Hand Hygiene Guidelines Research Articles

Comparison of Hand Hygiene Adherence Rate before and after Training in a Multispecialty Hospital, Gujarat, India

Introduction: The most effective way to break the chain of transmission of infection in healthcare facility is Hand Hygiene (HH). However, the HH adherence rate/compliance is varying worldwide. Healthcare facilities should follow comprehensive, systematic approach for assessment of HH adherence rate. Periodic monitoring and necessary feedback is critical to improve HH adherence rate/compliance. Aim: To know the impact of the HH training of Healthcare Workers (HCW) on HH adherence rate. Materials and Methods: This prospective study was conducted at SMS Multispecialty Hospital, Ahmedabad, Gujarat, India. The study was conducted for the duration of six months (October 2019-March 2020). Total 416 opportunities were accessed in two sessions {203 pretraining and 213 post-training} among different HCWs of ICU and NICU. HH adherence rate was measured by direct observation methods by trained, non participating neutral person as per World Health Organisation (WHO) HH guidelines. HH training was given to HCWs (doctors, nursing staff and attendant) of Intensive Care Unit (ICU) and Neonatal Intensive Care Unit (NICU). Pre and post-training HH adherence rate was calculated among HCWs of ICU and NICU in respect to WHO’s five movement of HH. Chi-square test was used to do statistical analysis. Results: Pre and post-training HH adherence rate of HCWs of ICU is 41% and 69% respectively. However, pre and post- training HH adherence rate of HCWs of NICU was 52% and 75%, respectively. Both ICU and NICU post-training HH adherence rate of HCWs was improved which was statistically significant (p-value <0.00001). Both pre and post-training, compared to doctors, nursing staff had better HH adherence rate (45%, 67% in ICU and 58% and 78% in NICU). Hand rub was preferred method of HH (93%). Conclusion: The HH training improved the HH adherence rate of HCWs of ICU and NICU. Induction and periodic training of HCWs improves HH adherence rate of HCWs.

Knowledge and attitude of dental professionals toward COVID-19 in Riyadh, Saudi Arabia: a cross-sectional survey.

Coronavirus disease-2019 (COVID-19) is a life-threatening global pandemic. The dental profession is considered a high-risk group in the transmission of the responsible virus. To assess the knowledge and attitude among dental professionals in response to the COVID-19 pandemic. We conducted a cross-sectional study of dental graduates, interns, postgraduates, and dental faculty from May to July 2020. A standardized questionnaire was developed to assess knowledge and attitude of 650 participants. The questionnaire comprised 14 questions to assess general knowledge about COVID-19, 11 questions regarding knowledge about prevention of COVID-19 in dental practice, and 10 questions regarding the attitude toward preventing COVID-19. Among the study population, only 376 (57.8%) knew the causative virus for COVID-19. Only 425 (65.3%) knew about rinsing the mouth with an antimicrobial solution or 1% hydrogen peroxide before the dental procedure. Regarding the hand hygiene guidelines, 357 (54.9%) had knowledge of the Centers for Disease Control and Prevention (CDC) and 377 (58.0%) about World Health Organization (WHO) guidelines. At the time of our survey, 72% of the participants showed sufficient knowledge, while 28% had low or insufficient knowledge about COVID-19. While there was a lack of knowledge among dental professionals in Riyadh, Saudi Arabia about COVID-19, there was an excellent positive attitude toward preventing disease. Greater awareness is needed to control the spread of this disease.

Examining the Importance of Hand Hygiene Policy and Patient Safety Culture on Improving Healthcare Workers' Adherence to Hand Hygiene Practice in Critical Care Settings in the Sultanate of Oman: A Scoping Review.

