Hand Hygiene Campaign Research Articles

Process Improvement to Reduce Healthcare Associated C. difficile Infections: A Bundled Approach

<h3>Background</h3> A community hospital experienced an increase in Healthcare Associated C. difficile infections in Fiscal Year 2017. Over 70% of the cases were identified in a single unit and were associated with common rooms. Utilizing a continuous improvement process, it was determined that we had multiple opportunities within environmental cleaning, antibiotic utilization, appropriate and prompt testing, compliance with hand hygiene and isolation precautions. <h3>Methods</h3> Front line staff assisted in creating standard work for room stripping and cleaning. Another opportunity was to streamlining our cleaning chemicals. At one point, we utilized two different chemicals and application methods. This variation lead to confusion and compliance downstream. March 2018, UV-C was deployed to treat bathrooms after daily cleaning and after terminal cleaning. Refreshing our Hand Hygiene Campaign was another intervention to increase awareness around appropriateness hand hygiene and tackle barriers to compliance. Our data also showed many of our positive patients received a laxative within 24 hours of testing. We refreshed our education and developed a best practice advisory in our electronic medical record. To ensure prompt collection, a magnetic visual cue was created for the patient's door. A protocol to assist in de-escalating Proton Pump Inhibitor was developed in addition to a process for prophylactic antibiotics for patients with a recent history of C diff. <h3>Results</h3> We have celebrated many new milestones since starting our process improvement journey. From FY 17-FY19, we had a 51% decrease in the number of infections and a 47% reduction in our Standardized Infection Ratio. <h3>Conclusions</h3> We began our journey towards reducing C. diff infections in May 2017 and continue working towards our ultimate goal of zero patient harm. In order to develop solutions and achieve results, we needed to have the front line staff voices heard and work together for what was best for our patients.

Multifaceted interventions for healthcare-associated infections and rational use of antibiotics in a low-to-middle-income country: Can they be sustained?

Transmission of infection between patients by health workers, and the irrational use of antibiotics are preventable causes for healthcare-associated infections (HAI) and multi-resistant organisms. A previous study implementing a hand hygiene campaign and antibiotic stewardship program significantly reduced these infections. Sustaining such interventions can be challenging. To evaluate whether there was a sustained effect of a multifaceted infection control and antibiotic stewardship program on HAI and antibiotic use 5 years after it began. A prospective evaluation study was conducted over 26 months (from February 2016 to April 2018) in a teaching hospital in Indonesia, 5 years after the implementation of an antibiotic stewardship and infection control program, which was successful when initially evaluated. All children admitted to the pediatric ICU and pediatric wards were observed daily. Assessment of HAI was made based on the criteria from the Centers for Disease Control and Prevention. Assessment of rational antibiotic use was based on the WHO Pocket Book of Hospital Care for Children. Multivariable logistic regression analysis was used to quantify the relationship between the HAI and the multifaceted intervention. We observed an increase in HAIs, from 8.6% (123/1419 patients) in the initial post-intervention period in 2011-2013 to 16.9% (314/1855) in the evaluation study (relative risk (RR) (95% CI) 1.95 (1.60 to 2.37)). After adjusting for potential confounders, we found that an increase in HAI in the evaluation period with adjusted OR 1.94 (95% CI 1.53 to 2.45). Inappropriate antibiotic use also increased, from 20.6% (182 of 882 patients who were prescribed antibiotics) to 48.6% (545/1855) (RR 2.35 (2.04 to 2.71)). Hand hygiene compliance also declined from 62.9% (1125/1789) observed moments requiring hand hygiene to 51% (1526/2993) (RR 3.33 (2.99 to 3.70)). Healthcare-associated infections and irrational use of antibiotics remain significant even after the implementation of a multifaceted infection control intervention and antibiotic stewardship program. There is a need for continuous input, ongoing surveillance and long-term monitoring of these interventions to sustain compliance and effectiveness and address problems as they emerge.

