Hand Hygiene Opportunities Research Articles

Adherence to hand hygiene at five moments and specific protection in a tertiary care hospital during the COVID-19 pandemic.

During the COVID-19 pandemic, adherence to hygiene measures is an objective aimed at reducing morbidity and mortality. To evaluate adherence to hand hygiene and protection measures during the COVID-19 pandemic in a tertiary care hospital. Cross-sectional study on health personnel handwashing at the five moments recommended by the World Health Organization, as well as on the use of specific personal protective equipment. One hundred and seventeen hand hygiene opportunities were observed in health personnel. Hand washing was observed in 40 (34 %) and omission in 76 (65 %). Adherence to the use of face shield was observed in five (4 %), and lack of adherence in 112 (96%). Adherence to the use of face mask was observed in 65 nursing professionals (87 %), with appropriate use of the mask in 56 of them (60 %) and use of face shield in one (1 %). Health personnel showed low proportions of adherence to hand hygiene and use of equipment for specific protection during the COVID-19 pandemic.

An Assessment of Hand Hygiene Practices among Health Care Providers in Operation Theatre

Aims: To assess the frequency of hand hygiene opportunities available to health care providers during surgeries and to assess the frequency of hand hygiene practices of health care providers in those hand hygiene opportunities. Study design: Cross sectional study Place and duration of study: Operation theatre and recovery room at The Indus Hospital Korangi Campus and Sheikh Saeed Memorial Campus from 21stMarch 2021 to 30th August 2021 Methodology: Two hundred and eighty one health care professional for 55 surgeries were included for hand hygiene opportunities and their hand hygiene practice. Every opportunity to practice hand hygiene was observed and noted as having occurred (hand wash or hand rub) or missed. Throughout the period, the PI was recorded opportunities for hand hygiene and missed opportunities using WHO’s hand hygiene observational form. Results: The average age of the health care provider was 31.22±8.15 years. The overall adherence to hand hygiene practice according to WHO guidelines was 16.1% while 83.9% were not according to WHO hand hygiene guideline. Failure of hand hygiene practice was significantly high in all type of hand hygiene opportunity. Rate of missed/failure hand hygiene practice was significantly high in nurses and technician and also their qualification (p<0.05). Conclusion: The poor hand hygiene compliance was frequently noticed among health care workers. Hand hygiene should be an educational priority and it needs to be implemented effectively. Therefore, hand hygiene resources is an integral part for better strategic and improvement strategy. Keywords: Hand hygiene, Contamination, Health care associated infections; Prevention.

WHO ‘My five moments for hand hygiene’ in anaesthesia induction: a video-based analysis reveals novel system challenges and design opportunities

Anaesthesia induction is a fast-paced, complex activity that involves a high density of hand-to-surface exposures. Hand hygiene (HH) adherence has been reported to be low, which bears the potential for unnoticed pathogen transmission between consecutive patients. To study the fit of the World Health Organization's (WHO) five moments of HH concept to the anaesthesia induction workflow. Video recordings of 59 anaesthesia inductions were analysed according to the WHO HH observation method considering each hand-to-surface exposure of every involved anaesthesia provider. Binary logistic regression was used to determine risk factors for non-adherence, i.e. professional category, gender, task role, gloves, holding of objects, team size and HH moment. Additionally, half of all videos were recoded for quantitative and qualitative analysis of provider self-touching. Overall, 2240 HH opportunities were met by 105 HH actions (4.7%). The drug administrator role (odds ratio (OR): 2.2), the senior physician status (OR: 2.1), donning (OR: 2.6) and doffing (OR: 3.6) of gloves were associated with higher HH adherence. Notably, 47.2% of all HH opportunities were caused by self-touching behaviour. Provider clothes, face, and patient skin were the most frequently touched surfaces. The high density of hand-to-surface exposures, a high cognitive load, prolonged glove use, carried mobile objects, self-touching, and personal behaviour patterns were potential causes for non-adherence. A purpose-designed HH concept based on these results, involving the introduction of designated objects and provider clothes to the patient zone, could improve HH adherence and microbiological safety.

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

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

Hand Hygiene Compliance Decreases as Workload Increases

According to this study: Hand hygiene compliance decreased significantly in the ICU setting when the number of hand hygiene opportunities exceeded 30 per hour.Adequate staffing during higher workload periods is needed to ensure that health care providers maintain a high level of hand hygiene compliance.