Several studies suggest that adherence to hand hygiene (HH) policy would be enhanced by improving the culture of safety in an organization. This could be achieved through continuous awareness programs about the dramatic effect of HH practice according to the HH policy on improving patient safety and quality care. Understanding the importance and purposes of HH policy by healthcare workers would allow them to prioritize HH policy in their planning. Therefore, healthcare leaders should be responsible and accountable for strengthening their healthcare system by improving infrastructure, providing adequate support and resources, providing comprehensive monitoring and evaluation of patient safety initiatives, monitoring adherence to the regional Gulf Cooperation Council (GCC) and local Oman HH policy and using World Health Organization (WHO) guidelines for patient safety and HH as a basis for providing safer care. This should involve HH policy as a basic and mandatory program during an internship or in new staff orientation programs, spending enough resources on conducting more research studies and benchmarking findings with other international countries or any other organization such as WHO or Centres for Disease Control (CDC). The development of an HH policy at three different levels, macro, meso, and micro, is discussed in this article. In this sense, patient safety and quality care are the most important issues when adopting any policy.

Utilizing the SEIPS model to guide hand hygiene interventions at a tertiary hospital in Ethiopia.

We aimed to apply the Systems Engineering Initiative for Patient Safety (SEIPS) model to increase effectiveness and sustainability of the World Health Organization's (WHOs) hand hygiene (HH) guidelines within healthcare systems. Our cross-sectional, mixed-methods study took place at Jimma University Medical Center (JUMC), a tertiary care hospital in Jimma, Ethiopia, between November 2018 and August 2020 and consisted of three phases: baseline assessment, intervention, and follow-up assessment. We conducted questionnaires addressing HH knowledge and attitudes, interviews to identify HH barriers and facilitators within the SEIPS framework, and observations at the WHO's 5 moments of HH amongst healthcare workers (HCWs) at JUMC. We then implemented HH interventions based on WHO guidelines and results from our baseline assessment. Follow-up HH observations were conducted months later during the Covid-19 pandemic. 250 HCWs completed questionnaires with an average knowledge score of 61.4% and attitude scores indicating agreement that HH promotes patient safety. Interview participants cited multiple barriers to HH including shortages and location of HH materials, inadequate training, minimal Infection Prevention Control team presence, and high workload. We found an overall baseline HH compliance rate of 9.4% and a follow-up compliance rate of 72.1%. Drastically higher follow-up compared to baseline compliance rates were likely impacted by our HH interventions and Covid-19. HCWs showed motivation for patient safety despite low HH knowledge. Utilizing the SEIPS model helped identify institution-specific barriers that informed targeted interventions beyond WHO guidelines aimed at increasing effectiveness and sustainability of HH efforts.

Hand Hygiene and Mask-Wearing Practices during COVID-19 among Healthcare Workers: Misinformation as a Predictor.

ABSTRACT.Poor public health information is a hurdle in infectious disease control. The study aims to examine whether healthcare workers adhere to hand hygiene and mask-wearing guidelines during the COVID-19 pandemic and to explore their exposure to misinformation about the pandemic as a predictor. A cross-sectional survey was sent to 518 healthcare workers across Indonesia, the fourth largest nation in the world, in September 2020 during the COVID-19 pandemic. The respondents reported whether they adhered to the guidelines of hand hygiene and mask wearing and whether they believed in four pieces of misinformation about the origin, severity, contagion, and prevention of COVID-19. The association between misinformation and hand hygiene and mask wearing was tested with logistic regression models controlling for demographic and health-related covariates. Approximately 25% of healthcare workers did not always adhere to hand hygiene guidelines and approximately 5% did not adhere to mask-wearing guidelines. There are significant associations between all four pieces of misinformation and hand hygiene and mask wearing. It is important to improve public health information about COVID-19, which may hold key to healthcare workers’ hand hygiene and mask wearing and to protect their health and patients’ safety.

Nurses’ views on and compliance with the guidelines of hand hygiene, including nail hygiene in a multi-profile hospital in Lesser Poland Province – the evidence for need of continuous education and training

Abstract Aim. The aim of this study was to examine the current situation and potential needs for education aiming at improving Polish nurses’ views and attitudes in terms of compliance with hand hygiene guidelines. Material and methods. The study was based on a diagnostic survey method. A questionnaire based study and also visual evaluation of the nurses’ nails was carried out as well. Results. Our results reveal unsatisfactory nurses’ attitudes and compliance with the given area of hand hygiene recommendations. Especially, despite the nurses’ strong support for natural nails, in practice they did not always comply with the guidelines. Conclusions. It is necessary to develop and implement effective strategies of continuing education and training aiming at changing habits of healthcare workers, including nurses, in hand hygiene.

