Staff Adherence Research Articles

Teaching Ultrasound at the Point of Care in Times of Social Distancing.

Point-of-care ultrasound has become an integral aspect of critical care training. The Bedside Assessment by Sonography In Critical Care Medicine Curriculum was established at the University of Toronto to train critical care trainees in basic echocardiography and general critical care ultrasound. During the coronavirus disease (COVID-19) pandemic, our program needed to adapt quickly to ensure staff safety and adherence to infection-control protocols. In this article, we share our experience and reflect on the challenges and benefits of shifting from a primarily in-person teaching model to a hybrid model of remote and in-person teaching. Curricular changes were threefold: the transition to entirely web-based interactive didactic teaching and online imaging interpretation modules, the recruitment of sonographers at multiple academic sites as instructors to facilitate in-person practices with lower instructor to trainee ratio, and the use of a mobile application for informal group case-based discussions. Challenges included lost opportunities for scanning healthy volunteers, variability in attendance at online lectures, and a lower number of study submissions for review. However, curricular changes enabled maintenance of directly observed practice, high levels of engagement with recorded content, and an expansion of our reach to a global audience. We believe that future curricula should combine high-quality online curriculum and resources with the ongoing in-person delivery of key elements of curriculum to allow for direct observation and feedback as well as the maintenance of self-directed point-of-care ultrasound portfolios.

Effective approach to manage COVID-19 challenges in Hamad General Hospital dialysis facilities

Background: Hamad Medical Corporation (HMC) is providing dialysis treatment to approximately 1050 patients. COVID-19 started from China in December 2019, and the first case in Qatar was confirmed on 27th February 2020. There were challenges to provide dialysis treatment for COVID-19 positive and negative patients during the pandemic due to severe staff shortage, staff fear and psychological distress, workload, lack of dialysis slots, prolonged working hours and staff fatigue. Some staff were even deployed to COVID-19 facilities (modular dialysis services, hotel and quarantine facilities) to provide treatment. Methods: 1) A COVID-19 management committee was established 2) An on-call team was assigned to manage new cases and review dialysis slots availability. 3) Staff performance and adherence to safety measures was monitored. 4) A hierarchy model was implemented for COVID-19. A) Elimination: – Confirmed COVID-19 patients were not to receive dialysis at Ambulatory Dialysis centres. – Unit meetings were only held online. B) Substitution: – Dialysis services were to be provided in HMC dialysis facilities, COVID-19 hospitals, and isolation/quarantine facilities (home/hotels). – Administrators with chronic disease worked from home. C) Engineering: – Reduce number of chairs in tearoom and waiting area – Rearrange offices, working spaces, and conference room to keep everyone 2 meters apart. D) Administrative: – Staff, patient and family education – Screening by using visual triaging scale – Deployment of staff – Managing staff mental health and psychosocial well-being Results: 76 dialysis patients and 30 dialysis staff were infected. 900 hemodialysis sessions were provided inside quarantine and isolation facilities (home, hotel, Bu-Sidra, and other locations) and Hazm Mebaireek General Hospital (HMGH) Modular Dialysis Unit from March to October 2020 . The number of COVID-19 positive patients reduced from 39 in May 2020 to 12 in July 2020 (p = 0002). Conclusion: Thanks to our approach, we were able to provide a high quality and safe dialysis service for in-centre dialysis and in COVID-19 facilities and quarantine centres (home/hotels).

Predictors of missed infection control care: A tri-partite international study.

AimThis study aimed to quantify types and frequencies of missed infection control care and to develop a theoretical model for estimating nurses’ consensus scores about this form of missed care.DesignA non‐experimental research design using self‐audit data was selected to collect information about the types and frequencies of missed infection control care from nurses employed in hospitals located in three different countries. Data collection commenced mid‐year 2018.MethodsA multivariate approach was used to apply the consensus scores of 1.911 internationally based nurses in the missed opportunities for maintaining infection control.Results/findingsThirteen variables exert direct effects on the nurses’ total scores underpinning missed infection control care. These include the methods used to prevent hospital‐acquired infections, surveillance and hand hygiene practices. Significant nurses’ demographic factors also included their countries of origin, employment status, employer type, job retention intentions, work intensity, length of clinical experience and staff development attendance.ConclusionIn magnitude of importance and having the largest effect on missed infection control care is missed care related to reducing hospital‐acquired infections followed closely by surveillance. Missed infection control care can be quantified, and variances in its practices can be accounted by exploring the nurses’ differing demographic factors, including the nurses’ country of origin.ImpactVariations in missed infection control care can be accounted for across three countries. While ward hygiene is underestimated by staff as a mechanism to minimize nosocomial infections, infection control surveillance remains the key to reducing hospital‐acquired infections. The study's outcomes invite the use of an ongoing, whole‐of‐organization approach to infection control with scrutiny being needed for improved staff adherence particularly with hand hygiene.

