assessed by the 2007 India GSHS. Then, we used meta-analysis to compare the results from India with those from 11 other GSHS-participating countries in Asia and Africa (Djibouti, Indonesia, Jordan, Kenya, Lebanon, Myanmar, the Philippines, Tanzania, Thailand, Uganda, and the United Arab Emirates). Among 7904 middle school students in India, 25.5% reported symptoms of depression, 8.6% reported loneliness, and 7.8% reported anxiety-related insomnia. Both males and females who reported symptoms of depression had an increased likelihood of poor hand and oral hygiene, including washing their hands rarely or never and brushing their teeth less than daily. The meta-analysis for this association yielded statistically significant pooled odds ratios for both boys and girls. In girls, loneliness was also associated with poor hand and oral hygiene. Reduced mental health status in adolescents may lead to worse hygiene behaviors and an increased risk of infections. Teachers, parents, healthcare workers, and other adults who observe suboptimal hygiene status in an adolescent should consider whether this indicates a mental health issue that requires clinical services. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

"First-person view" of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool.

PubMed

Clack, Lauren; Scotoni, Manuela; Wolfensberger, Aline; Sax, Hugo

2017-01-01

Healthcare workers' hands are the foremost means of pathogen transmission in healthcare, but detailed hand trajectories have been insufficiently researched so far. We developed and applied a new method to systematically document hand-to-surface exposures (HSE) to delineate true hand transmission pathways in real-life healthcare settings. A head-mounted camera and commercial coding software were used to capture ten active care episodes by eight nurses and two physicians and code HSE type and duration using a hierarchical coding scheme. We identified HSE sequences of particular relevance to infectious risks for patients based on the WHO 'Five Moments for Hand Hygiene'. The study took place in a trauma intensive care unit in a 900-bed university hospital in Switzerland. Overall, the ten videos totaled 296.5 min and featured eight nurses and two physicians. A total of 4222 HSE were identified (1 HSE every 4.2 s), which concerned bare (79%) and gloved (21%) hands. The HSE inside the patient zone ( n  = 1775; 42%) included mobile objects (33%), immobile surfaces (5%), and patient intact skin (4%), while HSE outside the patient zone ( n  = 1953; 46%) included HCW's own body (10%), mobile objects (28%), and immobile surfaces (8%). A further 494 (12%) events involved patient critical sites. Sequential analysis revealed 291 HSE transitions from outside to inside patient zone, i.e. "colonization events", and 217 from any surface to critical sites, i.e. "infection events". Hand hygiene occurred 97 times, 14 (5% adherence) times at colonization events and three (1% adherence) times at infection events. On average, hand rubbing lasted 13 ± 9 s. The abundance of HSE underscores the central role of hands in the spread of potential pathogens while hand hygiene occurred rarely at potential colonization and infection events. Our approach produced a valid video and coding instrument for in-depth analysis of hand trajectories during active patient care that may help to design more efficient prevention schemes.

Evaluation of a prevention programme efficiency for patients with fixed orthodontic appliances.

PubMed

Matić, Sava; Ivanović, Mirjana; Nikolić, Predrag

2011-03-01

Orthodontic treatment enables the establishment of functional occlusion and improvement of oral health, however, it increases the risk of periodontal disease development. The aim of this paper was to examine the efficiency of the applied programme for the prevention of gingivitis in children undergoing the fixed orthodontic appliance therapy and to determine the most efficient devices and techniques for maintaining oral hygiene during orthodontic treatment. The study included 80 patients of both genders--60 patients comprised the experimental group and 20 patients comprised the control group. All of them were patients of the Clinic for Orthodontics at the School of Dentistry in Belgrade, aged between 13 and 18. The Silness-Löe Plaque Index (PI) was utilised for the assessment of oral hygiene quality and Silness-Löe Gingival Index (GI) and Mühlemann Papilla Bleeding Index (PBI) were utilised for the assessment of gingival state. Checkups were conducted as a single-blind study at the beginning and after the first, the third and the sixth month of the preventive and prophylactic programme. During the observed period, a statistically significant change in PI, GI and PBI values was noticed (p < 0.005), as well as the difference in the dynamics of value changes during the periods between the observed groups. The preventive programme, applied to children undergoing the fixed orthodontic appliance therapy, had a positive effect both on oral hygiene quality and gingival state. The values of the examined parameters of the patients from the experimental group were significantly lower in comparison with those of the patients from the control group. The most efficient combination of devices for oral hygiene during orthodontic treatment was: a Curaprox CP5460 toothbrush, CD Ortho 60 orthodontic toothbrush and Curaprox CPS 14 interdental brush.

Health seeking and hygiene behaviours predict nutritional status of pre-school children in a slum area of Addis Ababa, Ethiopia.

PubMed

Abate, G; Kogi-Makau, W; Muroki, N M

2000-10-01

A cross-sectional study was done from March to May 1997 in four selected slum kebeles (villages) of Addis Ababa in which nutritional status of 758 children aged 6 to 36 months was examined and stratified into malnourished and well nourished groups. Analysis of hygiene and health seeking practices of randomly selected households of the two sets of children determined practices that significantly exacerbate childhood malnutrition. The rates of immunization for the malnourished (80.2%) and well nourished households (77.6%) were practically the same. No significant difference was found in the prevalence of home treatment or food withholding habits at times of diarrhoea episodes between the two groups. The study established six variables to predict childhood malnutrition in the slum section of Addis Ababa: 1) presence of child waste inside house (Odds Ratio = 7.44; p < 0.0001), 2) diarrhoea treatment at the hospital (OR = 0.47;p < 0.05), 3) prolonged storage of cooked foods (OR = 2.86;p < 0.05), 4) feeding with washed hands (OR = 0.44; p < 0.01), and 5) poor handling of drinking water (OR = 3.18; p < 0.01) and 6) foods (OR = 3.52; p < 0.01). Hence strong and sustainable advice with a view of changing the behaviours of households towards good personal and household hygiene practices, and increased utilization of health settings is recommended as these may limit the overall success of public health programmes.

[HAND HYGIENE BELIEFS AND PERCEPTIONS OF NURSING STUDENTS].

PubMed

Hernández-García, Ignacio; Cardoso-Muñoz, Antonio Manuel

2016-05-01

A key element to promote the compliance of hand hygiene (HH) among health care workers (HCWs) is to analyze their perceptions of it. Our objective was to evaluate the beliefs and perceptions that nursing students have on HH. A cross-sectional study was performed during the 2011-2012 school year. It included all enrolled nursing students from a Spanish University. The information was obtained by a self-administered questionnaire, which assessed the importance of HH to control nosocomial infections (NI), beliefs (by Hand Hygiene Beliefs Scale-HHBS) and perceptions of the importance given to HH in the curriculum (by Hand Hygiene Importance Scale-HHIS). Associations were analyzed using logistic regression. 146 students of the 270 (54.1%) completed the questionnaire. Assessing the importance of HH as NI control measure ranged from 4 to 10 points (median = 9). The more agreement HHIS item was to consider HH as an important part of the curriculum (76.1%), while HHBS item was to believe that hands washing after going to the toilet reduces the transmission of infectious diseases (100%). Importance of HH to control NI valued with > 9 points was associated with the agreement to consider it as an relevant part of the curriculum (OR:2.5), and to believe that HCWs play an important role in preventing NI (OR: 4.3). HH was rated as an important NI control measure. Educational programs should be carried out at universities to students do HH, whether they observe poor compliance among HCWs in their practices.

De-worming school children and hygiene intervention.

PubMed

Luong, T V

2003-06-01

Helminths or worm infestations refer to worms that live as parasites in the human body and are a fundamental cause of disease associated with health and nutrition problems beyond gastrointestinal tract disturbances. Globally, over 3.5 billion people are infected with intestinal worms, of which 1.47 billion are with roundworm, 1.3 billion people with hookworm and 1.05 billion with whipworm. School children aged 5 - 15 years suffer the highest infection rate and worm burden that attributes to poor sanitation and hygiene. About 400 million school-age children are infected with roundworm, whipworm and hookworm worldwide, a large proportion of whom are found in the East Asia region (Cambodia, China, Lao PDR, Thailand and Vietnam). These parasites consume nutrients from children they infect, thus retarding their physical development. They destroy tissues and organs, cause abdominal pain, diarrhoea, intestinal obstruction, anaemia, ulcers and other health problems. All of these consequences of infection can slow cognitive development and thus impair learning. De-worming school children by anthelmintic drug treatment is a curative approach for expelling the heavy worm load. However, drug therapy alone is only a short-term measure of reducing worm infection and re-infection is frequent. Control measures through improved sanitation, hygiene and de-worming are needed to prevent infection and re-infection. UNICEF has supported many governments in this (and other) regions to assist in the provision of water supply and sanitary facilities and intensive hygiene education in many schools through the Water, Environment and Sanitation (WES) programme. The UNICEF supported school sanitation and hygiene education (SSHE) programme, and other programmes, could effectively enhance behaviour change in children to break the routes of worm transmission and other waterborne diseases.

Neutralization efficiency of alcohol based products used for rapid hand disinfection

PubMed

Chojecka, Agnieszka; Tarka, Patryk; Kierzkowska, Anna; Nitsch-Osuch, Aneta; Kanecki, Krzysztof

Alcohols are the most commonly used active substances in preparations for quick hand disinfection. They should be bactericidal in very short contact time. PN-EN 13727 + A2: 2015-12 standard, for testing hygienic and surgical handrub disinfection preparations, provides mandatory test conditions of disinfectants in contact times with the range of 30 s to 60 s (hygienic handrub disinfection) and 60 s to 5 min (surgical handrub disinfection). A short contact times for hand hygiene products require a short time of neutralization process. For contact times less than or equal to 10 minutes, the estimated neutralization time is 10 s ± 1 s. Neutralization is a process that abolishes the action of disinfectants. Correct application of this process allows for proper use of disinfectants in practice and its biocidal effect. Objectives. Verification of the effectiveness of 10-second neutralization time of alcohol based preparations for hygienic handrub disinfection Neutralization of two products with different ethanol content (89% and 70%) for hygienic handrub disinfection according to PN-EN 13727 + A2: 2015-12 was investigated. The effectiveness of the neutralizer was assessed by determining toxicity of neutralizer, activity of residual effects of the tested products and their derivatives produced during neutralization (10 s) for test organisms (Staphylococcus aureus ATCC 6538; Pseudomonas aeruginosa ATCC 15442; Enterococcus hirae ATCC 10541; Escherichia coli K12 NCTC 10538) The 10-second neutralization time was sufficient to eliminate the residual activity of products for hygienic handrub disinfection with differentiated ethanol concentration. The neutralizer used did not show toxicity to bacteria and did not produce toxic products with tested preparations after neutralization Conclusions. The use of 10-second neutralization time allows in a precise way designate the contact times for hygienic handrub disinfection products

Hand sanitizer-dispensing door handles increase hand hygiene compliance: a pilot study.

PubMed

Babiarz, Lukasz S; Savoie, Brent; McGuire, Mark; McConnell, Lauren; Nagy, Paul

2014-04-01

Improving rates of hand hygiene compliance (HHC) has been shown to reduce nosocomial disease. We compared the HHC for a traditional wall-mounted unit and a novel sanitizer-dispensing door handle device in a hospital inpatient ultrasound area. HHC increased 24.5%-77.1% (P < .001) for the exam room with the sanitizer-dispensing door handle, whereas it remained unchanged for the other rooms. Technical improvements like a sanitizer-dispensing door handle can improve hospital HHC. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Hand sanitiser provision for reducing illness absences in primary school children: a cluster randomised trial.

PubMed

Priest, Patricia; McKenzie, Joanne E; Audas, Rick; Poore, Marion; Brunton, Cheryl; Reeves, Lesley

2014-08-01

The potential for transmission of infectious diseases offered by the school environment are likely to be an important contributor to the rates of infectious disease experienced by children. This study aimed to test whether the addition of hand sanitiser in primary school classrooms compared with usual hand hygiene would reduce illness absences in primary school children in New Zealand. This parallel-group cluster randomised trial took place in 68 primary schools, where schools were allocated using restricted randomisation (1:1 ratio) to the intervention or control group. All children (aged 5 to 11 y) in attendance at participating schools received an in-class hand hygiene education session. Schools in the intervention group were provided with alcohol-based hand sanitiser dispensers in classrooms for the winter school terms (27 April to 25 September 2009). Control schools received only the hand hygiene education session. The primary outcome was the number of absence episodes due to any illness among 2,443 follow-up children whose caregivers were telephoned after each absence from school. Secondary outcomes measured among follow-up children were the number of absence episodes due to specific illness (respiratory or gastrointestinal), length of illness and illness absence episodes, and number of episodes where at least one other member of the household became ill subsequently (child or adult). We also examined whether provision of sanitiser was associated with experience of a skin reaction. The number of absences for any reason and the length of the absence episode were measured in all primary school children enrolled at the schools. Children, school administrative staff, and the school liaison research assistants were not blind to group allocation. Outcome assessors of follow-up children were blind to group allocation. Of the 1,301 and 1,142 follow-up children in the hand sanitiser and control groups, respectively, the rate of absence episodes due to illness per 100 child-days was similar (1.21 and 1.16, respectively, incidence rate ratio 1.06, 95% CI 0.94 to 1.18). The provision of an alcohol-based hand sanitiser dispenser in classrooms was not effective in reducing rates of absence episodes due to respiratory or gastrointestinal illness, the length of illness or illness absence episodes, or the rate of subsequent infection for other members of the household in these children. The percentage of children experiencing a skin reaction was similar (10.4% hand sanitiser versus 10.3% control, risk ratio 1.01, 95% CI 0.78 to 1.30). The rate or length of absence episodes for any reason measured for all children also did not differ between groups. Limitations of the study include that the study was conducted during an influenza pandemic, with associated public health messaging about hand hygiene, which may have increased hand hygiene among all children and thereby reduced any additional effectiveness of sanitiser provision. We did not quite achieve the planned sample size of 1,350 follow-up children per group, although we still obtained precise estimates of the intervention effects. Also, it is possible that follow-up children were healthier than non-participating eligible children, with therefore less to gain from improved hand hygiene. However, lack of effectiveness of hand sanitiser provision on the rate of absences among all children suggests that this may not be the explanation. The provision of hand sanitiser in addition to usual hand hygiene in primary schools in New Zealand did not prevent disease of severity sufficient to cause school absence. Australian New Zealand Clinical Trials Registry ACTRN12609000478213. Please see later in the article for the Editors' Summary.

Hand Sanitiser Provision for Reducing Illness Absences in Primary School Children: A Cluster Randomised Trial

PubMed Central

Audas, Rick; Poore, Marion; Brunton, Cheryl; Reeves, Lesley

2014-01-01

Background The potential for transmission of infectious diseases offered by the school environment are likely to be an important contributor to the rates of infectious disease experienced by children. This study aimed to test whether the addition of hand sanitiser in primary school classrooms compared with usual hand hygiene would reduce illness absences in primary school children in New Zealand. Methods and Findings This parallel-group cluster randomised trial took place in 68 primary schools, where schools were allocated using restricted randomisation (1∶1 ratio) to the intervention or control group. All children (aged 5 to 11 y) in attendance at participating schools received an in-class hand hygiene education session. Schools in the intervention group were provided with alcohol-based hand sanitiser dispensers in classrooms for the winter school terms (27 April to 25 September 2009). Control schools received only the hand hygiene education session. The primary outcome was the number of absence episodes due to any illness among 2,443 follow-up children whose caregivers were telephoned after each absence from school. Secondary outcomes measured among follow-up children were the number of absence episodes due to specific illness (respiratory or gastrointestinal), length of illness and illness absence episodes, and number of episodes where at least one other member of the household became ill subsequently (child or adult). We also examined whether provision of sanitiser was associated with experience of a skin reaction. The number of absences for any reason and the length of the absence episode were measured in all primary school children enrolled at the schools. Children, school administrative staff, and the school liaison research assistants were not blind to group allocation. Outcome assessors of follow-up children were blind to group allocation. Of the 1,301 and 1,142 follow-up children in the hand sanitiser and control groups, respectively, the rate of absence episodes due to illness per 100 child-days was similar (1.21 and 1.16, respectively, incidence rate ratio 1.06, 95% CI 0.94 to 1.18). The provision of an alcohol-based hand sanitiser dispenser in classrooms was not effective in reducing rates of absence episodes due to respiratory or gastrointestinal illness, the length of illness or illness absence episodes, or the rate of subsequent infection for other members of the household in these children. The percentage of children experiencing a skin reaction was similar (10.4% hand sanitiser versus 10.3% control, risk ratio 1.01, 95% CI 0.78 to 1.30). The rate or length of absence episodes for any reason measured for all children also did not differ between groups. Limitations of the study include that the study was conducted during an influenza pandemic, with associated public health messaging about hand hygiene, which may have increased hand hygiene among all children and thereby reduced any additional effectiveness of sanitiser provision. We did not quite achieve the planned sample size of 1,350 follow-up children per group, although we still obtained precise estimates of the intervention effects. Also, it is possible that follow-up children were healthier than non-participating eligible children, with therefore less to gain from improved hand hygiene. However, lack of effectiveness of hand sanitiser provision on the rate of absences among all children suggests that this may not be the explanation. Conclusions The provision of hand sanitiser in addition to usual hand hygiene in primary schools in New Zealand did not prevent disease of severity sufficient to cause school absence. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12609000478213 Please see later in the article for the Editors' Summary PMID:25117155

Hand hygiene and skin health.

PubMed

Kownatzki, E

2003-12-01

The high rate of hand problems associated with the hand hygiene of medical professions is due to a combination of damaging factors: (1) the removal of barrier lipids by detergent cleaning and alcohol antisepsis followed by a loss of moisturizers and stratum corneum water and (2) the overhydration of the stratum corneum by sweat trapped within gloves. Together the facilitate the invasion of irritants and allergens which elicit inflammatory responses in the dermis. Among the lipids and water-soluble substances removed are natural antibacterials. Their loss leads to increased growth of transient and pathogenic micro-organisms which jeapordizes the very intention of skin hygiene. The kinetics of damage and its repair, and epidemiological evidence suggest that modern synthetic detergents as used in foaming liquid cleansers are the major offender. Conversely, the replacement of detergents with non-detergent emulsion cleansers has been shown to be effective in reducing the prevalence of hand problems among hospital staff. Presently recommended hand antisepsis reduces the risks to patients, but puts the burden on the health care provider. Rather than fighting micro-organisms at the expense of the skin's health, the skin and its own defences should be considered a collaborator in combating infectious diseases.

A systematic approach for the location of hand sanitizer dispensers in hospitals.

PubMed

Cure, Laila; Van Enk, Richard; Tiong, Ewing

2014-09-01

Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.

Progress towards the eradication of Aujeszky's disease in New Zealand by vaccination with a subunit vaccine.

PubMed

Motha, M X; Atkinson, G; Hoyle, F P

1994-08-27

Attempts to control Aujeszky's disease by vaccination with a glycoprotein-I negative subunit vaccine have been made on nine New Zealand pig farms. Thirty-one to 42 months after the programme of vaccination began, its progress was assessed by measuring the gI-antibody response in pigs from seven of the farms. Three farms had totally eradicated the 'wild' virus infection, one farm was close to achieving complete eradication and the other three farms had made little or no progress. One of the farms which eradicated the 'wild' virus infection achieved this status in two years by combining vaccination with an intensive testing and culling programme; the other two farms had eradicated the 'wild' virus infection by a combination of vaccination and good standards of hygiene without undertaking an intensive culling programme. The farms that had made little or no progress had less satisfactory standards of hygiene and did not practise an intensive testing and culling programme.

Efficacy of alcohol-based hand sanitizer on hands soiled with dirt and cooking oil.

PubMed

Pickering, Amy J; Davis, Jennifer; Boehm, Alexandria B

2011-09-01

Handwashing education and promotion are well established as effective strategies to reduce diarrhea and respiratory illness in countries around the world. However, access to reliable water supplies has been identified as an important barrier to regular handwashing in low-income countries. Alcohol-based hand sanitizer (ABHS) is an effective hand hygiene method that does not require water, but its use is not currently recommended when hands are visibly soiled. This study evaluated the efficacy of ABHS on volunteers' hands artificially contaminated with Escherichia coli in the presence of dirt (soil from Tanzania) and cooking oil. ABHS reduced levels of E. coli by a mean of 2.33 log colony forming units (CFU) per clean hand, 2.32 log CFU per dirt-covered hand, and 2.13 log CFU per oil-coated hand. No significant difference in efficacy was detected between hands that were clean versus dirty or oily. ABHS may be an appropriate hand hygiene method for hands that are moderately soiled, and an attractive option for field settings in which access to water and soap is limited.

Staff education aimed at reducing ventilator-associated pneumonia.

PubMed

Yilmaz, Gurdal; Aydin, Hava; Aydin, Mustafa; Saylan, Sedat; Ulusoy, Hulya; Koksal, Iftihar

2016-12-01

Mechanical ventilation is a life-saving invasive procedure performed in intensive care units (ICUs) where critical patients are given advanced support. The purpose of this study was to assess the effect of personnel training on the incidence of ventilator-associated pneumonia (VAP). The study, performed prospectively in the ICU, was planned in two periods. In both periods, patient characteristics were recorded on patient data forms. In the second period, ICU physicians and assistant health personnel were given regular theoretical and practical training. Twenty-two cases of VAP developed in the pre-training period, an incidence of 31.2. Nineteen cases of VAP developed in the post-training period, an incidence of 21.0 (P<0.001). Training reduced development of VAP by 31.7 %. Crude VAP mortality was 69 % in the first period and 26 % in the second (P<0.001). Statistically significant risk factors for VAP in both periods were prolonged hospitalization, increased number of days on mechanical ventilation, and enteral nutrition; risk factors determined in the first period were re-intubation, central venous catheter use and heart failure and, in the second period, erythrocyte transfusion >5 units (P<0.05). Prior to training, compliance with hand washing (before and after procedure), appropriate aseptic endotracheal aspiration and adequate oral hygiene in particular were very low. An improvement was observed after training (P<0.001). The training of personnel who will apply infection control procedures for the prevention of healthcare-associated infections is highly important. Hand hygiene and other infection control measures must be emphasized in training programmes, and standard procedures in patient interventions must be revised.

