Hand Hygiene Compliance Research Articles

Effectiveness of infection prevention and control interventions in health care facilities in Africa: A systematic review

Health care-associated infections (HAIs) are a major threat to patient safety and quality care. However, they are avoidable by implementing evidence-based infection prevention and control (IPC) measures. This review evaluated the evidence of the effectiveness of IPC interventions in reducing rates of HAIs in health care settings in Africa. We searched several databases: CENTRAL, EMBASE, PUBMED, CINAHL, WHO IRIS, and AJOL for primary studies reporting rates of the 4 most frequent HAIs: surgical site infections, central line--associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumoniae, and increase in hand hygiene compliance. Two reviewers appraised the studies and PRISMA guidelines were followed. Out of 4,624 studies identified from databases and additional sources, 15 studies were finally included in the review. Themajority of studies were of pre- and post-test study design. All the studies implemented a combination of interventions and not as stand-alone components. Across all included studies, an improvement was reported in at least 1primary outcome. Our review highlights the potential of IPC interventions in reducing HAIs and improving compliance with hand hygiene in health care facilities in Africa. For future research, we recommend more pragmatic study designs with improved methodological rigor.

QAPI 152 - Relaunch of Electronic Monitoring System to Sustain Hand Hygiene Opportunities and Compliance

QAPI 152 - Relaunch of Electronic Monitoring System to Sustain Hand Hygiene Opportunities and Compliance

QAPI 118 - Can Achieving High Hand Hygiene Compliance in the Hospital be Sustainable, Reliable, and Affordable?

QAPI 118 - Can Achieving High Hand Hygiene Compliance in the Hospital be Sustainable, Reliable, and Affordable?

Is there a relationship between nurses' hand hygiene beliefs, practices and ethical sensitivity?

BackgroundHand hygiene is the most important way to prevent health care-associated infections. It is important for all nurses that come in physical contact with patients the most to follow hand hygiene rules. AimThis study aimed to determine the relationship between nurses' hand hygiene beliefs and practices and their ethical sensitivity. MethodThis descriptive and cross-sectional study was conducted with nurses working in internal medicine, surgery and intensive care clinics of a university hospital between June and August 2022. A total of 350 nurses participated in the study. A Personal Information Form, the Ethical Sensitivity Questionnaire (ESQ), the Hand Hygiene Practice Inventory (HHPI), and the Hand Hygiene Beliefs Scale (HHBS) were used for data collection. ResultsFindings support that nurses have moderate ethical sensitivity (88.36 ± 26.33), good hand hygiene beliefs (85.60 ± 9.21) and practice (66.14 ± 5.90). Despite there being no statistical significance in evaluating the relationship between hand hygiene practice and ethical sensitivity (p = 0.253, r = −0.061), there was a statically significant inverse relationship between hand hygiene beliefs and ethical sensitivity (p = 0.001, r = −0.172). The hand hygiene compliance score of the nurses who received only ethics training after nursing school (p = 0.000); the hand hygiene belief (p = 0.011) and hand hygiene practice (p = 0.007) scores of those who received both ethics and hand hygiene training were higher. ConclusionsIt can be said that the ethical sensitivity of nurses does not affect their hand hygiene practices, and the hand hygiene and ethics education they receive after school education increases their hand hygiene beliefs and practices.

#1817 Decrease in hospital-acquired blood stream infection by using automated sensor technology to improve and keep a high level of hand hygiene compliance