Characteristics of On-Site Infection Prevention and Control Visits for COVID-19—California, February 2020–December 2020

Background: The novel coronavirus (COVID-19) pandemic has caused significant morbidity and mortality in California: 2,218,000 cases and 24,598 deaths had occurred by December 31, 2020. Deaths at skilled nursing facilities (SNFs) and assisted living facilities (ALFs) comprise 26.2% of deaths in California; the fatality rate (299 per 10,000 SNF and ALF residents) in such facilities is nearly 50 times the statewide COVID-19 mortality rate (6.4 per 10,000 California residents). For healthcare facility (SNF, ALF, acute-care hospitals) and correctional facility outbreak management, the California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program deployed trained infection preventionists (IPs) to perform on-site infection prevention and control (IPC) assessments and to provide recommendations to staff and local health departments (LHDs). We describe the number and distribution of visits across the state and common IPC challenges identified. Methods: From February 1, 2020, to December 31, 2020, CDPH IP visits were requested directly by facilities, coordinated through LHDs and other state agencies, or prompted by a facility’s increasing case count on twice weekly review of the daily California healthcare facility data survey (Survey 123). Deployed IPs evaluated facility COVID-19 IPC protocols, assessed facility staff adherence using a standardized assessment tool, and provided verbal feedback followed by written summary reports and recommendations. We categorized visits geographically into 5 California Health Officer Association regions and by month, and we reviewed visit reports for common findings. Results: In total, 623 visits were performed for 489 outbreaks at 465 distinct facilities across 46 LHDs; 71 facilities received ≥2 visits. Southern California facilities received 292 visits (46.9%), San Joaquin region facilities received 138 visits (22.2%), Bay Area facilities received 131 visits (21%), Greater Sacramento facilities received 54 visits (8.7%), and Rural North facilities received 8 visits (1.3%) (Figure 1). The highest number of visits per month occurred in December (n = 143, 22.9%), followed by July (n = 87, 13.9%), and April (n = 83, 13.3%). Common IPC challenges included inappropriate resident cohorting practices, improper use of personal protective equipment, and lapses in physical distancing, and source control in breakrooms. Conclusions: On-site visits by CDPH IPs during the COVID-19 pandemic in California, though resource-intensive, provided substantial technical support for healthcare facilities during outbreaks and identified key areas for IPC improvement. Ongoing CDPH HAI guidance and training materials for facility-based IP staff are now being informed by these IPC challenges.Funding: NoDisclosures: None

Compliance of Dental Staff and Students to Dental Guideline amidst the COVID-19 Pandemic: An Institutional Analysis

COVID-19 can be transferred via aerosols. Amidst the COVID-19 pandemic, dental practitioners, supporting clinical staff and clinical-year dental students are directly exposed to aerosols produced during dental treatment. Thus, the Faculty of Dentistry of Universiti Sains Islam Malaysia (USIM) developed dental guidelines that included a standard operating procedure for clinical settings. This study aimed to assess the adherence of clinical staff and students to dental guidelines during the COVID-19 pandemic and investigate the nature and extent of difficulties encountered by the faculty members in complying with the guidelines. The dental guidelines were explained to all faculty members, and then an audit form was developed on the basis of the guidelines. A series of clinical audits was conducted on a weekly basis. Afterwards, a survey was conducted to investigate any problems faced by dental clinical staff and students in terms of complying with the guidelines. The percentage of noncompliance to wearing goggles and face shields during dental procedures was 7.1% and 2.1%, respectively. Amongst 128 respondents, 84.1% reported unclear vision due to the fogging of the goggles, whereas 45.2% reported blurred vision when goggles and face shields were worn together. Moreover, approximately 30.2% of the respondents claimed that KN95 masks contribute to difficulty in breathing. Nevertheless, most of the dental clinical staff and students were compliant to the dental guidelines. Noncompliance was mainly caused by the fogging issue when wearing goggles. Thus, this issue should be tackled to prevent the impairment of treatment quality.