The Feedback Intervention Trial (FIT) — Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial

PubMed Central

Fuller, Christopher; Michie, Susan; Savage, Joanne; McAteer, John; Besser, Sarah; Charlett, Andre; Hayward, Andrew; Cookson, Barry D.; Cooper, Ben S.; Duckworth, Georgia; Jeanes, Annette; Roberts, Jenny; Teare, Louise; Stone, Sheldon

2012-01-01

Introduction Achieving a sustained improvement in hand-hygiene compliance is the WHO’s first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness. Methods Three year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%). Results All 16 trusts (60 wards) randomised, 33 wards implemented intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all wards) accounting for confounders, temporal trends, ward type and fidelity to intervention (forms/month used). Intention to Treat Analysis Estimated odds ratio (OR) for hand hygiene compliance rose post randomisation (1.44; 95% CI 1.18, 1.76;p<0.001) in ITUs but not ACE wards, equivalent to 7–9% absolute increase in compliance. Per-Protocol Analysis for Implementing Wards OR for compliance rose for both ACE (1.67 [1.28–2.22]; p<0.001) & ITUs (2.09 [1.55–2.81];p<0.001) equating to absolute increases of 10–13% and 13–18% respectively. Fidelity to intervention closely related to compliance on ITUs (OR 1.12 [1.04, 1.20];p = 0.003 per completed form) but not ACE wards. Conclusion Despite difficulties in implementation, intention-to-treat, per-protocol and fidelity to intervention, analyses showed an intervention coupling feedback to personalised action planning produced moderate but significant sustained improvements in hand-hygiene compliance, in wards implementing a national hand-hygiene campaign. Further implementation studies are needed to maximise the intervention’s effect in different settings. Trial Registration Controlled-Trials.com ISRCTN65246961 PMID:23110040

Microbial Efficacy of Waterless Hand Hygiene in Dar es Salaam, Tanzania

NASA Astrophysics Data System (ADS)

Pickering, A.; Boehm, A.; Davis, J.

2008-12-01

Millions of people die from diarrheal and respiratory diseases every year due to lack of proper sanitation, hygiene, and access to clean water. The act of handwashing with soap has been found to effectively reduce both diarrheal and respiratory illness, however, handwashing at critical times (i.e. after using the toilet, before preparing food) remains infrequent around the world. This research investigates the potential for alcohol- based hand sanitizer (ABHS) to be an effective and appropriate hand hygiene option in developing countries. A study was conducted to assess the microbiological effectiveness of ABHS, as compared to handwashing with soap and water, in field conditions in Dar es Salaam, Tanzania. A total of 205 participants, including mothers, nurses, students, and teachers, were introduced to ABHS, given a standardized amount (2ml) of product, and instructed on how to use the product correctly. Hand samples were obtained using the hand rinse method before and after the use of ABHS from 152 participants. The other 53 participants were hand sampled before and after handwashing with a non-antimicrobial liquid soap and clean water (prior to using ABHS). Visual inspections of the hands were performed before hand sampling to record the level of dirt on the hands. All hand samples were processed and analyzed by membrane filtration for concentrations of two microbial indicators, enterococci and E. coli. User perceptions of the product and willingness to pay are also documented. The results of this study provide valuable insight on the prospective of promoting ABHS in developing countries and water scarce areas.

Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 Benchmark Study.

PubMed

Steed, Connie; Kelly, J William; Blackhurst, Dawn; Boeker, Sue; Diller, Thomas; Alper, Paul; Larson, Elaine

2011-02-01

Measurement and monitoring of health care workers' hand hygiene compliance (i.e., actions/opportunities) is a key component of strategies to eliminate hospital-acquired infections. Little data exist on the expected number of hand hygiene opportunities (HHOs) in various hospital settings, however. The purpose of this study was to estimate HHOs in 2 types of hospitals--large teaching and small community--and 3 different clinical areas-medical-surgical intensive care units, general medical wards, and emergency departments. HHO data were collected through direct observations using the World Health Organization's monitoring methodology. Estimates of HHOs were developed for 12-hour AM/PM shifts and 24-hour time frames. During 436.7 hours of observation, 6,640 HHOs were identified. Estimates of HHOs ranged from 30 to 179 per patient-day on inpatient wards and from 1.84 to 5.03 per bed-hour in emergency departments. Significant differences in HHOs were found between the 2 hospital types and among the 3 clinical areas. This study is the first to use the World Health Organization's data collection methodology to estimate HHOs in general medical wards and emergency departments. These data can be used as denominator estimates to calculate hand hygiene compliance rates when product utilization data are available. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

[Influence of promotional material on hand hygiene in the safety culture of a tertiary hospital].

PubMed

Molina-Cabrillana, J; Dorta-Hung, M E; Otero Sanz, L; Henández Vera, J R; Martín-Rodríguez, M M; García de Carlos, P

2016-06-01

In order to increase safety culture about hand hygiene by means of messages and reminders about its importance in preventing nosocomial infections, we developed a new set of materials in the Complejo Hospitalario Universitario Insular Materno-Infantil of Las Palmas, Gran Canaria, constitued by two centres with 450 beds each and acredited for medical internal residents training. We hired a well-known caricaturist, who adapted the messages to the local way of speaking, by using characters that used to appear in his artwork in the local newspaper. Also, we continued to work with other graphic design professionals. We monitored adherence and consumption of products for hand rubbing. We noted an increase in both indicators in the following months after the implementation of this strategy. Moreover, we revised the infrastructures for hand hygiene, and were able to demonstrate improvements in most of the patient care areas. The material was well accepted by professionals, patients and visitors. No other interventions were made, so we think improvements can be attributable to this strategy in our setting. Copyright © 2016 SECA. Published by Elsevier Espana. All rights reserved.

Safe motherhood voucher programme coverage of health facility deliveries among poor women in South-western Uganda.

PubMed

Kanya, Lucy; Obare, Francis; Warren, Charlotte; Abuya, Timothy; Askew, Ian; Bellows, Ben

2014-07-01

There has been increased interest in and experimentation with demand-side mechanisms such as the use of vouchers that place purchasing power in the hands of targeted consumers to improve the uptake of healthcare services in low-income settings. A key measure of the success of such interventions is the extent to which the programmes have succeeded in reaching the target populations. This article estimates the coverage of facility deliveries by a maternal health voucher programme in South-western Uganda and examines whether such coverage is correlated with district-level characteristics such as poverty density and the number of contracted facilities. Analysis entails estimating the voucher coverage of health facility deliveries among the general population and poor population (PP) using programme data for 2010, which was the most complete calendar year of implementation of the Uganda safe motherhood (SM) voucher programme. The results show that: (1) the programme paid for 38% of estimated deliveries among the PP in the targeted districts, (2) there was a significant negative correlation between the poverty density in a district and proportions of births to poor women that were covered by the programme and (3) improving coverage of health facility deliveries for poor women is dependent upon increasing the sales and redemption rates. The findings suggest that to the extent that the programme stimulated demand for SM services by new users, it has the potential of increasing facility-based births among poor women in the region. In addition, the significant negative correlation between the poverty density and the proportions of facility-based births to poor women that are covered by the voucher programme suggests that there is need to increase both voucher sales and the rate of redemption to improve coverage in districts with high levels of poverty. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Access to Waterless Hand Sanitizer Improves Student Hand Hygiene Behavior in Primary Schools in Nairobi, Kenya

PubMed Central

Pickering, Amy J.; Davis, Jennifer; Blum, Annalise G.; Scalmanini, Jenna; Oyier, Beryl; Okoth, George; Breiman, Robert F.; Ram, Pavani K.

2013-01-01

Handwashing is difficult in settings with limited resources and water access. In primary schools within urban Kibera, Kenya, we investigated the impact of providing waterless hand sanitizer on student hand hygiene behavior. Two schools received a waterless hand sanitizer intervention, two schools received a handwashing with soap intervention, and two schools received no intervention. Hand cleaning behavior after toilet use was monitored for 2 months using structured observation. Hand cleaning after toileting was 82% at sanitizer schools (N = 2,507 toileting events), 38% at soap schools (N = 3,429), and 37% at control schools (N = 2,797). Students at sanitizer schools were 23% less likely to have observed rhinorrhea than control students (P = 0.02); reductions in student-reported gastrointestinal and respiratory illness symptoms were not statistically significant. Providing waterless hand sanitizer markedly increased student hand cleaning after toilet use, whereas the soap intervention did not. Waterless hand sanitizer may be a promising option to improve student hand cleansing behavior, particularly in schools with limited water access. PMID:23836575

Hand Hygiene: When and How

MedlinePlus

... glove removal) . WHY? To protect yourself and the health- care environment from harmful patient germs. WHEN? Clean your hands ... patient’ s side. WHY? To protect yourself and the health- care environment from harmful patient germs. WHEN? Clean your hands ...

[Promotion of orodental health in adolescents in Africa].

PubMed

Tapsoba, H; Deschamps, J P

1997-12-01

Bad dental hygiene in adults is usually the result of bad care during childhood. Within the framework of Health for All, WHO and the International Dental Federation defined global objectives for dental health which allow for monitoring progress in different countries. The most common dental problems, such as dental cavities, can be prevented by simple and inexpensive methods. Dental health is based on dental hygiene, nutrition, fluoride intake and dental service utilisation. Dental health promotion aims to create an environment favourable to the adoption of these healthy behaviours. The principle recommended dental health measures are through fluoridation of water, salt, and milk, a low consumption of sweets, and modification of the amount of sugar in the diet; implementation of monitored dental hygiene activities in schools; the organisation of regular dental services in schools/workplaces; and adopting legislative texts or laws requiring certain measures of prevention. In the past several years, certain African countries have set up national dental health programmes (there were 12 in 1993), However, the implementation of dental health promotion generally doesn't result from a national initiative, but from a regional or local scale. This is largely due to the lack of integration of dental health in activities of education and health promotion in general. Programmes planned at a national level and then implemented at a local level on a multisectoral base have had more success. This article presents examples of dental health promotion activities in several African countries, mainly focusing on programmes aimed at 12-13 year olds in primary school. Programmes from Morocco, Kenya, Madagascar, Côte d'Ivoire, Benin, and Tanzania are briefly presented and show that in Africa, dental health promotion has mostly consisted of the implementation of health education actions and that there are no consistent policies, unlike in other developing countries, for fluoridation of water, salt, and milk. In terms of dental health promotion, WHO recommends the promotion of traditional methods of dental hygiene (such as plants or sticks for cleaning), especially among adolescents living in rural and low income communities. In turn, the identification and promotion of the positive aspects of hygiene and traditional care will allow for the implementation of more culturally acceptable approaches.

Comparative efficacy of a simplified handwashing program for improvement in hand hygiene and reduction of school absenteeism among children with intellectual disability.

PubMed

Lee, Regina L T; Leung, Cynthia; Tong, Wah Kun; Chen, Hong; Lee, Paul H

2015-09-01

Infectious diseases are common among schoolchildren as a result of their poor hand hygiene, especially in those who have developmental disabilities. A quasi-experimental study using a pre- to post-test design with a control group was used to test the feasibility and sustainability of simplified 5-step handwashing techniques to measure the hand hygiene outcome for students with mild intellectual disability. Sickness-related school absenteeism was compared. The intervention group experienced a significant increase in the rating of their handwashing quality in both hands from pre- to post-test: left dorsum (+1.05, P < .001); right dorsum (+1.00, P < .001); left palm (+0.98, P < .001); and right palm (+1.09, P < .001). The pre- to post-test difference in the intervention group (+1.03, P < .001) was significantly greater than the difference in the control group (+0.34, P = .001). There were no differences between the post-test and the sustainability assessment in the intervention group. The intervention school experienced a significantly lower absenteeism rate (0.0167) than the control group in the same year (0.028, P = .04).Students in this study showed better performance in simplified handwashing techniques and experienced lower absenteeism than those using usual practice in special education school settings. The simplified 5-step hand hygiene technique has been proven effective in reducing the spread of infectious diseases. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Development of an observational measure of healthcare worker hand-hygiene behaviour: the hand-hygiene observation tool (HHOT).

PubMed

McAteer, J; Stone, S; Fuller, C; Charlett, A; Cookson, B; Slade, R; Michie, S

2008-03-01

Previous observational measures of healthcare worker (HCW) hand-hygiene behaviour (HHB) fail to provide adequate standard operating procedures (SOPs), accounts of inter-rater agreement testing or evidence of sensitivity to change. This study reports the development of an observational tool in a way that addresses these deficiencies. Observational categories were developed systematically, guided by a clinical guideline, previous measures and pilot hand-hygiene behaviour observations (HHOs). The measure, a simpler version of the Geneva tool, consists of HHOs (before and after low-risk, high-risk or unobserved contact), HHBs (soap, alcohol hand rub, no action, unknown), and type of HCW. Inter-observer agreement for each category was assessed by observation of 298 HHOs and HHBs by two independent observers on acute elderly and intensive care units. Raw agreement (%) and Kappa were 77% and 0.68 for HHB; 83% and 0.77 for HHO; and 90% and 0.77 for HCW. Inter-observer agreement for overall compliance of a group of HCWs was assessed by observation of 1191 HHOs and HHBs by two pairs of independent observers. Overall agreement was good (intraclass correlation coefficient = 0.79). Sensitivity to change was examined by autoregressive time-series modelling of longitudinal observations for 8 months on the intensive therapy unit during an Acinetobacter baumannii outbreak and subsequent strengthening of infection control measures. Sensitivity to change was demonstrated by a rise in compliance from 80 to 98% with an odds ratio of increased compliance of 7.00 (95% confidence interval: 4.02-12.2) P < 0.001.

A Helping Hand.

ERIC Educational Resources Information Center

Renner, Jason M.

2000-01-01

Discusses how designing a hand washing-friendly environment can help to reduce the spread of germs in school restrooms. Use of electronic faucets, surface risk management, traffic flow, and user- friendly hand washing systems that are convenient and maximally hygienic are examined. (GR)

Patient-driven hand hygiene audit process at a regional cancer center.

PubMed

Bow, E J; Bourrier, V; Trudel, J; Kostiuk, N; McLeod, J M

2018-01-01

A patient-driven hand hygiene compliance audit strategy was piloted in a Canadian provincial cancer agency during routine provision of cancer outpatient care by health care providers (physicians, nurses, and health care aides) under conditions where the deployment of an independent external auditor was not feasible. The results of the audit suggest the feasibility of this approach as a routine institutional performance metric. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Hygiene perception changes during the influenza A H1N1 pandemic in Germany: incorporating the results of two cross-sectional telephone surveys 2008-2009.

PubMed

Meilicke, Gerald; Riedmann, Klaus; Biederbick, Walter; Müller, Ute; Wierer, Traugott; Bartels, Cornelius

2013-10-16

The federal campaign Wir gegen Viren [Us against viruses] promoted hygiene in Germany during the influenza A H1N1 pandemic in 2009. The intervention aimed to encourage people to protect themselves against respiratory infections by simple means of hygiene behaviour. Quantitative research was carried out to outline changes in hygiene perception of the population over time, and to find out whether the potential hygiene perception changes were consistent to the federal campaign about hygiene or not. To determine changes in the hygiene perception of the population, two cross-sectional telephone surveys were held, each one with n = 2006 participants. The initial survey was carried out before the influenza A H1N1 pandemic in calendar week 49-51 in 2008 and the second in week 48 in 2009 directly after the peak of the pandemic in Germany. The questionnaire contained indicators about perceived hand hygiene efficacy, preference for coughing into the sleeve, propensity for presenteeism while showing symptoms of a cold and acceptance of hygiene masks. The proportion of people who perceive the efficacy of hand washing as "very good" increased significantly from 50.9% in 2008 to 61.1% in 2009. The proportion of people who perceive coughing into the sleeve as the best way to cough increased even more dramatically from 4.8% in 2008 to 38.3% in 2009. In contrast the propensity for presenteeism decreased significantly: The proportion of people who state that they always report to work while they show symptoms of a cold decreased from 50.8% in 2008 to 40.9% in 2009. Acceptance of hygiene masks has not changed significantly from 2008 to 2009. The results revealed changes in hygiene perception during influenza A H1N1 pandemic in Germany. The changes we found are in accordance with the hygiene recommendations given by the federal campaign Wir gegen Viren [Us against viruses]. Results can constitute a practical benchmark for future research about hygiene perception and hygiene promotion for adults. A pivotal question is: does the increase in hygiene perception persist after the pandemic has ceased?

Farm Fairs and Petting Zoos: A Review of Animal Contact as a Source of Zoonotic Enteric Disease.

PubMed

Conrad, Cheyenne C; Stanford, Kim; Narvaez-Bravo, Claudia; Callaway, Todd; McAllister, Tim

2017-02-01

Many public venues such as farms, fairs, and petting zoos encourage animal contact for both educational and entertainment purposes. However, healthy farm animals, including cattle, small ruminants, and poultry, can be reservoirs for enteric zoonotic pathogens, with human infections resulting in nausea, vomiting, diarrhea, and, in some cases, severe complications that can lead to death. As animals shed these organisms in their feces, contamination of themselves and their surroundings is unavoidable. The majority of North Americans reside in urban and suburban settings, and the general public often possess limited knowledge of agricultural practices and minimal contact with farm animals. Furthermore, there is a lack of understanding of zoonotic pathogens, particularly how these pathogens are spread and the human behaviors that may increase the risk of infection. Human risk behaviors include hand-to-mouth contact immediately after physical contact with animals and their environments, a practice that facilitates the ingestion of pathogens. It is often young children who become ill due to their under-developed immune systems and poorer hygienic practices compared with adults, such as more frequent hand-to-mouth behaviors, and infrequent or improper hand washing. These illnesses are often preventable, simply through adequate hygiene and hand washing. Our objective was to use a structured approach to review the main causal organisms responsible for human illnesses acquired in petting zoo and open farm environments, Shiga toxin-producing Escherichia coli, nontyphoidal Salmonella, Campylobacter, and Cryptosporidium. Notable outbreaks involving direct contact with farm animals and farm, fair, or petting zoo environments are discussed and recommendations for how public venues can increase safety and hand hygiene compliance among visitors are proposed. The most effective protective measures against enteric illnesses include education of the public, increasing overall awareness of the risks and the importance of hand hygiene, as well as access to hand-washing facilities.

[Hygiene practices for patients with HIV/AIDS].

PubMed

da Cunha, Gilmara Holanda; de Araujo, Thelma Leite; Lima, Francisca Elisângela Teixeira; Cavalcante, Tahissa Frota; Galvão, Marli Teresinha Gimeniz

2014-09-01

The objective of this study was to analyze the scientific production on health interventions related to hygiene for adults with HIV/AIDS. An integrative literature review was performed using six databases in June 2013. The descriptors AIDS and Hygiene were used, in Portuguese, English or Spanish. A total of 682 articles were found and 16 were selected. Personal hygiene practices were identified, such as hand washing, showers, tooth brushing and quitting smoking. Food hygiene practices involved washing food and kitchen utensils, using treated water, conserving and cooking food. Environmental hygiene took into account raising domestic animals, control of disease vectors, household cleanliness, waste disposal and basic sanitation. In conclusion, these specific hygiene interventions can be applied to the general population and, especially, to people with HIV/AIDS, due to immunosuppression.

Effect of hand hygiene and glove use on cleanliness of reusable surgical instruments.

PubMed

Costa, D M; Lopes, L K O; Tipple, A F V; Castillo, R B; Hu, H; Deva, A K; Vickery, K

2017-12-01

During functionality testing and packaging of reusable surgical instruments (RSI) for sterilization, instruments are frequently touched. There is a lack of standards relating to hand hygiene frequency and use of gloves in the sterilizing service unit packing area. To determine the effect of hand hygiene and glove use on maintenance of RSI cleanliness. Following manual and automated cleaning, Halsted-mosquito forceps were assessed for adenosine triphosphate (ATP), protein and microbial contamination after handling with gloved and ungloved but washed hands using an ATP surface swab test, bicinchoninic acid assay, and standard culture plate/broth, respectively. Gram's stain was used to classify the isolates. RSI contamination was assessed immediately following and 1, 2, and 4 h after washing hands. Packing instruments with hands that had been unwashed for 2 or 4 h resulted in a significant increase in contaminating ATP when compared with all other treatment groups (P < 0.05). There was a significant correlation between the time since washing hands, the amount of ATP (r = 0.93; P ≤ 0.001), and the microbial load (r = 0.83; P ≤ 0.001) contaminating the forceps, where the longer the time the hands remained unwashed the higher the contamination. Significantly more contaminating protein was found on forceps handled with ungloved hands that had not been washed for 2 or 4 h (P < 0.001). Critical RSI inspection, assembling, lubricating and packing should be performed using either gloves or within 1 h of washing hands. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Assessing the Health Impact of the following Measures in Schools in Maradi (Niger): Construction of Latrines, Clean Water Supply, Establishment of Hand Washing Stations, and Health Education

PubMed Central

Tohon, Zilahatou

2014-01-01

Objective. To assess the effect on health of the following measures in schools in Maradi (Niger): clean water supply, construction of latrines, establishment of hand washing stations, and health education. Methodology. It was a “before and after” intervention study on a sample of school children aged 7 to 12 years in the Maradi region. The interventions included building of latrines, supplying clean water, setting up hand washing stations, and teaching health education lessons. An individual questionnaire, analysis of stool samples, and a group questionnaire were administered to children and teachers, respectively. The threshold for significance was set at P < 0.05. Results. A statistically significant reduction in cases of diarrhoea and abdominal pains was noted after the project. Overall, carriage of at least one parasite increased from 7.5% before the project to 10.2% after it (P = 0.04). In the programme group schools, there was a statistically significant increase in the prevalence of Hymenolepis nana, from 0 to 1.9 (P = 0.02). Pinworm prevalence remained stable in this group but increased significantly in the control group. Conclusions. Putting health infrastructure in place in schools obviously had an impact on hygiene-related habits in the beneficiary schools and communities. PMID:24563779

The Effects of Social Influence on Nurses' Hand Hygiene Behaviors.

