Hand Hygiene Campaign Research Articles

Improving Data Quality from a Hematology Unit Hand Hygiene Observation Program

Background: For United States healthcare programs to be fully compliant with Joint Commission National Patient Safety Goal (NPSG) #7, organizations must implement and maintain a hand hygiene (HH) program that follows either the current Centers for Disease Control and Prevention (CDC) or the current World Health Organization (WHO) HH guidelines. Joint Commission standard IC.03.01.01 requires these organizations to provide metrics that evaluate the effectiveness of their program and program goals. Our center utilizes the direct observation method with the use of over 550 Hand Hygiene Observers (HHO) to collect our HH compliance. HHO are trained with a computer-based course that requires passing a post-education test. During fiscal year 2023 (FY23), Infection Control surveillance noted an increase in hospital-acquired infections (HAI) Clostridioides difficile infections (CDI), catheter-associated urinary tract infections (CAUTI), and multidrug-resistant organisms (MDRO) on our hematologic malignancy units (HM), which initiated an Infection Control (IC) investigation into possible causes. Increased rounding by our Infection Preventionist (IP) observed that HH compliance was much lower than unit HHO reported rates. Inquiries into this data discrepancy revealed barriers to accurate reporting, including HHO having low confidence in identifying and reporting non-compliant behavior. To that end, we conducted mandatory re-training of all HM HHO with the primary goal of improving the quality of our HH compliance data and addressing barriers with non-compliance reporting. Our secondary goal was to identify areas of improvement in institutional HH rates. Methods: In August 2023, 252 HM staff and HHO received detailed, in-person retraining by the HM IP. Training included reviewing the discrepancy in HHO and IP observations, potential causes of discrepancy, most commonly missed HH opportunities, examples of correct and incorrect HH practices, and addressing staff questions. Results: Following mandatory re-training of HM HHO, HH compliance for our HM units from September 2023 – December 2023 ranged from 89% to 98%, with increased reporting of non-compliance (Figure 1). A detailed dashboard was created that focused on HM HH compliance, containing the HHO observations and non-compliant reports. Conclusion: A one-time in-person retraining of HM HHO by our IP has led to an improvement in data quality, which is imperative for future quality improvement initiatives. Improving our HH data quality allowed IC to identify and provide actionable feedback to HM leaders, create targeted interventions to improve HAI rates, and improve patient safety. Future goals include retaining of all HHO and a HH campaign to ensure patient safety across our institution.

Hand hygiene compliance of respiratory physiotherapists: An analysis of trends over eight years including the COVID-19 pandemic period

BackgroundRespiratory physiotherapists (RPs) are an integral part of healthcare workers delivering care to intubated patients. Our study aimed to evaluate the effect of awareness campaigns on hand hygiene (HH) compliance among RPs. MethodAn observational single-center study was conducted between 2015 and 2022 in different ICU types in both adult and paediatric settings. The hand hygiene compliance rates were monitored prospectively and the quality improvement interventions included various hand hygiene campaigns and awareness sessions with RPs. Compliance was calculated as a percentage of events over total opportunities observed. ResultsThere was a significant increase in compliance rates for all five moments of HH (p-value: <0.05). Overall, mean compliance rate in ICUs was significantly higher than wards for Moment 1 (p-value: 0.0045), Moment 4 (p-value: 0.0372) and Moment 5 (p-value: 0.0036) by 24.2%, 22.7% and 21.5% respectively. Also, paediatric ICUs had higher HH compliance than adult ICUs for Moment 1 (87.5% vs 61.1%; p-value: 0.0459) and Moment 4 (93.7% vs 79.3%; p-value: 0.0255). A significant increase in HH compliance was observed in post-COVID-19 period compared to pre-COVID-19 period with respect to Moment 1, 2 and 5. ConclusionThis study adds to the almost non-existent literature on this important category of healthcare workers working in respiratory ICUs. Our results project an increase compliance after the HH awareness programmes over the years among RP which is critical to prevent spread infection by multidrug resistant organisms among the hospitals.

Educational intervention to improve infection prevention and control practices in four companion animal clinics in Switzerland