Abstract Background and Aims Hospital-acquired infection (HAIs) is a problem for 6-8% of hospitalized patients. HAIs has personal costs, prolongs the hospital stay, increasing the risk of morbidity, mortality, time and staff consuming. Hand hygiene (HH) is essential for preventing infections. World Health Organization (WHO) recommends hand hygiene compliance (HHC) as a key performance indicator. Manual observations of HHC are time consuming and may affect compliance by the physical presence of the observers (Hawthorne effect). There is a need to identify the most effective long-term intervention to improve HHC and reduce HAI. The Danish Ministry of Health have chosen blood stream infections (HA-BSI) as a national indicator for the overall risk of HAIs expecting an incidence of no more than 8 cases per 10,000 patient days. The aim of the present study was to examine the use of an automated sensor technology to improve HHC and prevent HAIs in an inpatient department for nephrology and intern medicine. Nephrology patients have a high number of invasive catheters, which may increases the risk of HAI. Method The study comprised a 2 year cohort with no specific HHC interventions (July 2018-June 2020), a baseline period (February 2020-June 2020) to investigate HHC level by an electronic hand hygiene measuring system (EHHMS) without ongoing HHC interventions followed by a 3 year cohort period (July 2020-June 2023) with various EHHMS-based feedback interventions to staff. Intervention consisted primarily of group feedback and later individual feedback. All caregivers and doctors carried an anonymous Sani ID tag (Sani Nudge, DK) fixed to their nametag throughout the study period. EHHMS-based Sani Sensors were located in designated locations in the clinical department with the purpose of continuously capturing the caregiver patient contact including staff use of liquid alcohol based hand rub (ABHR). In Denmark, the national hygiene guidelines also require that ABHR follow hand wash. Local hygiene mentors regularly presented anonymous group data on boards and in letters to the staff. Soon after there was a demand on individual data, which was then added by individual results forwarded in a personal email every week. HA-BSI was defined as the presence of a pathogen in the blood and the prescription of an appropriate concomitant antimicrobial treatment and classified as hospital-acquired if the patient has been hospitalized for >48 hours. Data were obtained from various electronic health care systems in the hospital. Results We collected HHC data by monitoring 203 caregivers and 50 doctors for a period of 40 months. Caregivers HHC improved after implementation of an electronic hand hygiene measuring system from baseline to group feedback and finally individual feedback (39% vs 50% vs 71%). For doctors, the improvement from baseline to group feedback and finally individual feedback was 30% vs. 32% vs 52%. The overall improvement curve reached a stable plateau after 20 months. An incidence rate of 14 HA-BSI cases per 10,000 patient days during a previous two years control period (95% CI 8.8-21.2) was during the intervention period markedly reduced to 5 HA-BSI cases per 10,000 patient days (95% CI 2.3-9.0). This difference was statistically significant, P = 0.004. Conclusion The use and feedback of the electronic hand hygiene monitoring system improved successfully hand hygiene compliance in the groups of both caregivers, doctors, and furthermore reduced the rate of HA-BSI significantly. We observed a significant stepwise increase in compliance after group feedback data and later after reporting individual data. There continue to be a need to find effective long-term interventions to improve and keep a high level of hand hygiene compliance and a sustained reduction in hospital-acquired bloodstream infection.

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.

Assessment of Post-Covid-19 Hand Hygiene Compliance Among Nigeria Certificate in Education Biology Students in Zaria, Nigeria

This study titled Assessment of post-COVID-19 hand hygiene compliance among Nigeria Certificate in Education Biology Students in Zaria, Nigeria was a cross-sectional survey work. The study was guided by three research questions and three research objectives. Three hundred forty-six (346) NCE biology students were chosen at random from a population of three thousand four hundred and forty-one using the random sampling technique. The data collection instrument was a structured questionnaire titled "Students Hand-Hygiene Compliance Questionnaire (SHCQ)" which underwent validation by two science education experts from Ahmadu Bello University, Zaria. Split-half method was adopted to determine reliability which gave the reliability coefficient value of 0.77 with Spearman rank statistics. The researchers administered the instrument to respondents over two weeks. The mean and standard deviation were used to analyse the gathered data. According to the results, the College established hand hygiene compliance during the COVID-19 era (X = 4.00, S.D. = 1.20); NCE Biology students in Zaria had low levels of post-COVID-19 hand hygiene compliance (X = 2.80, S.D. = 1.02); and there weren't many obstacles to post-COVID-19 hand hygiene compliance (X = 3.74, S.D. = 1.08). Recommendations among others include: the College management should continue to prioritize and reinforce a robust infrastructure for handwashing facilities, ensure the availability of soap and sanitizers, and conduct regular educational campaigns on proper hand hygiene practices.

