Hand Hygiene Compliance Rates Research Articles

Rinse, gel, and foam – is there any evidence for a difference in their effectiveness in preventing infections?

BackgroundFollowing publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs).MethodsData regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted.ResultsThe amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs.ConclusionsCurrent evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.

Effectiveness of a hand hygiene training intervention in improving knowledge and compliance rate among healthcare workers in a respiratory disease hospital

BackgroundPracticing hand hygiene (HH) is a crucial element of infection control, with healthcare workers (HCWs) playing a vital role in preventing the spread of infection. However, inadequate knowledge and non-compliance to HH protocols pose significant challenges in healthcare settings. This study aimed to evaluate the effectiveness of an HH training intervention in enhancing knowledge and staff compliance within a respiratory disease hospital. MethodA pre-and post-training study was conducted among the healthcare workers in a respiratory disease treatment facility. The intervention comprised a series of 3-hour training sessions conducted over five days, focusing on the World Health Organization's (WHO) recommended guideline "Your Five Moments For Hand Hygiene." These sessions covered proper HH techniques and underscored the repercussions of inadequate compliance. Educational materials related to HH were displayed in prominent locations throughout the facility. The knowledge levels and compliance rate were assessed before and after the intervention. ResultThe intervention significantly improved HH knowledge levels and compliance rates among the participants. Marking a significant improvement, the compliance rate of HH protocols increased from 66.0% to 88.3% during the pre-to post-training period, with a concurrent increase in the mean knowledge score from 68.6% to 78.9%. ConclusionThis study underscores the potential of training and education in elevating HH compliance and knowledge among healthcare workers. The findings advocate that healthcare facilities routinely incorporate such interventions into their infection control programs, ultimately improving patient and healthcare worker safety.

Improving leadership skills of infection prevention and control teams by psychological empowerment: study protocol for a cluster randomised controlled trial (IP-POWER)

IntroductionInfection prevention and control (IPC) teams are routinely confronted with intense emotions in their daily work, as they are involved in many change processes with front-line medical staff, for example,...

A cluster of Candida parapsilosis displaying fluconazole-trailing in a neonatal intensive care unit successfully contained by multiple infection-control interventions.

This study aimed to investigate and contain a cluster of invasive candidiasis cases caused by fluconazole-resistant Candida parapsilosis (FRC) in a neonatal intensive care unit. Active surveillance was initiated. Direct observations of hand-hygiene compliance (HHC) among staff were conducted before and after the implementation of hand-hygiene (HH) education. Thirty-five environmental cultures were obtained. Phylogenetic analysis of FRC was performed using Fourier-transform infrared spectroscopy and microsatellite genotyping. A total of 14 patients (mean birth weight = 860 g, gestational age = 25 weeks) infected with FRC were identified using the fully automated analyzer, including 5 with clinical infection (three with catheter-related bloodstream infection, one with cutaneous infection, and one with fatal peritonitis) and 9 with colonization. The HHC rate in nurses before performing a sterile or aseptic procedure significantly improved after the HH education (P < .05). Sinks near the patients were contaminated with FRC. All FRC strains were confirmed to be susceptible to fluconazole using the CLSI method, and the microdilution procedure indicated a trailing effect. Phylogenetic analysis showed that all the fluconazole-trailing isolates from patients were clustered together and had the same genotype. Sinks were successfully decontaminated using accelerated hydrogen peroxide and drainage pipes were replaced. Ultraviolet-C decontamination was applied in the milk preparation room. No new cases were detected after the education and disinfection interventions. Sinks are an important reservoir of C. parapsilosis. Active surveillance, environmental hygiene, and constant staff education on maintaining a high level of HHC are necessary to limit the spread of C. parapsilosis.