Infection prevention and control (IPC) practices vary among companion animal clinics and outbreaks with carbapenemase-producing Enterobacterales (CPE) have been described. This study investigates the effect of an IPC intervention (introduction of IPC protocols, IPC lectures, hand hygiene campaign) in four companion animal clinics. IPC practices, environmental and hand contamination with antimicrobial-resistant microorganisms (ARM) and hand hygiene (HH) were assessed at baseline and one and five months after intervention. IPC scores (% maximum score) improved from (median, range) 57.8% (48.0-59.8%) to 82.9% (81.4-86.3%) one month after intervention. Cleaning frequency assessed by fluorescent tagging increased from (median, range) 16.7% (8.9-18.9%) to 30.6% (27.8-52.2%) one months and 32.8% (32.2-33.3%) five months after intervention. ARM contamination was low in three clinics at baseline and undetectable after intervention. One clinic showed extensive contamination with ARM including CPE before and after intervention (7.5-15.5% ARM-positive and 5.0-11.5% CPE-positive samples). Mean HH compliance [95% CI] improved from 20.9% [19.2-22.8%] to 42.5% [40.4-44.7%] one and 38.7% [35.7-41.7%] five months after intervention. Compliance was lowest in the pre-operating preparation area at baseline (11.8% [9.3-14.8%]) and in the ICU after intervention (28.8% [23.3-35.1%]). HH compliance was similar in veterinarians (21.5% [19.0-24.3%]) and nurses (20.2% [17.9-22.7%]) at baseline but higher in veterinarians (46.0% [42.9-49.1%]) than nurses (39.0% [36.0-42.1%]) one month after intervention. The IPC intervention improved IPC scores, cleaning frequency and HH compliance in all clinics. Adapted approaches might be needed in outbreak situations.

Preventing healthcare-associated MRSA bacteremia: getting to the root of the problem.

Bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA) remain a major challenge in most countries worldwide. We describe a quasi-experimental sequential intervention at Mater Dei Hospital, Malta, to reduce hyper-prevalence of healthcare-associated MRSA bacteremia (HA-MRSA-B). The hospital initiated a hand hygiene (HH) campaign in 2008 to improve alcohol hand rub (AHR) use. In 2011, this was followed by root cause analysis (RCA) of all HA-MRSA-B cases and finally universal MRSA admission screening in 2014. Change-point analysis was used to evaluate the impact of the interventions. The effect of the HH campaign became evident when AHR consumption reached 40L/1000 occupied bed days (BD). RCAs identified intravascular devices as the likely risk factor in 83% of all HA-MRSA-B; specifically non-tunneled double-lumen hemodialysis catheters (36%), peripheral venous cannulas (25%), and central venous catheters (22%). Interventions to improve their management resulted in the greatest reduction of HA-MRSA-B rates. They were informed by the RCA findings and targeted behavior change through education, motivation, and system change. Universal MRSA admission screening provided the final decline in incidence. Each intervention affected HA-MRSA-B rates after a lag period of approximately 18-24 months. Overall, HA-MRSA-B incidence decreased from 1.72 cases/10000BD in 2008 to 0.18/10000BD in 2019; a reduction of almost 90%. Intravenous device interventions were also associated with a reduction of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia rates. Significant improvement in HA-MRSA-B is possible, even in highly endemic regions. It requires well-planned behavior change interventions which are compatible with local context and culture.

Reducing hospital-acquired infections and improving the rational use of antibiotics in a tertiary care hospital in Bangalore

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.To assess the effectiveness of a multifaceted infection control and antibiotic stewardship programme on HAIs and antibiotic use. A retrospective study was conducted for a study period of 11months (June 2021-April 2022) in Vydehi Hospital, Bangalore. All patients admitted to the intensive care unit and wards were included in the study. Intervention period was 6 months (June 2021-Nov 2021) and post-intervention period was 5 months (Dec 2021- April 2022). Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of hand hygiene campaign, isolation of multidrug resistance organism’s patients, water and air quality analysis, training of health care workers in infection control practices, and antibiotic stewardship. Data was collected using an identical method in the intervention and post intervention periods.We observed a major reduction in HAIs, from 89% (198/222 patients) in the intervention period to 10.8% (24/222 patients) in the post intervention period (relative risk (RR) (95% CI) 0.48 (0.31 to 0.56). Antibiotic use in ICUs declined from 58% (780/1347) to 44% (442/995) (RR 0.44 (0.40 to 0.55). Overall, hand hygiene compliance among the health- care workers was maintained at 100% during both the periods. 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 patients in developing countries.

Successful Implementation of an Electronic Application in Reinvigorating a Healthcare Organization's Hand Hygiene Program

