Hand Hygiene Compliance Research Articles

A "Wise" Intervention to Increase Hand Hygiene Compliance of Nurses in Acute Care Units in US Hospitals: A Multiple Baseline Interrupted Time-Series Evaluation.

Objective: This study tested a 'wise' intervention (quick prompt of a specific psychological mec) in acute care hospital units to improve nurses' hand hygiene compliance (HHC). Design: A multiple baseline design in two medical-surgical teaching hospitals in the United States. Measurements: Hand hygiene data was collected using an electronic compliance monitoring system with sensors placed in doorways and on corresponding soap and alcohol-based hand rub dispensers. The outcome measure was the proportion of opportunities in which HH was undertaken by staff per week in each unit. Intervention: A quick-and-easy psychological prime to reinvigorate professional identity. Methods: Interrupted time series analysis using a quasi-Poisson regression model with statistical process control charts for each unit. Results: A statistically significant increase in HHC rates that was sustained for months post-intervention. However, the patterns by unit were not statistically significant once temporal trends were considered. Other factors, such as the unit type and the use of incentives could have impacted the results. Conclusions: These analyses suggest that the aggregate impact should not be taken as evidence of intervention effectiveness. This study therefore cannot be considered to have provided a strong foundation for use of a 'wise' intervention, despite its relatively small financial, logistical and psychological cost.

IoT‐Based Hand Hygiene Compliance Monitoring System and Validation of Its Effectiveness in Hospital Environments

AbstractHealthcare‐associated infection (HAI) is the most common adverse medical event that affects patients. Internationally, healthcare workers (HCWs) are monitored for hand hygiene compliance to reduce HAI risk. While direct observation is considered the gold standard for monitoring, it has several disadvantages. To address this, the study focused on developing a comprehensive hand hygiene system that integrates the Internet of Things (IoT) hand hygiene with soap and water (HHW) and alcohol‐based formulation (HHA) monitoring, incorporates real‐time data visualization on a web interface to track HCWs' hand hygiene practices, and provides instant calculations of compliance and accuracy rates. This IoT system uses Bluetooth for HCW positioning and HHW detection, ultrasonic sensors for handwashing duration, and pressure sensors for HHA detection. Furthermore, a cloud server, database, and website are established to manage and display the data received by the IoT devices. To reduce HAI in Taiwan, hospitals must provide both HHW and HHA systems, and HCWs can choose either method when hand hygiene is necessary. The system achieved 72% accuracy in clinical practice within an adult intensive care unit (ICU).

Analysis of the Implementation of Standard Precautions in Preventing Healthcare Associated Infections (HAI's) at Wampu Norita General Hospital

Standard precautions are needed to implement the IPC program in hospitals. Implementation of Standard Precautions can be carried out because it is driven by the PPI Committee or Team. The PPI Committee or Team is formed based on needs, workload, and type of health service facilities. The eleven components of standard precautions can be implemented in every health service, especially in Indonesia which is trying to reduce HAIs. HAIs are known as nosocomial infections that occur in hospital patients, where infection has not occurred while the patient has been hospitalized for more than 48 hours. The large risk of infection in hospitals encourages the need to reduce the risk of infection through the PPI Program. A descriptive qualitative research method was chosen to obtain meaning from a number of individuals and social groups. The qualitative research process includes asking questions, collecting data, analyzing data, and interpreting the meaning of the data. The sample in this study was 8 informants, including Hospital Leaders, heads of Hospital Quality, Nurses in charge of the field, Daily Executive Officers, and Executive Nurses in service units. The results show that the PPI policy has been implemented well which includes the PPI Structure and Team, Infection Surveillance Manual, Standard Precautions and implementation of Hand Hygiene and PPE, as well as the budget. Meanwhile, the condition of facilities and infrastructure is not optimal, such as hand hygiene facilities and use of PPE, collection of HAI infection surveillance data, and training. Conclusion: The Standard Precautions Implementation Policy already exists and is based on Minister of Health Regulation No. 27 of 2017. The results of the Hand Hygiene and PPE compliance audit do not match the Quality Profile, facilities, and infrastructure are not optimal, namely below 100%, and stock in the premises is still limited