Gambaran Kepatuhan Hand Hygiene Perawat di Instalasi Dialisis RSUD Dr. Soetomo Surabaya Tahun 2022

Healthcare-Associated Infection is one of the health problems in the world. In Indonesia, the incidence of Healthcare-Associated infections is relatively high. Patients with chronic kidney disease undergoing hemodialysis are at increased risk for Infection. The main chain of infection transmission is from the hands of health workers. Hand hygiene is essential in preventing Infection. However, the hand hygiene compliance of health workers is still low. This study aimed to describe the nurse's hand hygiene compliance, identify the factors that influence it and determine solutions to improve it. This study was descriptive-observational. The population of this study was all dialysis nurses in the Dialysis Unit of Dr. Soetomo General Hospital Surabaya. The sample size based on WHO requirements was 200 opportunities for hand hygiene. Identify the root cause using a fishbone diagram—determine alternative solutions to problems using Capability, Accessibility, Readiness, and Leverage methods. Based on the observations, nurses' compliance with hand hygiene was 28.5%. The lowest nurse compliance rate is at the indication before and after touching the patient. The factors that most influence the hand hygiene of dialysis nurses are the lack of knowledge and awareness of the importance of hand hygiene and the performance of the IPCLN team, which is not optimal. Hand hygiene socialization more creatively and sustainably, as well as improving the performance of the Infection Prevention and Control Team at the Dialysis unit, is expected to be able to increase hand hygiene compliance optimally.
 Keywords: Hand hygiene, Compliance, Nurses, Infection

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit.

Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was 'basic' (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to 'intermediate' level (262). There was no change in the neonatal unit HA-BSI rate. Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.

1215. Variation in Hand Hygiene Improvement After Implementation of an Electronic Hand Hygiene System During the COVID-19 Pandemic

Abstract Background Electronic hand hygiene (HH) monitoring systems have many potential advantages but there are limited data on wide-scale implementation of these systems. TableHand Hygiene Observations, Improvement in Adherence Rates and SIR Trends by Hospital Methods We deployed an electronic HH monitoring system in over 2,100 acute and critical care rooms across 9 hospitals in an academic health system. Badges with a Bluetooth beacon were issued to over 7,000 healthcare workers. Deployment began in early 2020 and was interrupted by the pandemic. The rollout of interventions to improve HH adherence was managed at the hospital level. Healthcare-associated infections (HAIs) were determined by the infection prevention team using standard CDC definitions. Hospital-level HH adherence rates were compared to a composite SIR including SIRs for CLABSI, CAUTI, hospital-onset MRSA bloodstream infections and hospital-onset Clostridiodes difficile infections. Results Between January 2020 and April 2022, there were over 36 million hand hygiene opportunities with an average of 19 observations per staffed room per day. Overall HH adherence improved from 46% to 60%, with significant variation by hospital (4 improving by >25% and 3 by < 5%). Hospitals whose implementation was most delayed showed the least improvement. Preliminary analysis found no relationship between hand hygiene improvement and the SIR composite aggregated by calendar year. Conclusion Despite the challenges of large-scale implementation of an electronic HH system during a pandemic, we demonstrated an overall improvement in HH adherence. The wide variation in improvement among hospitals was due to timing of implementation, variation in the dedicated hospital-specific project management resources and leadership engagement. In addition to technology, successful implementation of electronic HH systems requires dedicated resources and culture change. Pandemic-related staffing challenges, disruption of standard HAI prevention efforts and intensive device utilization confounded our ability to show a relationship between HH adherence and HAI rates. Disclosures All Authors: No reported disclosures.

Hand hygiene monitoring: Comparison between app and paper forms for direct observation.

Healthcare-associated infections (HAIs) are a global public health threat. Italy is one of the countries with the highest prevalence of HAI. Hand hygiene (HH) is a pillar of infection prevention and control. Monitoring HH is necessary to improve HH compliance, and direct observation is considered the gold standard. Transcription and analysis of data collected during direct observation of HH compliance with the WHO paper form are time-consuming. We collected, during a 9-day observation period, HH opportunities and compliance both with a smartphone application (SpeedyAudit) and with the WHO paper form. Then, we investigated the difference in the requiredtime for data transcription and analysis between the WHO paper form and the use of the app. The difference in the required time for data transcription and analysis was significant with a mean time of 2 s using the app and about 14-54 min/day using paper form (p=.004) while no significant difference was found in measured compliance rates between the two data collecting methods. HH monitoring with an app is time-saving, and the app we used was easy to use.

Hand Hygiene Practices during the COVID-19 Pandemic in Northern Italy: Assessment of Compliance Rates Measured by Direct Observation and Alcohol-Based Handrub Usage.