<h3>Background</h3> Our organization prioritizes the importance of a comprehensive hand hygiene program in promoting patient safety but found it challenging to meet regulatory requirements and to operationalize an efficient program. Recognizing that manual observations were labor intensive and automated hand hygiene was cost prohibitive, we looked to an innovative, inexpensive electronic application (app) to reinvigorate our hand hygiene program. <h3>Methods</h3> In 2021, our facility's hand hygiene committee, with support from senior leadership, developed and led a strategic plan to develop and implement a meaningful hand hygiene campaign with timeline for completion. This plan included a beta pilot to implement an innovative, affordable electronic app in all licensed inpatient and outpatient departments including nursing units, and surgical services over a five-month time period. Each area is required to submit a minimal number of observations per month which was calculated using regulatory guidelines. Manual tallies are no longer required. Data is submitted and analyzed electronically and available to act upon in real time. The strategic plan included comprehensive training, education, and continued feedback at all levels from bedside staff to administration. <h3>Results</h3> Upon complete implementation of our electronic application our monthly hand hygiene observations went from averaging a few hundred per month to 9000 observations per month. Transitioning from a manual to an electronic program has also resulted in a staggering cost savings of four full time employees for an approximated cost savings of 250,000 dollars annually. Additionally, a survey of all staff observers revealed that ninety three percent found the app to improve their workflow and save them time. <h3>Conclusions</h3> Through development, and implementation of this comprehensive electronic hand hygiene initiative our organization was able to meet all regulatory requirements, engage staff, increase patient safety, and recognize a significant cost savings for our organization. Senior leadership's support was key in the success of this program.

Implementation of a Sustainable Multidisciplinary Hand Hygiene Improvement Campaign

Background Hand hygiene is the best method to prevent the spread of infection. Healthcare facility historical hand hygiene data indicated compliance to be at 76.4% among inpatient and outpatient departments. Facility describes how development and adopting a culture change can increase hand hygiene compliance and improvement around patient safety. Methods Our hand hygiene campaign stemmed from an Infection Prevention and Control Liaisons Committee and expanded to include many multidisciplinary partners. Through literature review, brainstorming sessions, and all staff survey, an understanding of the current state and desired interventions were developed. Subcommittees lead the various intervention efforts including revision of the annual education module, improved audit methods, tools, analysis, and reports, developing a campaign specific code word “Sanitize Now and Prevent” or “SNAP,” peer feedback reminders, and peer nominated awards. Partnerships with marketing lead to a media campaign using a superhero theme in posters, theme song, videos, and infographics to reinforce campaign messaging and promote best practice. Many staff demonstrated commitment to best practice through signing a hand hygiene pledge. A hand hygiene focused topic was added to employee wellness platform. During the COVID pandemic, a mindfulness hand hygiene practice resource and video were created and shared to continue promoting best practice. Results Observation data demonstrated increasing compliance over time with improvement to 92.6%. Peers received recognition each quarter and interventions increased peer positive role modeling. Conclusions Engagement with and ongoing participation by a multidisciplinary team has led to increased accountability and ownership of practice and improved and sustained hand hygiene performance. Hand hygiene is the best method to prevent the spread of infection. Healthcare facility historical hand hygiene data indicated compliance to be at 76.4% among inpatient and outpatient departments. Facility describes how development and adopting a culture change can increase hand hygiene compliance and improvement around patient safety. Our hand hygiene campaign stemmed from an Infection Prevention and Control Liaisons Committee and expanded to include many multidisciplinary partners. Through literature review, brainstorming sessions, and all staff survey, an understanding of the current state and desired interventions were developed. Subcommittees lead the various intervention efforts including revision of the annual education module, improved audit methods, tools, analysis, and reports, developing a campaign specific code word “Sanitize Now and Prevent” or “SNAP,” peer feedback reminders, and peer nominated awards. Partnerships with marketing lead to a media campaign using a superhero theme in posters, theme song, videos, and infographics to reinforce campaign messaging and promote best practice. Many staff demonstrated commitment to best practice through signing a hand hygiene pledge. A hand hygiene focused topic was added to employee wellness platform. During the COVID pandemic, a mindfulness hand hygiene practice resource and video were created and shared to continue promoting best practice. Observation data demonstrated increasing compliance over time with improvement to 92.6%. Peers received recognition each quarter and interventions increased peer positive role modeling. Engagement with and ongoing participation by a multidisciplinary team has led to increased accountability and ownership of practice and improved and sustained hand hygiene performance.

Outbreak investigation of CRAB at an acute-care hospital ICU during the COVID-19 pandemic–Chicago, Illinois, March 2020–September 2021