Effectiveness of a Ward level target accountability strategy for hand hygiene

BackgroundHand hygiene is a simple and effective solution in prevention of Multi Drug Resistant Organisms. Hand Hygiene campaigns have mostly taken the form of a generalised hospital approach with visual reminders and rewards for improvement in compliance. We describe a hand hygiene programme that sets an individualised ward target to increase accountability and drive improvement.MethodsWe undertook to develop a “Hand Hygiene Accountability” model, where the mean compliance rate, using the WHO hand hygiene assessment tool, for each ward over the past 6 months plus 10% was used as a target for that particular ward.Rewards were given to wards with the most percentage improvement over the year. A graded escalation was used for wards that did not meet targets based on 1,2 or 3 months of non-compliance. The most extreme action, setting up a task force directed by the Chairman of our Medical Board, would be required if 3 continuous months of non-compliance was observed. Hand Hygiene audits were performed by staff trained using the WHO audit tools. The same strategy was repeated at our community hospital.Active surveillance testing for Methicillin Resistant Staphylococcus aureus (MRSA) using nasal, groin and axilla swabs established before the project continued to be in operation, as did surveillance for hospital acquired MRSA bacteraemia (using NHSN criteria), hospital-onset Clostridioides difficile (HO-CD), and multi-resistant gram-negative bacilli.ResultsData from July 2015 to December 2017 was analysed. In the acute and community hospitals, 21,582 and 5770 hand hygiene (HH) observations were undertaken respectively.In the acute care hospital, HH compliance rates went from 65 to 78% (p-value < 0.00001). There was a reduction in MRSA bacteraemia from 5 episodes at the start of the study to 0 in 2017.In the community hospital, HH compliance improved from a mean of 64 to 75% (p-value 0.00005). MRSA transmission rate decreased from 5.72 per 1000 patient days, to 2.79 per 1000 patient days (p-value 0.00035) with an admission prevalence of 13.1% for 2016 and 20.6% in 2017.ConclusionsUsing a ward level accountability for hand hygiene is possible and can be successful in improving hand hygiene rates, possibly reducing transmission of MDROs. Realistic targets need to be set and adequate rewards and incentives provided to ensure continuous improvement.

Innovative Surveillance and Execution of the World Health Organization's 5 Moments of Hand Hygiene in an Acute-care Hospital

BACKGROUND Hand hygiene (HH) is critical to the prevention of serious infections in the healthcare setting. Caregivers have been found to have suboptimal HH practices. The World Health Organization (WHO) 5 Moments of HH program was implemented in an acute-care hospital in an effort to increase caregiver participation, renew interest, and raise visibility. METHODS Over a four month period in 2018, 128 participants were surveyed with an abbreviated WHO HH Perception Survey for Health-Care Workers in an acute-care and critical access hospital. Of the respondents, 67% were from nursing or ancillary nursing services. The abbreviated WHO HH Perception survey was utilized as a way to understand and improve caregiver perceptions and practices related to HH. A question highlighting HH improvement and the receipt of regular results regarding HH performance was targeted. RESULTS On the WHO HH Self-Assessment Framework (SAF) the acute-care hospital scored 280 (range of 0 – 500), intermediate, for HH facility level and obtained a satisfactory level of 12 for HH Leadership. On a scale of 1 – 7, 73% of overall participants rated “receiving regular feedback regarding HH performance” ≥ 5 on the WHO HH perceptions survey. Based on this feedback and the WHO HHSAF, the acute-care hospital implemented a multimodal approach to HH practices through a novel framework. CONCLUSIONS This targeted approach illuminated participant values regarding regular feedback on HH performance. In response, infection prevention implemented secret shopper HH cameras that rotate departments in conjunction with frequent rounding on units to provide immediate feedback on HH compliance and missed opportunities. Feedback was provided to floor nurses, nurse managers, and assistant nurse managers. Additionally, a dynamic traveling HH campaign was implemented to socialize the WHO 5 Moments. The campaign asked all staff to participate in HH activities and to renew their commitment to HH through unit specific posters and signatures. Hand hygiene (HH) is critical to the prevention of serious infections in the healthcare setting. Caregivers have been found to have suboptimal HH practices. The World Health Organization (WHO) 5 Moments of HH program was implemented in an acute-care hospital in an effort to increase caregiver participation, renew interest, and raise visibility. Over a four month period in 2018, 128 participants were surveyed with an abbreviated WHO HH Perception Survey for Health-Care Workers in an acute-care and critical access hospital. Of the respondents, 67% were from nursing or ancillary nursing services. The abbreviated WHO HH Perception survey was utilized as a way to understand and improve caregiver perceptions and practices related to HH. A question highlighting HH improvement and the receipt of regular results regarding HH performance was targeted. On the WHO HH Self-Assessment Framework (SAF) the acute-care hospital scored 280 (range of 0 – 500), intermediate, for HH facility level and obtained a satisfactory level of 12 for HH Leadership. On a scale of 1 – 7, 73% of overall participants rated “receiving regular feedback regarding HH performance” ≥ 5 on the WHO HH perceptions survey. Based on this feedback and the WHO HHSAF, the acute-care hospital implemented a multimodal approach to HH practices through a novel framework. This targeted approach illuminated participant values regarding regular feedback on HH performance. In response, infection prevention implemented secret shopper HH cameras that rotate departments in conjunction with frequent rounding on units to provide immediate feedback on HH compliance and missed opportunities. Feedback was provided to floor nurses, nurse managers, and assistant nurse managers. Additionally, a dynamic traveling HH campaign was implemented to socialize the WHO 5 Moments. The campaign asked all staff to participate in HH activities and to renew their commitment to HH through unit specific posters and signatures.