Barriers to physical distancing among healthcare workers on an academic hospital unit during the coronavirus disease 2019 (COVID-19) pandemic.

Physical distancing among healthcare workers (HCWs) is an essential strategy in preventing HCW-to-HCWs transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2). To understand barriers to physical distancing among HCWs on an inpatient unit and identify strategies for improvement. Qualitative study including observations and semistructured interviews conducted over 3 months. A non-COVID-19 adult general medical unit in an academic tertiary-care hospital. HCWs based on the unit. We performed a qualitative study in which we (1) observed HCW activities and proximity to each other on the unit during weekday shifts July-October 2020 and (2) conducted semi-structured interviews of HCWs to understand their experiences with and perspectives of physical distancing in the hospital. Qualitative data were coded based on a human-factors engineering model. We completed 25 hours of observations and 20 HCW interviews. High-risk interactions often occurred during handoffs of care at shift changes and patient rounds, when HCWs gathered regularly in close proximity for at least 15 minutes. Identified barriers included spacing and availability of computers, the need to communicate confidential patient information, and the desire to maintain relationships at work. Physical distancing can be improved in hospitals by restructuring computer workstations, work rooms, and break rooms; applying visible cognitive aids; adapting shift times; and supporting rounds and meetings with virtual conferencing. Additional strategies to promote staff adherence to physical distancing include rewarding positive behaviors, having peer leaders model physical distancing, and encouraging additional safe avenues for social connection at a safe distance.

Presentation and surgical management of a gossypiboma presenting with small bowel obstruction

Gossypiboma is a cotton-based foreign body retained within the human body following a surgical procedure. Transmural migration of intra-abdominal gossypiboma into the small bowel is rare; however, it can present with life-threatening complications. We report a case of a 28-year-old male who presented with small bowel obstruction due to gossypiboma, 11 years after the initial surgical procedure. Due to the size of the retained surgical swab, 40 cm × 40 cm, an open surgical approach was preferred. Following removal of the retained swab and bowel reconstruction, the patient was followed in clinic and discharged without complications. Staff education and adherence to operating room record-keeping protocols can prevent gossypiboma. To the best of our knowledge such a long interval between the initial surgery and presentation of gossypiboma that large has not been previously reported in the literature.

The perceptions of healthcare professionals about accreditation and its impact on quality of healthcare in Kuwait: a qualitative study.

The accreditation of healthcare organizations has been applied as a quality assurance mechanism of healthcare services. Kuwait health authorities implemented a national healthcare accreditation program at the governmental healthcare system. This study aimed to explore the perceptions of healthcare professionals (HCPs) about healthcare accreditation, perceived challenges to implementing accreditation, and views on how to overcome these challenges. A phenomenological qualitative framework was adopted to conduct focus group interviews to explore perceptions of HCPs about accreditation in governmental healthcare system. Data were collected from 30 HCPs using seven focus group interviews. The verbatim transcripts of the interviews were analysed using the framework approach. The HCPs indicated that accreditation enhanced patient safety culture at their organizations through staff adherence to good practices, improved documentation and patient handover practices, and incident reporting. The facilitators to the implementation of accreditation that emerged from interviews included administrative support, staff training about accreditation, and expansion in application of electronic systems. Participants reported several challenges to implementing accreditation including challenges related to staff (eg, high workload, burdens imposed by accreditation requirements), challenges related to organizational system and resources (eg, poor teamwork among HCPs, inadequate infrastructure in some facilities), and challenges related to patients (eg, poor understanding about accreditation). However, most participants expressed positive attitudes towards accreditation and appreciated its impact on quality of healthcare. Participants suggested ways to support accreditation such as increasing staff numbers to reduce workload, enhancing staff motivation and education about accreditation, developing proactive leadership and staff teamwork, and improving patients' awareness about accreditation. HCPs in Kuwait expressed positive attitudes towards accreditation while also recognizing the challenges that may hinder its implementation. The collaboration between different stakeholders in this process is essential to overcome these challenges and support HCPs to meet accreditation standards and improve quality of healthcare services.