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is primarily associated with hospital-acquired infections and is an urgent public health threat due to its ability to contaminate the environment and cause severe disease. In 2019, Illinois began pilot surveillance for CRAB requiring select laboratories to submit specimens for molecular characterization. On July 17, 2020, the Chicago Department of Public Health (CDPH) was notified of an increase in CRAB infections in a 20-bed ICU at an acute-care hospital in Chicago (hospital A) during the initial COVID-19 surge. We summarize the outbreak investigation findings and infection control recommendations. Methods: Clinical cultures were collected from patients in hospital A, and CRAB-positive isolates were sent to the Wisconsin State Laboratory of Hygiene for mechanism of resistance and antibiotic susceptibility testing. On-site assessments and remote follow-ups were conducted by CDPH infection preventionists to evaluate infection control practices including environmental cleaning, hand hygiene compliance, and use of personal protective equipment (PPE). The Illinois Department of Public Health and CDPH summarized the testing results, facilitated a containment response, and provided recommendations for infection control. Results: From March 18, 2020, to September 30, 2021, 56 patients with CRAB infections were identified from hospital A, and 33 (59%) of these cases were pan-nonsusceptible. Most specimen sources were sputum (n = 30, 54%), followed by blood (n = 13, 23%), urine (n = 6, 11%) and other (n = 7, 13%). Among isolates with mechanism testing (n = 54), 45 (83%) were positive for OXA-24/40 and 9 (17%) were positive for OXA-23. Of the CRAB-positive patients, 28 (50%) were previously positive for SARS-CoV-2. To date, 25 of these patients (45%) have been discharged and 31 (55%) have died. Two onsite visits and 7 remote-assistance sessions were conducted as part of the investigation. In response to increased COVID-19 hospitalizations, hospital A moved to crisis-capacity PPE use and encountered staffing shortages, which led to compromised infection control measures. Cleaning agents (Quat disinfectant cleaner) were also found to be ineffective against CRAB and required long contact times. Conclusions: In response to the CRAB outbreak at hospital A, CDPH recommended that the hospital stop crisis-capacity protocols for PPE, conduct admission screening and point-prevalence testing for CRAB, implement a hand hygiene campaign, and use an EPA-registered List K product for environmental cleaning. These recommendations were implemented in May 2021, and no CRAB cases have been reported since July 2021. To reduce CRAB transmission during the pandemic, facility leadership must commit resources to educate staff on effective infection control practices including conventional use of PPE, appropriate cleaning agents, and improved hand hygiene.Funding: NoneDisclosures: None

Implementation of an electronic, secure, web-based application to support routine hand hygiene observation with immediate direct feedback and anonymized benchmarking

A secure web-based electronic tool was developed and implemented to record adherence to hand hygiene during routine care and to provide direct feedback including anonymized benchmarking. It was found suitable for documenting hand hygiene improvements in a local campaign and following rollout to other institutions in 2013, the tool is currently used in >100 hospitals in Switzerland and will play a major part in upcoming national hand hygiene campaigns.

Prevention of Contact Dermatitis Due to Hand Hygiene in The Era of COVID-19

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is known to cause COVID-19 (Coronavirus Disease 2019), and it is rapidly spreading throughout the world that it is declared as a global pandemic. Hand hygiene is widely promoted as it is recommended to reduce the risk of COVID-19 transmission. Contact dermatitis is one of the risks of hand hygiene campaign during the COVID-19. Purpose: This study aimed to assess the parents' level of knowledge before and after health education about contact dermatitis due to hand hygiene. Methods: This was a cross-sectional study, and the data was collected via questionnaires. This study involved 53 respondents. Result: There was a significant increase in respondents' knowledge level after being educated (Wilcoxon test, p=0.000), as evidenced in the mean score of pre-test and post-test evaluation. Conclusion: To lower the incidence, education on contact dermatitis prevention due to hand hygiene during the COVID-19 pandemic is required.

The Covid 19 pandemic as a factor of compliance with the rules of hand hygiene of hospital staff

Introduction. Hand cleansing and disinfection is the most effi- cient method for reducing the rates of hospital-acquired infections which are a serious medical and economic problem. Striving to ensure the maximum safety of the therapeutic process, we decided to promote hand hygiene by implementing the educational pro- gram titled “Clean Care is a Safer Care”. The occurrence of the COVID-19 pandemic affected the compliance with procedures related to the sanitary regime, including the frequency and accu- racy of hand decontamination by medical personnel. Objective. The objective of the study was to assess the useful- ness of the educational program titled “Clean Care is a Safer Care” as a tool for increasing compliance with hand hygiene principles. Methods. We monitored the compliance with the hygiene proce- dure before implementation of the program as well as during the hand hygiene campaign by means of direct observation as well as the disinfectant consumption rates. Results. In the initial self-assessment survey, the hospital had scored 270/500 points (54%). Preliminary audit revealed the hygiene compliance rate at the level of 49%. After broad-scaled educational efforts, the semi-annual audit revealed an increase in hand hygiene compliance rate up to 81% (hospital average) while the final audit carried out after one year of campaigning revealed a compliance rate of 77%. The final score for the hospi- tal increased to 435/500 points. Conclusions. COVID-19 pandemic dramatically increased accu- racy of proper hand hygiene procedures and consumption of dis- infectant agents. The educational program has succeeded to reach its goal; however, long-term educational efforts are required to maintain and improve the quality of provided services.

Impact of an Interventional Program on Improving Compliance of Hand Hygiene and Reducing Hospital-Acquired Infection in the Critical Care Unit.