Hand hygiene (HH) is among the most effective measures for reducing the transmission of healthcare-associated infections and SARS-CoV-2. We aimed to assess HH practices among healthcare workers (HCWs) of three hub hospitals in Northern Italy during the COVID-19 pandemic, by assessing HH compliance measured by direct observation and alcohol-based handrub usage. An observational study was conducted over a period of three months, between February and April 2021. HH compliance audits were conducted using the WHO My 5 Moments for HH approach. Multivariable logistic regression was used to evaluate independent predictors of HH compliance: ward type, HCW category and HH indication. Spearman correlation was used to investigate the relationship between HH compliance and alcohol-based handrub consumption. In total, 2880 HH opportunities were observed, with an overall compliance of 68%. Significant differences were found in compliance rates across ward types, HCW categories and HH indications. The mean alcohol-based handrub usage among included wards was 41.63 mL/PD. No correlation was identified between compliance rates and alcohol-based handrub consumption (ρ 0.023, p 0.943). This study provided a snapshot of HH practices in a pandemic context, which could be useful as a reference for future studies.

The effect of the SARS-CoV-2 pandemic in the compliance of hand hygiene in ICU in a tertiary hospital

Abstract Background Hand hygiene (HH) is one of the main preventive methods for healthcare-associated infections. Our aim is to compare the level of HH compliance in 2021, SARS-CoV-2 pandemic period, with the previous 2019 period. Methods Descriptive cross-sectional study of direct observation on compliance of HH in adult intensive care unit (AICU) and neonatal intensive care unit (NICU) in a third-level hospital in Madrid during the years 2019 and 2021. Trained healthcare workers observed and recorded hand hygiene opportunities (HHO) among staff (nurse, nurses’ aide, physicians and orderly) using the World Health Organization's “My Five Moments for Hand Hygiene” tool. All observations of professional that attended patients in SARS-CoV-2 isolation units were excluded. Results Overall, there was a total of 1199 HHO, 961 in AICU (2019:466; 2021:495) and 238 in NICU (2019:122; 2021:116). HH compliance in AICU improved from 57.5% in 2019 to 65.9% in 2021 (p = 0.008) and remained unchanged in NICU (2019:90.2% vs 2021:88.8%; p = 0.730). In AICU all professional categories, except nurse’s aide, improved HH compliance being statistically significant in physicians (2019:33.8% vs 2021:50.0%; p = 0.009). In relation to the 5 moments, an increase in HH compliance was observed in: before and after touching a patient/after touching patient surroundings, being only statistically significant in moment after touching a patient (2019:69.4% vs 2021:83.7%; p = 0.001). In NICU there were no significant changes between the two periods regarding to the professional category or the five moments of HH. In NICU there were no significant changes between the two periods regarding to the professional category or the five moments of HH. Conclusions The increase in compliance of HH within the adult ICUs demonstrates this adaptation, stating a behavioural change in the habits of professionals. This increase was no observed in the NICU since their compliance was already extremely high. Key messages • There has been an increase in HH compliance in the AICU. • The HH method has varied, becoming COVID-19 specific.

Comparison of hand hygiene compliance among healthcare workers in Intensive care units and wards of COVID-19: A large scale multicentric study in India

BackgroundHand hygiene is a significant component involved in preventing transmission of health care associated infections including COVID-19. Compliance to hand hygiene among the health care workers (HCWs) requires evaluation and timely feedback. “You can't improve what you can't measure” is a famous saying and this multicentric study was designed to measure hand hygiene compliance and have birds eye view on hand hygiene compliance in COVID Intensive care units (ICUs) and wards across India. MethodsA prospective multicentric observational study was conducted for a period of 6 months in 92 health care facility across India which included varied type of public and private hospitals. Hand hygiene audit was conducted in COVID ICU and COVID non-ICU wards in all these facilities by their HCWs using the IBHAR mobile application based on WHO's hand hygiene audit tool. Hand hygiene total adherence rate (HHTAR) and hand hygiene complete adherence rate (HHCAR) were analyzed and compared between 2 locations. Adherence rates were analyzed based on the zones, institute type, profession and for each WHO moments. ResultsA total of 1,61,056 hand hygiene opportunities were documented and adherence rates were recorded higher in COVID wards (HHTAR-61.4%; HHCAR-28.8%) than COVID ICUs (HHTAR-57.8%; HHCAR-25.6%). Overall, the adherence rates were observed higher in COVID wards (HHTAR- 68.1%; HHCAR-38.3%) of private hospitals, COVID wards of the west zone (HHTAR- 70.2%; HHCAR-36.8%), cleaning staffs of the COVID ward scores better compliance than all other professions in COVID ICUs and COVID wards. HHTAR was found to be the higher in moment 3 (After body fluid exposure-76.3%) followed by moment 4 (after touching patient-73.7%) done in COVID wards compared to moments done in ICUs. ConclusionsThis study highlights the practice of hand hygiene in COVID care locations across India. Effective strategies need to be implemented in COVID ICUs across the facilities to improve the compliance.