689. Significant Improvement in Hand Hygiene Compliance and Decline in Clostridioides difficile Infections with Implementation of Infection Prevention Interventions

Abstract Background Per CDC, C. difficile is an urgent microbial threat. Despite use of CDC diagnostic criteria, 2-step testing protocol and antimicrobial stewardship interventions limiting broad spectrum antimicrobial use, we witnessed an increase in infections in 2022, therefore, additional interventions were implemented. Methods A multifaceted QI intervention program to improve IPC (infection prevention and control) practices was implemented in July 2022 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Interventions included: auditing and real time observations for health care personnel (HCP) hand hygiene compliance; monitoring soap/sanitizer usage; educational interventions including posters posted throughout the hospital emphasizing hand hygiene, “A clean in and clean out” approach and contact precautions reminders posted in patient rooms/nursing stations, weekly nursing huddles focused on nursing and ancillary staff education, provider counseling and continued coaching. Pre-intervention period (P1: 1/10/2021- 6/30/2022) was compared with Intervention period (P2: 07/01/2022-3/31/2023) for hand hygiene compliance and C. difficile infection rates. Results Overall adequate hand hygiene compliance rates for all health care personnel (HCP) increased from 71% during P1 to 85% during P2 (P&amp;lt; 0.05). All categories of HCP showed a significant improvement in hand hygiene compliance from P1 to P2, with rates for physicians increasing from 74% to 92% (p&amp;lt; 0.05), nurses from 68% to 94% (p&amp;lt; 0.001); nurse practitioners/physician assistants from 75% to 90% (p&amp;lt; 0.05), ancillary staff (chaplain, medical technicians, social workers) from 60% to 89% (p&amp;lt; 0.01)]. Hand hygiene product use increased significantly and soap usage alone increased from 45% to 75% in P2 (p&amp;lt; 0.05). C. difficile infections declined significantly from a mean of 1.9 infections per 1000 patient days during P1 to 0.5 infections per 1000 patient days during P2 (p&amp;lt; 0.001); SIR (Standardized infection ratio) decreased from 1.14 during P1 to 0.4 during P2 (p&amp;lt; 0.01). No C. difficile related mortality was observed. Conclusion With implementation of multifaceted IPC interventions, significantly improved hand hygiene rates and a significant decline in C. difficile infections were observed. Disclosures All Authors: No reported disclosures

Effects of data-driven feedback on nurses' and physicians' hand hygiene in hospitals – a non-resource-intensive intervention in real-life clinical practice

Hand hygiene (HH) by healthcare workers (HCWs) is one of the most important measures to prevent hospital-acquired infections. However, HCWs struggle to adhere to HH guidelines. We aimed to investigate the effect of a non-resource intensive intervention with group and individual feedback on HCWs HH in a real-life clinical practice during the COVID-19 pandemic. In 2021, an 11-month prospective, interventional study was conducted in two inpatient departments at a Danish university hospital. An automated hand hygiene monitoring system (Sani Nudge™) was used to collect data. HH opportunities and alcohol-based hand rub events were measured. Data were provided as HH compliance (HHC) rates. We compared HHC across 1) a baseline period, 2) an intervention period with weekly feedback in groups, followed by 3) an intervention period with weekly individual feedback on emails, and 4) a follow-up period. We analyzed data from physicians (N=65) and nurses (N=109). In total, 231,022 hygiene opportunities were analyzed. Overall, we observed no significant effect of feedback, regardless of whether it was provided to the group or individuals. We found a trend toward a higher HHC in staff restrooms than in medication rooms and patient rooms. The lowest HHC was found in patient rooms. The automated hand hygiene monitoring system enabled assessment of the interventions. We found no significant effect of group or individual feedback at the two departments. However, other factors may have influenced the results during the pandemic, such as time constraints, workplace culture, and the degree of leadership support.

Current issues in hand hygiene

Multiple aspects of hand hygiene have changed in recent years. A PubMed search was conducted to identify recent articles about hand hygiene. The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.

Process Evaluation of an Acute-Care Nurse-Centred Hand Hygiene Intervention in US Hospitals.