PubMed

Piras, Susan E; Minnick, Ann; Lauderdale, Jana; Dietrich, Mary S; Vogus, Timothy J

2018-04-01

The aim of this article is to describe the associations of nurses' hand hygiene (HH) attitudes, subjective norms, and perceived behavioral control with observed and self-reported HH behavior. Hand hygiene is an essential strategy to prevent healthcare-associated infections. Despite tremendous efforts, nurses' HH adherence rates remain suboptimal. This quantitative descriptive study of ICU nurses in the southeastern United States was guided by the theory of planned behavior. The self-administered Patient Safety Opinion Survey and iScrub application, which facilitates observation, comprised the data set. Nurses' observed HH median was 55%; tendency to self-report was a much higher 90%. Subjective norm and perceived control scores were associated with observed and self-reported HH (P < .05) but not attitude scores or reports of intention. Nurses' subjective norm and perceived control are associated with observed and self-reported HH performance. Healthcare workers overestimate their HH performance. Findings suggest future research to explore manipulators of these variables to change nurses' HH behavior.

Hand hygiene in preventing nosocomial infections:a nursing research.

PubMed

Di Muzio, M; Cammilletti, V; Petrelli, E; Di Simone, E

2015-01-01

To verify whether there is some correlation between the nursing workload and the occurrence of healthcare-associated infections. An anonymous questionnaire made up of 20 items has been drafted for this specific purpose and delivered to a sample of 70 participants, including 33 nurses and 37 nursing students of a well-known University Hospital in Rome. The study is supported by extensive documental research, and a specific literature review. Hand hygiene is a mandatory daily practice, simple but critical, but not always clear enough for both nurses and students. The investigation demonstrated inconsistencies between nurses' and students' behaviour and what is recommended by the new WHO international guidelines. The documented correlation between the workload and the occurrence of healthcare-associated infections may be explained by the negative effect of nursing workload on correct hand-washing procedures. Out of the total sample, 58.6% answered affirmatively to both the presence of healthcare-associated infections within their unit and an excessive daily workload. Indeed, the remaining 41.4% of the sample do not report an excessive workload and states that "there are no healthcare-associated infections within their operational reality, at least not in the time period covered by the present investigation". Although limited to a small sample, this study may reveal that the correct practice of hand washing, prompted and considered fundamental by WHO, is still much underrated. Hand hygiene should be better understood and practiced in all healthcare facilities, through a series of interventions such as: specific training courses, the presence of a gel sanitizer next to each patient's bed or in each patient's room, as well as the adoption of the new international guidelines in all units. The analysis of other correlations found the presence of a protective factor (RR<1) regarding the replacement of gloves for each patient and the use of disinfectant gel, both related to the excessive workload and the presence of infections. In fact, we found no statistically significant values to support such considerations (p>0.05). The same considerations could be also inferred as far as the presence of gel dispensers and disposable wipes near hospital beds are concerned, for the distribution of information leaflets about proper hand hygiene and the frequency of updating courses declared by both nurses and nursing students. The quality of health care starts from the simplest things, such proper hand hygiene.

SaniTwice: a novel approach to hand hygiene for reducing bacterial contamination on hands when soap and water are unavailable.

PubMed

Edmonds, Sarah L; Mann, James; McCormack, Robert R; Macinga, David R; Fricker, Christopher M; Arbogast, James W; Dolan, Michael J

2010-12-01

The risk of inadequate hand hygiene in food handling settings is exacerbated when water is limited or unavailable, thereby making washing with soap and water difficult. The SaniTwice method involves application of excess alcohol-based hand sanitizer (ABHS), hand "washing" for 15 s, and thorough cleaning with paper towels while hands are still wet, followed by a standard application of ABHS. This study investigated the effectiveness of the SaniTwice methodology as an alternative to hand washing for cleaning and removal of microorganisms. On hands moderately soiled with beef broth containing Escherichia coli (ATCC 11229), washing with a nonantimicrobial hand washing product achieved a 2.86 (±0.64)-log reduction in microbial contamination compared with the baseline, whereas the SaniTwice method with 62 % ethanol (EtOH) gel, 62 % EtOH foam, and 70 % EtOH advanced formula gel achieved reductions of 2.64 ± 0.89, 3.64 ± 0.57, and 4.61 ± 0.33 log units, respectively. When hands were heavily soiled from handling raw hamburger containing E. coli, washing with nonantimicrobial hand washing product and antimicrobial hand washing product achieved reductions of 2.65 ± 0.33 and 2.69 ± 0.32 log units, respectively, whereas SaniTwice with 62 % EtOH foam, 70 % EtOH gel, and 70 % EtOH advanced formula gel achieved reductions of 2.87 ± 0.42, 2.99 ± 0.51, and 3.92 ± 0.65 log units, respectively. These results clearly demonstrate that the in vivo antibacterial efficacy of the SaniTwice regimen with various ABHS is equivalent to or exceeds that of the standard hand washing approach as specified in the U.S. Food and Drug Administration Food Code. Implementation of the SaniTwice regimen in food handling settings with limited water availability should significantly reduce the risk of foodborne infections resulting from inadequate hand hygiene.

Facemasks, Hand Hygiene, and Influenza among Young Adults: A Randomized Intervention Trial

PubMed Central

Aiello, Allison E.; Perez, Vanessa; Coulborn, Rebecca M.; Davis, Brian M.; Uddin, Monica; Monto, Arnold S.

2012-01-01

Limited vaccine availability and the potential for resistance to antiviral medications have led to calls for establishing the efficacy of non-pharmaceutical measures for mitigating pandemic influenza. Our objective was to examine if the use of face masks and hand hygiene reduced rates of influenza-like illness (ILI) and laboratory-confirmed influenza in the natural setting. A cluster-randomized intervention trial was designed involving 1,178 young adults living in 37 residence houses in 5 university residence halls during the 2007–2008 influenza season. Participants were assigned to face mask and hand hygiene, face mask only, or control group during the study. Discrete-time survival models using generalized estimating equations to estimate intervention effects on ILI and confirmed influenza A/B infection over a 6-week study period were examined. A significant reduction in the rate of ILI was observed in weeks 3 through 6 of the study, with a maximum reduction of 75% during the final study week (rate ratio [RR] = 0.25, [95% CI, 0.07 to 0.87]). Both intervention groups compared to the control showed cumulative reductions in rates of influenza over the study period, although results did not reach statistical significance. Generalizability limited to similar settings and age groups. Face masks and hand hygiene combined may reduce the rate of ILI and confirmed influenza in community settings. These non-pharmaceutical measures should be recommended in crowded settings at the start of an influenza pandemic. Trail Registration Clinicaltrials.gov NCT00490633 PMID:22295066

Implementation science in low-resource settings: using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana.

PubMed

Kallam, Brianne; Pettitt-Schieber, Christie; Owen, Medge; Agyare Asante, Rebecca; Darko, Elizabeth; Ramaswamy, Rohit

2018-05-19

Low-resource clinical settings often face obstacles that challenge the implementation of recommended evidence-based practices (EBPs). Implementation science approaches are useful in identifying barriers and developing strategies to address them. Ridge Regional Hospital (RRH), a tertiary referral hospital in Accra, Ghana experienced a spike in rates of neonatal sepsis and launched a quality improvement (QI) initiative that identified poor adherence to hand hygiene in the neonatal intensive care unit as a potential source of infections. A multi-modal change package of World Health Organization-recommended solutions was created to address this issue. To ensure that the outputs of the QI effort were adopted within the organization, leaders at RRH and Kybele, Inc. used an implementation science framework called the 'Interactive Systems Framework for Dissemination and Implementation' (ISF) to create a package of locally acceptable implementation strategies. The ISF has never been used before to guide implementation in low-resource settings. Hand hygiene compliance rose from 67% to 92% overall, including a 36% increase during the night shifts-a group of healthcare workers with typically very low levels of compliance. The drastic improvement in adherence to hand hygiene suggests the potential value of the joint use of QI and implementation science to promote the creation and application of contextually appropriate EBPs in low-resource settings. Our results also suggest that using an implementation framework such as the ISF could rapidly increase the uptake of other evidence-based interventions in low-resource settings.

Promoting a Hand Hygiene Program Using Social Media: An Observational Study.

PubMed

Pan, Sung-Ching; Sheng, Wang-Huei; Tien, Kuei-Lien; Chien, Kuang-Tse; Chen, Yee-Chun; Chang, Shawn-Chwen

2016-01-01

Hand hygiene is an important component in infection control to protect patient safety and reduce health care-associated infection. Our aim was to evaluate the efficacy of different social media on the promotion of a hand hygiene (HH) program. The observational study was conducted from May 5 to December 31, 2014, at a 2600-bed tertiary care hospital. A 3-minute video of an HH campaign in 8 languages was posted to YouTube. The Chinese version was promoted through three platforms: the hospital website, the hospital group email, and the Facebook site of a well-known Internet illustrator. The video traffic was analyzed via Google Analytics. HH compliance was measured in November 2013 and 2014. There were 5252 views of the video, mainly of the Chinese-language version (3509/5252, 66.81%). The NTUH website had 24,000 subscribers, and 151 of them viewed the video (connection rate was 151/24,000, 0.63%). There were 9967 users of the hospital email group and the connection rate was 0.91% (91/9967). The connection rate was 6.17% (807/13,080) from Facebook, significantly higher than the other 2 venues (both P<.001). HH compliance sustained from 83.7% (473/565) in 2013 to 86.7% (589/679) in 2014 (P=.13) among all HCWs. Facebook had the highest connection rate in the HH video campaign. The use of novel social media such as Facebook should be considered for future programs that promote hand hygiene and other healthy behaviors.

Marketing hygiene behaviours: the impact of different communication channels on reported handwashing behaviour of women in Ghana.

PubMed

Scott, Beth E; Schmidt, Wolf P; Aunger, Robert; Garbrah-Aidoo, Nana; Animashaun, Rasaaque

2008-06-01

In 2003-04, a National Handwashing Campaign utilizing mass media and community events took place in Ghana. This article describes the results of the evaluation of the campaign in a sample of 497 women with children <5 years. The unifying message across all communication channels was that hands were not 'truly' clean unless washed with soap. The campaign reached 82% of the study population. Sixty-two per cent of women knew the campaign song, 44% were exposed to one channel and 36% to two or more. Overall, TV and radio had greater reach and impact on reported handwashing than community events, while exposure to both a mass media channel and an event yielded the greatest effect, resulting in a 30% increase in reported handwashing with soap after visiting the toilet or cleaning a child's bottom. Our evaluation questions wide-held belief that community events are more effective agents of behaviour change than mass media commercials, at least in the case of hygiene promotion. However, failure of mass media to reach the entire target audience, particularly in specific regions and lower socio-economic groups, and the additive effect of exposure, underscores the need to implement integrated communication programmes utilizing a variety of complementary channels.

Impact of rural water projects on hygienic behaviour in Swaziland

NASA Astrophysics Data System (ADS)

Peter, Graciana

In Swaziland, access to safe water supply and sanitation has improved significantly and was expected to result in improved health and, in particular, reduced infant mortality rates. On the contrary, mortality rates in the under 5 years age group are high and have doubled from 60 in 1996, to 120 deaths per 1000 in 2006. The main objective of the study was to assess whether the water projects permit, and are accompanied by, changes in hygienic behaviour to prevent transmission of diseases. The study area was Phonjwane, located in the dry Lowveld of Swaziland, where water projects play a significant role in meeting domestic water demands. Hygienic behaviour and sanitation facilities were analysed and compared before and after project. The results of the study show that domestic water supply projects have significantly reduced distances travelled and time taken to collect water, and that increased quantities of water are collected and used. While the majority of respondents (95.6%) used the domestic water project source, the quantities allowed per household (125 l which translates to an average of 20.8 l per person) were insufficient and therefore were supplemented with harvested rainwater (57.8%), water from a polluted river (17.8%), and water from a dam (2.2%). Increased water quantities have permitted more baths and washing of clothes and hands, but significant proportions of the population still skip hygienic practices such as keeping water for washing hands inside or near toilet facilities (40%) and washing hands (20%). The study concludes that the water supply project has permitted and improved hygienic practices but not sufficiently. The health benefits of safe domestic water supplies are hampered by insufficient quantities of water availed through the projects, possible contamination of the water in the house, poor hygienic behaviours and lack of appropriate sanitation measures by some households. There is a need to provide sufficient quantities of safe water to meet all domestic demands. Domestic water supply must be accompanied by appropriate sanitation and hygienic education.

Skin and surface lead contamination, hygiene programs, and work practices of bridge surface preparation and painting contractors.

PubMed

Virji, M Abbas; Woskie, Susan R; Pepper, Lewis D

2009-02-01

A 2005 regulatory review of the lead in construction standard by the Occupational Safety and Health Administration (OSHA) noted that alternative pathways of exposure can be as significant as inhalation exposure and that noncompliance with the standard pertaining to hygiene facilities and practices was the second most commonly violated section of the standard. Noncompliance with provisions of the standard and unhealthy work and hygiene practices likely increase the likelihood of take-home lead via contaminated clothing, automobiles, and skin, thus contributing to elevated blood lead levels (BLL) among construction workers and their family members. We performed a cross-sectional study of bridge painters working for small contractors in Massachusetts to investigate causes of persistent elevated BLLs and to assess lead exposures. Thirteen work sites were evaluated for a 2-week period during which surface and skin wipe samples were collected and qualitative information was obtained on personal hygiene practices, decontamination and hand wash facilities, and respiratory protection programs. Results showed lead contamination on workers' skin, respirators, personal automobiles, and the decontamination unit, indicating a significant potential for take-home lead exposure. Overall, the geometric mean (GM) skin lead levels ranged from 373 microg on workers' faces at end of shift to 814 microg on hands at break time. The overall GM lead level inside respirators was 143 microg before work and 286 microg after work. Lead contamination was also present inside workers' personal vehicles as well as on surfaces inside the clean side of the decontamination unit. Review of the respiratory protection programs, work site decontamination and hand wash facilities, and personal hygiene practices indicated that these factors had significant impact on skin and surface contamination levels and identified significant opportunities for improving work site facilities and personal practices. Elevated lead exposure and BLL can be minimized by strict adherence to the OSHA provisions for functioning decontamination and hygiene facilities and healthy personal hygiene practices.

Transmission Dynamics of Carbapenemase-Producing Klebsiella Pneumoniae and Anticipated Impact of Infection Control Strategies in a Surgical Unit

PubMed Central

Sypsa, Vana; Psichogiou, Mina; Bouzala, Georgia-Aikaterina; Hadjihannas, Linos; Hatzakis, Angelos; Daikos, Georgios L.

2012-01-01

Background Carbapenemase-producing Klebsiella pneumoniae (CPKP) has been established as important nosocomial pathogen in many geographic regions. Transmission from patient to patient via the hands of healthcare workers is the main route of spread in the acute-care setting. Methodology/Principal Findings Epidemiological and infection control data were recorded during a prospective observational study conducted in a surgical unit of a tertiary-care hospital in Greece. Surveillance culture for CPKP were obtained from all patients upon admission and weekly thereafter. The Ross-Macdonald model for vector-borne diseases was applied to obtain estimates for the basic reproduction number R0 (average number of secondary cases per primary case in the absence of infection control) and assess the impact of infection control measures on CPKP containment in endemic and hyperendemic settings. Eighteen of 850 patients were colonized with CPKP on admission and 51 acquired CPKP during hospilazation. R0 reached 2 and exceeded unity for long periods of time under the observed hand hygiene compliance (21%). The minimum hand hygiene compliance level necessary to control transmission was 50%. Reduction of 60% to 90% in colonized patients on admission, through active surveillance culture, contact precautions and isolation/cohorting, in combination with 60% compliance in hand hygiene would result in rapid decline in CPKP prevalence within 8–12 weeks. Antibiotics restrictions did not have a substantial benefit when an aggressive control strategy was implemented. Conclusions/Significance Surveillance culture on admission and isolation/cohorting of colonized patients coupled with moderate hand hygiene compliance and contact precautions may lead to rapid control of CPKP in endemic and hyperendemic healthcare settings. PMID:22859965

Reduction in the Incidence of Influenza A but Not Influenza B Associated with Use of Hand Sanitizer and Cough Hygiene in Schools: A Randomized Controlled Trial

PubMed Central

STEBBINS, SAMUEL; CUMMINGS, DEREK A.T.; STARK, JAMES H.; VUKOTICH, CHUCK; MITRUKA, KIREN; THOMPSON, WILLIAM; RINALDO, CHARLES; ROTH, LOREN; WAGNER, MICHAEL; WISNIEWSKI, STEPHEN R.; DATO, VIRGINIA; ENG, HEATHER; BURKE, DONALD S.

2012-01-01

Background Laboratory-based evidence is lacking regarding the efficacy of non-pharmaceutical interventions such as alcohol-based hand sanitizer and respiratory hygiene to reduce the spread of influenza. Methods The Pittsburgh Influenza Prevention Project was a cluster-randomized trial conducted in ten Pittsburgh, PA elementary schools during the 2007-2008 influenza season. Children in five intervention schools received training in hand and respiratory hygiene, and were provided and encouraged to use hand sanitizer regularly. Children in five schools acted as controls. Children with influenza-like illness were tested for influenza A and B by RT-PCR. Results 3360 children participated. Using RT-PCR, 54 cases of influenza A and 50 cases of influenza B were detected. We found no significant effect of the intervention on the primary study outcome of all laboratory confirmed influenza cases (IRR 0.81 95% CI 0.54, 1.23). However, we did find statistically significant differences in protocol-specified ancillary outcomes. Children in intervention schools had significantly fewer laboratory-confirmed influenza A infections than children in control schools, with an adjusted IRR of 0.48 (95% CI 0.26, 0.87). Total absent episodes were also significantly lower among the intervention group than among the control group; adjusted IRR 0.74 (95% CI 0.56, 0.97). Conclusions Non-pharmaceutical interventions (respiratory hygiene education and the regular use of hand sanitizer) did not reduce total laboratory confirmed influenza. However the interventions did reduce school total absence episodes by 26% and laboratory-confirmed influenza A infections by 52%. Our results suggest that NPIs can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children. PMID:21691245

Be seen and heard being clean: A novel patient-centered approach to hand hygiene.

PubMed

Caine, Lynda Z; Pinkham, Ashley M; Noble, James T

2016-07-01

A quasiexperimental pre- and posttest design was used to evaluate hand hygiene (HH) rates on a medical-surgical unit. Data were collected by asking patients if they had seen or heard staff members cleaning their hands. Sixty-five percent of patients reported seeing or hearing staff perform HH preintervention and 93% reported observations postintervention (P < .001). Through incorporating an auditory cue we engaged patients while removing the burden placed on them to question health care worker behavior, and increased both staff and patient awareness of personal HH behavior. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Factors influencing hand washing behaviour in primary schools: process evaluation within a randomised controlled trial

PubMed Central

Chittleborough, Catherine R.; Nicholson, Alexandra L.; Basker, Elaine; Bell, Sarah; Campbell, Rona

2013-01-01

This paper explores factors that may influence hand washing behaviour among pupils and staff in primary schools. A qualitative process evaluation within a cluster randomised controlled trial included pupil focus groups (n=16, ages 6 to 11, semi-structured interviews (n=16 teachers) and observations of hand washing facilities (n=57). Pupils and staff in intervention and control schools demonstrated a similar level of understanding of how, when and why they should wash their hands. Lack of time, poor adult modelling of regular hand washing and unattractive facilities were seen as important barriers to regular hand washing. Reminders and explanations for the importance of hand hygiene were thought to have a positive impact. Influencing individual choices about hand washing through education and information may be necessary, but not sufficient, for initiating and maintaining good hand washing practices. Structural factors, including having time to wash hands using accessible, clean facilities, and being encouraged through the existence of hand washing opportunities in the daily routine and hand washing being viewed as the social norm, will also influence hand washing behaviour. The effectiveness of educational interventions at improving hand hygiene in primary schools may be improved by changing priorities of staff and increasing accessibility to quality facilities. PMID:22623617

Factors influencing hand washing behaviour in primary schools: process evaluation within a randomized controlled trial.

PubMed

Chittleborough, Catherine R; Nicholson, Alexandra L; Basker, Elaine; Bell, Sarah; Campbell, Rona

2012-12-01

This article explores factors that may influence hand washing behaviour among pupils and staff in primary schools. A qualitative process evaluation within a cluster randomized controlled trial included pupil focus groups (n = 16, aged 6-11 years), semi-structured interviews (n = 16 teachers) and observations of hand washing facilities (n = 57). Pupils and staff in intervention and control schools demonstrated a similar level of understanding of how, when and why they should wash their hands. Lack of time, poor adult modelling of regular hand washing and unattractive facilities were seen as important barriers to regular hand washing. Reminders and explanations for the importance of hand hygiene were thought to have a positive impact. Influencing individual choices about hand washing through education and information may be necessary, but not sufficient, for initiating and maintaining good hand washing practices. Structural factors, including having time to wash hands using accessible, clean facilities, and being encouraged through the existence of hand washing opportunities in the daily routine and hand washing being viewed as the social norm, will also influence hand washing behaviour. The effectiveness of educational interventions at improving hand hygiene in primary schools may be improved by changing priorities of staff and increasing accessibility to quality facilities.

High Hand Contamination Rates During Norovirus Outbreaks in Long-Term Care Facilities.