Fighting HAIs by monitoring hand hygiene compliance in the Umberto I teaching Hospital in Rome

Abstract Background Healthcare-associated infections (HAIs) are one of the most common preventable complications in hospitalised patients related to increased morbidity and mortality for patients. Proper hand hygiene (HH) can decrease the prevalence of HAIs within care settings. The aim of the study was to evaluate the effects of a monitoring and feedback system on HH compliance (HHC). Methods Three monitoring and feedback studies have been carried out in Umberto I teaching hospital of Rome since 2021. Healthcare workers (HCWs), were trained on how to carry out the direct observation on the 5 WHO moments on HH. The data collection lasted two weeks each year. Following data collection, they were analysed and discussed annually with HCWs. A multivariable logistic regression model was constructed to identify predictors of HH compliance. Results A total of 15874 HH were observed, of which 40.1% in 2023. The recorded HHC was 71.0% in 2021, 75.4% in 2022 and 71.6% in 2023. Multivariable analyses showed that HHC was positively associated with female sex of observed (aOR:1.3, 95% CI:1.1-1.4), during weekend days or holidays (aOR:1.3 95% CI:1.1-1.4) and all indications with respect to ‘before touching a patient’. Regarding the professional category of the observer, compared to physicians, midwives were more likely to report compliant observations (aOR=2.4, 95% CI: 1.4-4.1). On the other hand, a negative association was found with external ward staff and other HCWs and no-HCWs compared to physicians. Ward area and year of observation did not influence the probability of the outcome. Conclusions The results of this study revealed sub-optimal adherence to HH, with the lowest rates observed prior to patient interaction. That, coupled with the variability seen among HCWs, underlines the difficulties in achieving a uniform level of compliance. Therefore, ongoing training to raise awareness among HCWs and to repeat the survey over time identifying any major problems is essential. Key messages • Monitoring the reasons for non-adherence to hand hygiene in healthcare institutions in order to formulate strategies to improve HH adherence among hospital staff is essential. • Hand hygiene (HH) monitoring systems can produce measurable improvements in HH adherence by healthcare personnel, resulting in a reduction in the incidence of healthcare-associated infections.

Enhancing infection prevention and control through hand hygiene compliance in six Ugandan hospitals using quality improvement approaches.

Hand hygiene (HH) plays a crucial role in mitigating healthcare-associated infections. Improving HH compliance in healthcare facilities in resource-limited settings is urgently needed. We implemented the World Health Organization (WHO) HH improvement strategy using a continuous quality improvement (CQI) approach targeting improvement in HH compliance by healthcare workers (HCWs). An intervention was implemented in six hospitals using a longitudinal study design between May 2019 and April 2023. We set up and monitored infection prevention and control (IPC) and HH programs using WHO's infection prevention and control assessment framework at the facility level (IPCAF) and hand hygiene self-assessment framework (HHSAF) tools. We implemented HH interventions using CQI techniques while targeting HCW HH knowledge and compliance with the WHO's Five Moments of HH. By the end of the intervention, IPC and HH capacity improved in all six hospitals, from a median score of 547.0 and 252.5 on IPCAF and HHSAF tools at baseline to an advanced score of 635.0 and 350.0 at endline assessment, respectively. Similarly, HCWs' HH knowledge improved in all hospitals, from a mean score of 45.0% at baseline to 76.0% at endline assessment, most notably among nurses. HH compliance, as assessed using WHO's HH observation tool, at least doubled in all hospitals, rising from 19.9% to 53.8%, with before touching a patient registering the highest (22-fold) improvement. On linear regression analysis, no significant association was observed between HH compliance and IPCAF b = -0.0004 (95% CI -0.093, 0.93) p = 0.990, HHSAF b = 0.009 (95% CI -.0127, 0.145) p = 0.842 and HCW knowledge on HH/IPC b = -0.165 (95% CI 0.815, 0.485) p = 0.519. This is the first documented comprehensive utilization of CQI approaches to implement HH as an entry point for the development of hospital IPC programs, and evaluation of WHO tools and approaches for IPC and HH improvement in Uganda. Implementation of the WHO HH improvement strategy using a CQI approach can lead to remarkable improvement in HH capacity, and HCW compliance and knowledge in hospitals within resource-limited settings.