This paper describes a process evaluation of a 'wise' intervention that took place in six acute care units in two medical-surgical teaching hospitals in the United States during 2016-2017. 'Wise' interventions are short, inexpensive interventions that depend on triggering specific psychological mechanisms to achieve behaviour change. This study sought to increase the hand hygiene compliance (HHC) rates before entering a patient's room among nurses. The intervention centred on the use of threat to professional identity to prompt improved HHC. Through questionnaires administered to intervention participants and the implementation facilitator, together with independent observation of intervention delivery, we examined whether the steps in the Theory of Change occurred as expected. We found that aspects of the implementation-including mode of delivery, use of incentives, and how nurses were recruited and complied with the intervention-affected reach and likely effectiveness. While components of the intervention's mechanisms of impact-such as the element of surprise-were successful, they ultimately did not translate into performance of the target behaviour. Performance was also not affected by use of an implementation intention as repeated performance of HHC over years of being a nurse has likely already established well-ingrained practices. Context did have an effect; the safety culture of the units, the involvement of the Nurse Managers, the level of accountability for HHC in each unit, and the hospitals themselves all influenced levels of engagement. These conclusions should have implications for those interested in the applicability of 'wise' interventions and those seeking to improve HHC in hospitals.

Evaluation of the effectiveness of hospital infection prevention and control based on the SMART principle.

Hospital infection not only increases patient suffering and mortality, but also causes huge economic losses. It is urgent to take effective measures to improve the situation of hospital infection and focus on hand hygiene and disinfection. The SMART principle is to follow the principles of specificity, measurability, attainability, relevance, and timeliness when setting goals. This study aims to use the SMART principle in the prevention and control of hospital infection, to take a series of measures on the hospital infection such as hand hygiene, and to evaluate the implementation effect. This study is a retrospective study. From January to June 2020, the SMART principle was used to carry out intervention for infection prevention and control in the Xiangya International Medical Department, Central South University, and implement the infection prevention and control quality improvement plan. Using indicator data as targeting measurement standard, we established evaluation indicators for hospital infection prevention and control knowledge awareness and hand hygiene compliance rate as the process monitoring, surgical site infection rate and catheter-related urinary tract infection rate as the result monitoring. The evaluation indicators after intervention (July 2020 to June 2021) were compared with those before intervention (January 2019 to December 2019). Fifty-one medical staff working in the Xiangya International Medical Department were included. There were 12 doctors and 39 nurses, and 6 males and 45 females. The age ranged from 21 to 57 (30.2±7.1) years. After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of medical staff were significantly higher than those before the intervention (both P<0.05), but there were no significant differences in surgical site infection rate and catheter-related urinary tract infection rate before and after intervention (both P>0.05). After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of medical staff in the internal and surgical wards were higher than those before the intervention (all P<0.05). The awareness of hospital infection prevention and control knowledge of medical staff in surgical wards was low but improved significantly. The compliance rate of hand hygiene of medical staff in internal wards was high and improved significantly. After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of male and female medical staff were higher than those before the intervention (all P<0.05), both of which were significantly higher in males than in females. After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate for medical staff aged less than 30 years old and 30 to 40 years old were higher than those before the intervention (all P<0.05). Medical staff aged 30 to 40 years had a low awareness of hospital infection prevention and control knowledge, but both indicators improved most significantly. After the intervention, the awareness of hospital infection prevention and control knowledge of doctors and nurses was increased (both P<0.05). The awareness of doctors improved more significantly, and the hand hygiene compliance rate of nurses improved (P<0.05). After the intervention, the awareness of hospital infection prevention and control knowledge and hand hygiene compliance rate of medical staff with primary and intermediate professional titles were higher than those before the intervention (all P<0.05), and the improvement was more significant for medical staff with intermediate professional titles. Based on the SMART principle management method, the implementation of quality improvement plans combined with various domestic and international evaluation standards for infection prevention and control can effectively improve the awareness of infection control knowledge and hand hygiene compliance rate of medical staff, strengthen the prevention and control of hospital infection, and further ensure the safety of patients.