Knowledge, Attitudes, and Practices of Undergraduate Dental Students About Sterilization, Disinfection, and Infection Control: A Questionnaire-Based Study.

The core of infection control in dental settings involves minimizing potential cross-infection risks between patients and from patients to other workers in health care. Infection control is important for promoting enhanced adherence to protocols through sterilization, disinfection, and infection control knowledge, attitudes, and practices (KAP) among undergraduate dental students. A cross-sectional survey among 222 undergraduates of Dental Students and Interns of the Dental Institute, Rajendra Institute of Medical Sciences, Ranchi, India, was conducted. KAP of participants related to sterilization and disinfection were assessed before and after educational lectures using a pre-fabricated questionnaire. All 182 respondents considered the importance of sterilization and disinfection during the dental procedure. While 98.8% had adequate knowledge about isolation and immunization, only 3.8% were vaccinated against hepatitis B virus (HBV). They were perfect in hand hygiene compliance (100%) and awareness regarding autoclave sterilization stood at 78.8%. Mean KAP scores were 7.03 ± 1.39, 10.15 ± 1.40, and 9. The undergraduate dental students showed a high level of awareness but wide gaps between practice and attitude of sterilization protocols. Therefore, there is a need for interventions that could bridge the theory-practice gap to improve adherence to infection control measures.

A Quality Improvement Project to Increase Infection Control Compliance Among Endoscopy Staff at a Large Urban Medical Center

Although nurses and other healthcare professionals play a key role in preventing hospital-associated infections, studies show that infection control compliance rates have remained low. The purpose of this quality improvement project was to increase infection control compliance of hand hygiene and procedure room disinfection among endoscopy staff at a large urban medical center in Cincinnati, Ohio. This quality improvement project provided an education session on current evidence-based infection control guidelines to 20 participants, including registered nurses and technicians within the endoscopy department. Direct observational audits were conducted 4 weeks before and 4 weeks after the education session, measuring compliance with hand sanitizer, soap and water, and procedure room disinfection, over a period of 150 days. The project goals were met, as hand sanitizer compliance improved by 12%–83%; overall soap and water compliance improved by 20%–75%; and endoscopy procedure room disinfection compliance improved by 14%–92%.

Relationship between Knowledge Level and Hand Hygiene Compliance among Nurses at Kudungga Sangatta Regional Hospital

Hand hygiene is an effective step to break the chain of infection transmission. Root cause analysis shows that the knowledge factor is a determinant of hand hygiene compliance behavior. Knowledge of correct hand hygiene can provide protection against cross-contamination of diseases from one patient to another. The aim is to determine the relationship between knowledge level and hand hygiene compliance among nurses at Kudungga Regional Hospital. This type of quantitative research uses cross-sectional methods. The population in this study was 185 nurses at Kudungga Regional Hospital. Sample of 185 people/ The test results obtained a p-value = 0.000 (<0.05) with an odds ratio = 8.509. There is a relationship between the level of knowledge and hand hygiene compliance among nurses at Kudungga Sangatta Regional Hospital. It is hoped that the hospital will be able to improve the quality of service health to pay more attention to the risk of infection in the work environment.

Ten years of hand hygiene excellence: a summary of outcomes, and a comparison of indicators, from award-winning hospitals worldwide.