Mental health nurses experience of the introduction and practice of the Safewards model: a qualitative descriptive study

BackgroundA lack of safety experienced by patients and staff in acute psychiatric units is a major concern and containment methods used to manage conflict have the potential to cause harm and upset to both staff and patients. To ensure safety for all, it is highly desirable to reduce levels of conflict and containment and the Safewards model is an evidence-based model aimed at reducing conflict and containment rates by improving nurse-patient relationships and safety.MethodsThe aim of this study was to explore mental health nurses’ experience of the introduction and practice of three Safewards interventions; reassurance, soft words and discharge messages. A qualitative descriptive research design utilising a purposive sample (n = 21) of registered psychiatric nurses (n = 16) and managers (n = 5) in an acute psychiatric unit in Ireland. Following a 12-week implementation of Safewards, three focus groups were conducted, two with nursing staff and one with nurse managers. Data were analysed using Braun and Clarke thematic analysis framework which supported the identification of four themes: introducing Safewards, challenges of Safewards, impact of Safewards and working towards success.ResultsThe findings indicate that the process of implementation was inadequate in the training and education of staff, and that poor support from management led to poor staff adherence and acceptance of the Safewards interventions. The reported impact of Safewards on nursing practice and patient experience were mixed. Overall, engagement and implementation under the right conditions are essential for success and while some participants perceived that the interventions already existed in practice, participants agreed Safewards enhanced their communication skills and relationships with patients.ConclusionThe implementation of Safewards requires effective leadership and support from management, mandatory training for all staff, and the involvement of staff and patients during implementation. Future research should focus on the training and education required for successful implementation of Safewards and explore the impact of Safewards on nursing practice and patient experience.

Reducing Cardiac Telemetry Nuisance Alarms Through Evidence-Based Interventions.

Cardiac telemetry nuisance alarms due to leads off and poor signal increase staff workflow interruptions, decrease staff trust in technology, and can compromise patient safety. Interventions were directed at reducing nuisance alarms on a 32-bed, non-intensive care - a cardiac telemetry unit. A nursing staff education module with evidence-based practices for reducing nuisance alarms, a daily care protocol for patients on cardiac telemetry monitoring, and daily audits of protocol adherence were implemented. Staff pre- and posttest comparisons on their knowledge relating to nuisance alarms and the evidence-based protocol demonstrated a significant mean increase of 3.02 (95% CI, 2.55-3.48). Daily audits for 7 weeks demonstrated an average of 58.46% staff adherence. Telemetry technician call volume reduction was 16% postimplementation, while nuisance alarms were not reduced significantly. This rapid-cycle, quality improvement process resulted in minimal reduction in nuisance alarms but improved staff awareness of the issue and reduced workflow interruptions.

Implementation of the 1-Hour Sepsis Bundle and Evaluation of Staff Adherence: An Evidence-based Practice Quality Improvement Project

Implementation of the 1-Hour Sepsis Bundle and Evaluation of Staff Adherence: An Evidence-based Practice Quality Improvement Project

M34 Enhanced Recovery After Surgery (ERAS) Pathway for Cardiac Surgery: The First Australian Experience

The use of ERAS pathways has previously being proven to improve care in multiple surgical specialties. It is however a new concept in cardiac surgery where it can facilitate a patient centred and standardised perioperative care. Unfortunately, their applicability in real life clinical scenarios is impacted by multiple factors, including clinician/health staff adherence, changing knowledge and consensus differences of the multidisciplinary team. ERAS pathways are a combination of evidence-based guidelines, clinical protocols and best practice rules, design to reduce physiological and psychological stress in surgical patients as well as achieve a rapid recovery.

Factors influencing adherence of health-care staff with infection prevention and control guidelines amidst coronavirus pandemic