İnegöl Devlet Hastanesi sağlık çalışanlarının el hijyeni uygulamalarının değerlendirilmesi

Introduction and Aim: Hand hygiene is the cheapest and easiest method to prevent health-related infections. Determining the beliefs and practices related to hand hygiene is very important to increase compliance. In this study, it is aimed to determine the beliefs and practices of healthcare professionals towards hand hygiene, to determine the factors affecting them and the current hand hygiene compliance rates. Methods: This descriptive and cross-sectional study was conducted with 437 people working in İnegöl State hospital between January 10 and December 31, 2022. Data were collected with Personal Information Form, Hand Hygiene Observation Form, Hand Hygiene Belief Scale and Hand Hygiene Practices Inventory form. The data of the variables were shown with frequency and percentage. Pearson correlation analysis was used to evaluate the relationship between hand hygiene practice inventory and belief score averages. Results: The hand hygiene practice inventory and hand hygiene belief scores of the healthcare professionals participating in the study were 63.45±6.35 and 85.32±8.25, respectively. It was determined that there was a weak positive and significant correlation between the two scales (r=0.307, p&lt;0.001). Considering the compliance rates by indication, it was 89.6% before the patient, 82% before the aseptic procedures, and 98.7% after the patient. Hand hygiene compliance was determined as 92.3% in the nurse group, 83.9% in the doctor group, 97.6% in the surgical units, and hospital-wide compliance was determined as 90.3%. Conclusion: The answers given by the people to the inventory and the observation results were found to be directly proportional. It was determined that the belief in hand hygiene affects the practice of hand hygiene and the informed observation increases the general hand hygiene compliance. Of the five indications; It was thought that hand hygiene compliance was higher after the patient and this was due to the desire of people to protect themselves.

Prevalence of compliance with surgical hand hygiene procedures of medical staff at the central obstetrics and gynecology hospital in 2022 and some related factors

Backgroud: The study aimed to determine the prevalence and analysis of some factors related to medical staff's adherence to surgical hand hygiene. Methods: A cross-sectional descriptive study was performed on 316 surgical hand hygiene visits of medical staff participating in surgery at the Anesthesia and Resuscitation Department of the National Hospital of Obstetrics and Gynecology in 2022. Results: 100% of surgical hand hygiene using antibacterial soap. The compliance rate for surgical hand hygiene is 61.7%; Compared with the surgical hand hygiene session of the emergency surgery, the compliance with surgical hand hygiene during the session surgery was 3.0 times higher; Hygiene times of surgical assistant medical staff are 2.2 times more likely to comply than staff in charge of instruments. Conclusion: The hospital needs solutions to improve the medical staff's surgical hand hygiene compliance rate, especially for staff participating in emergency surgery.

P40 The effectiveness of contextualizing multimodal strategy on doctors to improve hand hygiene compliance in surgical wards at Ahmadu Bello University Teaching Hospital Zaria, Nigeria