Infection prevention: laying an essential foundation for quality universal health coverage

Infection prevention: laying an essential foundation for quality universal health coverage

2019 WHO hand hygiene campaign and global survey: clean care for all—it's in your hands

2019 WHO hand hygiene campaign and global survey: clean care for all—it's in your hands

Sustaining Hand Hygiene and Sanitation Campaign in Sub-Saharan Africa: A Glowing Tribute to Ignaz Semmelweis

Ignaz Semmelweis the father of hand hygiene made this startling discovery of strong association of contaminated hands with incidence of puerperal fever and deaths in 1847 and embarked on aggressive campaign to stem the tide of maternal deaths at that time and eventually succumbed to death due to septicaemia in 1865. At present about 171 years since this discovery, the entire humanity is yet to fully embrace the full practice of hand hygiene and reduce as much as half of the morbidities and mortalities from communicable diseases across the globe. Sub-Saharan Africa remains the last stronghold of millions of avoidable deaths from poor hand hygiene and 156 million people from Nigeria are yet to have access to facilities for hand hygiene. Facilities for hand hygiene should be adequately provided in all hospitals and clinics, schools and all settings experiencing assemblage of crowds while health education and advocacy is stepped. This will serve as a mark of honour to Ignaz Semmelweis, the man that paid the supreme price saving the lives of millions across the globe in defence of hand hygiene.

EC-89 - Hand Hygiene Campaigns in a Private Hospital in São Paulo: Unconventional Approaches for Better Results

EC-89 - Hand Hygiene Campaigns in a Private Hospital in São Paulo: Unconventional Approaches for Better Results

2018 WHO hand hygiene campaign: preventing sepsis in health care and the path to universal health coverage

2018 WHO hand hygiene campaign: preventing sepsis in health care and the path to universal health coverage

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

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.

Association of national and hospital factors to hospitals' alcohol-based handrub consumption in Europe: results of the European PROHIBIT study

ObjectivesHand hygiene is considered the most effective way to reduce the transmission of (multidrug-resistant) organisms and to prevent healthcare-associated infections. Hand rubbing with alcohol-based handrub (AHR) has become the reference standard for hand hygiene. Data on AHR consumption are easy to obtain and can serve as an approximation for hand hygiene compliance. As described earlier, AHR consumption varies among European hospitals. In the current study the role of various hospital and country indicators for AHR consumption is analysed. MethodsAs part of the European Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project hospital-based data on infection prevention and control (IPC) structure and organization and hospital-wide AHR consumption were obtained from acute care hospitals. National indicators such as income, public health expenditure, national hand hygiene campaigns, IPC training and the six Hofstede dimensions were identified. Univariable and multivariable linear regression analyses using generalized linear models were performed to estimate the association between AHR consumption and indicators at both hospital and country levels. ResultsData from 232 hospitals from 22 European countries were analysed. Multivariate risk factor analysis showed independent associations between AHR consumption and private and university-affiliated hospitals (multiplicative effect, 95% CI: 1.76, 1.21–2.55; and 1.39, 1.17–1.64, respectively), high-income countries (3.61, 2.94–4.43), and countries offering national curricula for the training of IPC nurses (3.77, 2.32–6.13). However, no cultural dimension was independently associated with AHR consumption. ConclusionCountry indicators such as high-income, national training on IPC, and hospital type and status are positively associated with AHR consumption in Europe.