Hand hygiene is a crucial measure for the prevention of healthcare-associated infections (HAIs). The Hand Hygiene Excellence Award (HHEA) is an international programme acknowledging healthcare facilities for their leadership in implementing hand hygiene improvement programmes, including the World Health Organisation's Multimodal Improvement Strategy. This study aimed at summarising the results of the HHEA campaign between 2010 and 2021 and investigating the relationship between different hand hygiene parameters based on data from participating healthcare facilities. A retrospective analysis was performed on datasets from HHEA forms, including data on hand hygiene compliance, alcohol-based handrub (ABHR) consumption, and Hand Hygiene Self-Assessment Framework (HHSAF) scores. Descriptive statistics were reported for each variable. The correlation between variables was inspected through Kendall's test, while possible non-linear relationships between hand hygiene compliance, ABHR consumption and HHSAF scores were sought through the Locally Estimated Scatterplot Smoothing or logistic regression models. A tree-structured partitioning model was developed to further confirm the obtained findings. Ninety-seven healthcare facilities from 28 countries in three world regions (Asia-Pacific, Europe, Latin America) were awarded the HHEA and thus included in the analysis. HHSAF scores indicated an advanced hand hygiene promotion level (median 445 points, IQR 395-480). System change (100 [95-100] points) and institutional safety climate (85 [70-95] points) showed the highest and lowest score, respectively. In most cases, hand hygiene compliance was above 70%, with heterogeneity between countries. ABHR consumption above 20 millilitres per patient-day (ml/PD) was widely reported, with overall increasing trends. HHSAF scores were positively correlated with hand hygiene compliance (τ = 0.211, p = 0.007). We observed a positive correlation between compliance rates and ABHR consumption (τ = 0.193, p < 0.001), although the average predicted consumption was stable around 55-60ml/PD for compliance rates above 80-85%. Logistic regression and partitioning tree analyses revealed that higher HHSAF scores were more likely in the high-ABHR consumption group at cut-offs around 57-59ml/PD. Ten years after its inception, the HHEA proves to be a valuable hand hygiene improvement programme in healthcare facilities worldwide. Consistent results were provided by the different hand hygiene indicators and the HHSAF score represents a valuable proxy measure of hand hygiene compliance.

Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria

BackgroundSub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach.MethodsWe followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10–13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed.ResultsBased on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants.ConclusionsThrough dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities.

Implementatie van de Infectierisicoscan in een ziekenhuisnetwerk door het Hospital Outbreak Support Team

Implementation of the Infection Risk Scan in a hospital network by the Hospital Outbreak Support Team The Infection Risk Scan (IRIS) assesses the quality of infection prevention and control (IPC) and antimicrobial stewardship (AMS) in a hospital ward by the standardized measurement of a broad range of quality indicators. IRIS was implemented in the geriatric wards of the 4 hospitals of the Plexus healthcare network ‘Oost-Vlaams-Brabant’ (Belgium). The goal was to compare the IPC and AMS policies of the hospitals in order to define common improvement strategies within the Hospital Outbreak Support Team (HOST), a federal project concerning IPC and AMS. In the first part of IRIS, the risk profile of the patient population is determined by a point prevalence measurement of 4 variables. In the second part, the improvement plot is created based on the measurement of 7 quality indicators. Improvement actions can be deduced from quality indicators with higher improvement potentials. The risk profiles of the 4 hospitals were highly comparable and the improvement plots showed an intermediate to high improvement potential for the use of AMT and hand hygiene compliance. There were important differences in the appropriate use of transurethral and intravascular catheters, with 2 hospitals having a low and 2 hospitals having a high improvement potential. IRIS was a useful tool in the early phase of the HOST project to benchmark the IPC and AMT policies between the Plexus hospitals and to decide what future projects could be collaborated on. As a result of IRIS, it was decided to define common care bundles for the prevention of catheter-associated urinary tract and blood stream infections and to determine hospital-specific actions with regard to the optimisation of AMS.

Hand hygiene compliance in nursing home wards: The effects of feedback with lights on alcohol-based hand rub dispensers

Hand hygiene (HH) among healthcare workers (HCWs) is crucial in preventing infections in nursing homes. However, HH compliance (HHC) among HCWs remains low. This study aimed to investigate the effect of feedback lights on HCWs' HHC. A 5-month interventional study was conducted in 3 wards in a nursing home in Denmark. During the intervention period, a green light with a smiley appeared on the alcohol-based hand rub (ABHR) dispensers when HCWs used the ABHR, acknowledging HCWs for using the ABHR. HHC was monitored using an automatic HH monitoring system (AHHMS). A total of 64 HCWs were enrolled. The AHHMS collected 23,696 HH opportunities in apartments and dirty utility rooms. Overall, HHC in the apartments increased from 50% at baseline (95% CI: 48, 53) to 56% (95% CI: 54, 58) during the intervention. However, the increased HHC level was not sustained during follow-up. The AHHMS enabled the assessment of the intervention. We found a significant effect of light-guided feedback in the apartments. However, the increased HHC was not sustained after the light was switched off.