Abstract Background Hospital acquired infection (HAI) is a major problem in healthcare delivery worldwide despite medical advances. A low HH compliance rate of 17.1% was found among surgical health workers at Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria. Although hand hygiene (HH) is a proven low-cost means to curtail HAI, low HH compliance is a global reality. The WHO multimodal strategy attempts to address low HH compliance within the frame of contextual realities. Methods This was an interventional study utilizing action research through a mixed method approach to investigate the effectiveness of employing a contextualized multimodal strategy to enhance the HH compliance rate of doctors at ABUTH Zaria. The study was from August to October 2022. A behavioural change campaign (BCC) HH workshop was carried out on doctors, and data collection followed immediately in the surgical wards (i.e. clusters) that had received environmental modification through the provision HH posters and nurses for visual and verbal reminders, respectively. The four clusters were: visual reminders only, verbal reminders only, visual and verbal reminders combined and neither visual nor verbal reminders (i.e. control). All clusters received an uninterrupted supply of alcohol-based hand rubs (ABHR) throughout the study period. The HH observation proforma for ‘five moments of HH’ template was used to collect the quantitative data through direct observation while qualitative data were by one-on-one interviews on doctors in surgical wards at ABUTH Zaria. Results The cumulative HH compliance rate by doctors was 69% (N = 1774). This was significantly different from the baseline HH compliance rate of 17.1% before this study’s intervention (P &amp;lt; 0.0001, C. I. 45.5% to 57.7%). HH was observed from doctors most in wards with both visual and verbal reminders (78%) while lowest (59%) where visual and verbal reminders were not provided, i.e. C4 (n = 444). Compared with the baseline HH compliance, all interventions were significant. However, compared with C4, visual reminders only (C1) had insignificant effect on influencing the HH practice of doctors while visual and verbal reminders combined. Verbal reminders only (C2) were found to be as effective as when combined with visual reminders (78%) as the difference was statistically insignificant (P = 0.4791, CI −3.5% to 7.5%, χ2 = 0.5). However, all doctors reported being motivated to perform HH by the presence of ABHR which was similar to the significance found even in the ward where no verbal or visual reminders (59%, n = 444) were used compared with the baseline (17%, n = 286) before this intervention study (P &amp;lt; 0.0001, CI 35% to 48%, χ2 = 125). All respondents reported hearing about the HH behavioural change workshop even though only one attended. Conclusions Continuous workshop on HH is necessary to sustain awareness of health workers on the importance of hand hygiene. The presence of ABHRs alone was enough motivation for doctors to perform HH but verbal reminders were significant in sustaining this positive attitude towards HH. A scaling of this intervention is needed in other departments so that staff can have changes made to their values towards healthcare delivery as well at ABUTH Zaria. Contextualizing the WHO multimodal strategy is an efficient and acceptable means of addressing the problem of low HH compliance.

Effects of the Implementation of Intelligent Technology for Hand Hygiene in Hospitals: Systematic Review and Meta-analysis.

The World Health Organization recommends regular hand hygiene monitoring and feedback to improve hand hygiene behaviors and health care-associated infection rates. Intelligent technologies for hand hygiene are increasingly being developed as alternative or supplemental monitoring approaches. However, there is insufficient evidence regarding the effect of this type of intervention, with conflicting results in the literature. We conduct a systematic review and meta-analysis to evaluate the effects of using intelligent technology for hand hygiene in hospitals. We searched 7 databases from inception to December 31, 2022. Two reviewers independently and blindly selected studies, extracted data, and assessed the risk of bias. A meta-analysis was performed using the RevMan 5.3 and STATA 15.1 software. Sensitivity and subgroup analyses were also conducted. Overall certainty of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation approach. The systematic review protocol was registered. The 36 studies comprised 2 randomized controlled trials and 34 quasi-experimental studies. The included intelligent technologies involved 5 functions: performance reminders，electronic counting and remote monitoring，data processing，feedback，and education. Compared with usual care, the intelligent technology intervention for hand hygiene improved health care workers' hand hygiene compliance (risk ratio 1.56, 95% CI 1.47-1.66; P<.001), reduced health care-associated infection rates (risk ratio 0.25, 95% CI 0.19-0.33; P<.001), and was not associated with multidrug-resistant organism detection rates (risk ratio 0.53, 95% CI 0.27-1.04; P=.07). Three covariates, including publication year, study design, and intervention, were not factors of hand hygiene compliance or hospital-acquired infection rates analyzed by meta-regression. Sensitivity analysis showed stable results except for the pooled outcome of multidrug-resistant organism detection rates. The caliber of 3 pieces of evidence suggested a dearth of high-caliber research. Intelligent technologies for hand hygiene play an integral role in hospital. However, low quality of evidence and important heterogeneity were observed. Larger clinical trials are required to evaluate the impact of intelligent technology on multidrug-resistant organism detection rates and other clinical outcomes.

