Hand Hygiene Compliance Monitoring Research Articles

Hand hygiene compliance in India

Healthcare workers (HCWs) hands are the most common vehicle for the transmission of healthcare-associated pathogens. Evidence-based guidelines for healthcare workers’ hand hygiene practices exist, but compliance with these is internationally low. Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of a successful hand hygiene promotion program. But in India very few studies addressed the issue of hand hygiene compliance. The main aim of the study was to assess the hand hygiene compliance among different health care workers.

The challenges of implementing a national hand hygiene initiative in rural and remote areas: Is it time for a new approach to auditing?

Abstract Direct observation of health professionals is recognised as the ‘gold standard' for monitoring hand hygiene compliance. Trained and validated auditors directly observe health professionals' hand hygiene behaviours, and assess their compliance with standard guidelines. In June 2010, a hand hygiene program that coincided with the adoption of the National Hand Hygiene Initiative (NHHI), including the Five Moments for Hand Hygiene, was introduced into a rural health service district in Australia. Infection prevention and control representatives from each inpatient facility within the district attended hand hygiene auditor training during a 2-day face-to-face workshop using standard models and training materials. The district infection control practitioner and a representative from the jurisdiction's infection prevention and control unit conducted the workshop. The success of the program has been variable, particularly at the institutional level. In part, this has been due to a lack of administrative leadership and refusal by Directors of Nursing in some facilities to site the alcohol-based hand hygiene product at the point of care. At the individual level, not all representatives have achieved the benchmark set by the NHHI for validation of auditors, with some reporting difficulty grasping the definitions and methodology of auditing. The subsequent process of re-training auditors has been resource-intensive due to the significant physical distance between facilities and limited on-site resources. These challenges and difficulties have brought into question the sustainability of the NHHI model for a geographically vast health service district. This paper examines the implementation of a nationally sanctioned hand hygiene program in a rural and remote health service district, and proposes a novel model for monitoring hand hygiene compliance in such settings.

An Electronic Hand Hygiene Surveillance Device: A Pilot Study Exploring Surrogate Markers for Hand Hygiene Compliance

To evaluate the feasibility of using an electronic hand hygiene surveillance and feedback monitoring device. A 2-phase pilot study included initial direct observation of hand hygiene practices as part of routine hospital quality assurance (phase I) and subsequent monitoring using an electronic hand hygiene surveillance device (phase II). A 700-bed tertiary care teaching hospital. Phase I included a convenience sample of healthcare workers. Phase II included 7 medical interns and 7 registered nurses recruited through email and at work-related meetings. During phase I, healthcare workers were directly observed at patient room entry and exit during the period April through November 2008. During phase II, hand hygiene data were gathered through indirect observation using the electronic device during a 4-week period in August 2009. Twenty patient rooms were fitted with electronic trigger devices that signaled a reader unit worn by participants when they entered the room, and 70 dispensers for liquid soap or hand sanitizer were fitted with triggers that signaled the reader unit when the dispenser was used. The accuracy of the devices was checked by the principal investigator, who manually recorded his room entries and exits and dispenser use while wearing a reader unit. During phase I, hand hygiene occurred before room entry for 95 (25.1%) and after room exit for 149 (39.4%) of 378 directly observed patient room visits, for a cumulative composite compliance rate of 32.3%. Among the 378 room visits, 347 (91.8%) involved contact with the patient and/or environment. During phase II, electronic monitoring revealed a cumulative composite compliance rate of 25.5%. The electronic device captured 61 (98%) of 62 manually recorded room entries and 133 (95%) of 140 manually recorded dispensing events. The electronic hand hygiene surveillance device seems to be a practical method for routinely monitoring hand hygiene compliance in healthcare workers.

Successful Implementation of the World Health Organization Hand Hygiene Improvement Strategy in a Referral Hospital in Mali, Africa

To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country. A before-and-after study from December 2006 through June 2008, with a 6-month baseline evaluation period and a follow-up period of 8 months from the beginning of the intervention. University Hospital, Bamako, Mali. Participants. Two hundred twenty-four healthcare workers. The intervention consisted of introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Hand hygiene infrastructure, compliance, healthcare workers' knowledge and perceptions, and handrub consumption were evaluated at baseline and at follow-up. Severe deficiencies in the infrastructure for hand hygiene were identified before the intervention. Local handrub production and quality control proved to be feasible, affordable, and satisfactory. At follow-up, handrubbing was the quasi-exclusive hand hygiene technique (93.3%). Compliance increased from 8.0% at baseline to 21.8% at follow-up (P < .001). Improvement was observed across all professional categories and medical specialities and was independently associated with the intervention (odds ratio, 2.50; 95% confidence interval, 1.8-3.5). Knowledge enhanced significantly (P < .05), and perception surveys showed a high appreciation of each strategy component by staff. Multimodal hand hygiene promotion is feasible and effective in a low-income country. Access to handrub was critical for its success. These findings motivated the government of Mali to expand the intervention nationwide. This experience represents a significant advancement for patient safety in developing countries.