Practical challenges in following hand hygiene guidelines during the COVID-19 pandemic: an Indian perspective

Promoting good hygiene is one of the most basic and efficient tools that all countries must continue to adopt throughout the COVID-19 pandemic. COVID-19 has spread far and wide with basically no locale left unblemished. The speed of the spread and the disturbing demise rates have seen numerous nations and wards acquaint measures with forestalling the spread of COVID‐19, and hand washing highlight firmly in these. Hand washing has gotten extensive consideration during the COVID‐19 pandemic. It is a basic, essential preventive measure that a great many people can do freely. However, in India, the specific issues hamper compelling hand washing. This article will mention to us what are the issues confronted and how we can improve in these viewpoints.

Scientific Evidence Supports the Use of Alcohol-Based Hand Sanitizers as an Effective Alternative to Hand Washing in Retail Food and Food Service Settings When Heavy Soiling Is Not Present on Hands

Suboptimal food worker health and hygiene has been a common contributing factor in foodborne disease outbreaks for many years. Despite clear U.S. Food and Drug Administration (FDA) Model Food Code recommendations for hand washing and glove use, food worker compliance with hand washing recommendations has remained poor for >20 years. Food workers' compliance with recommended hand washing guidelines is adversely impacted by a number of barriers, including complaints of time pressure, inadequate number and/or location of hand washing sinks and hand washing supplies, lack of food knowledge and training regarding hand washing, the belief that wearing gloves obviates the need for hand washing, insufficient management commitment, and adverse skin effects caused by frequent hand washing. Although many of the issues related to poor hand washing practices in food service facilities are the same as those in health care settings, a new approach to health care hand hygiene was deemed necessary >15 years ago due to persistently low compliance rates among health care personnel. Evidence-based hand hygiene guidelines for health care settings were published by both the Centers for Disease Control and Prevention in 2002 and by the World Health Organization in 2009. Despite similar low hand washing compliance rates among retail food establishment workers, no changes in the Food Code guidelines for hand washing have been made since 2001. In direct contrast to health care settings, where frequent use of alcohol-based hand sanitizers (ABHSs) in lieu of hand washing has improved hand hygiene compliance rates and reduced infections, the Food Code continues to permit the use of ABHSs only after hands have been washed with soap and water. This article provides clear evidence to support modifying the FDA Model Food Code to allow the use of ABHSs as an acceptable alternative to hand washing in situations where heavy soiling is not present. Emphasis on the importance of hand washing when hands are heavily soiled and appropriate use of gloves is still indicated.

A large-scale investigation of alcohol-based handrub (ABHR) volume: hand coverage correlations utilizing an innovative quantitative evaluation system