SG-APSIC1171: A new approach of hand hygiene observation with focus on healthcare worker (HCW) category

Objectives: The past hand hygiene (HH) compliance rate has indicated the low number of opportunities for some healthcare workers (HCWs) because the infection control liaison officer (ICLO) tended to capture opportunities from nurses who were available, despite the proportional allocation of opportunities per HCW type based on the World Health Organization (WHO) HH methodology. Therefore, HH compliance rates may not have accurately represented the specific HCW type, which may have affected the overall HH compliance rate. We sought to determine an accurate baseline of HH compliance rate with consistent number of opportunities across all HCW categories. Methods: HH auditors were ICLOs trained in HH observation by the infection control nurse (ICN) according to the WHO “My Five Moments of Hand Hygiene.” HH observations were conducted bimonthly with assigned areas focusing only on 1 HCW category for each session: nursing, medical, clinical support services, or environmental services. A briefing session was given on the day of observation, with the goal of collecting 20 opportunities per area with HCW focus during their peak activities. Direct feedback and positive reinforcement were given to HCWs after observations were completed. Results: A survey of 96 ICLOs indicated that observations based on HCW focus allowed them to capture more HH opportunities and concentrate on their observations. The new approach showed a significant increase in number of opportunities across all HCW categories that was more representative. We also successfully determined a new baseline for all HCW categories, with further breakdown of HCW type. Conclusions: A new methodology of HH observation with a focus on HCW category has resulted in more HH opportunities across all HCW categories and improved representation of the HH compliance rate.

SG-APSIC1105: The effectiveness of the infection control interventions in decreasing multidrug-resistant organism transmission in the Department of Neonatology of Hung Vuong Hospital

Objectives: Infection control and prevention (IPC) is one of the most important factors in decreasing multidrug-resistant organism (MRDO) transmission. We evaluated the effectiveness of the IPC program in reducing the spread of MDROs at the Department of Neonatology of Hung Vuong Hospital. Methods: This research was conducted from April 2020 to September 2020 in the neonatology department in 3 phases: (1) We determined the compliance rate of hand hygiene and high-touch surfaces cleaning (via camera monitoring). (2) We conducted the following interventions: We developed specific cleaning protocols for the neonatology department. We provided training regarding MRDO transmission control and prevention for healthcare workers. We implemented a counseling program for active screening and isolation for hospitalized children; added isolation rooms for children with MRDO asymptomatic infections. And we improved feedback efficiency through an online group between the infection control and prevention team and the department of neonatology. (3) We re-evaluated compliance with hand hygiene practices and cleaning of high-touch surfaces, then we compared the rates of positive MRDO cultures before and after these interventions. Results: Before the interventions, 453 hand hygiene observations were recorded and 322 high-touch-surface cleaning observations were recorded. The hand hygiene compliance rate improved significantly from 33.2% to 85.5% (PR, 11.9; 95% CI, 7.4–19.3; P&lt; .01). The high-touch-surface cleaning rate increased from 82.4% to 93.5% (PR, 3.1, 95% CI, 1.5–6.4; P &lt; .01). The rate of high-touch surfaces being cleaned with proper technique increased from 38.5% to 87.9% (PR, 11.6; 95% CI, 6.3–21.3; P &lt; .01). In total, 103 swab samples were positive for MRDOs by culture before and after the intervention. The rate of positive MRDO cultures decreased from 80.8% to 64.7% (P = .017). Conclusions: Enhancing hand hygiene and high-touch-surface cleaning compliance helped reduce MRDO transmission in the Department Neonatology of Hung Vuong Hospital.

Steady amelioration of institutional hand hygiene behavior among health care personnel after 12-year consistent intervention