Engaging the Patient as Observer to Promote Hand Hygiene Compliance in Ambulatory Care

Monitoring hand hygiene guideline compliance in an ambulatory environment can be challenging. For example, direct observation by independent observers is impractical because the sink and hand sanitizer dispensers are most often located inside the examination room. At Johns Hopkins Outpatient Center, an ambulatory care facility located on the campus of The Johns Hopkins Hospital in Baltimore, patients were engaged as an observer in monitoring hand hygiene compliance. The Johns Hopkins Hospital's ambulatory quality and patient safety (AQPS) task force, after assessing common methods of monitoring hand hygiene compliance including direct observation, self-reporting, and product usage, evaluated using the patient as an observer. Of 50 patients interviewed, 43 (86%) indicated a willingness to monitor and report providers' compliance with hand hygiene guidelines. In collaboration with providers, a patient-as-observer hand hygiene monitoring process was developed and piloted. Qualitative feedback postimplementation did not indicate that the process would inhibit the patient-provider relationship. The cost of the program to implement and maintain averages $0.17 per patient encounter. The overall patient response rate was 21.6% (range, 12%-77%), based on completed observation cards to total appointments completed. Hand hygiene compliance as measured by the patient-as-observer process averaged 88% (range, 74%-100%). Independent observation revealed 100% concurrence between the patient's recorded observation and the independent observer. Engaging the patient to report on hand hygiene compliance was found to be efficient and acceptable to patients and providers, and the results of the observations were representative of actual provider behavior.

Measurement and interpretation of hand hygiene compliance rates: importance of monitoring entire care episodes

Our objective was to assess the importance of monitoring hand hygiene compliance (HHC) during series of successive contacts with patients or surroundings for measurement and interpretation of the compliance rates. A direct observational study of HHC was performed in four intensive care units (ICUs) and four healthcare settings with non-intensive care wards (NICWs). Hand hygiene (HH) opportunities were differentiated into two categories: extra-series opportunities (ESOs) (before or after a single contact, and before the first contact or after the last contact of a series of successive contacts) or as intra-series opportunities (ISOs) (from the opportunity following the first contact to the opportunity preceding the last in the same series). In all, 903 opportunities of HH were performed in ICUs and 760 in NICWs. The proportion of ISOs was 46.0% in ICUs and 22.9% in NICWs. The overall HHC was significantly higher in NICWs than in ICUs (61.2% vs 47.5%, P<0.00001). The HHC was significantly higher for ESOs than for ISOs (67.7% vs 28.5%, P<0.00001). The HHC for ISOs was significantly higher in ICUs (32.2% vs 19.0%, P<0.005). If the distribution of categories of HH opportunities observed in NICWs had been the same as in ICUs, the overall HHC would have been similar in NICWs (46.4%) and in ICUs (47.5%). Monitoring HHC during entire care episodes in series of successive contacts is necessary to avoid a strong overestimation of the overall compliance rates. Concurrently, comparison of compliance data should take into account the proportion of ISOs included in the evaluation study.

Monitoring and feedback of hand hygiene compliance and the impact on facility-acquired methicillin-resistant Staphylococcus aureus

In 2006, we began monitoring hand hygiene compliance by direct observation. In 2006, with no changes in the methicillin-resistant Staphylococcus aureus (MRSA) control program, a 38% reduction of facility-acquired rates for this organism was realized. These results indicate that focused monitoring of hand hygiene can reduce facility-acquired rates of MRSA.

Hand hygiene compliance monitoring: current perspectives from the USA

Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of a successful hand hygiene promotion program. Direct observation of care providers by trained personnel is currently considered the gold standard. Advantages include the ability to determine if hand hygiene is being performed at the correct times, establish compliance rates by healthcare worker type, and assess hand hygiene technique. However, observation surveys are time-consuming, permit observation of only a small fraction of all hand hygiene opportunities, and can be influenced by inter-rater reliability. Comparison of compliance rates obtained through observation surveys is problematic due to lack of standardization of criteria for compliance and observation techniques. Self-reporting of compliance is not sufficiently reliable to be useful. Monitoring the usage of hand hygiene products requires much less time and can be performed on an ongoing basis, and is less complicated. However, it does not provide information about the appropriateness and quality of hand hygiene practices or compliance rates by health-care worker type. Furthermore, it is not clear how product usage correlates with compliance established by observational surveys. Electronic methods for monitoring compliance require further evaluation before they can be routinely recommended. Clearly, further research is needed to develop efficient, reliable, and reproducible methods for monitoring hand hygiene compliance.