Introduction:This study aimed to determine the effect of a hand hygiene (HH) and awareness campaign on knowledge and compliance with HH practices among health-care workers working staff in the main intensive care units and also to evaluate the rates of hospital-acquired infection (HAI) before and after the intervention.Methods:A prospective, interventional, pre–post design was utilized and carried out in three phases: the first stage was a 1-month preintervention stage to develop the foundation of the compliance rate of handwashing; the second stage was the interventional handwashing campaign; the third stage was the postintervention stage to improve the compliance rate of handwashing. Two instruments were used in this study: the HH Knowledge Questionnaire developed by the World Health Organization to assess HH knowledge and the Handwashing Questionnaire developed to evaluate HH washing.Results:HH knowledge has been increased from preintervention (M = 11.84, standard deviation [SD] = 2.41) to postintervention (M = 18.80, SD = 2.93), and the effective compliance with HH practice was as low as 49% in June 2017 to 75% in February 2018. In addition, the HAI rate was dropped from 13.2% in June 2017 to 9% in February 2018. An inverse association was recognized between HH compliance and HAI rates.Conclusions:These results recommend that reasonable approaches can decrease the HAI rate of intensive care units. A nationwide handwashing interventional program can be employed in all hospitals.

Influence of COVID-19 Pandemic on Health-care Workers’ Hand Hygiene Practice at a Private Academic Hospital in Johannesburg, South Africa: A Quantitative and Qualitative Longitudinal Study

ABSTRACT Background: Hand hygiene (HH) is a cornerstone infection prevention measure and is crucial in the fight against the COVID-19 pandemic. Improving and monitoring of HH compliance in a hospital setting is a complex challenge given the behavioural component associated with it. We aimed to assess the impact of the COVID-19 pandemic on HH compliance using both quantifiable hand product usage and observational data. Methods: Using the hospital's HH usage monitoring system, the quantity of different HH products per nursing unit, expressed as millilitres (mL) per patient bed day (PBD), was analysed longitudinally during the course of the pandemic. Observational HH compliance data was drawn from the hospital audit system for comparison. Results: Across all units, there was a significant increase in HH product usage coinciding with the onset of the pandemic (53 mL/PBD to 111 mL/PBD, in non-critical care units (non-CCU's); 127 mL/PBD to 217 mL/PBD, in CCU's). This increase was largely attributable to an increase in alcohol-based hand rub usage. Discordance with observed compliance rates was noted. Conclusion: An unprecedented increase in HH product usage in a hospital setting was seen to coincide with the onset of the COVID-19 pandemic. No specific HH campaign was introduced, and the improved usage compliance appears to be driven primarily by health-care workers’ own behavioural change.

Determinants of Protective Behaviour Adoption and the Implications for Health Authorities During a Pandemic

International Journal of Medicine and Public Health,2020,10,4,189-197.DOI:10.5530/ijmedph.2020.4.41Published:November 2020Type:Original ArticleDeterminants of Protective Behaviour Adoption and the Implications for Health Authorities During a PandemicMickaela Jordan Nixon, and Mona Jafari Koshkouei Mickaela Jordan Nixon1,3,*, Mona Jafari Koshkouei2,3 1Medical Sciences Division, University of Oxford, Oxford, UK. 2Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK. 3St Peter’s College, University of Oxford, Oxford, UK. Abstract:Introduction: Health authorities across the world have implemented non-pharmaceutical interventions (NPIs) such as social distancing measures and hand hygiene campaigns in response to COVID-19. However, the adoption of health-protective behaviour by individuals in alignment with these interventions, although effective, is variable. Results: Evidence suggests that increases in perceived disease severity, disease susceptibility and intervention efficacy correlate with the adoption of protective behaviours. Additionally, external cues from select, credible sources promote behavioural adoption whilst barriers to behavioural change, such as the opportunity cost faced by the employed, dissuade adoption. Lastly, demographic and socioeconomic factors play a role with men, the young, those with lower educational status and those less socially connected being less likely to adopt protective behaviours. Conclusion: For health authorities, an understanding of these correlates can better inform efforts to increase adherence to NPIs and stem novel viral transmission. Approaches such as risk personalisation, the communication of evidence-based effects of interventions and education regarding lesserused behaviours (e.g., mask-wearing) are discussed. Also highlighted is the importance of consistent communication via local actors such as General Practitioners and the role of multilevel social networks. Lastly, the need for tailored efforts to enhance protective behaviour adoption in specific sub-populations is considered. Keywords:Behaviour, COVID-19, Health belief model, PreventativeView:PDF (278.48 KB)

Strategy for Increasing Alcohol Gel Consumption Based on Realistic Simulation, Opinion of Healthcare Workers, Structure Adequacy and Change in Alcohol Product