PubMed

Park, Geun Woo; Williamson, Keenan J; DeBess, Emilio; Cieslak, Paul R; Gregoricus, Nicole; De Nardo, Elizabeth; Fricker, Christopher; Costantini, Verónica; Vinjé, Jan

2018-02-01

We examined norovirus contamination on hands of ill patients during 12 norovirus outbreaks in 12 long-term care facilities (LTCFs). The higher frequency and norovirus titers on hands of residents compared to hands of heathcare workers highlights the importance of adhering to appropriate hand hygiene practices during norovirus outbreaks in LTCFs. Infect Control Hosp Epidemiol 2018;39:219-221.

Health promotion interventions to prevent early childhood human influenza at the household level: a realist review to identify implications for programmes in Hong Kong.

PubMed

Lam, Winsome; Dawson, Angela; Fowler, Cathrine

2015-04-01

To identify factors affecting the delivery of health promotion interventions to prevent early childhood human influenza at the household level. Yearly, influenza epidemics seriously affect all age groups, particularly those with weakened immune systems, including children. Influenza is transmitted easily from person to person through droplet and direct contact. Maintaining personal hygiene, avoiding close contact with the infected person and proper hand washing are recommended as the most effective means of preventing the transmission of influenza. However, it is not clear what programme-related mechanisms and contexts are crucial to the successful delivery of interventions in the home. This study systematically reviewed published research studies to identify factors influencing the effective delivery of health promotion programmes targeting influenza in a household. Realist review. A realist review methodology was selected to examine what interventions are effective in preventing and managing influenza at the household level and in what circumstances. A structured search of the peer-reviewed primary research literature was undertaken using a defined search protocol. Eight studies were retrieved for the analysis. Mechanisms impacting on intervention delivery were identified, including timing of implementation, programme reach, organisational and healthcare worker involvement, mode and place of delivery, contact with infected person, health practice compliance and sustainability at home. These findings suggest contextual factors that could be identified through ecological approaches to health promotion that are crucial for policymakers to consider when designing interventions. The active involvement of community nurses through an integrated household visiting programme may help to better deliver family-based health promotion interventions to prevent illnesses such as influenza in children. © 2014 John Wiley & Sons Ltd.

Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time?--a randomized controlled trial.

PubMed

Rock, Clare; Harris, Anthony D; Reich, Nicholas G; Johnson, J Kristie; Thom, Kerri A

2013-11-01

Hand hygiene (HH) is recognized as a basic effective measure in prevention of nosocomial infections. However, the importance of HH before donning nonsterile gloves is unknown, and few published studies address this issue. Despite the lack of evidence, the World Health Organization and other leading bodies recommend this practice. The aim of this study was to assess the utility of HH before donning nonsterile gloves prior to patient contact. A prospective, randomized, controlled trial of health care workers entering Contact Isolation rooms in intensive care units was performed. Baseline finger and palm prints were made from dominant hands onto agar plates. Health care workers were then randomized to directly don nonsterile gloves or perform HH and then don nonsterile gloves. Postgloving finger and palm prints were then made from the gloved hands. Plates were incubated and colony-forming units (CFU) of bacteria were counted. Total bacterial colony counts of gloved hands did not differ between the 2 groups (6.9 vs 8.1 CFU, respectively, P = .52). Staphylococcus aureus was identified from gloves (once in "hand hygiene prior to gloving" group, twice in "direct gloving" group). All other organisms were expected commensal flora. HH before donning nonsterile gloves does not decrease already low bacterial counts on gloves. The utility of HH before donning nonsterile gloves may be unnecessary. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Patient experiences of partnering with healthcare professionals for hand hygiene compliance: a systematic review.

PubMed

Butenko, Samantha; Lockwood, Craig; McArthur, Alexa

2017-06-01

Healthcare-associated infections pose a significant risk to patients in acute healthcare settings such as hospitals. Increasingly, patients are encouraged to be active participants and partner with healthcare professionals to positively influence their own safety and overall experience throughout their healthcare journey. Patient-focused safety initiatives include the empowerment of patients to be active partners with healthcare professionals in order to influence the hand hygiene behaviors and compliance of the healthcare professionals providing care to them. Partnering within the context of healthcare, and between the patient and healthcare professional, can be considered as a general concept that involves the empowerment of patients to participate in their care. Terms used to describe patient partnering within healthcare vary and include patient participation, patient-centeredness, patient empowerment and patient engagement. Although patients appear generally to have positive attitudes and intentions about engaging in their safety and partnering in the healthcare setting, their intentions and actual behaviors vary considerably. Patients appear less likely to engage in behaviors that require questioning of the perceived or real authority of healthcare professionals. A patient's intention and subsequent act of partnering with healthcare professionals for hand hygiene compliance by the healthcare professional are influenced by complex internal, external and social factors as well as cultural, behavioral and systematic factors. To determine the best available evidence in relation to the experiences of the patient partnering with healthcare professionals for hand hygiene compliance. The current review considered qualitative (critical or interpretive) papers that included adult in-patients and healthcare professionals (medical and nursing staff), in the acute hospital-care setting. Adult was considered to be any person aged 18 years or over. It should be noted that consumers in this context were patients and vice versa; the term patient is therefore used throughout this report for consistency. The current review considered studies that investigated the experience of partnership between patients and healthcare professionals in relation to hand hygiene compliance. This review investigated the phenomena of partnering from both the perspectives of the patient and the healthcare professional. The current review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. As qualitative studies were identified and on appraisal found to be of sufficient quality for inclusion, this review did not seek alternate forms of evidence such as text and opinion. The search strategy aimed to find both published and unpublished studies from 1990 to May 2015. Studies published in English were considered for inclusion in this review. Qualitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Qualitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-QARI. Qualitative research findings were pooled using JBI-QARI. Following the systematic search and critical appraisal process, three studies were included in the review for data extraction and synthesis of findings. The review process resulted in 29 study findings that were aggregated into seven categories. The categories generated two meta-synthesized findings. The two final synthesized findings were as follows. Synthesized finding 1: Organizational structures enable partnering between healthcare professionals and patients for hand hygiene compliance; however, the culture, beliefs and behaviors of healthcare professionals and patients do not fully support this partnership. Synthesized finding 2: Patients have differing levels of knowledge and balance partnering in hand hygiene against possible detrimental impacts on the caring relationship provided by healthcare professionals, out of concern for their own wellbeing, health outcomes, treatment and/or recovery. The current review highlights the complexity of the patient's experience of partnering with healthcare professionals for hand hygiene compliance. The experiences reported indicated that there is a possible disparity between the healthcare facility and healthcare professionals' promotion and intention of partnering for hand hygiene compliance, and the actual patient's acceptance, participation, partnership, experience and implementation of this initiative. This disconnect between intent and action appears to be influenced by a number of factors including organizational structures as well as drivers such as cultural beliefs and behavior.

Influence of a preschool preventive dental programme on caries prevalence, oral care and secretory immunity to Streptococcus mutans in young adults.

PubMed

Aida, K L; de Paula Ramos, S; Seixas, G F; Bozza, A; Couto de Almeida, R S; Dezan Garbelini, C C

2018-05-01

To evaluate oral hygiene habits, decayed, missing and filled teeth (DMFT) and surfaces (DMFS), dental care, dietetic habits and anti-Streptococcus mutans salivary secretory Immunoglobulin A (SIgA) in young adults who attended a preventive programme during preschool age. The study group (Baby Clinic) comprised 72 patients, aged 18-25 years, who had participated in the Baby Clinic preventive programme. The control group was age- and gender-matched. The patients were examined and unstimulated whole saliva was sampled for detection of anti-S. mutansSIgA antibodies. Control patients presented increased DMFS scores (P < .05). Hygiene habits, cariogenic diet and antibody levels were not different between groups (P > .05). Baby Clinic patients presented better periodontal status (P < .005), less calculus (P < .005) and bleeding on probing (P < .005), and reported visiting dental services more regularly (P < .05). Adjusted multivariate linear regression analysis demonstrated that DMFT was associated with study group (P < .05), gender (P < .05), parents' education (P < .05), carbohydrate intake (P < .001) and levels of anti-S. mutansSIgA (P < .007). DMFS was associated with time elapsed since the last visit to the dentist (P < .005) and weekly carbohydrate intake (P < .005). Preventive programmes for preschool children positively impact on DMFS and periodontal status in young adults, but have no long-term effects on dietary or hygiene habits. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Use of hand-held computers to determine the relative contribution of different cognitive, attitudinal, social, and organizational factors on health care workers' decision to decontaminate hands.

PubMed

Lee, Karen; Burnett, Emma; Morrison, Kenny; Ricketts, Ian

2014-02-01

Observational and survey methods have limitations in measuring hand hygiene behavior. The ability of a personal digital assistant to anonymously gather data at the point of decision making could potentially address these. Participants were provided with a personal digital assistant to be used for three 2-hour periods and asked to rate influential factors of the Health Belief Model (HBM). Participants were also required to enter what they thought they should do and what they actually did. A total of 741 hand hygiene opportunities was recorded. All HBM constructs were higher for hand hygiene opportunities where there was compliance versus noncompliance, with a significant difference for patient pressure, my risk, perceived benefits, perceived seriousness, and availability of good facilities. Only 20% of doctors, 28% of nurses, and 66% of physiotherapists always did what they thought they should. There was no correlation between self-reported and actual compliance. The HBM appeared to be a useful theoretical framework. Surprisingly, participants rated their compliance as high despite having recorded instances where they did not do what they thought they should do. This suggests that staff may have a different definition of compliance than strict observation of the guidelines. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

It's in Your Hands: An Educational Initiative to Improve Parent/Family Hand Hygiene Compliance.

PubMed

Chandonnet, Celeste J; Boutwell, Kristan M; Spigel, Nadine; Carter, Judith; DeGrazia, Michele; Ozonoff, Al; Flaherty, Kathleen

Health care-associated infections contribute to increased morbidity and mortality, increased resource use, higher costs, and extended hospitalizations. Proper hand hygiene (HH) is essential to health care-associated infection prevention. Low compliance among parents in our neonatal intensive care unit (NICU) was identified and prompted development of an HH initiative. The objective of this quality improvement project was to improve parent HH practices with the ultimate goal of achieving 100% compliance with parent HH. Between December 2011 and November 2014, our NICU Infection Prevention Committee developed and implemented the parent/family HH initiative entitled "It's in Your Hands" and created learning materials based on the World Health Organization and Centers for Disease Control and Prevention recommendations. Materials included information sheets, posters, stickers, and checklists. Audits, based on the World Health Organization's Five Moments for Hand Hygiene, were performed several times per week to monitor compliance. Before the intervention, only 71% (n = 1143) of all observed parents and family members performed proper HH. After the intervention, proper HH increased to 89% (n = 939). An average compliance of 89% was maintained throughout the intervention phase. This initiative led to sustained improvements in HH compliance among NICU parents. It has empowered parents to speak up and request proper HH from health care providers when interacting with their child. This initiative has been adopted as a hospital-wide standard of care.

Evaluation of a Hand Washing Program for 2nd-Graders

ERIC Educational Resources Information Center

Tousman, Stuart; Arnold, Dani; Helland, Wealtha; Roth, Ruth; Heshelman, Nannatte; Castaneda, Oralia; Fischer, Emily; O'Neil, Kristen; Bileto, Stephanie

2007-01-01

The purpose of this project was to determine if a multiple-week learner-centered hand washing program could improve hand hygiene behaviors of 2nd-graders in a northern Illinois public school system. Volunteers from the Rockford Hand Washing Coalition went into 19 different classrooms for 4 consecutive weeks and taught a learner-centered program.…

Hygiene Practices During Food Preparation in Rural Bangladesh: Opportunities to Improve the Impact of Handwashing Interventions.

PubMed

Nizame, Fosiul A; Leontsini, Elli; Luby, Stephen P; Nuruzzaman, Md; Parveen, Shahana; Winch, Peter J; Ram, Pavani K; Unicomb, Leanne

2016-08-03

This study explored the steps of food preparation, related handwashing opportunities, current practices, and community perceptions regarding foods at high-risk of contamination such as mashed foods and salads. In three rural Bangladeshi villages, we collected qualitative and observational data. Food preparation was a complex and multistep process. Food preparation was interrupted by tasks that could contaminate the preparers' hands, after which they continued food preparation without washing hands. Community members typically ate hand-mixed, uncooked mashed food and salad as accompaniments to curry and rice at meals. Hand-mixed dried foods were mostly consumed as a snack. Observers recorded handwashing during preparation of these foods. Among 24 observed caregivers, of 85 opportunities to wash hands with soap during food preparation, washing hands with soap occurred twice, both times after cutting fish, whereas washing hands with water alone was common. A simple and feasible approach is promotion of handwashing with soap upon entering and re-entering the food preparation area, and ensuring that everything needed for handwashing should be within easy reach. © The American Society of Tropical Medicine and Hygiene.

[Historical development and current demands on medical training, further and advanced training in hygiene and infection prevention].

PubMed

Exner, M; Kramer, A

2012-11-01

New risks in nosocomial infections and the dramatic increase in antibiotic-resistant pathogens in healthcare facilities have pointed to the urgent need for a good education of students and practitioners in the basics of hospital hygiene and infection prevention. On the other hand in the last 10 years a large number of institutes of hygiene in universities were closed with remarkable consequences concerning the decreased education in modern hygiene and public health. A broad historical overview over the last 200 years of teaching hygiene and public health at German universities is given which was integrated into the education of medical students. Nowadays many universities do not teach modern hygiene and public health. The demand of re-establishing new institutes of hygiene by the German Medical Council is discussed. The curriculum for the formation of hospital hygienists is presented.

Social-cognitive antecedents of hand washing: Action control bridges the planning-behaviour gap.

PubMed

Reyes Fernández, Benjamín; Knoll, Nina; Hamilton, Kyra; Schwarzer, Ralf

2016-08-01

To examine motivational and volitional factors for hand washing in young adults, using the Health Action Process Approach (HAPA) as a theoretical framework. In a longitudinal design with two measurement points, six weeks apart, university students (N = 440) completed paper-based questionnaires. Prior hand washing frequency, self-efficacy, outcome expectancies, intention and action planning were measured at baseline, and coping planning, action control and hand washing frequency were measured at follow-up. A theory-based structural equation model was specified. In line with the HAPA, the motivational factors of self-efficacy and outcome expectancies predicted intention, whereas the volitional factors of planning and action control mediated between intention and changes in hand washing frequency. Action control was confirmed as the most proximal factor on hand washing behaviour, thus representing a bridge of the planning-behaviour gap. Both motivational and volitional processes are important to consider in the improvement of hand hygiene practices. Moreover, the statistically significant effects for planning and action control illustrate the importance of these key self-regulatory factors in the prediction of hand hygiene. The current study highlights the importance of adopting models that account for motivational and volitional factors to better understand hand washing behaviour.

An alternative methodology for interpretation and reporting of hand hygiene compliance data.

PubMed

DiDiodato, Giulio

2012-05-01

Since 2009, all hospitals in Ontario have been mandated to publicly report health care provider compliance with hand hygiene opportunities (http://www.health.gov.on.ca/patient_safety/index.html). Hand hygiene compliance (HHC) is reported for 2 of the 4 moments during the health care provider-patient encounter. This study analyzes the HHC data by using an alternative methodology for interpretation and reporting. Annualized HHC data were available for fiscal years 2009 and 2010 for each of the 5 hospital corporations (6 sites) in the North Simcoe Muskoka Local Health Integration Network. The weighted average for HHC was used to estimate the overall observed rate for HHC for each hospital and reporting period. Using Bayes' probability theorem, this estimate was used to predict the probability that any patient would experience HHC for at least 75% of hand hygiene moments. This probability was categorized as excellent (≥75%), above average (50%-74%), below average (25%-49%), or poor (<25%). The results were reported using a balanced scorecard display. The overall observed rates for HHC ranged from 50% to 87% (mean, 75% ± 11%, P = .079). Using the alternative methodology for reporting, 6 of the 12 reporting periods would be categorized as excellent, 1 as above average, 2 as below average, and 3 as poor. Population-level HHC data can be converted to patient-level risk information. Reporting this information to the public may increase the value and understandability of this patient safety indicator. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Effectiveness of a hand hygiene promotion strategy using alcohol-based handrub in 6 intensive care units in Colombia.

PubMed

Barrera, Lena; Zingg, Walter; Mendez, Fabian; Pittet, Didier

2011-10-01

Hand hygiene is an effective strategy for the prevention of health care-associated infection (HAI). We investigated the effect of a hand hygiene promotion strategy introducing alcohol-based handrub (AHBR) on the incidence of HAI in a university hospital in Colombia. A Prospective cohort study was performed in 6 intensive care units from January 2001 to December 2005. HAI were identified using standard US Centers for Disease Control and Prevention definitions. Alcohol-based handrub dispensers were installed between February and June 2002. Total ABHR consumption was 5,794 L (mean, 28.9 L per 1,000 patient-days) and significantly increased over time (+9.2% per year; P < .001). Of 14,516 patients cumulating 166,498 patient-days, 2,398 (16.5%) acquired a total of 3,490 HAI episodes (20.9 per 1,000 patient-days). Incidence densities for central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia, and urinary tract infections were 7.7, 10.6, and 3.6 episodes per 1,000 device-days, respectively. A significant decrease was observed for CLABSI (-12.7% per year; P < .001) with low nurse-to-patient ratio independently associated with infection (odds ratio, 1.11; 95% confidence interval: 1.07-1.16; P < .001). Improved hand hygiene measured by increased ABHR consumption resulted in CLABSI reduction. Low nurse-to-patient ratio is independently associated with HAI in an upper-middle income country. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Practices related to late-onset sepsis in very low-birth weight preterm infants.

PubMed

Bentlin, Maria Regina; Rugolo, Ligia M S S; Ferrari, Ligia S L

2015-01-01

To understand the practices related to late-onset sepsis (LOS) in the centers of the Brazilian Neonatal Research Network, and to propose strategies to reduce the incidence of LOS. This was a cross-sectional descriptive multicenter study approved by the Ethics Committee. Three questionnaires regarding hand hygiene, vascular catheters, and diagnosis/treatment of LOS were sent to the coordinator of each center. The center with the lowest incidence of LOS was compared with the others. All 16 centers answered the questionnaires. Regarding hand hygiene, 87% use chlorhexidine or 70% alcohol; alcohol gel is used in 100%; 80% use bedside dispensers (50% had one dispenser for every two beds); practical training occurs in 100% and theoretical training in 70% of the centers, and 37% train once a year. Catheters: 94% have a protocol, and 75% have a line insertion team. Diagnosis/treatment: complete blood count and blood culture are used in 100%, PCR in 87%, hematological scores in 75%; oxacillin and aminoglycosides is the empirical therapy in 50% of centers. Characteristics of the center with lowest incidence of LOS: stricter hand hygiene; catheter insertion and maintenance groups; use of blood culture, PCR, and hematological score for diagnosis; empirical therapy with oxacillin and aminoglycoside. The knowledge of the practices of each center allowed for the identification of aspects to be improved as a strategy to reduce LOS, including: alcohol gel use, hand hygiene training, implementation of catheter teams, and wise use of antibiotic therapy. Copyright © 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

[Hygiene and Infection Prevention in Medical Institutions, Kindergartens and Schools - Statutory Basis, Infection Control Practice and Experiences of the Public Health Services].

PubMed

Heudorf, U

2015-07-01

Infection prevention is one of the main tasks of the public health services. The "Protection against infection act" places all medical institutions and facilities for children (kindergartens and schools) under the obligation to assume responsibility and to cooperate. Duties of the institutions are described, and public health services are obliged to perform hygiene control visits.Regarding medical institutions, the guidelines of the German Commission on Hospital Hygiene and Infection Control have to be observed, and the counties were obliged to publish hygiene enactments. Subsequently, good improvements in hygiene management in medical institutions were achieved. In schools, however, severe hygienic problems (i.e. sanitary hygiene, indoor air hygiene) are detected, without any improvement - obviously due to a missing sense of responsibility in the school community. Causes for poor behaviour prevention (hand hygiene, ventilation) and missing situational prevention (i.e. cleaning) are discussed. Without reversion to the obviously needed but nearly forgotten subject school hygiene, obligatory guidelines and the assuming of responsibility, permanent improvements cannot be achieved. © Georg Thieme Verlag KG Stuttgart · New York.

Effectiveness of short-term, enhanced, infection control support in improving compliance with infection control guidelines and practice in nursing homes: a cluster randomized trial.

PubMed

Gopal Rao, G; Jeanes, A; Russell, H; Wilson, D; Atere-Roberts, E; O'Sullivan, D; Donaldson, N

2009-10-01

In this prospective cluster randomized controlled trial we evaluated the impact of short-term provision of enhanced infection control support on infection control practice in nursing homes in South London. Twelve nursing homes were recruited, six each in intervention (300 residents) and control (265 residents) groups. Baseline observations of hand hygiene facilities, environmental cleanliness and safe disposal of clinical waste showed poor compliance in both groups. Post-intervention observations showed improvement in both groups. There was no statistical difference between the two groups in the compliance for hand hygiene facilities (P=0.69); environmental cleanliness (P=0.43) and safe disposal of clinical waste (P=0.96). In both groups, greatest improvement was in compliance with safe disposal of clinical waste and the least improvement was in hand hygiene facilities. Since infection control practice improved in intervention and control groups, we could not demonstrate that provision of short-term, enhanced, infection control support in nursing homes had a significant impact in infection control practice.

Assessment of factors influencing hygiene behaviour among school children in Mereb-Leke District, Northern Ethiopia: a cross-sectional study.