BackgroundCurrent hand hygiene guidelines do not provide recommendations on a specific volume for the clinical hand rubbing procedure. According to recent studies volume should be adjusted in order to achieve complete coverage. However, hand size is a parameter that highly influences the hand coverage quality when using alcohol-based handrubs (ABHR). The purpose of this study was to establish a quantitative correlation between applied ABHR volume and achieved hand coverage.MethodABHR based hand hygiene events were evaluated utilizing a digital health device, the Semmelweis hand hygiene system with respect to coverage achieved on the skin surface. Medical students and surgical residents (N = 356) were randomly selected and given predetermined ABHR volumes. Additionally, hand sizes were calculated using specialized software developed for this purpose. Drying time, ABHR volume awareness, as well spillage awareness were documented for each hand hygiene event.ResultsHand coverage achieved during a hand hygiene event strongly depends on the applied ABHR volume. At a 1 ml dose, the uncovered hand area was approximately 7.10%, at 2 ml it decreased to 1.68%, and at 3 ml it further decreased to 1.02%. The achieved coverage is strongly correlated to hand size, nevertheless, a 3 ml applied volume proved sufficient for most hand hygiene events (84%). When applying a lower amount of ABHR (1.5 ml), even people with smaller hands failed to cover their entire hand surface. Furthermore, a 3 ml volume requires more than the guideline prescribed 20–30 s to dry. In addition, results suggest that drying time is not only affected by hand size, but perhaps other factors may be involved as well (e.g., skin temperature and degree of hydration). ABHR volumes of 3.5 ml or more were inefficient, as the disinfectant spilled while the additional rubbing time did not improve hand coverage.ConclusionsHand sizes differ a lot among HCWs. After objectively measuring participants, the surface of the smallest hand was just over half compared to the largest hand (259 cm2 and 498 cm2, respectively). While a 3 ml ABHR volume is reasonable for medium-size hands, the need for an optimized volume of handrub for each individual is critical, as it offers several advantages. Not only it can ensure adequate hand hygiene quality, but also prevent unnecessary costs. Bluntly increasing the volume also increases spillage and therefore waste of disinfectant in the case of smaller hands. In addition, adherence could potentially decrease due to the required longer drying time, therefore, adjusting the dosage according to hand size may also increase the overall hand hygiene compliance.

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

Impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among healthcare workers of an intensive care unit: a quasi-experimental study

Background/objectiveAfter wearing powdered gloves, healthcare workers (HCW) are supposed to wash their hands instead of using alcohol-based hand-rub (ABHR). Washing hands takes longer than using ABHR, and the use of powdered gloves may be an obstacle to hand-hygiene compliance. This study aimed to evaluate the impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among HCW of an intensive care unit (ICU).MethodsA quasi-experimental study was conducted in a general ICU of a tertiary care university hospital in Brazil. From June 1st to July 15th, 2017, all HCW were provided with powdered latex gloves only for all clinical procedures. From July 15th to August 31st, 2017, HCW were provided with nitrile powder-free gloves only. Hand-hygiene compliance was assessed through direct observation, and evaluated according to the World Health Organization Hand Hygiene guidelines. We calculated that a sample size of 544 hand hygiene opportunities needed to be observed per period. Data analysis were performed using the STATA SE® version 14, and we compared the individual’s percentage of compliance using the t test for paired data before and after the intervention.ResultsOverall, 40 HCW were assessed before and after the introduction of nitrile powder-free gloves, with 1114 and 1139 observations of hand hygiene opportunities, respectively. The proportion of compliance with hand hygiene was 55% (95% confidence interval [CI] 51–59%) using powdered latex gloves and 60% (95% CI 57–63%) using powder-free gloves. The difference in proportions between the two types of gloves was 5.1% (95% CI 2.5–7.6%, p < 0.001).ConclusionOur data indicate that replacing powdered gloves with powder-free gloves positively influenced hand-hygiene compliance by HCW in an ICU setting.

856. Assessment of Hand Hygiene amongst Health Care Professionals at Jimma University Medical Center

BackgroundLack of hand hygiene (HH) amongst healthcare workers (HCWs) contributes to healthcare associated infections and the spread of multidrug-resistant organisms. We assessed HCW HH knowledge, attitudes, and compliance using WHO tools and applied the Systems Engineering Initiative for Patient Safety (SEIPS) model in interviews to help guide and increase sustainability of HH interventions.MethodsWe conducted a cross-sectional study at Jimma University Medical Center (JUMC) in Jimma, Ethiopia. We assessed HCW’s HH knowledge and attitudes using questionnaires adapted from WHO resources via systematic sampling. Observations of HH practices at WHO’s 5 Moments of HH were conducted by non-identified, trained observers via systematic sampling. 22 semi-structured interviews were conducted via convenience sampling with HCWs using an interview guide based on the SEIPS model.ResultsWe observed 1,386 HH moments and found a compliance rate of 9.38%, with compliance highest after contact with patient surroundings (27.92%) compared to the other four HH moments (1.77 - 9.57%). Of 251 survey participants, 13.6% had prior HH training and 69.9% reported routine HH compliance. The average knowledge score was 61.4%, with no significant difference between participants that identified as trained vs untrained (p=0.41). 68% of interview participants stated they were unaware of JUMC’s Infection Prevention and Control (IPC) team and are more likely to perform HH if a patient appears infectious. Interview participants cited multiple barriers to HH (table 1).Table 1 ConclusionBaseline HH compliance and knowledge were low despite perceived compliance and regardless of prior HH training. Relatively higher compliance after patient contact may be due to perceptions of patient infectiousness. Utilizing the SEIPS model as an adjunct to WHO HH guidelines has provided actionable items upon which the JUMC IPC team can focus to improve HH practices: providing a sustainable supply of alcohol hand rub, ongoing HH education targeting knowledge deficits, and enhanced IPC presence and HH monitoring.DisclosuresMeredith Kavalier, MD, University of Wisconsin-Madison Global Health Institute (Grant/Research Support)