Effects of an Interactive Handwashing Lecture on First-Year Thai Nursing Students: A Pretest-Posttest Study

Background: Hand hygiene is essential in healthcare to prevent infections and ensure patient safety. The World Health Organization highlights hand hygiene as a key measure to reduce healthcare-associated infections. However, adherence to hand hygiene protocols is often inadequate, with a low compliance rate. First-year nursing students are at a critical stage in developing foundational practices. Traditional teaching methods have shown limited success in achieving long-term adherence, necessitating the need for more interactive and engaging teaching methods. Therefore, this study aims to evaluate the effects of an interactive lecture on the handwashing knowledge of first-year nursing students. Methods: This study employed a quasi-experimental one-group pretest-posttest design involving 60 first-year Thai nursing students at Boromarajjonani College of Nursing. After four weeks of interactive lectures, participants completed a pretest and posttest to assess changes in hand hygiene knowledge and understanding of WHO Five Moments for Hand Hygiene. The intervention included visual demonstrations, hands-on practice, and real-time feedback. Data were analyzed using descriptive statistics and paired t-tests to determine the intervention’s effectiveness. Results: The study showed significant improvements in both handwashing knowledge and understanding of WHO Five Moments for Hand Hygiene post-intervention. The mean score for handwashing knowledge increased from 5.41 (SD = 1.06) to 6.62 (SD = 1.10) (t(59) = 7.154, p < 0.001). Similarly, the mean score for understanding WHO Five Moments for Hand Hygiene improved from 4.32 (SD = 0.68) to 4.97 (SD = 0.84) (t(59) = 5.60, p < 0.001). Correct responses to specific handwashing questions also increased significantly. Conclusions: The interactive handwashing lecture intervention significantly improved nursing students’ knowledge and understanding of hand hygiene practices. These findings support the integration of interactive educational strategies in nursing curricula to improve hand hygiene compliance and patient safety. Future research should address study limitations, such as sample size and long-term knowledge retention, to further validate these results.

Evaluation of Electronic Hand Hygiene Monitoring Systems in UAE Hospitals

Abstract Introduction/Objective Introduction: Hand hygiene (HH) compliance is pivotal in preventing infections in healthcare settings, necessitating robust monitoring systems. This abstract outlines the assessment of three electronic HH monitoring systems across four United Arab Emirates (UAE) hospitals. Methods/Case Report Methods: A prospective observational study was conducted in four UAE governmental hospitals, evaluating three HH monitoring systems. Sensors were strategically positioned on alcohol-based dispensers, healthcare workers’ ID badges, and patients’ beds in these systems. Additionally, a comparative analysis was performed between direct observation data and automated system data. Results (if a Case Study enter NA) Results: System 1 was evaluated at Hospitals A and B, revealing HH compliance rates of 65% and 46%, respectively, contrasting with direct observation rates of 88% and 80%. Hospital C assessed System 2, reporting a compliance rate of 70%, compared to direct observation’s 94%. System 3, evaluated at Hospital D, showed a compliance rate of 39%, in contrast to the 88% observed directly. Conclusion Conclusion: While electronic monitoring systems offer continuous surveillance and data analysis benefits, they also present limitations. These include challenges in accurately distinguishing HH indications and opportunities, identifying all required HH moments, and capturing technique nuances. Understanding these strengths and limitations is vital for healthcare institutions aiming to implement effective HH monitoring strategies to enhance patient safety and reduce healthcare-associated infections (HAI