Institutional hand hygiene (HH) behavior is difficult to monitor and improve consistently, especially over long periods. This study aimed to investigate the long-term effects of HH promotion activities. We launched the HH promotion team in 2010 and conducted interventions including goal setting, observation and feedback, education, reward incentives, and accountability. Optimal HH compliance rates were calculated based on adherence to all 6-step HH technique and appropriate time recommended by the World Health Organization. HH and optimal HH compliance were calculated over 12 years. Poisson regression analysis was used to determine the trend in HH compliance according to year. In 2010, HH and optimal HH compliance were 59.7% and 15.6%, respectively. HH compliance increased by 83.9% in 2013 and remained over 75%. HH compliance increased significantly, with a relative risk (RR) of 1.014 (95% CI 1.002-1.025, P=.018). Optimal HH compliance increased by 67.8% in 2013 and remained over 60%, except in 2016 (58.8%) and 2019 (59.8%). Optimal HH compliance increased with RR 1.033 (95% CI 0.991-1.076, P=.123). HH and optimal HH compliance increased significantly over the 12 years when subgroup analysis was performed by job category. HH promotion team activities improved and maintained optimal HH compliance among HCWs.

SG-APSIC1165: Hand hygiene feedback card—Providing real-time feedback to improve hand hygiene compliance

Objectives: Hand hygiene is widely recognized as the most effective practice for preventing healthcare-associated infections. Despite ongoing interventions and strategies implemented by the infection control committee, the compliance with and consistency in the hand hygiene practice remains a challenge. At times, staff are unaware when they are noncompliant with hand hygiene; therefore, a more robust strategic approach is needed. One such strategy is customized audit with real-time feedback. A literature review highlighted the effectiveness of audit coupled with specific feedback. This approach was also supported by several guidelines and regulatory bodies that recognized the importance of audit and feedback in hand hygiene improvement efforts. For example, the World Health Organization (WHO) has emphasized 5 core components of improving hand hygiene. One of these components is evaluation and feedback. We sought to provide feedback to healthcare personnel when they do not show compliance with the Five Moments of Hand Hygiene. We aimed to achieve &gt;95% hand hygiene compliance among healthcare staff. Methods: Information on the use of the hand hygiene feedback card was provided to the auditors. The hand hygiene feedback card procedure began in all the wards in May 2020. This process first started with orientation of the auditors regarding the hand hygiene feedback card, followed by auditing hand hygiene practice. Staff who did not comply with hand hygiene procedures were given real-time feedback via a card that specified the missed hand hygiene movement. Results: Overall hand hygiene compliance among healthcare staff increased by 6% after the hand hygiene feedback card procedure was implemented. Conclusions: Overall, the hand hygiene feedback card was effective in improving hand hygiene. Through this quality improvement project, significant and sustained gains in hand hygiene compliance rates of &gt;95% can be achieved.

SG-APSIC1055: Hand hygiene challenges among the ancillary team during the COVID-19 pandemic

Objectives: Ancillary staff members perform operational support functions and play an active role in enhancing the patient care experience. Infection prevention practices among ancillary staff play a critical role in preventing transmission of microorganisms, which ensures the safety of patients. Low hand hygiene compliance was found among porters in a cross-institutional hand hygiene audit in 2021. A quality improvement team was formed to improve hand hygiene compliance, especially during the COVID-19 pandemic. Methods: A focus-group discussion and survey were conducted to understand hand hygiene knowledge and challenges among porters. Using the findings, the team initiated Glo–germ education tools, pocket alcohol hand-rub agents, pocket moisturizer, poster display, and a toolbox messaging system via conversion of group roll call to satellite-area roll call. Respective satellite teams were sent hand hygiene reminders, and prompt corrective action was taken following noncompliance events. Analytic comparisons of pre- and postsurvey data were performed using the χ2 test, and P &lt; .05 was regarded as statistically significant. Results: In total, 572 ancillary staff participated in the survey. Knowledge of hand hygiene practices improved significantly following the interventions, as shown in the comparison of pre- and postintervention results: knowledge of the hand hygiene steps (P &lt; .001), knowledge of the duration of hand rub (P &lt; .001), and knowledge of duration of handwashing (P &lt; .001). Also, 295 staff members (97.68%) stated that implementation measures increased their awareness of the importance of hand hygiene. Moreover, the hand hygiene compliance rate improved from 77.8% to 100%. There were no significant differences related to sex (P = .089), age group (P = .355), years of working (P = .359), education level (P = .268), or difficulty in reading English (P = .906). Conclusions: Evaluating staff hand hygiene knowledge and understanding the challenges faced among porters helped toward the development of appropriate interventions and assurance of success in project.