Background: Healthcare-related infections (HAIs) imply higher morbidity and mortality, length of hospitalization, and costs to institutions and the health system. An important practice for HAI control is hand hygiene. Due to the need for greater adherence to the practice of hand hygiene, as well as understanding about behavior and motivations related to actions associated with infection control, we conducted this study based on inquiry and intervention. Objectives: To describe the increase in adherence to hand hygiene through a multimodal strategy based on realistic simulation, inquiry, change of alcohol and training on actions related to infection control. Methods: In May 2018, a survey was administered to healthcare workers (HCW) regarding structure, process, and behavior related to hand hygiene. Training was also performed, which simulated a bed marked with GloGerm (later revealed with the application of black light), performing tasks by professionals, and completing a test. In November 2018, the structure of hand hygiene and points at which the alcoholic product was offered were redefined, and the alcohol-based product and its dispensers were exchanged. In December 2018, an educational campaign on hand hygiene and change disclosure was held. In February 2019, a new survey was applied to employees. Alcohol consumption was measured per patient day in the periods and compared with the historical average. Results: In the first application of the survey, 263 HCW reported dissatisfaction with hand hygiene structure (46% preferred water and soap). Most reported that training and structure would improve adherence. The training took place for 540 HCWs from many different professional positions. Alcohol gel consumption had a sustained increase from an average of 37 mL per patient day in the first semester to 49 mL per patient day in the second semester. After the product change and the new hand hygiene campaign, a second relevant and sustained increase has took place: the first 4-month average in 2019 was 67 mL per patient day. In the second survey, conducted with 187 HCWs, there was an increase in preference for alcohol-based product from a wall dispenser (from 38% to 62%).Funding: NoneDisclosures: None

The Implementation of Active Environmental Surveillance in a Veterinary Referral Hospital Setting

Emily Feyes, The Ohio State University College of Veterinary Medicine; Dixie Mollenkopf, The Ohio State University College of Veterinary Medicine; Thomas Wittum, The Ohio State University College of Veterinary Medicine; Dubraska Diaz-Campos, The Ohio State University College of Veterinary Medicine; Rikki Horne, The Ohio State University College of Veterinary MedicineBackground: The Ohio State University College of Veterinary Medicine (OSU-CVM) Antimicrobial Stewardship Working Group (ASWG) uses monthly environmental surveillance to understand the effectiveness of our veterinary medical center (VMC) infection control and biosecurity protocols in reducing environmental contamination with multidrug resistant organisms. Monthly surveillance allows us to monitor trends in the recovery of these resistant organisms and address issues of concern that could impact our patients, clients, staff, and students. Methods: The OSU-CVM ASWG collects samples from &gt;100 surfaces within the companion animal, farm animal, and equine sections of our hospital each month. Sampling has been continuous since January 2018. Samples are collected from both human–animal contact and human-only contact surfaces using Swiffer electrostatic cloths. These samples are cultured for recovery of Salmonella spp, extended-spectrum cephalosporin-resistant Enterobacteriaceae, carbapenemase-producing Enterobacteriaceae (CPE), and methicillin-resistant Staphylococcus spp. Results: The recovery of these antibiotic resistant target organisms is low in the environment of our hospital. Recovery from human-only contact surfaces (19.8%) is very similar to recovery from human–animal contact surfaces (25.5%). We commonly recover Enterobacteriaceae (E.coli, Klebsiella spp, and Enterobacter spp) that are resistant to extended-spectrum cephalosporins (496 of 2,016; 24.6%) from the VMC environment. These antibiotic-resistant indicator bacteria are expected in a veterinary hospital setting where use the of β-lactam drugs is common. Recovery of both Salmonella spp and CPE has remained very low in our hospital environment over the past 19 months: 16 of 2,016 (0.7%) for Salmonella and 15 of 2,016 (0.8%) for CPE. Discussion: The active environmental surveillance component of our antimicrobial stewardship program has allowed us to reduce the threat of nosocomial infections within our hospital and address environmental contamination issues before they become a problem. Our consistently low recovery of resistant organisms indicates the effectiveness of our existing cleaning and disinfection protocols and biosecurity measures. Due to the nature of our patient population, we do expect to find resistant organisms in the patient-contact areas of the hospital environment. However, our similar rates of resistant organisms from human-only surfaces (eg, computer keyboards, door handles, telephones, and Cubex machines) indicates a need to improve our hand hygiene practices. These data are now supporting the implementation of a new hand hygiene campaign in our veterinary hospital.Funding: NoneDisclosures: None

Hand Hygiene in Acute Care Hospitals—Evaluation of 12 Years National Hand Hygiene Campaign in Germany