Knowledge, Attitudes, and Perceptions towards Hand Hygiene Practice Amongst Students at a Nursing College in Lesotho

Background: Hands are critical vectors for microorganisms that cause healthcare-associated infections (HAIs). Hand hygiene, being done the right way, at the right time, and being given the right priority in a healthcare setting is an effective strategy to reduce HAIs and associated costs. Different strategies have been put in place to help improve hand hygiene compliance among healthcare workers; amongst them, continuous training is advised at all levels of care. Aim: This study, focusing on nursing students, aimed to describe their knowledge, attitudes, and perceptions towards hand hygiene, highlighting their crucial role in maintaining health and preventing infections. Methods: This study was a quantitative cross-sectional study. One hundred and fourteen questionnaires were distributed; 103 were filled out and returned by willing students at Maluti Adventist College, thus a 90% response rate. Results: 62% (64) demonstrated moderate knowledge, all had positive attitudes, and 61% (63) had a positive perception towards hand hygiene. There was a significant (p-value = 0.012) association between knowledge and training. Conclusions and recommendations: These provide valuable input for enhancing the World Health Organization’s (WHO) hand hygiene multimodal strategy, the SAFE LIFE Clean YOUR HAND campaign, and healthcare workers’ teaching curriculum. All stakeholders should implement strategies that prioritize knowledge dissemination to promote effective hand hygiene practices among healthcare workers worldwide.

The state of hand rub dispensers in healthcare settings – a multicenter assessment in 19 German healthcare facilities

BackgroundHand hygiene is one of the most important hygiene measures to prevent healthcare-associated infections. Well-functioning hand rub dispensers are the foundation of hand hygiene but are often overlooked in research. As the point of origin for hand hygiene, dispensers not only promote compliance through ease of use, but also strongly influence the amount of hand rub used per disinfection. This work investigates how dispenser types and conditions affect dispensed volumes and usability.MethodsData from 5,014 wall-mounted or point-of-care dispensers was collected from 19 German healthcare facilities during installation of an electronic hand hygiene monitoring system, including dispenser type and dispensed hand rub volumes. Of these dispensers, 56.2% were metal dispensers, and the majority (89.5%) were wall-mounted. For one hospital, 946 wall-mounted dispensers were analyzed in detail regarding pump material, damages, functionality, cleanliness, and filling levels.ResultsDispensed volumes varied across and within dispenser types, ranging from 0.4 mL to 4.4 mL per full actuation, with the largest volumes generally dispensed by plastic dispensers with a preset of 1.0 to 3.0 mL per actuation. In general, most dispensers dispense more hand rub per full actuation than specified by the manufacturer. When different types of dispensers are used within a healthcare facility, vastly different volumes can be dispensed, making reliable and reproducible disinfection difficult for healthcare workers. In the detailed analysis of 946 dispensers, 27.1% had cosmetic defects, reduced performance, or were unusable, with empty disinfectant being the most common reason. Only 19.7% of working dispensers delivered their maximum volume on the first full actuation.ConclusionEven though several studies addressed the variability in dispensed volumes of hand hygiene dispensers, studies dealing with dispenser types and functionality are lacking, promoting the common but false assumption that different dispensers may be equivalent and interchangeable. Variability in dispensed volumes, coupled with frequent dispenser defects and maintenance issues, can be a major barrier to hand hygiene compliance. To support healthcare workers, more attention should be paid to ‘dispenser compliance’, selecting dispensers with similar volume ranges and proper maintenance.