SG-APSIC1064: The role of infection control activities on healthcare-associated infections during 2017-2021 at intensive care units in Cho Ray Hospital

Objectives: Healthcare-associated infections (HAIs) are one of the greatest challenges and concerns in Vietnam and around the world. Many studies have shown that HAIs may result in an increase in hospital length of stay, antibiotic use, multidrug-resistant organism (MDROs) infections, treatment costs, and mortality. Therefore, in the past 5 years, the Department of Infection Control of Cho Ray Hospital has carried out many infection and prevention control (IPC) activities to reduce the rates of HAI and MDRO infection. We evaluated IPC activities and results achieved in these efforts at Cho Ray Hospital during 2017–2021. Methods: We described the implemented IPC activities and retrospectively collected data from HAIs surveillance reports during 2017–2021 for 3 intensive care units (ICUs): ICU-B, ICU-D, and the NICU. Results: In the past 5 years, we implemented synchronous IPC activities, including promoting hand hygiene training and surveillance, environmental cleaning surveillance, carrying out improvement projects such as a ventilator-associated pneumonia (VAP) prevention bundle, an MDRO prevention bundle, and an environmental cleaning quality improvement project. Many positive results were achieved, although a slight increase in the HAI incidence occurred in 2021 due to the COVID-19 pandemic. Overall, the hand hygiene compliance rate increased from 49.7% to 83.8%. The rate of HAIs per 1,000 patient days decreased steadily from 5.4 to 2.4. The VAP rate fell from 30.5 to 17.2 per 1,000 patient days, and the central-line–associated bloodstream infection (CLABSI) rate decreased gradually from 5.4 to 2.4 per 1,000 patient days. The catheter-associated urinary tract infection (CAUTI) rate decreased from 2.9 to 0.9 per 1,000 patient days, and the MDRO infection rate decreased significantly from 32.7 to 11.3 per 1,000 patient days. Conclusions: The synchronous implementation of HAI prevention bundles promoting hand hygiene and environmental cleaning achieved significant effects in the efforts to decrease HAIs and MDROs in the ICUs of Cho Ray Hospital.

Developing a design-based concept to improve hand hygiene in the neonatal intensive care unit

BackgroundHand hygiene (HH) is the most critical measure in the prevention of nosocomial infections in the neonatal intensive care unit (NICU). Improving and sustaining adequate HH compliance rates, however, remains a significant challenge. Using a behavioral change framework and nudge theory, we developed a design-based concept aimed at facilitating and stimulating HH behavior.MethodsConcept development was initiated by selecting a theoretical framework after which contextual field studies aimed at discovering causes for poor compliance were conducted. Potential solutions were brainstormed upon during focus group sessions. Low-fidelity prototypes were tested regarding feasibility, usability, and acceptability. A final concept was crafted drawing from findings from each design phase.ResultsComplying with recommended HH guidelines is unrealistic and infeasible due to frequent competing (clinical) priorities requiring HH. The concept “Island-based nursing,” where a patient room is divided into two geographical areas, namely, the island and general zone, was created. HH must be performed upon entering and exiting the island zone, and after exposure to any surface within the general zone. Reminding of HH is prompted by illuminated demarcation of the island zone, serving as the concept’s nudge.ConclusionsIsland zone demarcation facilitates and economizes HH indications in an innovative and intuitive manner.ImpactAlthough hand hygiene (HH) is the single most important element in the prevention of nosocomial infections in neonates, improving and sustaining adequate HH compliance rates remains a significant challenge.Complying with recommended HH guidelines was found to be unrealistic and infeasible due to the significant amount of time required for HH in a setting with a high workload and many competing (clinical) priorities.The concept of “Island-based nursing,” under which the primary HH indication is upon entering and exiting the island zone, facilitates and economizes HH indications in an innovative and user-friendly manner.