PubMed

Assefa, Mulubirhan; Kumie, Abera

2014-09-26

Poor school sanitation and hygiene is a major problem in developing countries and remains high risk behaviour among primary school going children. Many outbreaks of gastrointestinal infections have been associated with primary schools. This research paper was designed to assess the factors influencing hygiene behaviour among school children. A cross sectional study was conducted in Mereb-Leke District, Tigray National Regional State among school children. The study population consisted of those who are in the second cycle as they are more mature and most senior in primary schools. A multi-stage probability sampling procedure with three stages was used to select participated schools. A total of 528 school children were randomly selected from students networking list of selected schools. Structured questionnaire and observational checklist at home and school setting were used to collect data. Statistical analysis was done using SPSS Version 17.0 after the data has been entered using Epi-Info version 3.5.3. Primarily variables that had p-value <0.2 at bivariate analysis were used to develop logistic model to identify factors influencing hygiene behaviour via crude and adjusted odds ratio. Children were grouped according to whether positive or negative hygiene behaviour outcome which permitted identifying factor affecting hygiene behaviour. Out of these, 326 (61.7%) had positive hygiene behaviour. The study found that knowledge s on water handling (AOR, 2.24; 95% CI 1.54, 3.26), hand washing (AOR, 1.70; 95% CI 1.12, 2.57) and awareness on water handling matters (AOR, 2.0; 95% CI 1.37, 2.90), hand washing practice (AOR, 2.36; 95% CI 1.62, 3.45) were significantly associated to hygiene behaviour status. Being a member of hygiene and sanitation club (COR 0.42; 95% CI 0.26, 0.68), parent's health package status (COR 0.62; 95% CI 0.43, 0.90), training on hygiene and sanitation and experience of visiting model school (COR 1.99; 95% CI 1.37, 2.88) had significance difference in hygiene behaviour. This study has shown that knowledge, awareness, training on hygiene and sanitation, being a member of hygiene and sanitation club, experience of visiting model school, and parent's health package status were factors influenced hygiene behaviour.

The effectiveness of home hand exercise programmes in rheumatoid arthritis: a systematic review.

PubMed

Hammond, Alison; Prior, Yeliz

2016-09-01

Rheumatoid arthritis (RA) commonly reduces hand function. We systematically reviewed trials to investigate effects of home hand exercise programmes on hand symptoms and function in RA. We searched: Medline (1946-), AMED, CINAHL, Physiotherapy Evidence Database, OT Seeker, the Cochrane Library, ISI Web of Science from inception to January 2016. Nineteen trials were evaluated. Only three were randomized controlled trials with a low risk of bias (n = 665). Significant short-term improvements occurred in hand function, pain and grip strength, with long-term improvements in hand and upper limb function and pinch strength. Heterogeneity of outcome measures meant meta-analysis was not possible. Evaluation of low and moderate risk of bias trials indicated high-intensity home hand exercise programmes led to better short-term outcomes than low-intensity programmes. Such programmes are cost-effective. Further research is required to evaluate methods of helping people with RA maintain long-term home hand exercise. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Helsinki declaration on patient safety in anaesthesiology -part 10: infection control/hygiene].

PubMed

Kerwat, Klaus; Wulf, Hinnerk

2013-11-01

There is a plethora of laws, regulations, guidelines and recommendations relating to infection control and hygiene. Major issues are the prevention of nosocomial infections, staff protection and environmental protection. Of the highest relevance are the infection control law [Infektionsschutzgesetz (IfSG)], the hygiene regulations of the German federal states [Hygieneverordnungen der Bundesländer], the German technical rules for biological materials [Technische Regel Biologische Arbeitsstoffe 250 (TRBA 250)] - biological materials in health-care and welfare work [Biologische Arbeitsstoffe im Gesundheitswesen und in der Wohlfahrtspflege], the guidelines for hospital hygiene and prevention of infection of the commission for hospital hygiene and prevention of infection of the Robert-Koch Institute [Richtlinie für Krankenhaushygiene und Infektionsprävention von der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut], the recommendations of the commission on anti-infectives, resistance and therapy of the Robert-Koch Institute [Empfehlungen der Kommission Antiinfektiva, Resistenz und Therapie (ART) beim Robert Koch-Institut]. Of subordinate importance are, e.g., the recommendations of the German Society for Anesthesiology and Intensive Medicine (DGAI). It is practically impossible for an anesthesiologist working in a hospital to have knowledge of all laws, regulations, guidelines and recommendations. And this is also not reasonable. Thus it is necessary to distinguish the relevant from the irrelevant. Checklists can be useful here. The most important and effective individual action in hospital hygiene is and remains hand hygiene as is propagated in the action "clean hands", irrespective of all laws, regulations, guidelines and recommendations. © Georg Thieme Verlag Stuttgart · New York.

[Infrastructure and adherence to hand hygiene: challenges to patient safety].

PubMed

Bathke, Janaína; de Cunico, Priscila Almeida; Maziero, Eliane Cristina Sanches; Cauduro, Fernanda Leticia Frates; Sarquis, Leila Maria Mansano; de Cruz, Elaine Drehmer Almeida

2013-06-01

Considering the importance of hands in the chain of transmission of microorganisms, this observational research investigated the material infrastructure and compliance of hand hygiene in an intensive care unit in the south of Brazil in 2010. The data was collected by direct non-participant observation and through the use of self-administered questionnaires to be completed by the 39 participants, which was analyzed with the assistance of the chi2 Test, descriptive statistics and quantitative discourse analysis. Although health professionals overestimate compliance rates, recognize the practice as relevant to the prevention of infection and refer there are no impeding factors, of the 1,277 opportunities observed, compliance was 26% and significantly lower before patient contact and the use of aseptic procedures than after patient contact: infrastructure was shown to be deficient. The results indicate risk to patient safety, and thus, the planning of corrective actions to promote hand washing is relevant.

Making change easy: A peer-to-peer guide on transitioning to new hand hygiene products.

PubMed

Amirov, Chingiz M; Candon, Heather L; Jacob, Latha

2017-01-01

This report summarizes our experiences planning and implementing the transition to a new commercial line of hand hygiene products and their dispensing systems in a large academic health care facility in Toronto, Canada. Our lessons learned are organized into a practical guide made available in 2 different formats: this article and an illustrated peer-to-peer guide (http://www.baycrest.org/wp-content/uploads/HCE-PROG-HH_HighQuality.pdf). Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Sustainable reduction of nasal colonization and hand contamination with Staphylococcus aureus in food handlers, 2002-2011.

PubMed

Ho, J; Boost, M; O'Donoghue, M

2015-06-01

A longitudinal study of nasal colonization and hand contamination of food handlers with Staphylococcus aureus commenced in 2002 prior to the outbreak of severe acute respiratory syndrome. In the follow-up in 2003 when hygiene measures were strictly implemented, significant reductions in carriage were observed. To investigate if this change was sustained, nasal and hand carriage rates were compared between the earlier studies and a further sampling in 2011. The initial nasal carriage rate was 35% and hand contamination 41·2%, decreasing to 23·5% and 11·6%, respectively in 2003 (P < 0·001). In 2011, nasal carriage was similar to 2003 (22·9%), while hand contamination dropped further to 3·7% (P < 0·001). Spa-typing revealed 39 types in 2002 and 42 in 2011. This study reveals that the marked reduction in colonization had been sustained. This may be attributed to reduced opportunities for spread due to enhanced hygiene and reinforces its importance for control of disease.

Variation in feminine hygiene practices as a function of age.

PubMed

Czerwinski, B S

2000-01-01

To examine variation in feminine hygiene practices as a function of increasing age. A nonexperimental, descriptive research design with study sample stratified by age. Women over 18 years of age. Of 713 women who completed and returned the feminine hygiene practices questionnaire, 180 were younger than 41 years, 171 were 41-48 years, 184 were 49-57 years, and 178 were 58 years or older. All participants were members of a California professional home economics organization. A 40-item feminine hygiene practices questionnaire dealing with body cleansing practices, feminine products usage, and both general and specific menses collection and protection practices. Significant age-related differences were found in several areas of body cleansing and feminine products usage, including sponge bathing and use of feminine and deodorant spray, wet wipes, and panty liners. In all age groups, 20-30% of women reported douching, even in the face of continued reports of the dangers in this practice. In addition, reduced numbers of women (n = 245) in all age groups reported washing hands before using tampons or pads, although more (n = 314) reported washing their hands afterward. Continuing education about proper feminine hygiene practices, especially regarding douching and handwashing before and after genitourinary contact, will be important across all age groups.

Comparison of the antibacterial efficacy and acceptability of an alcohol-based hand rinse with two alcohol-based hand gels during routine patient care.

PubMed

Barbut, Frédéric; Maury, Eric; Goldwirt, Laurianne; Boëlle, Piérre-Yves; Neyme, Denis; Aman, Rubina; Rossi, Beatrice; Offenstadt, Georges

2007-06-01

The aims of this study were to compare the antibacterial efficacy of handrubbing with an alcoholic rinse (AHRR) and two different alcoholic gels (AHRG) in reducing hand contamination under practical use conditions. We wanted to assess the acceptability of the three products and to determine the effect of each product on overall hand hygiene compliance. A prospective alternating time-series clinical trial was performed in a medical intensive care unit. The study was divided into three six-week periods (P1, P2, P3). Handrubbing was achieved with Sterillium rinse (AHRR) during P1, sterillium gel(AHRG-1) during P2 and Manugel Plus (AHRG-2) during P3. Pre- and post-rubbing hand contaminations were assessed immediately after a direct contact with a patient, using the glove juice technique. Health care workers (HCWs) evaluated the acceptability of the products through a self-administered anonymous questionnaire. Compliance of HCWs with hand hygiene was assessed during the three periods. We studied 242 handrubbing opportunities. The mean reduction factor (expressed as the Log(10) CFU/mL) of the AHRR, AHRG-1 and AHRG-2 were 1.28+/-0.95, 1.29+/-0.84 and 0.51+/-0.73, respectively (p<0.001). Assessment of the three products by HCWs indicated that AHRR and AHRG-1 were significantly better accepted than AHRG-2. The overall compliance of HCWs to hand hygiene was better when gel was available. Under practical use conditions, AHRG-1 and AHRR were more effective than AHRG-2, although all were claimed to pass the European standard EN1500. In vivo trials are essential to compare the antimicrobial efficacy of products for handrubbing.

Hand hygiene regimens for the reduction of risk in food service environments.

PubMed

Edmonds, Sarah L; McCormack, Robert R; Zhou, Sifang Steve; Macinga, David R; Fricker, Christopher M

2012-07-01

Pathogenic strains of Escherichia coli and human norovirus are the main etiologic agents of foodborne illness resulting from inadequate hand hygiene practices by food service workers. This study was conducted to evaluate the antibacterial and antiviral efficacy of various hand hygiene product regimens under different soil conditions representative of those in food service settings and assess the impact of product formulation on this efficacy. On hands contaminated with chicken broth containing E. coli, representing a moderate soil load, a regimen combining an antimicrobial hand washing product with a 70% ethanol advanced formula (EtOH AF) gel achieved a 5.22-log reduction, whereas a nonantimicrobial hand washing product alone achieved a 3.10log reduction. When hands were heavily soiled from handling ground beef containing E. coli, a wash-sanitize regimen with a 0.5% chloroxylenol antimicrobial hand washing product and the 70% EtOH AF gel achieved a 4.60-log reduction, whereas a wash-sanitize regimen with a 62% EtOH foam achieved a 4.11-log reduction. Sanitizing with the 70% EtOH AF gel alone was more effective than hand washing with a nonantimicrobial product for reducing murine norovirus (MNV), a surrogate for human norovirus, with 2.60- and 1.79-log reductions, respectively. When combined with hand washing, the 70% EtOH AF gel produced a 3.19-log reduction against MNV. A regimen using the SaniTwice protocol with the 70% EtOH AF gel produced a 4.04-log reduction against MNV. These data suggest that although the process of hand washing helped to remove pathogens from the hands, use of a wash-sanitize regimen was even more effective for reducing organisms. Use of a high-efficacy sanitizer as part of a wash-sanitize regimen further increased the efficacy of the regimen. The use of a well-formulated alcohol-based hand rub as part of a wash-sanitize regimen should be considered as a means to reduce risk of infection transmission in food service facilities.

Impact of school health education program on personal hygiene among school children of Lucknow district.

PubMed

Khatoon, Ruby; Sachan, Beena; Khan, Mohsin Ali; Srivastava, J P

2017-01-01

Personal hygiene plays a major role to promote healthy life. This study was performed to assess the current level of knowledge and practicing behavior in regard to hand washing, bathing, tooth brushing, and taking care of nail and hair. A cross-sectional descriptive study was conducted on 800 students of Lucknow district. All the students were interviewed with a structured questionnaire (pretest). A visual display of good and bad personal hygiene was shown on projector and explained the benefits of good personal hygiene behavior. Again, structured questionnaire was given (posttest). Most of the students belonged to the 10-12 years age group. The knowledge of the students regarding general body cleanliness was 87.5% in posttest as compared to 53.8% in pretest. Keeping the hair well-trimmed was considered as a part of personal hygiene by 38.0% of students. Knowledge about eating less food in diarrhea was positive in 80% of students. Only 12.5% of students accepted that diarrhea can kill children (pretest) while 100% (posttest) children were aware of this fact. Practice regarding change of clothes was on alternate day in 79.5% of students. Most of the students were found washing their hair once a week (72.5%) and 70% students were washing hands before meal. Overall trend of knowledge and practice about personal hygiene was in poor condition among students at the time of pretest. Posttest results were highly satisfactory.

Variation in infection prevention practices in dialysis facilities: results from the national opportunity to improve infection control in ESRD (End-Stage Renal Disease) project.

PubMed

Chenoweth, Carol E; Hines, Stephen C; Hall, Kendall K; Saran, Rajiv; Kalbfleisch, John D; Spencer, Teri; Frank, Kelly M; Carlson, Diane; Deane, Jan; Roys, Erik; Scholz, Natalie; Parrotte, Casey; Messana, Joseph M

2015-07-01

OBJECTIVE To observe patient care across hemodialysis facilities enrolled in the National Opportunity to Improve Infection Control in ESRD (end-stage renal disease) (NOTICE) project in order to evaluate adherence to evidence-based practices aimed at prevention of infection. SETTING AND PARTICIPANTS Thirty-four hemodialysis facilities were randomly selected from among 772 facilities in 4 end-stage renal disease participating networks. Facility selection was stratified on dialysis organization affiliation, size, socioeconomic status, and urban/rural status. MEASUREMENTS Trained infection control evaluators used an infection control worksheet to observe 73 distinct infection control practices at the hemodialysis facilities, from October 1, 2011, through January 31, 2012. RESULTS There was considerable variation in infection control practices across enrolled facilities. Overall adherence to recommended practices was 68% (range, 45%-92%) across all facilities. Overall adherence to expected hand hygiene practice was 72% (range, 10%-100%). Compliance to hand hygiene before and after procedures was high; however, during procedures hand hygiene compliance averaged 58%. Use of chlorhexidine as the specific agent for exit site care was 19% overall but varied from 0% to 35% by facility type. The 8 checklists varied in the frequency of perfect performance from 0% for meeting every item on the checklist for disinfection practices to 22% on the arteriovenous access practices at initiation. CONCLUSIONS Our findings suggest that there are many areas for improvement in hand hygiene and other infection prevention practices in end-stage renal disease. These NOTICE project findings will help inform the development of a larger quality improvement initiative at dialysis facilities.

Strengthening organizations to implement evidence-based clinical practices.

PubMed

VanDeusen Lukas, Carol; Engle, Ryann L; Holmes, Sally K; Parker, Victoria A; Petzel, Robert A; Nealon Seibert, Marjorie; Shwartz, Michael; Sullivan, Jennifer L

2010-01-01

Despite recognition that implementation of evidence-based clinical practices (EBPs) usually depends on the structure and processes of the larger health care organizational context, the dynamics of implementation are not well understood. This project's aim was to deepen that understanding by implementing and evaluating an organizational model hypothesized to strengthen the ability of health care organizations to facilitate EBPs. CONCEPTUAL MODEL: The model posits that implementation of EBPs will be enhanced through the presence of three interacting components: active leadership commitment to quality, robust clinical process redesign incorporating EBPs into routine operations, and use of management structures and processes to support and align redesign. In a mixed-methods longitudinal comparative case study design, seven medical centers in one network in the Department of Veterans Affairs participated in an intervention to implement the organizational model over 3 years. The network was selected randomly from three interested in using the model. The target EBP was hand-hygiene compliance. Measures included ratings of implementation fidelity, observed hand-hygiene compliance, and factors affecting model implementation drawn from interviews. Analyses support the hypothesis that greater fidelity to the organizational model was associated with higher compliance with hand-hygiene guidelines. High-fidelity sites showed larger effect sizes for improvement in hand-hygiene compliance than lower-fidelity sites. Adherence to the organizational model was in turn affected by factors in three categories: urgency to improve, organizational environment, and improvement climate. Implementation of EBPs, particularly those that cut across multiple processes of care, is a complex process with many possibilities for failure. The results provide the basis for a refined understanding of relationships among components of the organizational model and factors in the organizational context affecting them. This understanding suggests practical lessons for future implementation efforts and contributes to theoretical understanding of the dynamics of the implementation of EBPs.

Determinant roles of environmental contamination and noncompliance with standard precautions in the risk of hepatitis C virus transmission in a hemodialysis unit.

PubMed

Girou, Emmanuelle; Chevaliez, Stéphane; Challine, Dominique; Thiessart, Michaël; Morice, Yoann; Lesprit, Philippe; Tkoub-Scheirlinck, Latifa; Soing-Altrach, Sophan; Cizeau, Florence; Cavin, Celine; André, Martine; Dahmanne, Djamel; Lang, Philippe; Pawlotsky, Jean-Michel

2008-09-01

Nosocomial transmission is the second most frequent cause of hepatitis C virus (HCV) infection. A prospective observational study was conducted to assess the roles of environmental contamination and noncompliance with standard precautions in HCV cross-transmission in a hemodialysis unit. Patients undergoing chronic hemodialysis in a French university hospital unit were systematically screened, revealing 2 sporadic cases of HCV transmission. An investigation was launched to determine whether the patients were infected in the hemodialysis unit and the possible roles of environmental contamination and noncompliance with standard precautions. We examined possible relationships among new cases of HCV infection, environmental contamination by blood and HCV RNA, and compliance with guidelines on hand hygiene and glove use. Two patients experienced seroconversion to HCV during the study period. Phylogenetic analyses showed that 1 of these patients was infected with the same strain as that affecting a chronically infected patient also treated in the unit. Of 740 environmental surface samples, 82 (11%) contained hemoglobin; 6 (7%) of those contained HCV RNA. The rate of compliance with hand hygiene was 37% (95% confidence interval, 35%-39%), and gloves were immediately removed after patient care in 33% (95% confidence interval, 29%-37%) of cases. A low ratio of nurses to patients and poor hand hygiene were independent predictors of the presence of hemoglobin on environmental surfaces. Blood-contaminated surfaces may be a source of HCV cross-transmission in a hemodialysis unit. Strict compliance with hand hygiene and glove use and strict organization of care procedures are needed to reduce the risk of HCV cross-transmission among patients undergoing hemodialysis.

A controlled trial of universal gloving versus contact precautions for preventing the transmission of multidrug-resistant organisms.

PubMed

Bearman, Gonzalo M L; Marra, Alexandre R; Sessler, Curtis N; Smith, Wally R; Rosato, Adriana; Laplante, Justin K; Wenzel, Richard P; Edmond, Michael B

2007-12-01

Contact precautions are recommended to reduce the transmission of multidrug-resistant organisms. However, the optimal method for control of multidrug-resistant organisms remains unclear. A controlled trial was conducted in a medical intensive care unit. Phase 1 was a 3-month period of standard practice in which patients were placed in contact precautions per Centers for Disease Control and Prevention guidelines. In the second 3 months, phase 2, gloves were required for all patient contact, and no patients were placed in contact precautions. Compliance with contact precautions in phase 1 versus universal gloving in phase 2 was 75.7% versus 87.0%, respectively (P < .001). Hand hygiene compliance before patient care was significantly higher in phase 1 when compared with phase 2 (18.7% vs 11.4%, respectively, P < .001). Hand hygiene compliance after patient care was 57.7% in phase 1 versus 52.5% in phase 2 (P = .011). Nosocomial infection rates per 1000 device-days in phase 1 versus phase 2 were as follows: bloodstream infection, 6.2 versus 14.1, respectively (P < .001); urinary tract infection, 4.3 versus 7.4, respectively (P < .001); and ventilator-associated pneumonia, 0 versus 2.3, respectively (P < .001). There were no differences in vancomycin-resistant enterococci or methicillin-resistant Staphylococcus aureus acquisition in the 2 study phases; however, in both phases, the majority of vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus conversions were clonal. Compliance with universal gloving was significantly greater than compliance with contact precautions. However, greater compliance with hand hygiene was observed in the contact precautions phase. Measures must be in place to both increase and sustain hand hygiene compliance so as to minimize the risk of nosocomial cross transmission before reevaluating the concept of replacing contact precautions with universal gloving.

Acceptability and Use of Portable Drinking Water and Hand Washing Stations in Health Care Facilities and Their Impact on Patient Hygiene Practices, Western Kenya

PubMed Central

Otieno, Ronald; Odhiambo, Aloyce; Faith, Sitnah H.

2015-01-01

Many health care facilities (HCF) in developing countries lack access to reliable hand washing stations and safe drinking water. To address this problem, we installed portable, low-cost hand washing stations (HWS) and drinking water stations (DWS), and trained healthcare workers (HCW) on hand hygiene, safe drinking water, and patient education techniques at 200 rural HCFs lacking a reliable water supply in western Kenya. We performed a survey at baseline and a follow-up evaluation at 15 months to assess the impact of the intervention at a random sample of 40 HCFs and 391 households nearest to these HCFs. From baseline to follow-up, there was a statistically significant increase in the percentage of dispensaries with access to HWSs with soap (42% vs. 77%, p<0.01) and access to safe drinking water (6% vs. 55%, p<0.01). Female heads of household in the HCF catchment area exhibited statistically significant increases from baseline to follow-up in the ability to state target times for hand washing (10% vs. 35%, p<0.01), perform all four hand washing steps correctly (32% vs. 43%, p = 0.01), and report treatment of stored drinking water using any method (73% vs. 92%, p<0.01); the percentage of households with detectable free residual chlorine in stored drinking water did not change (6%, vs. 8%, p = 0.14). The installation of low-cost, low-maintenance, locally-available, portable hand washing and drinking water stations in rural HCFs without access to 24-hour piped water helped assure that health workers had a place to wash their hands and provide safe drinking water. This HCF intervention may have also contributed to the improvement of hand hygiene and reported safe drinking water behaviors among households nearest to HCFs. PMID:25961293

Acceptability and use of portable drinking water and hand washing stations in health care facilities and their impact on patient hygiene practices, Western kenya.