Observation of Food Handlers’ Hand Hygiene Behavior During Production at a Sandwich-making Factory

Effective hand hygiene is essential during food production to reduce the risk of microbiological contamination. Improper hand hygiene by food handlers can be a major contributing factor in the spread of foodborne illnesses. Self-reported behavior does not equate to actual behavior as it has the limitation of biases. Therefore, observational data are more effective at assessing the actual behavior of food handlers. Covert observation utilizing closed-circuit television (CCTV) cameras can yield reliable data. This study utilized covert observation to assess hand hygiene compliance from CCTV footage of food handlers in a sandwich-making facility. An electronic observation checklist, based upon the company’s hand-hygiene protocol, was used to capture observed hand hygiene practices. A total of 588 occasions that required hand hygiene practices by food handlers (n = 12) were observed during the production of ready-to-eat (RTE) sandwiches over 16 h during two shifts. Food handlers did not wash their hands on 32% of occasions which required food hygiene practices. Of those occasions where there was an attempt to implement hand hygiene practices (n = 401), only 1% of behaviors were compliant with the company hand hygiene protocol. Observations indicated that 95% of attempts did not adhere to the recommended handwashing duration (≥20 s). Soap was not used in 4% of attempts, and hands were not wetted prior to applying soap in 16% of attempts. Additionally, 62% of attempts did not use hand sanitizer after handwashing and drying. Food handlers were observed attempting hand hygiene practices significantly more frequently (p < 0.001) when entering (89% of occasions) than exiting (8% of occasions) the production area. Findings indicate that appropriate interventions are needed to improve hand hygiene compliance of food handlers to ensure food is produced safely within the food manufacturing sector.

Electronic monitoring versus manual paper-based monitoring for hand hygiene compliance: a comprehensive health economic assessment analysis

BackgroundMonitoring hand hygiene compliance (HHC) of healthcare providers (HCPs) in healthcare facilities is critical for hand hygiene (HH) promotion. However, less is known about the cost and effectiveness of different HHC monitoring tools. In this study, we aimed to compare various health economic indicators corresponding to electronic system-based monitoring (ESM) and manual paper-based monitoring (MPM) for HHC to provide evidence-based advice for HHC monitoring measures targeted selecting.MethodsA before and after study in 40 clinical departments with 4,524 healthcare providers was conducted from December 2022 to January 2023 (MPM implementation phase) and March 2023 to May 2023 (ESM implementation phase). The cost-effectiveness, cost-efficiency, the extent of the Hawthorne effect, and indirect cost-benefit of the two monitoring methods were compared.ResultsThe total cost spent on ESM for the 40 departments (17,702.92 CNY) was 4,123.76 CNY lower than that of MPM (21,826.68 CNY). The HHC of MPM (80.16%) was higher than that of ESM (69.82%) (p < 0.01). In high- and medium-risk departments, the cost-effectiveness ratio of ESM (7,977.90 CNY and 13,794.60 CNY, respectively) was lower than that of MPM (9,039.61 CNY and 14,549.05 CNY, respectively). In low-risk departments, the cost-effectiveness ratio of ESM (3,910.77 CNY) was higher than that of MPM (3,899.06 CNY). Compared with ESM, the incremental cost of MPM in all departments was 4,123.76 CNY, the incremental effectiveness was 10.34%, and the incremental cost-effectiveness ratio was 39,881.62 CNY. Between the two monitoring methods, the efficiency of ESM (48.11%) in all departments was higher than that of MPM (14.20%) (p < 0.01). The cost-efficiency ratio of MPM in all departments (155,775.56 CNY) was higher than that of ESM (36,796.76 CNY). The extent of Hawthorne effect of MPM of HHC in all departments (43.99%) was higher than that of ESM (35.69%) (p < 0.01). When ESM was used as the HHC monitoring approach, the HAI rates (1.39%) in all departments were higher than that when MPM was used (1.34%) (p = 0.562). When the payment willingness was less than 40,000 CNY, the ESM method was the better option for cost-effectiveness; When the input exceeded this threshold, the MPM method was the better option for cost-effectiveness.ConclusionsESM exhibited notable advantages over MPM in terms of cost-effectiveness, cost-efficiency, cost-benefit, and the Hawthorne effect.

A clinical trial evaluation of handwashing products and educational resources to improve hand hygiene in paediatric patients and school children.