Compliance and adherence to hand hygiene practices for effective infection control.

Hand hygiene (HH) is the most effective way to curb the spread of healthcare-associated infections. Nonetheless, healthcare personnel encounter difficulties in adhering to WHO HH recommendations. This study aimed to investigate HH compliance and adherence after the implementation of an action plan in a municipal hospital in Moscow. An initial evaluation of HH compliance among clinical health workers was carried out in June 2022 according to the WHO HH guidelines followed by a 3-month re-audit of HH practices. The results were compared to the baseline to evaluate compliance and adherence to HH among healthcare personnel. From June to September 2022, there were 2,732 moments of contact with patients or their immediate surroundings. The HH total compliance rate significantly (p < 0.05) increased from 52.3% in June 2022 to 83.3% in September 2022 with a 75% overall total compliance rate. The profession-specific total compliance rate was highest among nurses (79.6%) and lowest among ancillary staff (69.7%). Staff were also more adherent to the before-moments compared to the after-moments of the HH guidelines. Monthly re-audits and providing feedback resulted in a significant improvement in compliance and adherence with HH guidelines after implementation of the action plan.

Analysis of Strategies to Improve Service Provider Hand Hygiene Compliance at Dono Tulungagung Community Health Center

The problem found at the Dono Tulungagung Community Health Center was a decrease in the hand hygiene compliance achievements of health service providers who did not meet the National Health Center Quality Indicator target of 85%. The aim of this research is to analyze strategies for increasing hand hygiene compliance achievements. This research uses a qualitative method with a descriptive analysis approach. Primary data was obtained through direct interviews with sources. The analysis uses fishbone diagrams to identify problems, the USG (Urgency, Seriousness, Growth) method to determine problem priorities and SWOT analysis (Strength, Weakness, Opportunity, Threat) to identify strategies in determining intervention plans. Based on the results of the fishbone, USG and SWOT analysis, the implementation strategy that can be implemented is to re-socialize hand hygiene material and the importance of maintaining hand hygiene compliance for all service providers at the Dono Tulungagung Community Health Center and updating posters on each sink wall as a reminder and instructions on how to wash hands correct.

Self-protective behaviors of Thai village health volunteers in community engagement during a COVID-19 outbreak: interpretation using the health belief model

BackgroundVillage health volunteers (VHVs) engaging in community-based COVID-19 prevention and control measures played a key role in mitigating effects of the COVID-19 pandemic in Thailand. We conducted a cross-sectional questionnaire survey study to investigate factors affecting VHVs’ COVID-19 self-protective behaviors and social distancing in Songkhla Province during the first COVID-19 outbreak. Such information may help to understand how to support VHVs in future pandemics.MethodsA total of 152 VHVs from 13 sub-districts participated in the study, completing a 54-item questionnaire based on the Health Belief Model (HBM). The questionnaire included items assessing susceptibility, severity, benefits, barriers, self-efficacy, social distancing, and self-protective behavior. Stepwise multiple regression analysis determined which aspects of the HBM could explain VHVs’ self-protective behavior.ResultsThe VHV population sampled broadly reflected the main demographic characteristics of the local population, although VHVs were predominantly female. Self-protective behavior was significantly associated with VHVs’ role (higher perceived compliance for village leaders than non-leaders) but not with other demographic characteristics. Most VHVs reported high levels of self-efficacy (80.5%), adherence to social distancing measures (70.9%), and engagement in self-protective behavior (72.8%) against COVID-19. However, compliance with hand hygiene appeared to be suboptimal, suggesting room for improvement. Self-efficacy and perceived social distancing showed strong and moderate correlations with self-protective behavior against COVID-19 (r = 0.917, β = 0.819; and r = 0.561, β = 0.173 respectively; p < 0.001). The final HBM-based regression model accounted for 87.2% of the variance in VHVs’ self-protective behavior.ConclusionsThis study highlights the importance of VHVs’ self-efficacy for achieving self-protective behavior during a COVID-19 outbreak, and suggests that self-efficacy may help to overcome barriers that might otherwise hinder behaviors to mitigate against COVID-19. Policies that support self-efficacy should be implemented in any future pandemic, and steps to support VHVs with hand hygiene compliance and empower non-leaders to increase their self-protective behavior may also be helpful. Whilst the HBM provided a useful framework for interpretation, the final model was driven mainly by self-efficacy.