Intensified hand-hygiene campaign including soap-and-water wash may prevent acute infections in office workers, as shown by a recognized-exposure -adjusted analysis of a randomized trial

BackgroundVariable exposure to causative agents of acute respiratory (RTI) or gastrointestinal tract infections (GTI) is a significant confounding factor in the analysis of the efficacy of interventions concerning these infections. We had an exceptional opportunity to reanalyze a previously published dataset from a trial assessing the effect of enhanced hand hygiene on the occurrence of RTI or GTI in adults, after adjustment for reported exposure and other covariates.MethodsTwenty-one working units (designated clusters) each including at least 50 office employees, totaling 1,270 persons, were randomized into two intervention arms (either using water-and-soap or alcohol-rub in hand cleansing), or in the control arm. Self-reported data was collected through weekly emails and included own symptoms of RTI or GTI, and exposures to other persons with similar symptoms. Differences in the weekly occurrences of RTI and GTI symptoms between the arms were analyzed using multilevel binary regression model with log link with personal and cluster specific random effects, self-reported exposure to homologous disease, randomization triplet, and seasonality as covariates in the Bayesian framework.ResultsOver the 16 months duration of the trial, 297 persons in the soap and water arm, 238 persons in the alcohol-based hand rub arm, and 230 controls sent reports. The arms were similar in age distribution and gender ratios. A temporally-associated reported exposure strongly increased the risk of both types of infection in all trial arms. Persons in the soap-and-water arm reported a significantly – about 24% lower weekly prevalence of GTI than the controls whether they had observed an exposure or not during the preceding week, while for RTI, this intervention reduced the prevalence only during weeks without a reported exposure. Alcohol-rub did not affect the symptom prevalence.ConclusionsWe conclude that while frequent and careful hand washing with soap and water partially protected office-working adults from GTI, the effect on RTI was only marginal in this study. Potential reasons for this difference include partially different transmission routes and a difference in the virus load. In this trial, frequent standardized hand rubbing with ethanol-based disinfectant did not reduce the weekly prevalence of either type of infections.Trial registrationClinicalTrials.gov Identifier: NCT00821509, 12 March 2009.

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

BackgroundThe 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.MethodsThe 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.ResultsAt 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.ConclusionPromotion 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.

Belgian hand hygiene campaigns in ICU, 2005-2015.

BackgroundHealthcare-associated infections (HCAI) are still a major problem especially in most intensive care units (ICU). Incompliance by clinical staff with hand hygiene (HH) increases rates of preventable infections. We report the outcome of the Belgian national hand hygiene campaign from 2005 to 2015 with focus on intensive care units.MethodsUsing the World Health organisation (WHO) standardised observation roster, trained infection control teams measured adherence to HH guidelines by direct observation. HH opportunities were counted and the actual episodes of HH were scored as no HH, HH with water and soap, or HH with alcohol-based hand rub. Measurements were repeatedly done before and after a one month awareness campaign every second year. Compliance was stratified by indication and by type of healthcare worker, and computed as a percentage of the number of HH episodes with water and soap or with alcohol-based hand rub, divided by the number of opportunities.ResultsA total of 108,050 hand hygiene opportunities were observed in ICU during this period. HH compliance increased significantly from 49.6 % before campaign in 2005 to 72.0 % before campaign in 2015. Over the same time frame, post campaign compliance increased from 67.0 to 80.2 %. The number of opportunities observed substantially increased when automated feedback was installed.ConclusionsIn Belgian intensive care units, hand hygiene compliance is getting improved overtime, though consecutive campaigns with immediate feedback are required to achieve and sustain a high compliance rate.