It is widely acknowledged that good hand hygiene (HH) is an important non-pharmaceutical method for reducing the transmission of infectious diseases. Children are at high risk of infection due to their immature immune systems. Hospital transmitted infections are a cause for concern worldwide, with poor HH suggested to be responsible for up to 20% of cases. Patients, in particular paediatric patients, are often overlooked when it comes to the promotion of hand hygiene compliance (HHC) in hospitals. This report describes the clinical evaluation of the 'Soaper Stars'; a collection of child-friendly HH products with linked educational resource, developed using the COM-B approach to behaviour change, and designed to encourage correct HH in paediatric patients and in schools. The Soaper Star products were distributed on paediatric wards in five UK hospitals, and the use of the products around mealtimes was evaluated. Workshops teaching the 'why when and how' of handwashing were run in four UK primary schools with pre and post evaluations conducted to establish impact on knowledge. Over 300 children were involved. The Soaper Stars products stimulated a 38% increase in HHC compared to when only hospital-issued products were available, and verbal feedback from families indicated that having the Soaper Star products encouraged improved HHC by all visitors, not just the patient. Workshops in four schools (283 pupils) showed an increase in knowledge around the transmission of infection and the need for good HH that was sustained for at least 4 weeks. The results of this study demonstrate that providing children with the age-appropriate knowledge about why HH is necessary, and the child-friendly means to maintain their HH, will lead to greater HHC, not just by individual children, but also their families.

A Multimodal Interventional Strategy To Increase Hand Hygiene Compliance In Intensive Care Unit Of A Tertiary Care Hospital In South India

A Multimodal Interventional Strategy To Increase Hand Hygiene Compliance In Intensive Care Unit Of A Tertiary Care Hospital In South India

An agent-based modeling approach for infection prevention predesign: simulating the spread of pathogens between humans and the environment in an Intensive Care Unit

ABSTRACT This study aims to investigate infection prevention measures in healthcare environments, focusing on the role of surface materials and hand hygiene compliance. To address this goal, an Agent-Based Model was developed to examine the combined effects of human factors and environmental interventions on the transmission of three types of healthcare-associated bacteria in an Intensive Care Unit (ICU). The model evaluates five key prevention measures: surface material selection, daily and terminal cleaning, hand hygiene compliance, and the use of personal protective equipment (PPE). Hand hygiene was chosen as the primary variable for model validation due to the extensive computational and field research available in this area. It also serves as a bridge between material design and human factors in infection transmission risk. Simulation data were compiled from each run by gathering the average value for the number of infected patients and contaminated environment over different scenarios. After validating the model, patients infectivity and environmental contamination associated with commonly used surface materials; namely quartz, copper-impregnated surfaces, plastic laminate, and stainless steel; were assessed under two scenarios of baseline and enhanced hand hygiene compliance. The findings underscore the importance of surface material choices in healthcare settings, suggesting that the most effective infection control strategies combine improved hand hygiene practices with the strategic use of materials in areas prone to bacterial contamination. These insights advise healthcare designers to adopt strategies that integrate both behavioral interventions and environmental components to minimize the risk of contamination and pathogen spread within healthcare environments.

Clean hands are caring hands: Improving anesthesia provider hand hygiene and double-glove compliance during induction of general anesthesia

Hand hygiene and double gloving practices during induction of general anesthesia can decrease transmission of bacteria to patients and subsequent healthcare associated infections; however, compliance to these practices is low. A pre/post-implementation quality improvement design was used with Plan-Do-Study-Act cycles. Several implementation strategies were used to improve hand hygiene and double glove compliance among anesthesia providers, including printed educational materials, video, in-person, and virtual meetings, visual reminders, audit and feedback, and improved access to hand sanitizer dispensers in the anesthesia workstation. Average hand hygiene compliance increased from 0% to 11.8% and double gloving compliance increased from 18.5% to 34.5%. A decrease in surgical site infections was shown in the post-implementation period. Although hand hygiene and double gloving practices increased after the initial implementation, the improvements were not sustained long-term. Practices to support sustainability, such as routine booster sessions, may be considered. Incorporating these quality improvement measures into practice may improve anesthesia provider hand hygiene compliance during induction of general anesthesia and impact subsequent infection rates.