Hand hygiene improvement of individual healthcare workers: results of the multicentre PROHIBIT study

BackgroundTraditionally, hand hygiene (HH) interventions do not identify the observed healthcare workers (HWCs) and therefore, reflect HH compliance only at population level. Intensive care units (ICUs) in seven European hospitals participating in the “Prevention of Hospital Infections by Intervention and Training” (PROHIBIT) study provided individual HH compliance levels. We analysed these to understand the determinants and dynamics of individual change in relation to the overall intervention effect.MethodsWe included HCWs who contributed at least two observation sessions before and after intervention. Improving, non-changing, and worsening HCWs were defined with a threshold of 20% compliance change. We used multivariable linear regression and spearman’s rank correlation to estimate determinants for the individual response to the intervention and correlation to overall change. Swarm graphs visualized ICU-specific patterns.ResultsIn total 280 HCWs contributed 17,748 HH opportunities during 2677 observation sessions. Overall, pooled HH compliance increased from 43.1 to 58.7%. The proportion of improving HCWs ranged from 33 to 95% among ICUs. The median HH increase per improving HCW ranged from 16 to 34 percentage points. ICU wide improvement correlated significantly with both the proportion of improving HCWs (ρ = 0.82 [95% CI 0.18–0.97], and their median HH increase (ρ = 0.79 [0.08–0.97]). Multilevel regression demonstrated that individual improvement was significantly associated with nurse profession, lower activity index, higher nurse-to-patient ratio, and lower baseline compliance.ConclusionsBoth the proportion of improving HCWs and their median individual improvement differed substantially among ICUs but correlated with the ICUs’ overall HH improvement. With comparable overall means the range in individual HH varied considerably between some hospitals, implying different transmission risks. Greater insight into improvement dynamics might help to design more effective HH interventions in the future.

Development and evaluation of an ultra-wide bandwidth based electronic hand hygiene monitoring system

BackgroundA large variety of electronic hand hygiene monitoring systems (EHHMS) are being developed and applied in health care settings. Monitoring hand hygiene (HH) opportunity at bed-level has been the key technical challenge. Accuracy evaluation needs more attention as the prerequisite upon widespread acceptance and adoption. MethodsFor the first time, we explored, debugged and upgraded an EHHMS based on ultra-wide bandwidth (UWB) which can obtain HH opportunities at bed-level. The real-time positioning and electronic fence of UWB technology was applied for EHHMS. The accuracy of EHHMS was compared with the simultaneous manual direct observations in real-world clinical setting. Sensitivity and specificity were calculated for EHHMS capturing HH action and opportunity. ResultsTwo generations of EHHMS were constructed. For the first generation, the system properly recorded 84% and 78% of the pre-identified HH actions and opportunities performed by experimenters. For the second generation, sensitivity and specificity of the system capturing HH action were 89% (84.83-92.36) and 100% (98.26-100.00), respectively. For capturing HH opportunity, the system showed the sensitivity and specificity of 86.52% (82.52-89.89) and 88.10% (84.14-91.36)), respectively. ConclusionThe EHHMS based on UWB could accurately identify HH action and opportunity with equivalent accuracy compared with simultaneous direct observation.

A nudge intervention to improve hand hygiene compliance in the hospital.

Hand hygiene among professionals plays a crucial role in preventing healthcare‐associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.

Hand Hygiene Compliance during COVID-19 Pandemic among Neonatal Nurses in a Federal University Teaching Hospital in Nigeria