Background: Hand hygiene is one of the most effective measures to prevent healthcare-associated infections and transmission of multidrug-resistant organisms in healthcare settings. The WHO proposes a multimodal intervention strategy to improve hand hygiene in healthcare settings. In 2008, a voluntary national campaign for hand hygiene was implemented in the German healthcare system. The objective of this study was to evaluate participation, practices, and performance of hand hygiene in German acute-care hospitals. Methods: In 2008 a national hand hygiene campaign began in Germany. Based on voluntary participation, the campaign’s goal was to implement the WHO 5 Moments model, to establish a national surveillance system for compliance to hand hygiene, to improve availability of alcohol-based hand-rub (ABHR) dispensers at points of care, and to implement interdisciplinary executive boards at each hospital to ensure sustainable implementation. Annual data on ABHR consumption and patient days (PD) were collected within the national surveillance system (HAND-KISS) on the individual ward level and were validated. Direct observation of compliance was performed according the recommendations of the WHO. Results: Overall, 1,047 of 1,942 acute-care hospitals in Germany participated in the national hand hygiene campaign in 2018, covering 81,571,917 patient days. Moreover, 9,360 regular wards (RWs), 338 intermediate care units (IMCs) and 1,342 intensive care units (ICUs) provided data on ABHR consumption. Between 2007 and 2018 in the ICU, ABHR consumption increased continuously from 70 mL/PD (IQR, 52–98) to 129 mL/PD (IQR, 102–162). In intermediate care units, ABHR consumption increased from 40 mL/PD (IQR, 15–54) to 67 mL/PD (IQR, 46–95), and on regular wards, ABHR consumption increased from 14 mL/PD (IQR, 10–21) to 29 mL/PD (IQR, 22–39). These increases were especially pronounced in wards that continuously provided annual data for ABHR consumption over the past 12 years. In 2014, electronic documentation for direct observation of compliance to hand hygiene was established. From 2014 until 2018, 1,598,209 opportunities were observed on 1,907 wards of 422 hospitals. The median directly observed compliance in 2018 was 76% (IQR, 66%–84%). Median compliance to the 5 Moments was 71% (IQR, 57%–82%) before touching a patient, 68% (IQR, 51%–85%) before clean or aseptic procedures, 83% (IQR, 72%–92%) after body fluid exposure or risk, 84% (IQR, 75%–90%) after touching a patient, and 74% (IQR, 61%–84%) after touching patient surroundings. Conclusions: The WHO multimodal intervention strategy has been successfully established in German acute-care hospitals. A surveillance system for ABHR consumption and direct observation of compliance to hand hygiene are widely used by hospitals in Germany. Hand hygiene practices have significantly improved in the German healthcare system.Funding: NoneDisclosures: None

Characteristics of Candida auris Patients at a Tertiary-Care Hospital, 2017–2019, Nairobi, Kenya

Background:Candida auris is of global concern due to its increasing frequency in intensive care units (ICUs), reported resistance to antifungal agents, propensity to cause outbreaks, and persistence in clinical environments. We investigated an increase in C. auris cases in an ICU in Kenya to determine the source of transmission and to control the spread of the disease. Methods: To identify cases, we reviewed laboratory records of patients with blood cultures yielding C. auris and organisms for which it is commonly misidentified by Vitek 2 v 8.01 software (ie, C. haemulonii, C. duobushaemulonii and C. famata) during January 2018–May 2019. We retrospectively reviewed medical charts of C. auris patients to extract information on demographics, underlying conditions, hospital procedures, treatments, and outcomes. We also enhanced infection control efforts by implementing contact precautions, equipment, and environmental disinfection, and hand hygiene training and compliance observations. Results: We identified 32 C. auris patients (Fig. 1). Median patient age was 55 years (IQR, 43–65), and 57% were male. Length of hospitalization before C. auris isolation was 30 days (IQR, 14–36). All had been admitted to the ICU. The most common reasons for admission were sepsis (50%), pneumonia (34%), surgery (25%), and stroke or other neurologic diagnosis (25%). Underlying comorbidities included hypertension (38%), diabetes mellitus (25%), and malignancy (29%). Two patients had HIV. Moreover, 61% of cultures yielded multidrug-resistant bacteria. Also, 33% of the patients had been admitted to this hospital in the preceding 3 months; 21% had been admitted to a hospital outside of Kenya; and 10% had been admitted to another hospital in Kenya in the previous year. Almost all (97%) had a central venous catheter, 45% had an acute dialysis catheter, 66% had an endotracheal tube, and 34% had a tracheostomy, with 69% receiving mechanical ventilation before C. auris isolation. Most (94%) had urinary catheters, 84% had nasogastric tubes, 91% had received total parenteral nutrition, and 75% had received blood products. All patients received broad-spectrum antibiotics and 49% received an antifungal before C. auris isolation. All-cause in-hospital mortality was 64% for the 28 patients whose outcomes were available. Following implementation of a hand hygiene campaign and improved equipment and environmental disinfection, no further cases were identified. Conclusions: We identified C. auris bloodstream infections associated with high all-cause mortality in a Kenyan hospital ICU. All patients had treatments and procedures suggesting severe underlying illness. Enhanced infection control contained the outbreak.Funding: NoneDisclosures: None