Clinical Effectiveness of a 3-Step Versus a 6-Step Hand Hygiene Technique: A Randomized Controlled Cross-over Study

Abstract Background The aim of this study is to assess the clinical effectiveness of the 3-step hand hygiene (HH) technique (3-HT) compared with the 6-step HH technique (6-HT; World Health Organization 6-step technique) using an alcohol-based hand rub. Methods A randomized controlled crossover trial was conducted from November to December 2023 in 10 wards of a tertiary A-level hospital according to CONSORT guidelines. The 240 healthcare workers (HCWs) were randomly divided into the 3-HT intervention group or the 6-HT control group. The trial was conducted in 2 stages, and the effectiveness of each indicator in the 2 groups was compared after a washout period of 2 weeks. Results Compared with the 6-HT, the 3-HT has demonstrated significant superiority in all indicators of HH compliance as well as the accuracy rate of HH practices. The total HH median times for the 3-HT and 6-HT were 16.00 (interquartile range, 15.00–20.00) and 32.50 (30.00–40.00) seconds, respectively (P &amp;lt; .05). The reduction factors for bacterial colony-forming unit counts did not differ and the colony-forming unit counts were not significantly different. Bacillus, Staphylococcus, and Micrococcus were detected before and after the use of hand rubs. HCWs preferred the 3-HT over the 6-HT. There were no significant difference in healthcare-associated infections rate between the 2 techniques. Conclusions The 3-HT was significantly superior to the 6-HT in terms of the HH eligibility rate, compliance, and HH time. The safety and feasibility of the 3-HT were verified by assessing microorganism count.

Evaluation of a Video-Based Concept for Hand Hygiene Education of Parents in a Neonatal Intensive Care Unit.

Current clinical guidelines support family-centered care in Neonatal Intensive Care Units (NICUs). This implies parents should also be involved in the most critical patient safety measures. Hand hygiene is the single most important tool to prevent healthcare-associated infections and related long-term effects. Although often studied in healthcare workers, the hand hygiene compliance of parents is rarely assessed. The aim of this study was to evaluate the effectiveness of an educational video, available in ten different languages, in teaching parents hand hygiene techniques in a NICU, lowering the burden on the staff. Parents in the intervention group were educated through a video; the control group received personal instruction from healthcare workers. The primary outcome parameter was the predicted probability of passing a subsequent hand scan. The quality of hand hygiene among parents educated through the video was at least as good as that of those who received instruction from a healthcare worker, demonstrated by a higher predicted probability of passing the hand scan (43.8% vs. 57.1% in male and 67.9% vs. 75.9% in female participants). The feedback from the intervention group was predominantly positive, with most parents (62%) expressing a preference for video-based education. Implementing a video-based approach seems to be effective for educating parents about hand hygiene in a NICU and was well accepted by the parents. This method offers a consistent standard of hand hygiene education, helps to overcome language barriers, and can also be used as regular reminder of the importance and proper technique of hand hygiene.

Impact of Direct Observation on Hand Hygiene Compliance in a Dental University Hospital: A Retrospective Cohort Study.