Multi-Tiered Approach to Hand Hygiene Compliance Monitoring

Multi-Tiered Approach to Hand Hygiene Compliance Monitoring

Use of electronic alerts to enhance hand hygiene compliance and decrease transmission of vancomycin-resistant Enterococcus in a hematology unit

Hand hygiene (HH) compliance among health care workers (HCWs) has been historically low and hampered by poor surveillance methods. This study evaluated the use of an electronic device to measure and impact HH compliance. The study is a prospective, interventional study in a 30-bed academic medical center hematology unit. Phase I of the study monitored baseline HH compliance, and phase II monitored HH compliance using automatic alerts. The primary outcome measure was HH compliance, and the secondary end point was nosocomial transmission of vancomycin-resistant Enterococcus (VRE). Eight thousand two hundred thirty-five HH opportunities were measured during the study, with HH compliance improvement from 36.3% at baseline to 70.1% during phase II. The use of audible alerts improved HH compliance for both the day shift (odds ratio [OR], 3.6) and the night shift (OR, 5.9), as well as across rooms with higher HCW traffic (OR, 1.6) and lower HCW traffic (OR, 3.2). Electronic devices can effectively monitor HH compliance among HCWs and facilitate improved adherence to guidelines. Electronic devices improve HH compliance regardless of time of day or room location. The development of innovative devices to improve HH is required to validate the long-term implications of this methodology.

Infection Control Education: Practice to Reality

ISSUE: Compliance with basic infection prevention practices, including hand hygiene is the cornerstone of reducing the risk of healthcare associated infections. Further more, the Centers for Disease Control and Prevention (CDC) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) endorse compliance with basic infection control practices, including hand hygiene. Unfortunately, these basics are not always practiced at optimum levels. In 2004, Infection Control began monitoring hand hygiene compliance, conformity ranging between 60% and 75% with a goal of 90% compliance. Standard education programs, including orientation, and mandated annual education had not improved compliance. Infection Control recognized learner activities needed to encourage healthcare worker ownership to help improve compliance with basic infection control practices, including hand hygiene.

Monitoring hand hygiene compliance in a university-affiliated medical center

BACKGROUND: HICPAC hand hygiene (HH) guidelines recommend periodic monitoring of HH compliance. Thus, we carried out a 3-month observational assessment of HH practice in our 719-bed hospital using “light-duty” nursing personnel. OBJECTIVES: To determine the reliability of using alternative available hospital resources to obtain baseline HH compliance data for use in the development of an effective HH program. METHODS: Two light-duty nursing staff members were deployed during the day and evening shifts over a 3-month period (576 hours) to observe compliance with HH policy throughout the adult and pediatric units and departments. Observers were trained and supervised by infection control (IC) staff to ensure inter-observer reliability. Staff members were observed to determine if hands were washed with soap and water or if alcohol-based hand gels was used before and after A) patient contact, after removal of gloves, and when caring for patients on contact precautions. RESULTS: From June through August 2004, 3890 opportunities for HH were observed. Overall compliance with use of soap and water or alcohol-based hand gel was 31% (1216/3890). HH before patient contact was 9% (170/1802) and after patient contact was 50% (1046/2088). Alcohol-based hand gel was used before or after patient contact 69% of the time compared to soap and water. Staff members were more likely to perform HH after contact with contact precautions patients and were more likely to use HH if they worked in pediatrics or intensive care units. HH occurred more often during the day (7 am–3 pm) (p CONCLUSIONS: Light-duty nursing personnel can be an important adjunct to IC departments when monitoring infection control practice. An additional 48 hours/week for 12 weeks (equivalent IC practitioner salary value of $16,883) were devoted to monitoring HH compliance and data entry by light-duty nursing staff. This effectively relieved the IC department staff from the data collection burden and allowed IC staff time to focus on interventions. The additional resources were IC budget-neutral and allowed us to obtain a level of detail that would otherwise not have been possible given our current IC staffing. The experience provided the opportunity to develop additional IC resources as well as provide immediate feedback for staff regarding HH practice. In addition, the data collected will serve as the basis for current and future interventions to improve HH compliance at our institution.