Knowledge and perceptions towards COVID-19 among final year undergraduate medical students and interns in Province 2, Nepal

Introduction: Corona Virus Disease-19, the COVID-19, has become a pandemic of public health concern, more so for developing countries like Nepal with an inadequate and vulnerable health system. Among all the seven provinces of the country, Province-2 seems to be at higher risk due to population density and open porous border with neighboring India. This survey was conducted among the undergraduate medical students of medical colleges in Province-2, Nepal to evaluate their knowledge and perception regarding the prevention and spread of the virus.&#x0D; Method: A descriptive cross-sectional study was conducted in September 2020 among final-year undergraduate medical students and interns from Janaki Medical College in Janakpur and National Medical College in Birgunj of Province-2, Nepal. A structured 30-item questionnaire containing demographics (5 items), knowledge (15 items), and perception (10 items) regarding COVID-19 was used for an online survey via email. Ethical approval was taken. Descriptive analysis was performed.&#x0D; Result: A total of 200 out of 250 respondents (&gt;95%) had an adequate level of knowledge on etiology, symptoms, hand hygiene, severity, vulnerability, precautionary measures, and treatment guidelines of COVID-19. More than 80% were ready to work in the hospital during the pandemic with support from their family and nearly half of them (49%) perceived that the preparedness and supplies were sufficient in their institutions.&#x0D; Conclusion: The survey revealed that the majority of the final-year medical students and interns in Province-2 Nepal had adequate knowledge and perception regarding COVID-19.

A Practical Guide to Using Time-and-Motion Methods to Monitor Compliance With Hand Hygiene Guidelines: Experience From Tanzanian Labor Wards.

Good-quality evidence on hand hygiene compliance among birth attendants in low-resource labor wards is limited. The World Health Organization Hand Hygiene Observation Form is widely used for directly observing behaviors, but it does not support capturing complex patterns of behavior. We developed the HANDS at Birth tool for direct observational studies of complex patterns of hand rubbing/washing, glove use, recontamination, and their determinants among birth attendants. Understanding these behaviors is particularly critical in wards with variable patient volumes or unpredictable patient complications, such as emergency departments, operating wards, or triage and isolation wards during epidemics. Here we provide detailed information on the design and implementation of the HANDS at Birth tool, with a particular focus on low-resource settings. We developed the HANDS at Birth tool from available guidelines, unstructured observation, and iterative refinement based on consultation with collaborators and pilot results. We designed the tool with WOMBAT software, which supports collecting multidimensional time-and-motion data. Our analysis of the tool's performance centered on interobserver agreement and convergent validity and the implications of the data structure for data analysis. The HANDS at Birth tool encompasses various hand actions and context-relevant information. Hand actions include procedures relevant during labor and delivery; hand hygiene or glove actions; and other types of touch. During field implementation, we used the tool for continuous observation of the birth attendant. Interobserver agreement was good (kappa range: 0.7-0.9), and the tool showed convergent validity. Using the HANDS at Birth tool is a feasible way to obtain useful information about compliance with hand hygiene procedures. The tool could be used after simple training and allows for collection of reliable information about the complex pattern of hygiene behaviors. Future studies should explore using this tool to observe behavior in labor wards in other settings and in other types of wards.