PubMed

Bennett, Sarah D; Otieno, Ronald; Ayers, Tracy L; Odhiambo, Aloyce; Faith, Sitnah H; Quick, Robert

2015-01-01

Many health care facilities (HCF) in developing countries lack access to reliable hand washing stations and safe drinking water. To address this problem, we installed portable, low-cost hand washing stations (HWS) and drinking water stations (DWS), and trained healthcare workers (HCW) on hand hygiene, safe drinking water, and patient education techniques at 200 rural HCFs lacking a reliable water supply in western Kenya. We performed a survey at baseline and a follow-up evaluation at 15 months to assess the impact of the intervention at a random sample of 40 HCFs and 391 households nearest to these HCFs. From baseline to follow-up, there was a statistically significant increase in the percentage of dispensaries with access to HWSs with soap (42% vs. 77%, p<0.01) and access to safe drinking water (6% vs. 55%, p<0.01). Female heads of household in the HCF catchment area exhibited statistically significant increases from baseline to follow-up in the ability to state target times for hand washing (10% vs. 35%, p<0.01), perform all four hand washing steps correctly (32% vs. 43%, p = 0.01), and report treatment of stored drinking water using any method (73% vs. 92%, p<0.01); the percentage of households with detectable free residual chlorine in stored drinking water did not change (6%, vs. 8%, p = 0.14). The installation of low-cost, low-maintenance, locally-available, portable hand washing and drinking water stations in rural HCFs without access to 24-hour piped water helped assure that health workers had a place to wash their hands and provide safe drinking water. This HCF intervention may have also contributed to the improvement of hand hygiene and reported safe drinking water behaviors among households nearest to HCFs.

Psychosocial determinants of self-reported hand hygiene behaviour: a survey comparing physicians and nurses in intensive care units.

PubMed

von Lengerke, T; Lutze, B; Graf, K; Krauth, C; Lange, K; Schwadtke, L; Stahmeyer, J; Chaberny, I F

2015-09-01

Research applying psychological behaviour change theories to hand hygiene compliance is scarce, especially for physicians. To identify psychosocial determinants of self-reported hand hygiene behaviour (HHB) of physicians and nurses in intensive care units (ICUs). A cross-sectional survey using a self-administered questionnaire that applied concepts from the Health Action Process Approach on hygienic hand disinfection was conducted in 10 ICUs and two haematopoietic stem cell transplantation units at Hannover Medical School, Germany. Self-reported compliance was operationalized as always disinfecting one's hands when given tasks associated with risk of infection. Using seven-point Likert scales, behavioural planning, maintenance self-efficacy and action control were assessed as psychological factors, and personnel and material resources, organizational problems and cooperation on the ward were assessed as perceived environmental factors. Multiple logistic regression analysis was employed. In total, 307 physicians and 348 nurses participated in this study (response rates 70.9% and 63.4%, respectively). Self-reported compliance did not differ between the groups (72.4% vs 69.4%, P = 0.405). While nurses reported stronger planning, self-efficacy and action control, physicians indicated better personnel resources and cooperation on the ward (P < 0.02). Self-efficacy [odds ratio (OR) 1.4, P = 0.041], action control (OR 1.8, P < 0.001) and cooperation on the ward (OR 1.5, P = 0.036) were positively associated with HHB among physicians, but only action control was positively associated with HHB among nurses (OR 1.6, P < 0.001). The associations between action control (self-regulatory strategies where behaviour is evaluated continuously and automatically against guidelines) and compliance indicate that HHB is a habit in need of self-monitoring. The fact that perceived cooperation on the ward was the only environmental correlate of HHB among physicians stresses the importance of team-directed interventions. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial.

PubMed

Stebbins, Samuel; Cummings, Derek A T; Stark, James H; Vukotich, Chuck; Mitruka, Kiren; Thompson, William; Rinaldo, Charles; Roth, Loren; Wagner, Michael; Wisniewski, Stephen R; Dato, Virginia; Eng, Heather; Burke, Donald S

2011-11-01

Laboratory-based evidence is lacking regarding the efficacy of nonpharmaceutical interventions (NPIs) such as alcohol-based hand sanitizer and respiratory hygiene to reduce the spread of influenza. The Pittsburgh Influenza Prevention Project was a cluster-randomized trial conducted in 10 elementary schools in Pittsburgh, PA, during the 2007 to 2008 influenza season. Children in 5 intervention schools received training in hand and respiratory hygiene, and were provided and encouraged to use hand sanitizer regularly. Children in 5 schools acted as controls. Children with influenza-like illness were tested for influenza A and B by reverse-transcriptase polymerase chain reaction. A total of 3360 children participated in this study. Using reverse-transcriptase polymerase chain reaction, 54 cases of influenza A and 50 cases of influenza B were detected. We found no significant effect of the intervention on the primary study outcome of all laboratory-confirmed influenza cases (incidence rate ratio [IRR]: 0.81; 95% confidence interval [CI]: 0.54, 1.23). However, we did find statistically significant differences in protocol-specified ancillary outcomes. Children in intervention schools had significantly fewer laboratory-confirmed influenza A infections than children in control schools, with an adjusted IRR of 0.48 (95% CI: 0.26, 0.87). Total absent episodes were also significantly lower among the intervention group than among the control group; adjusted IRR 0.74 (95% CI: 0.56, 0.97). NPIs (respiratory hygiene education and the regular use of hand sanitizer) did not reduce total laboratory-confirmed influenza. However, the interventions did reduce school total absence episodes by 26% and laboratory-confirmed influenza A infections by 52%. Our results suggest that NPIs can be an important adjunct to influenza vaccination programs to reduce the number of influenza A infections among children.

An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model.

PubMed

Nelson, Richard E; Jones, Makoto; Leecaster, Molly; Samore, Matthew H; Ray, William; Huttner, Angela; Huttner, Benedikt; Khader, Karim; Stevens, Vanessa W; Gerding, Dale; Schweizer, Marin L; Rubin, Michael A

2016-01-01

A number of strategies exist to reduce Clostridium difficile (C. difficile) transmission. We conducted an economic evaluation of "bundling" these strategies together. We constructed an agent-based computer simulation of nosocomial C. difficile transmission and infection in a hospital setting. This model included the following components: interactions between patients and health care workers; room contamination via C. difficile shedding; C. difficile hand carriage and removal via hand hygiene; patient acquisition of C. difficile via contact with contaminated rooms or health care workers; and patient antimicrobial use. Six interventions were introduced alone and "bundled" together: (a) aggressive C. difficile testing; (b) empiric isolation and treatment of symptomatic patients; (c) improved adherence to hand hygiene and (d) contact precautions; (e) improved use of soap and water for hand hygiene; and (f) improved environmental cleaning. Our analysis compared these interventions using values representing 3 different scenarios: (1) base-case (BASE) values that reflect typical hospital practice, (2) intervention (INT) values that represent implementation of hospital-wide efforts to reduce C. diff transmission, and (3) optimal (OPT) values representing the highest expected results from strong adherence to the interventions. Cost parameters for each intervention were obtained from published literature. We performed our analyses assuming low, normal, and high C. difficile importation prevalence and transmissibility of C. difficile. INT levels of the "bundled" intervention were cost-effective at a willingness-to-pay threshold of $100,000/quality-adjusted life-year in all importation prevalence and transmissibility scenarios. OPT levels of intervention were cost-effective for normal and high importation prevalence and transmissibility scenarios. When analyzed separately, hand hygiene compliance, environmental decontamination, and empiric isolation and treatment were the interventions that had the greatest impact on both cost and effectiveness. A combination of available interventions to prevent CDI is likely to be cost-effective but the cost-effectiveness varies for different levels of intensity of the interventions depending on epidemiological conditions such as C. difficile importation prevalence and transmissibility.

The basis of the modern medical hygiene in the medieval Medical School of Salerno.

PubMed

Bifulco, Maurizio; Capunzo, Mario; Marasco, Magda; Pisanti, Simona

2015-01-01

The link between hygiene and the concept of transmission of infective diseases was established earlier than the birth of microbiology, thanks to the studies of two neglected physicians of maternity clinic, Ignác Fülöp Semmelweis and Oliver Holmes, in the mid-1800s. Surprisingly, centuries earlier, a medieval women physician, Trotula de Ruggiero, introduced for the first time the notion of diseases’ prevention, highlighting the importance of the association of personal hygiene, balanced nutrition and physical activity for better health. Moreover, she was particularly concerned of hands hygiene for the midwives during child birth, to preserve the good health of both the mother and the baby. She practiced inside the medieval Medical School of Salerno, whose main text, the “Regimen Sanitatis Salerni” has an entire part dedicated to hygiene, providing hygienic precepts that anticipate the concepts derived from the revolutionary discoveries in medical science only centuries later.

Nosocomial infections and staff hygiene.

PubMed

Petroudi, Dimitra

2009-03-01

Nosocomial infections are a major source of morbidity and mortality in hospital settings. The most important defences against nosocomial transmission of viral, bacterial, and other infections are detailed and continuing education of staff and strict adherence to infection control policies. The issue is no longer whether hand hygiene is effective, but how to produce a sustained improvement in health workers' compliance.

A community-randomised controlled trial promoting waterless hand sanitizer and handwashing with soap, Dhaka, Bangladesh.

PubMed

Luby, Stephen P; Kadir, Mohammad Abdul; Yushuf Sharker, M A; Yeasmin, Farzana; Unicomb, Leanne; Sirajul Islam, M

2010-12-01

To pilot two intensive hand hygiene promotion interventions, one using soap and one using a waterless hand sanitizer, in low-income housing compounds in Dhaka, Bangladesh and assess subsequent changes in handwashing behaviour and hand microbiology. Fieldworkers randomized 30 housing compounds: 10 received handwashing promotion with free soap, 10 received handwashing promotion with free waterless hand sanitizer and 10 were non-intervention controls. Fieldworkers assessed handwashing behaviour by structured observation and collected hand rinse specimens. At baseline, compound residents washed their hands with soap 26% of the time after defecation and 30% after cleaning a child's anus but <1% at other times. Compared with baseline, residents of soap intervention compounds were much more likely to wash their hands with soap after faecal contact (85-91%), before preparing food (26%) and before eating (26%). Compounds that received waterless hand sanitizer cleansed their hands more commonly than control compounds that used soap (10.4%vs. 2.3%), but less commonly than soap intervention compounds used soap (25%). Post-intervention hand rinse samples from soap and sanitizer compounds had lower concentrations of faecal indicator bacteria compared with baseline and control compounds. Waterless hand sanitizer was readily adopted by this low-income community and reduced hand contamination but did not improve the frequency of handwashing compared with soap. Future deployments of waterless hand sanitizers may improve hand hygiene more effectively by targeting settings where soap and water is unavailable. © 2010 Blackwell Publishing Ltd.

Relationships among hygiene indicators in take-away foodservice establishments and the impact of climatic conditions.

PubMed

Djekic, I; Kuzmanović, J; Anđelković, A; Saračević, M; Stojanović, M M; Tomašević, I

2016-09-01

This paper examined the relationships among hygiene indicators in take-away foodservice establishments and the impact of climatic conditions. A total of 7545 samples were collected encompassing 2050 from food handlers' (HF) hands, 3991 from stainless steel food contact surfaces (FCS) and 1504 samples from plastic FCS. The study covered a period of 43 months. Hygiene-indicator bacteria (total plate count, Enterobacteriaceae Staphylococcus) were determined from the samples collected from 559 different take-away establishments. Climatic conditions were evaluated in respect to the outside temperature, pressure, humidity and precipitation. Logistic regression confirmed that the presence of precipitation was associated with an increased likelihood of exhibiting both Enterobacteriaceae and Staphylococcus on HF' hands as well as exhibiting Enterobacteriaceae on both types of FCS. Numerable Enterobacteriaceae and Staphylococcus levels on HF' hands were detected when higher outside temperatures and higher precipitations occurred. Higher outside temperatures were observed when Enterobacteriaceae were detected on both plastics (P < 0·05) and stainless steel (P > 0·05). Higher precipitation was observed when Enterobacteriaceae was detected on stainless steel while in contrast, this indicator was detected on plastics in periods with lower precipitation. This research confirms relationships between hygiene indicators in take-aways and climatic conditions, mostly temperature and precipitation. This study provides another perspective into the possible nature of cross-contamination and foodborne outbreaks originating in foodservice establishments and brings to attention the necessity of analysing various climatic conditions. © 2016 The Society for Applied Microbiology.

[Decrease in nosocomial infection based on continuous monitoring and control. 7 years' experience in a women's clinic].

PubMed

Hirsch, H A; Niehues, U; Decker, K

1985-12-13

During a seven-year programme of surveillance and control of infection data were collected by a specialist hygiene nurse on 47 551 gynaecological, obstetric and post-partum patients. The infection rate was highest (40.5%) after major surgical procedures. Infection rate after cesarian section was 16%, eight times the rate after vaginal delivery (2%). The most frequent type of infection was of the urinary tract (70%), usually asymptomatic bacteriuria. Next most frequent were pelvic infections, abdominal wound infections, and phlebitis via an intravenous entry in long-term parenteral nutrition. During the period of observation bacteriuria rate decreased by 75%, the other nosocomial infections by 64%, febrile standard morbidity by 81%. The decrease is largely due to the infection surveillance programme with the employment of a specialist hygiene nurse.

Reducing nosocomial infections in neonatal intensive care.

PubMed

Rogers, Eileen; Alderdice, Fiona; McCall, Emma; Jenkins, John; Craig, Stanley

2010-09-01

Nosocomial infection is a common problem in neonatal intensive care. A pilot quality improvement initiative focussing on hand hygiene and aimed at reducing nosocomial infection in very low birth weight (VLBW) infants was introduced in five Neonatal Intensive Care Units. Line associated laboratory confirmed bloodstream infection (LCBSI) and ventilator associated pneumonia (VAP) were chosen as main outcome measures. In VLBW infants, the rate of line associated LCBSI per 1000 central venous catheter days fell by 24%. The rate of VAP per 1000 ventilator days in VLBW infants fell by 38%. Pre- and post-intervention questionnaires showed a statistically significant increase in use of alcohol-based gels and increased knowledge of hand hygiene.

MRSA acquisition in an intensive care unit.

PubMed

Dancer, Stephanie J; Coyne, Michael; Speekenbrink, A; Samavedam, Sam; Kennedy, Julie; Wallace, Peter G M

2006-02-01

This paper describes a retrospective investigation of methicillin-resistant Staphylococcus aureus (MRSA) acquisition in an 8-bed intensive care unit (ICU) over a 5-month period. Clinical and microbiologic data were collected from the ICU, including MRSA detection dates, patient dependency scores, standardized environmental screening data, weekly bed occupancies, number of admissions, and nurse staffing levels. MRSA acquisition weeks were defined as weeks during which initial delivery of MRSA occurred before sampling and laboratory confirmation. Weekly workloads were plotted against staffing levels and modelled against MRSA acquisition weeks and hygiene failures. Of 174 patients admitted into the ICU, 28 (16%) were found to have MRSA; 12 of these (7%) acquired MRSA on the ICU within 7 of the 23 weeks studied. Six of these 7 weeks were associated with a deficit of trained nurses during the day and 5 with hygiene failures (data unavailable for 2). Pulsed-field gel electrophoresis (PFGE) profiles demonstrated relationships between staphylococci from staff hands, hand-touch sites, and patients' blood. MRSA acquisition in the ICU was temporally associated with reduced numbers of trained nurses and hygiene failures predominantly involving hand-touch sites. Epidemiologic analysis suggested that patient acquisitions were 7 times more likely to occur during periods of nurse understaffing.

The Influence of Contextual and Psychosocial Factors on Handwashing.

PubMed

Seimetz, Elisabeth; Boyayo, Anne-Marie; Mosler, Hans-Joachim

2016-06-01

Even though washing hands with soap is among the most effective measures to reduce the risk of infection, handwashing rates in infrastructure-restricted settings remain seriously low. Little is known about how context alone and in interaction with psychosocial factors influence hand hygiene behavior. The aim of this article was to explore how both contextual and psychosocial factors affect handwashing practices. A cross-sectional survey was conducted with 660 caregivers of primary school children in rural Burundi. Hierarchical regression analyses revealed that household wealth, the amount of water per person, and having a designated place for washing hands were contextual factors significantly predicting handwashing frequency, whereas the contextual factors, time spent collecting water and amount of money spent on soap, were not significant predictors. The contextual factors explained about 13% of the variance of reported handwashing frequency. The addition of the psychosocial factors to the regression model resulted in a significant 41% increase of explained variation in handwashing frequency. In this final model, the amount of water was the only contextual factor that remained a significant predictor. The most important predictors were a belief of self-efficacy, planning how, when, and where to wash hands, and always remembering to do so. The findings suggest that contextual constraints might be perceived rather than actual barriers and highlight the role of psychosocial factors in understanding hygiene behaviors. © The American Society of Tropical Medicine and Hygiene.

Health Risk Behaviour among In-School Adolescents in the Philippines: Trends between 2003, 2007 and 2011, A Cross-Sectional Study.

PubMed

Peltzer, Karl; Pengpid, Supa

2015-12-24

Intermittent monitoring of health risk behaviours at the population level is important for the planning and evaluation of national health promotion intervention programmes. The study aimed to provide trend estimates on the prevalence of various health risk behaviours assessed in the Global School-based Health Survey in 2003, 2007 and 2011 in the Philippines. Three waves of cross-sectional data included 18,285 school-going adolescents, 47.4% male and 52.6% female, aged between 11 years or younger and 16 years or older, with a mean age of about 14.7 years (SD = 1.2), and mainly in second to fourth year study Grade. Significant improvements in health risk and risk behaviours (overweight or obese and smokeless tobacco use among boys, being in a physical fight, troubles from alcohol drinking, mental health, oral and hand hygiene among both boys and girls) but also increases in health risk behaviour (bullying victimization, injury and loneliness) among both boys and girls were found in this large study over a period of eight years in the Philippines. High prevalences of health risk behaviours and increases in some of them should call for intensified school health promotion programmes to reduce such risk behaviours.

REAL-TIME FEEDBACK FOR IMPROVING COMPLIANCE TO HAND SANITIZATION AMONG HEALTHCARE WORKERS IN AN OPEN LAYOUT ICU USING RADIOFREQUENCY IDENTIFICATION

PubMed Central

Waghmare, Abijeet; Ekstrand, Maria; Raj, Tony; Selvam, Sumithra; Sreerama, Sai Madhukar; Sampath, Sriram

2015-01-01

Objective To increase hand sanitizer usage among healthcare workers by developing and implementing a low-cost intervention using RFID and wireless mesh networks to provide real-time alarms for increasing hand hygiene compliance during opportune moments in an open layout Intensive Care Unit (ICU). Method A wireless, RFID based system was developed and deployed in the ICU. The ICU beds were divded into an intervention arm (n=10) and a control arm (n=14). Passive RFID tags were issued to the doctors, nurses and support staff of the ICU. Long range RFID readers were positioned strategically. Sensors were placed beneath the hand sanitizers to record sanitizer usage. The system would alert the HCWs by flashing a light if an opportune moment for hand sanitization was detected. Results A significant increase in hand sanitizer use was noted in the intervention arm. Usage was highest during the early part of the workday and decreased as the day progressed. Hand wash events per person hour was highest among the ancilliary staff followed by the doctors and nurses. Conclusion Real-time feedback has potential to increase hand hygiene compliance among HCWs. The system demonstrates the possibility of automating compliance monitoring in an ICU with an open layout. PMID:25957165

Real-time feedback for improving compliance to hand sanitization among healthcare workers in an open layout ICU using radiofrequency identification.

PubMed

Radhakrishna, Kedar; Waghmare, Abijeet; Ekstrand, Maria; Raj, Tony; Selvam, Sumithra; Sreerama, Sai Madhukar; Sampath, Sriram

2015-06-01

The aim of this study is to increase hand sanitizer usage among healthcare workers by developing and implementing a low-cost intervention using RFID and wireless mesh networks to provide real-time alarms for increasing hand hygiene compliance during opportune moments in an open layout Intensive Care Unit (ICU). A wireless, RFID based system was developed and implemented in the ICU. The ICU beds were divded into an intervention arm (n = 10) and a control arm (n = 14). Passive RFID tags were issued to the doctors, nurses and support staff of the ICU. Long range RFID readers were positioned strategically. Sensors were placed beneath the hand sanitizers to record sanitizer usage. The system would alert the HCWs by flashing a light if an opportune moment for hand sanitization was detected. A significant increase in hand sanitizer use was noted in the intervention arm. Usage was highest during the early part of the workday and decreased as the day progressed. Hand wash events per person hour was highest among the ancilliary staff followed by the doctors and nurses. Real-time feedback has potential to increase hand hygiene compliance among HCWs. The system demonstrates the possibility of automating compliance monitoring in an ICU with an open layout.

Disinfection of the Radiologist Workstation and Radiologist Hand Hygiene: A Single Institution Practice Quality Improvement Project.