Effect of a national 4C antibiotic stewardship intervention on the clinical and molecular epidemiology of Clostridium difficile infections in a region of Scotland: a non-linear time-series analysis

Whereas many antibiotics increase risk of Clostridium difficile infection through dysbiosis, epidemic C difficile ribotypes characterised by multidrug resistance might depend on antibiotic selection pressures arising from population use of specific drugs. We examined the effect of a national antibiotic stewardship intervention limiting the use of 4C antibiotics (fluoroquinolones, clindamycin, co-amoxiclav, and cephalosporins) and other infection prevention and control strategies on the clinical and molecular epidemiology of C difficile infections in northeast Scotland. We did a non-linear time-series analysis and quasi-experimental study to explore ecological determinants of clinical burdens from C difficile infections and ribotype distributions in a health board serving 11% of the Scottish population. Study populations were adults (aged ≥16 years) registered with primary carer providers in the community (mean 455 508 inhabitants) or admitted to tertiary level, district general, or geriatric hospitals (mean 33 049 total admissions per month). A mixed persuasive-restrictive 4C antibiotic stewardship intervention was initiated in all populations on May 1, 2009. Other population-specific interventions considered included limiting indications for macrolide prescriptions, introduction of alcohol-based hand sanitiser, a national hand-hygiene campaign, national auditing and inspections of hospital environment cleanliness, and reminders to reduce inappropriate use of proton-pump inhibitors. The total effect of interventions was defined as the difference between observations and projected scenarios without intervention. Primary outcomes were prevalence density of C difficile infection per 1000 occupied bed-days in hospitals or per 100 000 inhabitant-days in the community. Between Jan 1, 1997, and Dec 31, 2012, we identified 4885 cases of hospital-onset C difficile infection among 1 289 929 admissions to study hospitals, and a further 1625 cases of community-onset C difficile infection among 455 508 adults registered in primary care. Use of 4C antibiotics was reduced by 50% in both hospitals (mean reduction 193 defined daily doses per 1000 occupied bed-days, 95% CI 45-328, p=0·008) and the community (1·85 defined daily doses per 1000 inhabitant-days, 95% CI 0·23-3·48, p=0·025) during antibiotic stewardship. Falling 4C use predicted rapid declines in multidrug-resistant ribotypes R001 and R027. Hospital-onset C difficile infection prevalence densities were associated with fluoroquinolone, third-generation cephalosporin, macrolides, and carbapenem use, exceeding hospital population specific total use thresholds. Community-onset C difficile infection prevalence density was predicted by recent hospital C difficile infection rates, introduction of mandatory surveillance in individuals older than 65 years, and primary-case use of fluoroquinolones and clindamycin exceeding total use thresholds. Compared with predictions without intervention, C difficile infection prevalence density fell by 68% (mean reduction 1·01 per 1000 occupied bed-days, 0·27-1·76, p=0·008) in hospitals and 45% (0·083, 0·045-0·121 cases per 100 000 inhabitant-days, p<0·0001) in the community, during antibiotic stewardship. We identified no significant effects from other interventions. Limiting population use of 4C antibiotics reduced selective pressures favouring multidrug-resistant epidemic ribotypes and was associated with substantial declines in total C difficile infections in northeast Scotland. Efforts to control C difficile through antibiotic stewardship should account for ribotype distributions and non-linear effects. NHS Grampian Microbiology Endowment Fund.

How to do better health reform: a snapshot of change and improvement initiatives in the health systems of 30 countries.

Health systems are continually being reformed. Why, and how? To answer these questions, we draw on a book we recently contributed, Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries. We analyse the impact that these health-reform initiatives have had on the quality and safety of care in an international context—that is, in low-, middle- and high-income countries—Argentina, Australia, Brazil, Chile, China, Denmark, England, Ghana, Germany, the Gulf states, Hong Kong, India, Indonesia, Israel, Italy, Japan, Mexico, Myanmar, New Zealand, Norway, Oman, Papua New Guinea (PNG), South Africa, the USA, Scotland and Sweden. Popular reforms in less well-off countries include boosting equity, providing infrastructure, and reducing mortality and morbidity in maternal and child health. In countries with higher GDP per capita, the focus is on new IT systems or trialling innovative funding models. Wealthy or less wealthy, countries are embracing ways to enhance quality of care and keep patients safe, via mechanisms such as accreditation, clinical guidelines and hand hygiene campaigns. Two timely reminders are that, first, a population's health is not determined solely by the acute system, but is a product of inter-sectoral effort—that is, measures to alleviate poverty and provide good housing, education, nutrition, running water and sanitation across the population. Second, all reformers and advocates of better-quality of care should include well-designed evaluation in their initiatives. Too often, improvement is assumed, not measured. That is perhaps the key message.