The Effect of Automated Hand Hygiene Monitoring Systems and Other Complementary Behavior-Change Strategies on Performance

Background: Technology and interest for use of automated hand hygiene monitoring systems (AHHMS) as a tool to help improve healthcare personnel hand hygiene has been advancing for the last decade. Emerging evidence indicates that the use of AHHMS plus complementary strategies improves hand hygiene (HH) performance rates and outcomes (eg, healthcare-associated infections). The WHO HH guideline “Multimodal Strategy” teaches the importance of multiple components as necessary to build and sustain HH compliance. Few published data compare the impact of different complementary behavioral strategies in combination with AHHMS on results. Methods: We utilized data from 1 AHHMS that records alcohol-based hand rub and soap dispensing and room entries and exits to provide group HH performance rates. Data were collected from 58 units in 10 hospitals in North America from July 2014 through August 2019. Hospitals were stratified into 4 categories based on their approach to hospital-initiated unit-level interventions and AHHMS vendor support (Table 1). Baseline data were defined for each unit as the initial 1–2 months of execution, before complementary strategies were initiated. Statistical analysis was performed on the annual number of dispenses and opportunities with a mixed-effects Poisson regression with random effects for facility, unit and year and fixed effects for intervention type and unit type. Interactions were not included in the model based on interaction plots and significance tests. Poisson assumptions were verified with Pearson residual plots. Results: HH performance rates overall and compared to the baseline are shown in Table 2. More than 8 million opportunities were achieved in all 58 units combined. An intervention strategy with multiple complementary components (ie, clinical support provided by the AHHMS vendor plus hospital-initiated unit level interventions) yielded significantly better HH performance than all other categories (&gt;20% increase, P &lt; .00001). Somewhat surprisingly, vendor clinical support or hospital-initiated, unit-level interventions alone with the AHHMS yielded a slight decrease in HH performance relative to AHHMS only (P &lt; .00001). Conclusions: AHHMS is a useful tool in understanding HH performance and identifying unit-based initiatives that need attention. Implementation of an AHHMS by itself or with limited complementary behavior-change strategies does not drive improvement. Support provided by the vendor and hospital-initiated, complementary strategies were not sufficient additions to the AHHMS individually, but in combination they resulted in the greatest improvements in HH performance. These findings illustrate the value of a partnership between the hospital and the AHHMS vendor.Funding: GOJO Industries, Inc., provided support for this study.Disclosures: James W. Arbogast, Lori D. Moore and Megan DiGiorgio report salary from GOJO Industries.

The Process of Developing and Implementing a Simplified Guideline for Hand Hygiene in the Operating Room

Background: Most studies on improving hand hygiene compliance (HHC) focus on clinical wards. The 5 Moments of Hand Hygiene, as stated by the WHO, are less easy to identify in an outpatient setting or procedure rooms. Therefore, observing compliance of these moments in an outpatient clinic or among healthcare workers (HCWs) in the operating room (OR), is far more difficult. Nonetheless, proper hand hygiene in the OR is of utmost importance to prevent postoperative wound infection. Objective: We developed and implement a scoring instrument with simplified moments of hand hygiene for nonsterile HCWs in the OR. Methods: All 13 hospitals of the Antibiotic Resistance Network Southwest Netherlands were asked to submit their guidelines on hand hygiene in the OR. These guidelines were, after discussion, combined into 1 guideline, describing different hand hygiene areas for different groups of nonsterile HCWs in the OR. After asking for feedback and incorporating these adjustments, the guideline was converted into a policy document. Based on this document, a paper scoring instrument was developed to observe HHC in the OR in a uniform way across all hospitals. The Erasmus University Medical Center Rotterdam, the Netherlands (Erasmus MC) acted as a pilot hospital where the implementation of the scoring instrument was studied. Results: The policy document has been approved by the infection committees of all 13 hospitals. The preliminary data of the pilot in the Erasmus MC, although still ongoing, are as follows. Hand hygiene in the OR was observed at 4 different time points. The anesthetist was observed once during 4 procedures in 3 different ORs. At the other 3 time points, the OR assistants (ie, OR nurses and circulating nurses) were observed during 4 procedures in 4 different ORs. Hand hygiene moments were easy to identify; the paper scoring instrument could be used to record observations of HHC in the OR. Conclusions: The guideline with the simplified moments of hand hygiene for nonsterile HCWs in the OR has been successfully implemented. The pilot test in the Erasmus MC already showed that, after defining the hand hygiene moments in the OR, the HHC in the OR is easier to observe and record using the scoring instrument. Moreover, the instrument has provided clarity for HCWs regarding the moments ate which they should disinfect their hands.Funding: NoneDisclosures: None