Application of PDCA Cycle in Hand Hygiene Management of Psychiatric Medical Staff

Objective: To study the application effect of the plan-do-check-act (PDCA) cycle management in the hand hygiene management of psychiatric medical staff. Methods: One hundred and twenty medical staff from a psychiatric hospital from May 2023 to December 2023 were selected and divided into two groups. The control group (May 2023 to August 2023) applied the conventional management model, and the observation group (September 2023 to December 2023) applied the PDCA cycle management. The hand hygiene compliance, hand hygiene knowledge, and hygiene qualifications were compared, including the amount of hand sanitizer used. Results: The proportion of medical staff’s hand hygiene compliance and hand hygiene knowledge mastery scores in the observation group were higher than those in the control group (P &lt; 0.05); the hand hygiene passing rate in the observation group was higher than that of the control group (P &lt; 0.05); the daily amount of hand sanitizer per patient bed and the amount of hand sanitizer used was higher than that of the control group (P &lt; 0.05). Conclusion: The PDCA cycle management model for psychiatric medical staff promoted the improvement of hand hygiene compliance and increased their hand hygiene qualifications. It is suitable for further popularization and application in future clinical practice.

Hand hygiene compliance in nursing home wards: the effect of increased accessibility of alcohol-based hand rub

Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission. To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs). An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period. A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30-32). A significant+18% absolute immediate effect (first five months) (95% CI: 17-19; P < 0.0001) and+13 percentage points (95% CI: 11-14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean+27 percentage point difference (P < 0.0001). Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential.

Examining the impact and response to an outbreak of carbapenemase-producing Enterobacterales in a neonatal unit in the United Kingdom: An outbreak report.

Carbapenemase-producing Enterobacterales (CPE) are a group of Gram-negative bacteria causing global concern due to their resistance to carbapenems. In this report, we detail the learning points from a CPE outbreak in a tertiary neonatal unit (NU) in the UK. Routine surveillance screening (rectal swabs) of babies on the NU identified a potential cluster of CPE carriage. Samples were sent to a reference laboratory for confirmatory testing. Environmental screening and cot mapping were undertaken to determine movements of babies within the unit. Regular audits of cleaning standards, hand hygiene, and maternal hygiene when expressing breast milk were carried out. The outbreak lasted 19weeks. During the outbreak, there were 360 admissions, with 11 babies being colonised with the outbreak strain. Once the outbreak was declared, there were enhanced Infection Prevention and Control (IPC) precautions (including increased environmental and equipment cleaning frequency). CPE screening frequency was increased and cot capacity was reduced. Hand hygiene compliance improved from 92% at the start of the outbreak to 100% by its close. Cleaning standards remained compliant. Maternal hygiene standards varied from 78% to 100%, but no cross-infection links were identified. Environmental screening was negative. No route of cross-infection was identified. Notably, no babies developed invasive CPE infection. This is the first report of a CPE outbreak in a UK NU. Although no specific mode of cross-transmission was identified and the outbreak's end cannot be attributed to any single intervention, the bundle of interventions proved successful after a 5-month period.