Impact of a hand hygiene campaign in a tertiary hospital in South Korea on the rate of hospital-onset methicillin-resistant Staphylococcus aureus bacteremia and economic evaluation of the campaign.

Hand hygiene (HH) is the most important factor affecting health care-associated infections. We introduced a World Health Organization HH campaign in October 2010. The monthly procurement of hand sanitizers per 1,000 patient days was calculated, and the monthly incidence of methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), classified into community- and hospital-onset (HO), was measured from a microbiologic laboratory database. Trends of MRSAB incidence were assessed using Bayesian structural time series models. A cost-benefit analysis was also performed based on the economic burden of HO MRSAB in Korea. Procurement of hand sanitizers increased 134% after the intervention (95% confidence interval [CI], 120%-149%), compared with the preintervention period (January 2008-September 2010). In the same manner, HH compliance improved from 33.2% in September 2010 to 92.2% after the intervention. The incidence of HO MRSAB per 100,000 patient days decreased 33% (95% CI, -57% to -7.8%) after the intervention. Because there was a calculated reduction of 65 HO MRSAB cases during the intervention period, the benefit outweighed the cost (total benefit [$851,565]/total cost [$167,495] = 5.08). Implementation of the HH campaign led to increased compliance and significantly reduced HO MRSAB incidence; it was also cost saving.

Improving Hand Hygiene Practices in a Rural Hospital in Sub-Saharan Africa.

OBJECTIVE To improve hand hygiene (HH) compliance among physicians and nurses in a rural hospital in sub-Saharan Africa (SSA) using the World Health Organization's (WHO's) Guidelines on Hand Hygiene in Health Care. DESIGN This study was a quasi-experimental design divided into 4 phases: (1) preparation of materials and acquisition of the hospital administration's support, (2) baseline evaluation, (3) intervention, and (4) follow-up evaluation. SETTING A 160-bed, non-referral hospital in Gitwe, Rwanda PARTICIPANTS A total of 12 physicians and 54 nurses participated in this study. METHODS The intervention consisted of introducing locally produced alcohol-based hand rub (ABHR); educating healthcare workers (HCWs) on proper HH practice; providing pocket-sized ABHR bottles for HCWs; placing HH reminders in the workplace; and surveying HCWs at surrounding health centers regarding HH compliance barriers. Hand hygiene infrastructure, compliance, and knowledge were assessed among physicians and nurses using baseline observations and a follow-up evaluation survey. RESULTS Overall, HH compliance improved from 34.1% at baseline to 68.9% post intervention (P.05). CONCLUSION Hand hygiene campaigns using WHO methods in SSA have been implemented exclusively in large, referral hospitals. This study shows that an HH program using the WHO tools successfully improved HH in a low-income, rural hospital in SSA. Infect Control Hosp Epidemiol 2016;37:834-839.

Compliance with hand hygiene: reference data from the national hand hygiene campaign in Germany

Hand hygiene is a key measure to prevent healthcare-associated infection. To promote hand hygiene nationally the German campaign 'Aktion Saubere Hände' was launched in January 2008, based on the World Health Organization's 'Clean Care is Safer Care' initiative. We report the first results from a full year of data collection on hand hygiene compliance recorded with the help of a renewed observation tool. Data were based on submissions from 109 participating hospitals collected from 576 wards between January 1st and December 31st, 2014. The overall median compliance was 73%, ranging from 55% (10th percentile) to 89% (90th percentile). The results demonstrated only small differences between adult and non-adult intensive care units (ICUs) with neonatal ICUs and paediatric non-ICUs maintaining higher compliance than adult care units. Performance among nurses was better than physicians, and overall rates of hand hygiene performance were significantly higher after patient contact than before.

Promoting a Hand Hygiene Program Using Social Media: An Observational Study.

BackgroundHand hygiene is an important component in infection control to protect patient safety and reduce health care-associated infection.ObjectiveOur aim was to evaluate the efficacy of different social media on the promotion of a hand hygiene (HH) program.MethodsThe 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.ResultsThere 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.ConclusionsFacebook 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.