Diagonal Interventions in Infection Prevention: Successful Collaboratives to Decrease CLABSI at a VA Health Care System

Background: Vertical interventions in public health are disease focused, whereas horizontal interventions are systems based. The new concept of “diagonal interventions” merging these 2 approaches is also applicable to infection prevention (IP). During fiscal year (FY) 2016, our facility identified 14 central-line–associated blood stream infections (CLABSIs), resulting in a rate of 1.44 cases per 1,000 catheter days, twice that of FY2015 (0.75 cases per 1,000 catheter days). Methods: Focusing on a horizontal “systems building” approach, the IP team used previously developed informal relationships to mobilize a formal multidisciplinary team comprised of IP, nursing educators, the intravenous therapy team, and frontline staff. Initially charged with implementation of disinfecting caps for needleless connectors, the IP team capitalized on this multidisciplinary resource to launch a multifaceted communication and education campaign supporting CLABSI-specific interventions. For vertical interventions, an IP risk assessment revealed variations in care and maintenance of central lines and the need for staff education. A literature search was conducted to identify evidence-based strategies for reducing CLABSIs, leading to the development of a nursing-led bundle of the following elements: (1) education on CDC hand hygiene guidelines, (2) central-line competency validation and assessment for nurses on hire and annually, (3) standardized processes across all wards for central-line dressing changes (“timed on Tuesdays”), and (4) a pilot program for disinfecting caps on 3 inpatient wards. The IP team identified CLABSIs using standard NHSN definitions. Catheter days were obtained on each inpatient ward. Unit-specific rates were calculated per 1,000 catheter days. Mann-Kendall Test was used to assess rate trends over time, whereas the Fisher exact test was used for rate comparisons. A P &lt; .05 was considered significant. Results: CLABSI rates decreased from 1.44 in FY2016 to 0.12 in FY2019 (Kendall τ = −0.5; P &lt; .001) (Fig. 1). During the 3-month pilot phase of disinfecting caps, no CLABSIs were identified on 3 intervention wards versus 3 CLABSIs on control wards (rate, 0 vs 2.57; P = .27) and 1 CLABSI in the 3-month baseline period prior to the intervention (0 vs 0.40; P &gt; .99). Disinfecting caps were expanded house-wide beginning in FY2018. The multidisciplinary team evolved into a sustained collaborative (“Scrub Club”) meeting biweekly. They have now broadened their focus to quality improvement initiatives for multiple healthcare-associated infections (HAIs). Conclusions: The IP team has traditionally utilized vertical models of intervention. The use of “diagonal” models that incorporate horizontal health systems strengthening can transform multidisciplinary partnerships into long-term collaboratives essential for sustained reduction of HAIs.Funding: NoneDisclosures: None