PubMed

Quon, Jeffrey S; Dilauro, Marc; Ryan, John G

2017-08-01

The purpose of this study was to evaluate the workstation disinfection rates and hand hygiene of radiologists and trainees at shared departmental workstations and assess the impact of education and reminder placards on daily habits. A 10-question survey was administered to all staff radiologists, fellows, and residents at our institution. The questions pertained to workstation disinfection, hand hygiene habits, and accessibility to disinfectant wipes and hand sanitizer stations. Subsequently, a short educational PowerPoint presentation was emailed to the department and small reminder placards were placed at each workstation. A follow-up survey was administered. Chi-square and Wilcoxon signed-rank tests were used to analyse the results. The percentage of participants who disinfect their workstations 1-2 times/week, 3-4 times/week or everyday increased from 53.4% (45 of 84 participants) to 74.3% (55 of 74 participants; P = .01), while the number who disinfect their workstation <1 time/week or never decreased from 46.4% (39 of 84 participants) to 25.7% (19 of 74 participants; P = .01). Hand washing before working at the workstation increased from 41.6% (35 of 84 participants) to 48.7% (36 of 74 participants; P = .76) and hand washing after working at the workstation increased from 50.0% (42 of 84 participants) to 56.8% (42 of 74 participants; P = .49). At our institution, the implementation of daily reminder placards at each workstation and the administration of an educational PowerPoint presentation improved the rate of radiologist workstation disinfection. Copyright © 2016 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

Removal of bio-aerosols by water flow on surfaces in health-care settings

NASA Astrophysics Data System (ADS)

Yu, Han; Li, Yuguo

2016-11-01

Hand hygiene is one of the most important and efficient measures to prevent infections, however the compliance with hand hygiene remains poor especially for health-care workers. To improve this situation, the mechanisms of hand cleansing need to be explored and a detailed study on the adhesion interactions for bio-aerosols on hand surfaces and the process during particles removal by flow is significant for more efficient methods to decrease infections. The first part of presentation will focus on modelling adhesion interactions between particles, like bacteria and virus, and hand surfaces with roughness in water environment. The model presented is based on the DLVO and its extended theories. The removal process comes next, which will put forward a new model to describe the removal of particles by water flow. In this model, molecular dynamics is combined with particle motion and the results by the model will be compared with experiment results and existed models (RnR, Rock & Roll). Finally, possible improvement of the study and future design of experiments will be discussed.

Prevention and control of methicillin-resistant Staphylococcus aureus.

PubMed

Humphreys, H; Grundmann, H; Skov, R; Lucet, J-C; Cauda, R

2009-02-01

Recent efforts to combat infections have focused on pharmaceutical interventions. However, the global spread of antimicrobial resistance calls for the reappraisal of personal and institutional hygiene. Hygiene embodies behavioural and procedural rules that prevent bacterial transmission. Consequently, the chance of spreading bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) is significantly reduced. Hygiene is part of the primacy and totality of patient care, ensuring that no harm is done. Any prevention and control strategy must be underpinned by changes in attitude, embraced by all. The major components of preventing and controlling MRSA include hand and environmental hygiene (as part of standard precautions), patient isolation, and patient/staff decolonization. Improving hand hygiene practice is especially important where the risk of infection is highest, e.g. in intensive care. Physical isolation has two advantages: the physical barrier interrupts transmission, and this barrier emphasizes that precautions are required. With limited isolation facilities, risk assessment should be conducted to indicate which patients should be isolated. Environmental hygiene, although important, has a lower priority than standard precautions. When a patient is ready for discharge (home) or transfer (to another healthcare facility), the overall interests of the patient should take priority. All patients should be informed of their MRSA-positive status as soon as possible. Because of increased mupirocin resistance, a selective approach to decolonization should be taken. When MRSA-positive staff are identified, restricting their professional activity will depend on the nature of their work. Finally, politicians and others need to commit to providing the necessary resources to maximize MRSA prevention and control.

Unlocking the Sporicidal Potential of Ethanol: Induced Sporicidal Activity of Ethanol against Clostridium difficile and Bacillus Spores under Altered Physical and Chemical Conditions

PubMed Central

Nerandzic, Michelle M.; Sunkesula, Venkata C. K.; C., Thriveen Sankar; Setlow, Peter; Donskey, Curtis J.

2015-01-01

Background Due to their efficacy and convenience, alcohol-based hand sanitizers have been widely adopted as the primary method of hand hygiene in healthcare settings. However, alcohols lack activity against bacterial spores produced by pathogens such as Clostridium difficile and Bacillus anthracis. We hypothesized that sporicidal activity could be induced in alcohols through alteration of physical or chemical conditions that have been shown to degrade or allow penetration of spore coats. Principal Findings Acidification, alkalinization, and heating of ethanol induced rapid sporicidal activity against C. difficile, and to a lesser extent Bacillus thuringiensis and Bacillus subtilis. The sporicidal activity of acidified ethanol was enhanced by increasing ionic strength and mild elevations in temperature. On skin, sporicidal ethanol formulations were as effective as soap and water hand washing in reducing levels of C. difficile spores. Conclusions These findings demonstrate that novel ethanol-based sporicidal hand hygiene formulations can be developed through alteration of physical and chemical conditions. PMID:26177038

The effect of a school-based educational intervention on menstrual health: an intervention study among adolescent girls in Bangladesh

PubMed Central

Haque, Syed Emdadul; Rahman, Mosiur; Itsuko, Kawashima; Mutahara, Mahmuda; Sakisaka, Kayako

2014-01-01

Objectives To assess the impact of a school-based menstrual education programme on: (1) menstrual knowledge, beliefs and practices, (2) menstrual disorders experienced, and (3) restrictions on menstruating adolescents. Design Intervention study. Setting Araihazar area, Bangladesh. Participants 416 adolescent female students aged 11–16 years, in grade 6–8, and living with their parents. Interventions A school-based health education study conducted from April 2012 to April 2013. Primary and secondary outcome measures We randomly selected 3 of 26 high schools in the study area. We delivered 6 months of educational intervention by trained (by an obstetrician and gynaecologist) research assistants (RAs) on menstrual hygiene among school girls. RAs read the questionnaire and participants answered. The changes in knowledge, beliefs and practices regarding menstruation, menstrual disorders experienced, and the restrictions and behaviours practiced by menstruating adolescents were compared between the baseline and the follow-up assessments. Results After health education, participants reported a significant improvement (p<0.001) in ‘high knowledge and beliefs’ scores compared to baseline (51% vs 82.4%). Significant improvement was also observed in overall good menstrual practices (28.8% vs 88.9%), including improvements in using sanitary pads (22.4% change after the intervention), frequency of changing pads/cloths per day (68.8%), drying the used absorbent (77.6%), methods of disposing of the used absorbent (25.5%), and cleaning of genitalia (19.2%). During the follow-up, the participants reported significant improvements in the regularity of their menstrual cycle (94.5% vs 99.5%) and fewer complications during menstruation (78.6% vs 59.6%). Conclusions The programme produced significant changes in the knowledge, beliefs and practices of menstrual hygiene, complications from lack of hygiene, and the behaviour and restrictions of the menstruating adolescents. These results demonstrate the feasibility of implementing a health education programme for adolescents on menstrual hygiene in secondary schools serving rural Bangladesh. PMID:24993753

Evaluation of the Effectiveness of a Primary Preventive Dental Health Education Programme Implemented Through School Teachers for Primary School Children in Mysore City

PubMed Central

Naidu, Jaya; Nandlal, B.

2017-01-01

Aims and Objectives: The present study was conducted with the aim of evaluating the effectiveness of a Primary Preventive Dental Health Education Programme conducted for 6–12-year-old primary school children in Mysore City. Materials and Methods: A total of 12 schools, one each in the category of Government, Aided, and Unaided, were randomly selected per zone viz., North, South, East, and West. These 12 schools constituted the study group where the Primary Preventive School Dental Health Education Programme (PPSDHEP) was implemented. Two additional schools were selected at random from the four zones to serve as the control. A total of 926 children participated in the study. The PPSDHEP involved the second-level transfer of preventive package wherein the oral health education was imparted to the school children by schoolteachers trained by the investigator. Among the parameters for evaluating the outcome of the programme were the pre and post-programme assessment (at the baseline and at follow-up, i.e., after 6 months) of knowledge, attitude, and practice (KAP), dental caries status, oral hygiene, and gingival health status. Results: The results suggest that the PPSDHEP resulted in bringing about an enhancement in the KAP towards oral health and also an improvement in dental caries, oral hygiene, and gingival health status of the school children in the study group. Conclusion: The present study supports the implementation of similar programmes in schools and the contention that schoolteachers are suitable personnel for imparting dental health education to school children on a regular basis. PMID:28462175

Assessment and pedagogy: a case study of two oral hygiene lecturers in South Africa.

PubMed

Vergotine, G

2012-08-01

There is evidence that most South African oral hygiene lecturers lack appropriate qualifications in the field of education. Their teaching skills are based mainly on clinical and practical experience, and this may impact on their understanding of the educational foundations of teaching, learning and assessment. To explore oral hygiene lecturers' knowledge and use of pedagogy and assessment and its alignment. A qualitative descriptive study design was used and case studies of two oral hygiene lecturers, each with qualifications in Education, were analyzed according to three themes: curriculum, pedagogy and assessment. The results showed that both participants had a good understanding of formative assessment (FA) and summative assessment (SA). They made use of FA but in neither case was the application ideal. Both used a range of teaching and assessment strategies but felt accountable to external demands of meeting outcomes. They linked their understanding of pedagogy and assessment to assist in the development of their courses and reported that this alignment had improved the quality of their programmes. This alignment by oral hygiene lecturers can influence curricular and pedagogic strategies. The professional educational development of lecturers in oral hygiene could be influential in improving the profession within the country.

Dysphagia management in a 3-year dental hygiene education programme in Japan.

PubMed

Sato, Yoko; Miura, Ai; Saito, Atsushi

2005-11-01

This paper reports the development and evaluation of a dysphagia management course taught to the third year dental hygiene students during 2004-2005 as one framework of the new curriculum. The course consisted of lectures by specialists in each field, basic practice and clinical practice at a facility for the elderly. Evaluation of the course showed that improvements were found in students' understanding in certain subjects when compared with that during 2003-2004. Scores on the post-test were statistically significantly higher than those on the pre-test, showing that basic knowledge of the students had been improved. Introductory and follow-up lectures by dental hygiene instructors and appropriate basic practice enhanced the learning process of the students. In the clinical practice, the concept of 'dental hygiene process of care' was incorporated. The dental hygiene process facilitated the students in planning and implementing dental hygiene care that meets the needs of the individual clients. This active learning experience enhanced the students' understanding of dysphagia management. Although further improvements are necessary, this dysphagia management course should help dental hygienists in playing a greater role in the field of oral care and dysphagia rehabilitation.

eBug--teaching children hygiene principles using educational games.

PubMed

Kostkova, Patty; Farrell, David; de Quincey, Ed; Weinberg, Julius; Lecky, Donna; McNulty, Cliodna

2010-01-01

Technology enhanced education has been recently established as a new approach for all stages of education. However, among these new IT media it is computer games playing the central role in delivering education in particular to children and teenagers, however, real world sound evaluation is often given little attention. The EU funded e-Bug project developed web games aimed at children to teach basic principles of prudent antibiotics use, hand and respiratory hygiene and aims to reinforces an awareness of microbes, hand and respiratory hygiene among junior and senior school children in 10 countries in Europe. An educational pack implemented in schools across Europe is complemented by Internet web games for two age groups teaching a set of learning objectives (LOs) using a fast and interactive platform game design for junior children and investigate detective games based on PBL principles for senior children. In this paper, we present the design of e-Bug junior and senior games and evaluation results.

Microorganisms as an Indicator of Hygiene Status Among Migrant Food Handlers in Peninsular Malaysia.

PubMed

Woh, Pei Yee; Thong, Kwai Lin; Lim, Yvonne Ai Lian; Behnke, Jerzy Marian; Lewis, John Watkin; Mohd Zain, Siti Nursheena

2017-10-01

This study used microbial indicators to assess the hygiene status of 383 migrant food handlers from 3 urban cities in Peninsular Malaysia. Microbiological analysis revealed that all the hand swabs tested 99.5% positive for aerobic plate counts (mean [M] ± standard deviation [SD] = 3.57 ± 0.83 log 10 CFU [colony forming unit]), 20.8% positive for total coliform/ Escherichia coli (M ± SD = 0.30 ± 0.67 log 10 CFU), and 63.4% positive for Staphylococcus aureus (M ± SD = 1.38 ± 1.26 log 10 CFU). In addition, aerobic plate counts and Staphylococcus aureus counts exceeded the acceptable standard levels. Bacterial counts were found to be significantly associated with subjects' country of origin ( P = .019) and working responsibilities ( P = .001). Our findings indicate high probability of transmission of pathogenic bacteria from the food handlers' hands to customers during meal preparation and serving. This calls for improvements in personal hygiene and sanitation standards by the relevant health authorities among migrant food handlers.

Hand hygiene practices of veterinary support staff in small animal private practice.

PubMed

Nakamura, R K; Tompkins, E; Braasch, E L; Martinez, J G; Bianco, D

2012-03-01

To evaluate the hand hygiene (HH) practices among veterinary technicians (VT) and veterinary support staff (VSS) in small animal private practice. This was a prospective questionnaire-based study involving 182 VT and VSS from 18 small animal hospitals in the USA. Questions asked included gender, number of animals handled per work shift, frequency of hand washing, reason for not washing more frequently, most common available hand washing agent, education regarding the importance of HH and frequency of ring wearing. Less than half of the respondents [76 of 182 (41·7%)] reported washing their hands regularly between handling patients and 154 of 182 (85·6%) believed they should have washed more frequently. The most commonly employed HH agent was hand soap [154 of 182 (84·6%)] and the most common reason cited for not washing more frequently was being too busy [132 of 182 (72·5%)]. Only 96 of 182 (52·7%) respondents were educated by doctors at their hospital regarding the importance of HH. The HH practices among VT and VSS in small animal private practice is poor. Hand soap was the most commonly employed agent among respondents in this study. Education of VT and VSS regarding the importance of HH requires improvement. © 2012 British Small Animal Veterinary Association.

Compliance and hygiene behaviour among soft contact lens wearers in the Maldives.

PubMed

Gyawali, Rajendra; Nestha Mohamed, Fathimath; Bist, Jeewanand; Kandel, Himal; Marasini, Sanjay; Khadka, Jyoti

2014-01-01

Significant levels of non-compliance and poor hygiene among contact lens wearers have been reported previously from different parts of the world. This survey aimed at identifying the scope of hygiene and non-compliant behaviour of soft contact lens wearers in the Maldives. Established soft lens wearers attending two eye clinics in Male' city, were interviewed in office or via telephone. A set of interviewer-administered questions was used to access the subjective response on compliance and hygiene behaviour (hand and lens case hygiene, water exposure, adherence to lens replacement schedule, dozing and overnight wear, awareness of aftercare visits and reuse of disinfecting solution). Participants were also asked to rate themselves as a contact lens user based on their perceived compliance and hygiene practices. Out of 107 participants, 79 (74.8 per cent) were interviewed in the office and the rest via telephone. The majority of lens wearers were female, office workers and students, with a mean age of 20.64 ± 4.4 years. Mean duration of lens wear was 28.04 ± 8.36 months. Most of them were using spherical lenses (86.9 per cent) on a daily wear basis (96.3 per cent). Major reported forms of non-compliance were poor hand hygiene (60.7 per cent), lack of aftercare awareness (39.3 per cent), water exposure (35.5 per cent) and over-use of lenses (24.3 per cent). While females were more likely to overuse their lenses than males (p < 0.005), other socio-demographic factors were not associated with reported non-compliance. Although around 90 per cent of the participants considered themselves average or good contact lens wearers, most exhibited some form of non-compliant and poor hygienic behaviour. A significant number of Maldivian contact lens wearers exhibited poor levels of hygiene and compliance with contact lenses and lens care systems. An effective educational reinforcement strategy needs to be developed to modify lens wearers' non-compliance. © 2013 The Authors. Clinical and Experimental Optometry © 2013 Optometrists Association Australia.

The percentage of nosocomial-related out of total hospitalizations for rotavirus gastroenteritis and its association with hand hygiene compliance.

PubMed

Waisbourd-Zinman, Orith; Ben-Ziony, Shiri; Solter, Ester; Chodick, Gabriel; Ashkenazi, Shai; Livni, Gilat

2011-03-01

Because the absolute numbers of both community-acquired and nosocomial rotavirus gastroenteritis (RVGE) vary, we studied the percentage of hospitalizations for RVGE that were transmitted nosocomially as an indicator of in-hospital acquisition of the infection. In a 4-year prospective study, the percentage of nosocomial RVGE declined steadily, from 20.3% in 2003 to 12.7% in 2006 (P = .001). Concomitantly, the rate of compliance with hand hygiene increased from 33.7% to 49% (P = .012), with a significant (P < .0001) inverse association noted between the two trends. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

An investigation of radiographers' mobile phone use and the success of an awareness campaign at reducing the nosocomial infection risks.

PubMed

Crofton, C C; Foley, S J

2018-02-01

Mobile phone use by healthcare workers (HCWs) is widespread. Studies have shown that HCW's mobile phones can harbour pathogens associated with nosocomial infections. This study investigated whether an awareness campaign will result in an improvement in radiographers' phone and hand hygiene practices. Radiographers working in the general department of two university hospitals were invited to participate. One hospital was assigned as the experiment hospital and the other as a control. In the experiment hospital, adenosine triphosphate (ATP) testing of each participant's mobile phone determined the cleanliness of its surface. A corresponding survey was completed to determine their current practices and level of awareness. Subsequently, an infection control poster campaign took place for a one-month period, followed by re-testing. In the control hospital, the ATP testing and survey were also completed before and after a one-month period, but without a poster campaign. Radiographers were generally unaware of the infection risks associated with mobile phone use with 44% of all participants never cleaning their phone. The campaign successfully improved phone hygiene frequency and method in the experiment hospital. However, it did not improve hand hygiene practices and actual phone cleanliness (mean ATP count reductions of 10% (experiment hospital) and 20% (control)). The ATP testing as a less direct form of intervention showed similar levels of success in comparison to the poster campaign. A multifaceted educational approach is likely to be most effective in raising awareness and changing radiographers' phone and hand hygiene practices. Copyright © 2017 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Significant reduction in vancomycin-resistant enterococcus colonization and bacteraemia after introduction of a bleach-based cleaning-disinfection programme.

PubMed

Grabsch, E A; Mahony, A A; Cameron, D R M; Martin, R D; Heland, M; Davey, P; Petty, M; Xie, S; Grayson, M L

2012-12-01

Vancomycin-resistant enterococcus (VRE) colonization and infection have increased at our hospital, despite adherence to standard VRE control guidelines. We implemented a multi-modal, hospital-wide improvement programme including a bleach-based cleaning-disinfection programme ('Bleach-Clean'). VRE colonization, infection and environmental contamination were compared pre and post implementation. The programme included a new product (sodium hypochlorite 1000 ppm + detergent), standardized cleaning-disinfection practices, employment of cleaning supervisors, and modified protocols to rely on alcohol-based hand hygiene and sleeveless aprons instead of long-sleeved gowns and gloves. VRE was isolated using chromogenic agar and/or routine laboratory methods. Outcomes were assessed during the 6 months pre and 12 months post implementation, including proportions (per 100 patients screened) of VRE colonization in high-risk wards (HRWs: intensive care, liver transplant, renal, haematology/oncology); proportions of environmental contamination; and episodes of VRE bacteraemia throughout the entire hospital. Significant reductions in newly recognized VRE colonizations (208/1948 patients screened vs 324/4035, a 24.8% reduction, P = 0.001) and environmental contamination (66.4% reduction, P = 0.012) were observed, but the proportion of patients colonized on admission was stable. The total burden of inpatients with VRE in the HRWs also declined (median percentage of colonized inpatients per week, 19.4% vs 17.3%, P = 0.016). Hospital-wide VRE bacteraemia declined from 14/2935 patients investigated to 5/6194 (83.1% reduction; P < 0.001), but there was no change in vancomycin-susceptible enterococcal bacteraemia (P = 0.54). The Bleach-Clean programme was associated with marked reductions in new VRE colonizations in high-risk patients, and VRE bacteraemia across the entire hospital. These findings have important implications for VRE control in endemic healthcare settings. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

A scale for measuring hygiene behavior: development, reliability and validity.

PubMed

Stevenson, Richard J; Case, Trevor I; Hodgson, Deborah; Porzig-Drummond, Renata; Barouei, Javad; Oaten, Megan J

2009-09-01

There is currently no general self-report measure for assessing hygiene behavior. This article details the development and testing of such a measure. In studies 1 to 4, a total of 855 participants were used for scale and subscale development and for reliability and validity testing. The latter involved establishing the relationships between self-reported hygiene behavior and existing measures, hand hygiene behavior, illness rates, and a physiological marker of immune function. In study 5, a total of 507 participants were used to assess the psychometric properties of the final revised version of the scale. The final 23-item scale comprised 5 subscales: general, household, food-related, handwashing technique, and personal hygiene. Studies 1 to 4 confirmed the scale's reliability and validity, and study 5 confirmed the scale's 5-factor structure. The scale is potentially suitable for multiple uses, in various settings, and for experimental and correlational approaches.

Preference and compliance of waterless hand-hygiene products versus soap and water.