Hand Hygiene In and Out: Compliance and Sustainability Are Possible: 90/90 Program in a Mexican Tertiary-Care Center

Background: The American British Cowdray Medical Center I.A.P., also known as ABC Medical Center, is a highly specialized hospital and private assistance institution located in Mexico City. The ABC Medical Center implemented hand hygiene policies since around 2009, when Mexico committed to patient security. However, hand hygiene compliance remained low. Methods: The objective of the Hand Hygiene 90/90 program was to increase hand hygiene compliance through an integral strategy including a multidisciplinary team with leaders from different areas (nursing, physicians, human resources, quality, and educators). It was named 90/90 because it aimed to accomplish a 90% hand hygiene compliance among all health providers and hospital staff in 90 days (October 1–December 29) upon entering and exiting patient rooms (ie, In &amp; Out). The Hand Hygiene 90/90 program led by the epidemiology area consisted of 5 specific components: management, supplies, education, monitoring, and social marketing (Fig. 1). For a period of 90 days, several permanent actions were implemented; they had a positive influence on the expected outcome (Fig. 2). Results: The starting point at the ABC Medical Center upon launching the program was 70% compliance. With the Hand Hygiene 90/90 program, the first steady change was observed at the end of November 2012 (ie, the sixth measurement point). An 88% compliance was achieved, all compliance was &gt;50% from this point on. The highest compliance was achieved among health providers (doctors and nurses), followed by administrative staff. At the end of December 2012, 91% compliance was achieved by all health providers and hospital staff. Sustainability has been possible over the years through ongoing hand hygiene campaigns. In the 5 years following the implementation of the program, hand hygiene compliance remained mostly below the 90% standard (Fig. 3). Conclusions: An intervention for continuous improvement and hand hygiene compliance using the WHO 5 Moments was implemented throughout 2018, (in addition to the In &amp; Out program). This intervention also incorporated elements of the WHO Multimodal Strategy 1 to develop a comprehensive hand hygiene program together with new indicators. The ABC Medical Center, with the support and leadership of the Ministry of Health, aims to become an example of institutions that achieve national and international benchmarks in the implementation of patient safety programs that are not only successful but also sustainable.Funding: NoneDisclosures: None

Healthcare Worker Experiences Implementing CRE Infection Control Measures at a vSNF—A Qualitative Analysis

Background: During 2017–2019 in the Chicago region, several ventilator-capable skilled nursing facilities (vSNFs) participated in a quality improvement project to control the spread of highly prevalent carbapenem-resistant Enterobacteriaceae (CRE). With guidance from regional project coordinators and public health departments that involved education, assistance with implementation, and adherence monitoring, the facilities implemented a CRE prevention bundle that included a hand hygiene campaign that promoted alcohol-based hand rub, contact precautions (personal protective equipment with glove/gown) for care of CRE-colonized residents, and 2% chlorhexidine gluconate (CHG) wipes for routine resident bathing. We conducted a qualitative study to better understand the ways that vSNF employees engage with the implementation of such infection control measures. Methods: 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) between September 2018 and November 2018. More than 11 hours of semistructured interviews were collected and transcribed. Data collection and analysis focused on identifying healthcare worker experiences during an infection control intervention. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results: Healthcare workers described the facility using language associated with a family environment (Table 1). Furthermore, healthcare workers demonstrated motivation to implement infection control policies (Table 2). However, healthcare workers expressed cultural and structural challenges encountered during implementation, such as their belief that some infection control measures discouraged maintenance of a home-like environment, lack of time, and understaffing. Some healthcare workers perceived that alcohol-based hand rub was ineffective over time and left unpleasant textures on the skin. Additionally, some workers did not trust the available gown and gloves used to prevent transmission. Lastly, healthcare workers typically did not prefer 2% CHG wipes over soap and water, citing residual resident postbathing smell as one indicator of CHG ineffectiveness. Conclusions: In a vSNF we found both considerable support and challenges implementing a CRE prevention bundle from the healthcare worker perspective. Healthcare workers were dedicated to recreating a home-like environment for their residents, which sometimes felt at odds with infection control interventions. Residual misconceptions (eg, alcohol-based hand rub is not effective) and negative worker perceptions (eg, permeability of contact precaution gowns and/or residue from alcohol-based hand rub) suggest that ongoing education and participation by healthcare workers in evaluating infection control products for interventions is critical.Funding: NoneDisclosures: None