Observation of Hand Hygiene Practices in Home Health Care

ObjectiveTo describe nurse hand hygiene practices in the home health care (HHC) setting, nurse adherence to hand hygiene guidelines, and factors associated with hand hygiene opportunities during home care visits. DesignObservational study of nurse hand hygiene practices. Settingand Participants: Licensed practical/vocational and registered nurses were observed in the homes of patients being served by a large nonprofit HHC agency. MethodsTwo researchers observed 400 home care visits conducted by 50 nurses. The World Health Organization's “5 Moments for Hand Hygiene” validated observation tool was used to record opportunities and actual practices of hand hygiene, with 3 additional opportunities specific to the HHC setting. Patient assessment data available in the agency electronic health record and a nurse demographic questionnaire were also collected to describe patients and nurse participants. ResultsA total of 2014 opportunities were observed. On arrival in the home was the most frequent opportunity (n = 384), the least frequent was after touching a patient's surroundings (n = 43). The average hand hygiene adherence rate was 45.6% after adjusting for clustering at the nurse level. Adherence was highest after contact with body fluid (65.1%) and lowest after touching a patient (29.5%). The number of hand hygiene opportunities was higher when patients being served were at increased risk of an infection-related emergency department visit or hospitalization and when the home environment was observed to be “dirty.” No nurse or patient demographic characteristics were associated with the rate of nurse hand hygiene adherence. Conclusions and ImplicationsHand hygiene adherence in HHC is suboptimal, with rates mirroring those reported in hospital and outpatient settings. The connection between poor hand hygiene and infection transmission has been well studied, and it has received widespread attention with the outbreak of SARS-CoV-2. Agencies can use results found in this study to better inform quality improvement initiatives.

Hand Hygiene Guidelines for Front Line Health Care Workers

Hand hygiene competence is one of the critical outcomes for health care workers who are working for covid patients.. Ensuring health care workers to reduce the risk of infections among nurses and health care workers. Adequate hand hygiene(HH) awareness for hospital staff like Nurses, ward technicians, health care workers should be implemented so as to reduce risks of facing infections. To assess the knowledge and awareness programmes to the front line warriors who are in direct contact with covid patients. A systematic review of studies published on January 1, 2009 based on, an online survey done in Canada where FIVE leading hospitals are actively involved and participated for Hand hygiene care. An online Data collection with simple and sample survey was conducted for Nurses, ward technicians, covid health care workers and Gram volunteers according to Guidelines given by World Health Organization’s SEVEN ( 7) hand washing steps. The Data collection was taken from 50 Nurses and 50 covid health care workers particularly working in rural areas of Parchur Mandal of Prakasam District in Andhra Pradesh state

Selected aspects of the knowledge and practice concerning hand hygiene guidelines in the context of infection control structures in hospitals and long-term care facilities - findings of a questionnaire survey.

Hand hygiene (HH) is the simplest and the most fundamental means of hospital-acquired infection (HAI) prevention in both hospitals and long-term care facilities (LTCFs) which differ as to their structure, organization and epidemiology. The objective of this study was to evaluate the knowledge of, and attitudes towards, compliance with the HH guidelines by medical staff of LTCFs and hospitals, in the context of infection control organization. The study was carried out among medical staff of LTCFs and hospitals using an anonymous questionnaire designed by the authors. The questionnaire was composed of 22 questions. Among 237 healthcare workers from LTCFs and hospitals (51.5% vs. 48.5%), the vast majority were women (97.5% vs. 94.8%), who were nurses (86.9% vs. 91.3%) with 21-30 years of experience (28.5% vs. 44.3%). The respondents, both working in hospitals and in LTCFs, declared that there was some surveillance of HAIs in their workplace - 78.8% vs. 87.8%, respectively, p = 0.082. However, the respondents from LTCFs significantly more often than those working in hospitals declared the lack of HAI registration (12.3% vs. 0.9%, p = 0.002), as well as the lack of surveillance of multidrug-resistant microorganisms (16.4% vs. 4.3%, p = 0.010). Although the knowledge of WHO HH guidelines was declared by over 90% of the respondents, only about 70% of them (with no significant difference between both types of facilities) properly indicated the 5 moments of HH. The results of the study indicate that the organizational conditions and practice of HH in LTCFs and hospitals present some differences. Therefore, there is a need for observational studies concerning HH in the context of the structure and organization of infection control, as they are necessary for the development and implementation of effective programs to improve the situation in this field. Med Pr. 2020;71(5):531-7.