Background: The world is currently experiencing second wave of the ongoing coronavirus disease-19 pandemic. Health workers are also being engulfed by this catastrophe along with others. Adherence to infection control practices is of utmost importance for healthcare workers to prevent the infection of health workforce and also the patients. Limited data are available regarding the same among healthcare workers in this region of Punjab. Hence, this study was planned to assess the adherence and practices of health-care staff regarding infection control practices and barriers faced by them in following these practices. Aim and Objectives: This study was designed to assess the awareness and practices of Infection Prevention and Control guidelines and to identify barriers and motivators for healthcare workers’ adherence to Infection Prevention and Control guidelines. Materials and Methods: The current study was a cross-sectional study conducted in the medical institutions of Punjab. A semi-structured self-made pre-validated questionnaire was circulated among the health-care staff through Google forms sent in different WhatsApp groups of the healthcare workers. Data collected were analyzed using Epi-Info statistical package for windows. Results: The knowledge level of the participants regarding all the other infection prevention and control (IPC) practices was good except for the recommended duration of hand hygiene. The practice of recommended steps of hand hygiene was poor and was fair in case of other parameters. The major barriers in the adherence of IPC were lack of training and unavailability of necessary infrastructure and equipment. Hand hygiene practice was found to be significantly associated with working experience and number of IPC training attended. Conclusion: The knowledge level of infection prevention and control measures among the respondents was good but the practice was poor. The infection control guidelines need to be vigorously enforced; doctors need to be properly oriented, trained, and retrained on the infection control measures and the needed consumables, and supplies should be provided, to ensure the strict adherence to the infection control guidelines at all times.

ЩОДЕННА ГАЗЕТА «РУСИНЪ» (1923 р.) ЯК ЗРАЗОК УНІВЕРСАЛЬНОГО ВИДАННЯ НА ЗАКАРПАТТІ

The article aims to analyze the first daily newspaper Rusyn (est. 1923) in the Transcarpathia via a prism of its compliance with thematic universalization. Additionally, it seeks to elucidate on the basis of newspaper publications and memoirs its material-technical base, sources of funding, publisher, editor-in-chief, editorial staff and authorship shaping its face; as well as to trace adherence of the editorial board to standards of the quality press. The originality/novelty of the scholarship is a comprehensive analysis of the outlined key factors impacting creation of the quality press publication. In the process of research we managed to elicit the findings and draw such conclusions: the first daily newspaper Rusyn (1923) became one of the vivid periodicals of Transcarpathia in the early 20th century due to a number of factors. Those were state funding; strong material and technical base; high intellectual level of the editor-in-chief and editorial staff; broad circle of authors (leading Ukrainian, Czech and Slovak scholars, journalists, public and political figures, writers of that time); distinct editorial bent and rigorous adherence of the editorial staff to the standards of the quality press. Keywords: the daily newspaper; Rusyn; Zakarpattia/Transcarpathia; editor-in-chief; publisher; creative/editorial staff; universal publication; standards; quality press.

Management of bacteriological specimens of patients suffering from coronavirus disease 2019 (COVID-19)

Management of bacteriological specimens of patients suffering from coronavirus disease 2019 (COVID-19)

Strategies for Promoting Hand Hygiene Compliance on Inpatient Psychiatric Units.

To identify recommendations to improve staff and patient adherence to hand hygiene best practices on inpatient psychiatric units, a survey of the literature was conducted to distill the most effective recommendations. Several interventions have been identified that have met with success in previous outbreaks of infectious disease. These interventions require little more than basic nursing skills: education, time and attention, and knowledge of one's patients. The literature suggests that strict hand hygiene and infection control processes can be implemented to the benefit of an inpatient psychiatric ward, but only with significant adjustments for staff and patients. [Journal of Psychosocial Nursing and Mental Health Services, 59(5), 21-24.].

Multidisciplinary Central-Line Bundle Audit Rounding: A Strategy to Reduce CLABSIs