Introduction Hand hygiene is crucial for preventing healthcare-associated infections in dental settings. Despite its importance, the hand hygiene compliance rates remain unclear, particularly in dental university hospitals where teaching, research, and clinical practice intersect. This study aimed to establish a baseline of hand hygiene compliance rates in a dental university hospital, evaluate the effectiveness of direct observation in improving compliance, and compare practices among different categories of healthcare workers. Materials and methods This retrospective cohort study was conducted at Kanagawa Dental University Hospital from April 2022 to March 2023. The design included four blinded direct observations to establish baseline compliance rates, followed by educational training and four unannounced explicit observations. Compliance was assessed based on the World Health Organization's "Your 5 Moments for Hand Hygiene: Dental Care," adapted for dental outpatient services. The study focused on hand hygiene using alcohol-based hand sanitizers, and compliance rates were calculated for dentists, dental hygienists, dental assistants, and trainee dentists. Monthly consumption of hand sanitizer per patient was tracked from January 2019 as a secondary measure. Statistical analysis included Fisher's exact test, unpaired t-tests, and analysis of variance (ANOVA). Results The baseline hand hygiene compliance rate was low at 15.6%, with the highest compliance (25.0%) for "After touching patient surroundings." Post-intervention, the overall compliance rate increased significantly to 36.0% (p < 0.001). Significant improvements were observed in moments "After body fluid exposure risk" (11.1% to 31.3%, p = 0.004), "After touching a patient" (12.0% to 52.9%, p = 0.006), and "After touching patient surroundings" (25.0% to 73.3%, p = 0.001). Dental hygienists, assistants, and trainee dentists showed significant increases in hand hygiene compliance, while dentists did not. Hand sanitizer consumption increased significantly from 2019 (2.38 ± 0.29 mL per patient) to 2020 (3.47 ± 0.49 mL, p < 0.001) and remained elevated through 2023. Conclusions This study revealed low baseline hand hygiene compliance in a dental university hospital setting. While direct observation and education led to significant short-term improvements, especially among allied health professionals, the disconnect between observed compliance rates and hand sanitizer consumption suggests these changes may not represent sustainable behavioral shifts. The varying improvement rates among different healthcare workers and the challenges in maintaining long-term adherence highlight the need for tailored, continuous interventions in dental education and practice settings to enhance hand hygiene compliance.

Integration of an electronic hand hygiene auditing system with electronic health records using machine learning to predict hospital-acquired infection in a health care setting

Hospital-acquired infections (HAIs) increase morbidity, mortality, and healthcare costs. Effective hand hygiene (HH) is crucial for prevention, but achieving high compliance remains challenge. This study explores using machine learning to integrate an electronic HH auditing system with electronic health records to predict HAIs. A retrospective cohort study was conducted at a Brazilian hospital during 2017-2020. HH compliance was recorded electronically, and patient data were collected from electronic health records. The primary outcomes were HAIs per CDC/NHSN surveillance definitions. Machine learning algorithms, balanced with Random Over Sampling Examples (ROSE), were utilized for predictive modeling, including generalized linear models (GLM); generalized additive models for location, scale, and shape (GAMLSS); random forest; support vector machine; and extreme gradient boosting (XGboost). 125 of 6,253 patients (2%) developed HAIs and 920,489 HH opportunities (49.3% compliance) were analyzed. A direct correlation between HH compliance and HAIs was observed. The GLM algorithm with ROSE demonstrated superior performance, with 84.2% sensitivity, 82.9% specificity, and a 93% AUC. Integrating electronic HH auditing systems with electronic health records and using machine learning models can enhance infection control surveillance and predict patient outcomes. Further research is needed to validate these findings and integrate them into clinical practice.

Application of PDCA in improving hand hygiene compliance and nosocomial infection quality in orthopedics†

Abstract Objective To explore the effect of the Plan-Do-Check-Action (PDCA) cycle on hand hygiene and nosocomial infection quality of orthopedic medical staff. Methods The whole year of 2021 was selected to monitor the quality of hand hygiene and hospitalization. Follow-up monitoring and real-time recording during the period of morning shift and medical operation concentration time, and compare the compliance of hand hygiene before and after implementation, and evaluate the quality of nosocomial infection. Results The hand hygiene compliance of doctors and nurses in stage P was 82%. The compliance of medical staff in stage D was 93%. The compliance of stage C was 94% and that of stage A was 95%. The quality score of hospital self-examination nosocomial infection was also significantly increased. Conclusions The PDCA management cycle can effectively improve the compliance of hand hygiene and the nosocomial infection quality, which is worthy of circulatory application in orthopedic nosocomial infection quality control, especially improving the quality of hand hygiene.