Introduction: Compliance with Hand hygiene (HH) has been considered as a simple and the most efficient strategy to reduce hospital-acquired infections (HAIs). Compliance with this practice is not often assessed in Nigeria and thus posed a significant risk to the quality of care and patient safety and especially in this era of the COVID-19 pandemic. The study aimed to assess neonatal nurses’ compliance to “my five moments for HH”. Method: A cross-sectional observational study was carried out in a Nigerian federal hospital, using an adapted version of a standardized observational WHO tool of ‘’my five moments of HH’’. A Chi-square test was employed to examine the relationship of HH compliance across units, shifts, and “my five moments for HH” opportunities. Results: The observer recorded 425 HH opportunities and the total HH compliance rate was (62.8%). There was no association between the units, working shifts, and nurses’ HH compliance. Compliance to HH was dependent on the five moments of HH (p &lt; 0.000), better compliance was seen after body fluid exposure (100%), followed by after newborn contact (86.3%), and after contact with newborn surroundings (63.4%), while compliance before newborn contact (28.5%), and before an aseptic procedure (9.1%) were poor. Conclusion: The findings of this study showed a significant gap with the HH compliance among neonatal nurses, suggesting multiple opportunities for neonatal infections despite the current awareness of HH in the Covid-19 pandemic. Hence, there is a need to intensify infection control practices in Nigeria, especially on HH practice.

Hand Hygiene Behaviors Monitored by an Electronic System in the Intensive Care Unit

Background Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. Methods An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. Results A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Conclusions Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance. Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance.

Clinical evaluation of an electronic hand hygiene monitoring system

BackgroundWe aimed to test the accuracy of an electronic hand hygiene monitoring system (EHHMS) during daily clinical activities in different wards and with varying health care professions. MethodsThe accuracy of an EHHMS (Sani Nudge) was assessed during real clinical conditions by comparing events registered by two observers in parallel with events registered by the EHHMS. The events were categorized as true-positive, false-positive, and false-negative registrations. Sensitivity and positive predictive value (PPV) were calculated. ResultsA total of 103 events performed by 25 health care workers (9 doctors, 11 nurses, and 5 cleaning assistants) were included in the analyses. The EHHMS had a sensitivity of 100% and a PPV of 100% when measuring alcohol-based hand rub. When looking at the hand hygiene opportunities of all health care workers combined taking place in the patient rooms and working rooms, the sensitivity was 75% and the PPV 95%. For doctors’ and nurses’ taking care of patients in their beds the EHHMS had a sensitivity of 100% and a PPV of 94%. ConclusionsThe objective accuracy measures demonstrate that this EHHMS can capture hand hygiene behavior under clinical conditions in different settings with clinical health care workers but show less accuracy with cleaning assistants.

The power of feedback: Implementing a comprehensive hand hygiene observer program

Hand hygiene (HH) is a fundamental component of infection prevention within all healthcare settings. We implemented a hospital-wide program built on overt HH observation, real-time feedback, and thematic analysis of HH misses. A robust observer training program was established to include foundational training in the WHO's My Five Moments of HH. Observational data from 2011 to 2019 were analyzed by unit, provider type, and thematic analyses of misses. During the study period, we conducted 160,917 hospital-wide observations on 29 units (monthly average of 1,490 observations). Institutional compliance remained above 95% from 2013 to 2019. Thematic analysis revealed "touching self" and "touching phone" as common, institution-wide reasons for HH misses. Overt observations facilitated communication between HH program and healthcare staff to better understand workflow and educate staff on HH opportunities. This program is an integral part of the Infection Prevention team and has been deployed to collect supplemental data during clusters and outbreaks investigations. In addition to having rich HH data, successes of this program, include increased awareness of IPC practices, enhanced communication about patient safety, enriched dialog and feedback around HH misses, and relationship building among program observers, unit staff and leaders.

Predictors of Compliance to Hand Hygiene among Health Care Workers in Rwanda

BackgroundHand hygiene is critical to the prevention of Healthcare Acquired Infections. Compliance of health care workers to hand hygiene in developing countries is reportedly low.ObjectiveThe aim of this study was to assess predictors of hand hygiene compliance among healthcare workers in RwandaMethodsThis cross-sectional study was conducted in 26 selected hospitals. Trained hospital IPC focal points anonymously observed 1380 hand hygiene opportunities from 341 healthcare workers. Logistic regression analysis was used to identify predictors of compliance to hand hygiene among health care workers using Stata.ResultsThe overall compliance to HH was 72.4%. It was respectively 70%, 77% and 60% less likely in labor (AOR=0.30, 95% CI: 0.19-0.49), maternity (AOR= 0.27, 95% CI: 0.17-0.43), and neonatology (AOR= 0.40 95% CI: 0.25-0.65) departments than in theater. Other clinical staff than nurses/midwives were 35% less likely to comply than did medical doctors. The availability of water source and soap at hand washing station was associated with 2.5 times higher odds of compliance (AOR=2.46, 95% CI: 1.27-4.77).ConclusionThe compliance to HH is associated with the availability of hand hygiene facilities. Well-maintained water sources and soap at hand washing stations should be a priority in health care settings.&#x0D; Rwanda J Med Health Sci 2022;5(2):170-179