Background: Central venous catheter (CVC) maintenance bundle elements, including labeling IV tubing and dressings, consistently changing them, intact dressings, and dry healthy insertion sites, together have been shown to reduce risks of developing central-line–associated bloodstream infections (CLABSIs).1,2 CLABSIs are a significant, but preventable, cause of mortality among critically ill patients.3 In the last 12 months, the 16-bed medical intensive care unit (MICU) at a large, urban, academic facility had 2,621 central-line days, presenting many opportunities for CLABSI prevention. During that time, weekly observations assessed compliance with CVC maintenance bundle elements. Interventions: Multidisciplinary rounds were conducted to monitor nursing staff adherence to CVC maintenance bundle elements. The following bundle elements observed during rounds: (1) Is central-line dressing occlusive/intact? (2) Is CVC insertion site healthy with no redness/drainage? (3) Is CVC dressing labeled with insertion date? (4) Date/time of last dressing change adheres to policy? (4) All CVC tubing is labeled with date/time? (5) All CVC tubing dates adhere to policy? (6) If stopcock is present, is cap present over unused port? “Just-in-time” staff coaching was employed when noncompliance was observed. Findings were sent to leadership for manager follow-up. Staff were informed about products available within the hospital, which can improve dressing adherence and mitigate insertion-site bleeding. Education was provided to staff defining exact requirements for CVC dressings. The acronym “IDOL” was used to help remind staff of these fundamentals: (1) Intact dressing borders are well adhered, with <50% of the white border detached. (2) Drainage should be within the chlorhexidine square. (3) Occlusive means no bubbles, kinks, or wrinkles in the dressing. (4) Labeling is required and must include insertion date, date/time of change, and initials. Results: In the first 2 months of rounds, overall compliance averaged 85%. Compliance increased to an average of 91% during the subsequent 10 months. Early on, most fallouts were found with dressings not occlusive or intact and excessive drainage from insertion sites. Initially, 71% of sites were without excess drainage, and 57% of dressings were occlusive or intact. These measures increased to 83% and 89%, respectively, after the interventions. A 50% decrease in the number of CLABSIs was observed during the observation period, compared to the previous 12-month period. Conclusions: Consistent use of bundles has been shown to significantly improve patient outcomes with regard to hospital-acquired infections (HAIs).3 Frequent observations, education to define staff expectations, and holding staff accountable have all helped improve compliance with maintenance bundle elements. Preventing CLABSIs is not only important for patient safety and quality of care. Regulatory and accrediting agencies are now increasing their focus on infections and are tying them to reimbursement.Funding: NoneDisclosures: None

Strengthening Adherence to a Central-Line–Associated Bloodstream Infection Prevention Bundle in a Surgical ICU in Vietnam

Background: Central-line–associated bloodstream infections (CLABSIs) increase the length of hospital stay, healthcare costs, and patient mortality. Objective: We conducted a quality improvement (QI) approach with plan-do-study-act (PDSA) cycle to strengthen adherence to a central-line (CL) maintenance bundle and to reduce CLABSI rate in a surgical intensive care unit (ICU) of children’s hospital 1 (CH1). Methods: The baseline CLABSI rate per 1,000 CL days and the ratio of CL days to patient days (device utilization ration; DUR) were captured for 12 months preceding the intervention. Baseline process indicators were captured for 2 months preceding implementation, including hand hygiene adherence, sterile technique for dressing change and CL access, CL hub cleaning, dating of CL components and daily chlorhexidine bathing. A multimodal intervention of clinician training, bedside checklist, and poster reminders of best practices was implemented. Process and outcome measures were monitored over 12 months of implementation. Z-test was used to calculate statistical significance before and after intervention. Results: Among 46 clinical ICU staff trained on a CLABSI maintenance bundle, mean pre- and posttest knowledge scores increased from 63% to 86%. Staff adherence to each CL care bundle element improved significantly (P < .001) and sustainably over the intervention period: hand hygiene adherence increased from 54% to 82%; sterile technique for dressing increased from 60% to 94%; sterile technique for CL access increased from 51% to 97%; hub scrubbing increased from 52% to 93%; dating of CL elements increased from 63% to 85%; daily chlorhexidine bathing increased from 52% to 87%. During the first 9 months, the CLABSI rate and the DUR decreased from 5.8 to 3.7 and from 0.43 to 0.41, respectively. In the following 2 months, the CLABSI rate increased to 12.7 while bundle adherence remained high. A root-cause analysis identified inadequate environmental hygiene and use of multidose saline bottles for multiple patients as potential factors. A PDSA cycle to improve these elements (enhanced cleaning; single-patient saline bottles) led to a decrease in the CLABSI rate from 12.7 to 3.0 after these efforts. Conclusions: This is the first time CH1 has used quality improvement methodology to implement an HAI prevention enhancement, which proved effective at creating and sustaining adherence to a multimodal CL maintenance bundle and an overall decrease in CLABSI rates. A 2-month increase in CLABSI rates highlights the unique challenges faced in low-resource settings and demonstrates the need for IPC elements not captured in a typical CLABSI prevention bundle. The quality improvement methodology provided a structured approach to implementing change. This methodology will be used for additional patient safety improvements at CH1 and other Viet Nam hospitals interested in CLABSI prevention.Funding: NoneDisclosures: None

Hand Hygiene Compliance in a University Hospital in West Bank, Palestine: An Observational Study 2017–2019