PubMed

Carr, Michele P; Sullivan, Stefanie; Gilmore, Jenny; Rashid, Robert G

2003-09-01

To compare handwashing using traditional antimicrobial soap and water with two antimicrobial waterless hand-hygiene products for personal preference and compliance. Fifty dental and dental hygiene students were randomly chosen to participate in the study. All subjects were anonymously observed prior to the introduction of the waterless products for handwashing compliance using soap and water for 1 week. All subjects were then instructed on the use of a waterless gel and foam for handwashing. Both waterless products were used for a period of 1 week and students again were anonymously observed. A questionnaire was distributed at the conclusion of the study to determine product preference. During handwashing with soap and water, the average time the soap was in contact with the hands was 7.0 seconds. The average contact time with the gel and foam was 15.3 seconds and 20.0 seconds, respectfully. Questionnaire results indicated that the foam was significantly preferred over the gel and soap and water (54%, 28% and 16%, respectively). The foam was also significantly preferred when evaluating fragrance (52%), kindness to the skin (66%), convenience (64%) and fastest drying time (54%). Results from this study indicate that the waterless foam product was significantly preferred over the waterless gel and traditional soap and water for handwashing procedures. Since handwashing guidelines, regardless of which product used, recommend a minimum of 15 seconds to minimize the number of transient microorganisms on the hands, compliance was found only with the foam and the gel.

Hand sanitizer and rates of acute illness in military aviation personnel.

PubMed

Van Camp, Roscoe O; Ortega, Hernando J

2007-02-01

Alcohol-based hand sanitizer (HS) kills most organisms that cause acute illness, an important cause of lost duty time among aviation personnel. This preliminary study observed the impact on the acute illness rate when HS was made readily accessible to pilots. Wall-mounted HS dispensers were placed in two fighter squadron operations buildings during November 2005 and various media were used to alert all base personnel to the importance of hand hygiene and cough hygiene. Data were obtained for two groups of personnel on the same base: 1) pilots who worked in the two HS-equipped buildings (Squadron) (n = 56); and 2) pilots and air traffic controllers who worked at other locations (Non-Squadron) (n = 61). The incidence of acute illness and the cumulative number of duty days lost was determined in each group for the winters of 2004-05 (no HS) and 2005-06 (HS available). For the Squadron group, the acute illness rates were 2.4% in 2004-5 (210 duty days lost) (no HS) compared with 0.9% in 2005-6 (78 duty days lost) when HS was provided. No year-to-year difference was apparent for the Non-Squadron group, where the illness rates were 2.4% in 2004-5 (229 duty days lost) and 2.3% in 2005-6 (221 duty days lost). Making HS readily available at locations frequented by pilots together with educating them regarding hand hygiene may reduce the occurrence of acute illness and number of duty days lost.

Determinants of personal and household hygiene among college students in New York City, 2011

PubMed Central

Miko, Benjamin A.; Cohen, Bevin; Conway, Laurie; Gilman, Allan; Seward, Samuel L.; Larson, Elaine

2013-01-01

Background Although several studies have characterized the hygiene habits of college students, few have assessed the determinants underlying such behaviors. Objectives Our study sought to describe students' knowledge, practices, and beliefs about hygiene and determine whether there is an association between reported behaviors and frequency of illness. Methods A sample of 299 undergraduate students completed a questionnaire assessing demographics, personal and household hygiene behaviors, beliefs and knowledge about hygiene, and general health status. Results Variation in reported hygiene habits was noted across several demographic factors. Women reported “always” washing their hands after using the toilet (87.1%) more than men (65.3%, P = .001). Similarly, freshmen reported such behavior (80.4%) more than sophomores (71.9%), juniors (67.7%), or seniors (50%, P = .011). Whereas 96.6% of participants thought that handwashing was either “very important” or “somewhat important” for preventing disease, smaller proportions thought it could prevent upper respiratory infections (85.1%) or gastroenteritis (48.3%), specifically. There was no significant relationship between reported behaviors and self-reported health status. Conclusion The hygiene habits of college students may be motivated by perceptions of socially acceptable behavior rather than scientific knowledge. Interventions targeting the social norms of incoming and continuing students may be effective in improving hygiene determinants and ultimately hygiene practices. PMID:22464037

Teaching oral hygiene to children with autism.

PubMed

Pilebro, C; Bäckman, B

2005-01-01

The need for improved oral hygiene routines in individuals with disabilities has been documented in many reports. The aim of this study was to evaluate whether visual pedagogy is a suitable way to teach children with autism how to brush their teeth. The investigation took the form of a prospective study including clinical examinations and structured interviews. Based on visual pedagogy, a series of pictures were produced that showed a structured method and technique of tooth brushing. The pictures were placed in the bathroom or wherever tooth brushing was performed. Fourteen children with autism aged between 5 and 13 years (mean age = 9.3 years), and their parents participated. Before the study, all parents found it difficult/very difficult to maintain good oral hygiene in their child. All children had visible plaque on their maxillary incisors and canines. After 12 months, the amount of visible plaque was reduced. After 18 months, most parents found maintaining good oral hygiene easier than before the study. All but one child/parent adopted the programme. Visual pedagogy is a useful tool in helping people with autism to improve their oral hygiene.

Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach During 3 Years in 6 Hospitals in 3 Mexican Cities.

PubMed

Miranda-Novales, María Guadalupe; Sobreyra-Oropeza, Martha; Rosenthal, Víctor Daniel; Higuera, Francisco; Armas-Ruiz, Alberto; Pérez-Serrato, Irma; Torres-Hernández, Héctor; Zamudio-Lugo, Irma; Flores-Ruiz, Eric M; Campuzano, Roberto; Mena-Brito, Jorge; Sánchez-López, Martha; Chávez-Gómez, Amalia; Rivera-Morales, Jaime; Valero-Rodríguez, Julián E

2015-06-10

To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene (HH) approach in Mexico, and analyze predictors of poor HH compliance. From June 2002 to April 2006, we conducted a prospective, observational, before-and-after study in 8 intensive care units (ICUs) from 6 hospitals in 3 cities of Mexico. The approach included administrative support, availability of supplies, education and training, reminders in the workplace, process surveillance, and performance feedback. A total of 13,201 observations for HH opportunities were done in each ICU, during randomly selected 30-minute periods. Overall, HH compliance increased from 45% to 79% (95% confidence interval [CI], 69.1-86.5; P = 0.01). Univariate and multivariate analyses showed that several variables were significantly associated with poor HH compliance: males versus females (61% versus 66%; 95% CI, 0.91-0.96; P = 0.0001), physicians versus nurses (62% versus 67%; 95% CI, 0.91-0.97; P = 0.0001), and adult versus neonatal ICUs (67% versus 54%; 95% CI, 0.79-0.84; P = 0.0001), among others. Hand hygiene programs should focus on variables found to be predictors of poor HH compliance.

Assessing hand hygiene resources and practices at a large african teaching hospital.

PubMed

Owusu-Ofori, Alex; Jennings, Rebecca; Burgess, Jennifer; Prasad, Priya A; Acheampong, Faustina; Coffin, Susan E

2010-08-01

To gather baseline data on hand hygiene (HH) practices in an African hospital with a newly established infection prevention and control team. Cross-sectional, observational study. Setting. Komfo Anokye Teaching Hospital, a large teaching hospital in Ghana with approximately 1,000 beds. All hospital staff with patient contact were eligible for assessment of HH practices. HH observations were conducted using a standardized data collection tool and method based on the World Health Organization's "5 Moments of Hand Hygiene." Small-group interviews were conducted to gather additional information on perceptions of HH and barriers to its use. HH resource needs were also assessed using a standardized tool. HH was attempted in 12% of the opportunities and was performed appropriately in 4% of the opportunities. Most main wards (89%) had at least 1 functional HH station. The most commonly identified barriers to HH were limited resources and lack of knowledge on appropriate times to perform HH. We developed and applied tools to evaluate HH resources and practices in a large African hospital. These assessments were undertaken to guide future efforts to improve HH at this hospital but can also serve as a model of the way to perform a systematic assessment at acute care hospitals in developing countries.

Using sensor networks to study the effect of peripatetic healthcare workers on the spread of hospital-associated infections.

PubMed

Hornbeck, Thomas; Naylor, David; Segre, Alberto M; Thomas, Geb; Herman, Ted; Polgreen, Philip M

2012-11-15

Super-spreading events, in which an individual with measurably high connectivity is responsible for infecting a large number of people, have been observed. Our goal is to determine the impact of hand hygiene noncompliance among peripatetic (eg, highly mobile or highly connected) healthcare workers compared with less-connected workers. We used a mote-based sensor network to record contacts among healthcare workers and patients in a 20-bed intensive care unit. The data collected from this network form the basis for an agent-based simulation to model the spread of nosocomial pathogens with various transmission probabilities. We identified the most- and least-connected healthcare workers. We then compared the effects of hand hygiene noncompliance as a function of connectedness. The data confirm the presence of peripatetic healthcare workers. Also, agent-based simulations using our real contact network data confirm that the average number of infected patients was significantly higher when the most connected healthcare worker did not practice hand hygiene and significantly lower when the least connected healthcare workers were noncompliant. Heterogeneity in healthcare worker contact patterns dramatically affects disease diffusion. Our findings should inform future infection control interventions and encourage the application of social network analysis to study disease transmission in healthcare settings.

Multimodal strategy to improve the adherence to hand hygiene and self-assessment of the institution for the promotion and practice of hand hygiene.

PubMed

Oliveira, A C; Gama, C S; Paula, A O

2018-03-01

Hand hygiene (HH) has a low rate of adherence worldwide. This study aimed to estimate the HH adherence rate before and after the implementation of the multimodal strategy and to perform a self-assessment of an institution for promotion and practice of HH. Before and after study, conducted in a university hospital. Professionals of the medical and nursing staff were included. Data collection was from October 2013 to July 2015, through observations of the HH opportunities and application of the HH self-assessment instrument for the institution. Descriptive and univariate analysis were performed. A total of 9500 HH opportunities were observed. The rate of adherence to HH in pre-intervention period was 20.8%, compared to 16.2% and 15.7% in post-intervention. Regarding the evaluation of the institution, it did not have an established ongoing program of training of professionals, no feedback of HH rates to professionals. The low rate of HH adherence reflected the evaluation of the institution in relation to its investment in the practice and promotion of HH, showing that the investment policy for HH adherence needs to be reviewed, considering that before the study the hospital has not been trained in the 'My Five Moments for HH'.

Importance of implementation level when evaluating the effect of the Hi Five Intervention on infectious illness and illness-related absenteeism.

PubMed

Denbæk, Anne Maj; Andersen, Anette; Bast, Lotus Sofie; Bonnesen, Camilla Thørring; Ersbøll, Annette Kjær; Due, Pernille; Johansen, Anette

2018-05-01

There is limited research on the importance of implementation when evaluating the effect of hand hygiene interventions in school settings in developed countries. The aim of this study was to examine the association between an implementation index and the effect of the intervention. The Hi Five Intervention was evaluated in a 3-armed cluster randomized controlled trial involving 43 randomly selected Danish schools. Analyses investigating the association between implementation of the Hi Five Intervention and infectious illness days, infectious illness episodes, illness-related absenteeism, and hand hygiene were carried out in a multilevel model (school, class, and child). The level of implementation was associated with hand hygiene and potentially associated with number of infectious illness days and infectious illness episodes among children. This association was not found for illness-related absenteeism. Classes that succeeded in achieving a high level of implementation of the Hi Five Intervention had a lower number of infectious illness days and infectious illness episodes, suggesting that the Hi Five Intervention, if implemented adequately, may be relevant as a tool to decrease infectious illness in a Danish school setting. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Social cohesion: The missing factor required for a successful hand hygiene program.

PubMed

Kwok, Yen Lee Angela; Harris, Peter; McLaws, Mary-Louise

2017-03-01

There are limited explorations into hospital staff reactions to automated hand hygiene surveillance or hand hygiene interventions. An automated surveillance system with daily feedback and a behavioral intervention component was trialed in 2 wards in an Australian tertiary teaching hospital. After 9 months, 12 clinicians from each ward were interviewed prior to the completion of the trial to explore satisfaction with the system and behavioral component of nudging each other with a reminder to comply. Only on completion of the trial were transcripts analyzed for themes. Staff from the ward with improved compliance described a socially cohesive team with a well-liked nurse unit manager who accessed daily compliance rates and worked with staff to set goals. This contrasted with the ward without improvement in compliance, whose staff described their great reluctance and discomfort to nudge each other to comply and distrust of the authenticity of the rates established from the automated system. Interventions for improving compliance are more likely to be successful in a ward with a social cohesive team. Patient safety interventions, in the first instance, may benefit from purposeful selection of wards with cohesive teams and skilled leaders who can transform clinicians into early adopters of the program. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model

PubMed Central

Nelson, Richard E.; Jones, Makoto; Leecaster, Molly; Samore, Matthew H.; Ray, William; Huttner, Angela; Huttner, Benedikt; Khader, Karim; Stevens, Vanessa W.; Gerding, Dale; Schweizer, Marin L.; Rubin, Michael A.

2016-01-01

Background A number of strategies exist to reduce Clostridium difficile (C. difficile) transmission. We conducted an economic evaluation of “bundling” these strategies together. Methods We constructed an agent-based computer simulation of nosocomial C. difficile transmission and infection in a hospital setting. This model included the following components: interactions between patients and health care workers; room contamination via C. difficile shedding; C. difficile hand carriage and removal via hand hygiene; patient acquisition of C. difficile via contact with contaminated rooms or health care workers; and patient antimicrobial use. Six interventions were introduced alone and "bundled" together: (a) aggressive C. difficile testing; (b) empiric isolation and treatment of symptomatic patients; (c) improved adherence to hand hygiene and (d) contact precautions; (e) improved use of soap and water for hand hygiene; and (f) improved environmental cleaning. Our analysis compared these interventions using values representing 3 different scenarios: (1) base-case (BASE) values that reflect typical hospital practice, (2) intervention (INT) values that represent implementation of hospital-wide efforts to reduce C. diff transmission, and (3) optimal (OPT) values representing the highest expected results from strong adherence to the interventions. Cost parameters for each intervention were obtained from published literature. We performed our analyses assuming low, normal, and high C. difficile importation prevalence and transmissibility of C. difficile. Results INT levels of the “bundled” intervention were cost-effective at a willingness-to-pay threshold of $100,000/quality-adjusted life-year in all importation prevalence and transmissibility scenarios. OPT levels of intervention were cost-effective for normal and high importation prevalence and transmissibility scenarios. When analyzed separately, hand hygiene compliance, environmental decontamination, and empiric isolation and treatment were the interventions that had the greatest impact on both cost and effectiveness. Conclusions A combination of available interventions to prevent CDI is likely to be cost-effective but the cost-effectiveness varies for different levels of intensity of the interventions depending on epidemiological conditions such as C. difficile importation prevalence and transmissibility. PMID:27031464

Examining school-based hygiene facilities: a quantitative assessment in a Ghanaian municipality.

PubMed

Appiah-Brempong, Emmanuel; Harris, Muriel J; Newton, Samuel; Gulis, Gabriel

2018-05-02

The crucial role of adequate water, sanitation and hygiene (WASH) facilities in influencing children's handwashing behaviour is widely reported. Report from UNICEF indicates a dearth of adequate data on WASH facilities in schools, especially in the developing world. This study sought to contribute to building the evidence-base on school hygiene facilities in Ghana. The study further explored for possible associations and differences between key variables within the context of school water, sanitation and hygiene. Data was collected from 37 junior high schools using an observational checklist. Methods of data analysis included a Scalogram model, Fisher's exact test, and a Student's t-test. Results of the study showed a facility deficiency in many schools: 33% of schools had students washing their hands in a shared receptacle (bowl), 24% had students using a single cotton towel to dry hands after handwashing, and only 16% of schools had a functional water facility. Furthermore, results of a proportion test indicated that 83% of schools which had functional water facilities also had functional handwashing stations. On the other hand, only 3% of schools which had functional water facilities also had a functional handwashing stations. A test of difference in the proportions of the two sets of schools showed a statistically significant difference (p < 0.001). In addition, 40% of schools which had financial provisions for water supply also had functional handwashing stations. On the other hand, only 7% of schools which had financial provisions for water supply also had functional handwashing stations. There was a statistically significant difference in the proportions of the two sets of schools (p = 0.02). We conclude that it is essential to have a financial provision for water supply in schools as this can potentially influence the existence of a handwashing station in a school. An intervention by government, educational authorities and civil society organisations towards enabling schools in low resource areas to have a sustainable budgetary allocation for WASH facilities would be timely.

Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards.

PubMed

Hor, Su-Yin; Hooker, Claire; Iedema, Rick; Wyer, Mary; Gilbert, Gwendolyn L; Jorm, Christine; O'Sullivan, Matthew Vincent Neil

2017-07-01

Hospital-acquired infections are the most common adverse event for inpatients worldwide. Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice. We report on an interventionist video-reflexive ethnography study that explored how healthcare workers performed IPC in three wards in two hospitals in New South Wales, Australia: an intensive care unit and two general surgical wards. We conducted 46 semistructured interviews, 24 weeks of fieldwork (observation and videoing) and 22 reflexive sessions with a total of 177 participants (medical, nursing, allied health, clerical and cleaning staff, and medical and nursing students). We performed a postintervention analysis, using a modified grounded theory approach, to account for the range of IPC practices identified by participants. We found that healthcare workers' routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving 'from clean to dirty' when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning. Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Monitoring the inputs required to extend and sustain hygiene promotion: findings from the GLAAS 2013/2014 survey.

PubMed

Moreland, Leslie D; Gore, Fiona M; Andre, Nathalie; Cairncross, Sandy; Ensink, Jeroen H J

2016-08-01

There are significant gaps in information about the inputs required to effectively extend and sustain hygiene promotion activities to improve people's health outcomes through water, sanitation and hygiene (WASH) interventions. We sought to analyse current country and global trends in the use of key inputs required for effective and sustainable implementation of hygiene promotion to help guide hygiene promotion policy and decision-making after 2015. Data collected in response to the GLAAS 2013/2014 survey from 93 countries of 94 were included, and responses were analysed for 12 questions assessing the inputs and enabling environment for hygiene promotion under four thematic areas. Data were included and analysed from 20 External Support Agencies (ESA) of 23 collected through self-administered surveys. Firstly, the data showed a large variation in the way in which hygiene promotion is defined and what constitutes key activities in this area. Secondly, challenges to implement hygiene promotion are considerable: include poor implementation of policies and plans, weak coordination mechanisms, human resource limitations and a lack of available hygiene promotion budget data. Despite the proven benefits of hand washing with soap, a critical hygiene-related factor in minimising infection, GLAAS 2013/2014 survey data showed that hygiene promotion remains a neglected component of WASH. Additional research to identify the context-specific strategies and inputs required to enhance the effectiveness of hygiene promotion at scale are needed. Improved data collection methods are also necessary to advance the availability and reliability of hygiene-specific information. © 2016 John Wiley & Sons Ltd.

Prevalence and Predictors of Intestinal Parasites among Food Handlers in Yebu Town, Southwest Ethiopia

PubMed Central

Tefera, Tamirat; Mebrie, Getye

2014-01-01

Background As a result of urbanization, eating and drinking from food service establishments is becoming a common practice in developing countries like Ethiopia, which increases the chances of food borne diseases. The health status and hygiene practices of food handlers are the major determinants of food contamination. In developing countries where there are poor regulatory systems for food hygiene, food handlers are often appointed without screening for possible infections associated with poor hygiene like intestinal parasites. Objective This study aimed at determining the prevalence and predictors of intestinal parasites and assessing the hygiene practices among food handlers in Yebu Town, southwest Ethiopia. Methods A cross-sectional study was conducted among a total of 118 food handlers in Yebu Town in January 2011. Fresh stool specimens were collected and processed using both direct wet mount and Formol ether concentration techniques. Results The overall prevalence of intestinal parasites among the study subjects was 44.1% (52/118). Ascaris lumbricoides and hookworm spp were the predominant parasites identified from the stool of study participants. Age above 35 years (AOR: 4.8, 95% CI: 1.1, 21.8), no regular practice of washing hands before a meal (AOR: 7.8, 95% CI: 2.8, 24.8), and untrimmed finger nail (AOR: 14.7, 95% CI: 2.8, 75.4) were independent predictors of intestinal parasitic infection among the food handlers. Conclusion The present study showed high prevalence of intestinal parasites among the study subjects. The study also revealed poor personal hygiene like poor practice of hand washing and poor finger nail hygiene. Therefore, much has to be done to improve the personal hygiene of the food handlers. Pre-placement and periodic screening of food handlers for parasites and prompt treatment, and health education on regular trimming or cleaning of fingernails would be the way forward for prevention of food borne diseases. PMID:25329050

Prevalence and predictors of intestinal parasites among food handlers in Yebu Town, southwest Ethiopia.

PubMed

Tefera, Tamirat; Mebrie, Getye

2014-01-01

As a result of urbanization, eating and drinking from food service establishments is becoming a common practice in developing countries like Ethiopia, which increases the chances of food borne diseases. The health status and hygiene practices of food handlers are the major determinants of food contamination. In developing countries where there are poor regulatory systems for food hygiene, food handlers are often appointed without screening for possible infections associated with poor hygiene like intestinal parasites. This study aimed at determining the prevalence and predictors of intestinal parasites and assessing the hygiene practices among food handlers in Yebu Town, southwest Ethiopia. A cross-sectional study was conducted among a total of 118 food handlers in Yebu Town in January 2011. Fresh stool specimens were collected and processed using both direct wet mount and Formol ether concentration techniques. The overall prevalence of intestinal parasites among the study subjects was 44.1% (52/118). Ascaris lumbricoides and hookworm spp were the predominant parasites identified from the stool of study participants. Age above 35 years (AOR: 4.8, 95% CI: 1.1, 21.8), no regular practice of washing hands before a meal (AOR: 7.8, 95% CI: 2.8, 24.8), and untrimmed finger nail (AOR: 14.7, 95% CI: 2.8, 75.4) were independent predictors of intestinal parasitic infection among the food handlers. The present study showed high prevalence of intestinal parasites among the study subjects. The study also revealed poor personal hygiene like poor practice of hand washing and poor finger nail hygiene. Therefore, much has to be done to improve the personal hygiene of the food handlers. Pre-placement and periodic screening of food handlers for parasites and prompt treatment, and health education on regular trimming or cleaning of fingernails would be the way forward for prevention of food borne diseases.