Background: Worldwide, medical staff adherence to hand hygiene (HH), the most cost-effective measure to decrease healthcare-associated infections (HAIs), is ~40%–60%. The infection control program (ICP) at An-Najah National University Hospital (NNUH), a tertiary-care referral teaching hospital located in Nablus, in northern Palestine, monitors HH compliance by direct observations using the WHO observation checklist. In this descriptive study, we investigated the prevalence of HH across the institution during 2017–2019. Methods: The WHO multimodal strategy to enhance HH in healthcare settings was implemented at NNUH, a tertiary-care referral hospital, in 2017. HH compliance has been measured during routine patient care by direct observation by ICP team and anonymously by other trained observers. Results are reported on monthly basis to the administration and medical team (nurses and doctors), and corrective plans to increase the compliance are discussed. Training is reinforced with ultraviolet light and fluorescent alcohol-based hand rub. Yearly, staff are engaged in HH Day activities (Figs. 1 and 2). Leadership support is constant by securing the annual budget for the HH program and the enforcement of HH policy across the setting. Results: NNUH, using the WHO Hand Hygiene Self-Assessment Framework, is currently in the advanced level (395 of 500) compared to 2017 (intermediate level, 292 of 500). Overall, HCW HH compliance increased from 44% (range, 31%–57%) in 2017 to 53% (range, 30%–72%) in 2018 and to 61% (range, 55%–66%) through October 2019. During the 3-year study period, Nursing compliance increased from 36% to 59% and to 64%, respectively, whereas the compliance for doctors increased from 42% to 56% and 58%, respectively. Regarding the missed opportunities, before patient was the most frequent cause for missed opportunity with a rate of 60% (Fig. 3). This missed opportunity was mainly related to the misuse of gloves (mainly among nurses), which requires an ad hoc intervention. Conclusions: Implementation of the WHO HH strategy is feasible and effective in low-income countries and leads to significant improvements in compliance. Periodic training, personnel engagement, and leadership are key factors of HH improvement in our setting.Funding: NoneDisclosures: None

Healthcare Worker Perceptions of Germs and Personal Hygiene Routines in a Ventilator-Capable Skilled Nursing Facility (vSNF)

Background: During a 2017–2019 intervention in Chicago-area vSNFs to control carbapenem-resistant Enterobacteriaceae, healthcare worker adherence to hand hygiene and personal protective equipment was stubbornly inadequate (hand hygiene adherence, ~16% and 56% on entry and exit), despite educational and monitoring efforts. Little is known about vSNF staff understanding of multidrug-resistant organism (MDRO) transmission. We conducted a qualitative analysis of staff members at a vSNF that included assessment of staff perceptions of personal MDRO acquisition risk and associated personal hygiene routines transitioning from work to home. Methods: Between September 2018 and November 2018, a PhD-candidate medical anthropologist conducted semistructured interviews with management (N = 5), nursing staff (N = 6), and certified nursing assistants (N = 6) at a vSNF in the Chicago region (Illinois) who had already received 1 year of MDRO staff education and hand hygiene adherence monitoring. More than 11 hours of semistructured interviews were collected and transcribed. Data collection and analysis included identifying how staff members related to their own risk of MDRO acquisition/infection and what personal hygiene routines they followed. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Staff members at all levels were able to describe their perceptions related to the risk of acquiring an MDRO and personal hygiene in great detail. The risk of acquiring an MDRO was perceived as a constant threat by staff members, who described germs as bad and everywhere (Table 1). The perceived threat of MDRO acquisition was connected to individual personal hygiene routines (eg, changing shoes before leaving work), which were considered important by staff members (Table 2). Nursing staff and certified nursing assistants noted that personal hygiene was a critical factor keeping their residents, themselves, and their families free from MDROs. Conclusions: In the context of a quality improvement campaign, vSNF healthcare workers are aware of the transmissibility of microscopic MDROs and are highly motivated in preventing transmission of MDROs to themselves. Such perceptions may explain actions such as why workers may be differentially adherent with infection control interventions (eg, more likely to perform hand hygiene leaving a room rather than going into a room, or less likely to change gowns in between residents in multibed rooms if they believe they are already personally protected with a gown). Our findings suggest that interventions to improve staff adherence to infection control measures may need to address other factors related to adherence besides knowledge deficit (eg, understaffing) and may need to acknowledge self-protection as a driving motivator for staff adherence.Funding: NoneDisclosures: None