Hand Hygiene Program Research Articles

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

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

Improving Data Quality from a Hematology Unit Hand Hygiene Observation Program

Background: For United States healthcare programs to be fully compliant with Joint Commission National Patient Safety Goal (NPSG) #7, organizations must implement and maintain a hand hygiene (HH) program that follows either the current Centers for Disease Control and Prevention (CDC) or the current World Health Organization (WHO) HH guidelines. Joint Commission standard IC.03.01.01 requires these organizations to provide metrics that evaluate the effectiveness of their program and program goals. Our center utilizes the direct observation method with the use of over 550 Hand Hygiene Observers (HHO) to collect our HH compliance. HHO are trained with a computer-based course that requires passing a post-education test. During fiscal year 2023 (FY23), Infection Control surveillance noted an increase in hospital-acquired infections (HAI) Clostridioides difficile infections (CDI), catheter-associated urinary tract infections (CAUTI), and multidrug-resistant organisms (MDRO) on our hematologic malignancy units (HM), which initiated an Infection Control (IC) investigation into possible causes. Increased rounding by our Infection Preventionist (IP) observed that HH compliance was much lower than unit HHO reported rates. Inquiries into this data discrepancy revealed barriers to accurate reporting, including HHO having low confidence in identifying and reporting non-compliant behavior. To that end, we conducted mandatory re-training of all HM HHO with the primary goal of improving the quality of our HH compliance data and addressing barriers with non-compliance reporting. Our secondary goal was to identify areas of improvement in institutional HH rates. Methods: In August 2023, 252 HM staff and HHO received detailed, in-person retraining by the HM IP. Training included reviewing the discrepancy in HHO and IP observations, potential causes of discrepancy, most commonly missed HH opportunities, examples of correct and incorrect HH practices, and addressing staff questions. Results: Following mandatory re-training of HM HHO, HH compliance for our HM units from September 2023 – December 2023 ranged from 89% to 98%, with increased reporting of non-compliance (Figure 1). A detailed dashboard was created that focused on HM HH compliance, containing the HHO observations and non-compliant reports. Conclusion: A one-time in-person retraining of HM HHO by our IP has led to an improvement in data quality, which is imperative for future quality improvement initiatives. Improving our HH data quality allowed IC to identify and provide actionable feedback to HM leaders, create targeted interventions to improve HAI rates, and improve patient safety. Future goals include retaining of all HHO and a HH campaign to ensure patient safety across our institution.

Enablers and barriers to vaccine uptake and handwashing practices to prevent and control COVID-19 in Kenya, Uganda, and Tanzania: a systematic review.

The global emergence of coronavirus disease 2019 (COVID-19) posed unprecedented challenges, jeopardizing decades of progress in healthcare systems, education, and poverty eradication. While proven interventions such as handwashing and mass vaccination offer effective means of curbing COVID-19 spread, their uptake remains low, potentially undermining future pandemic control efforts. This systematic review synthesized available evidence of the factors influencing vaccine uptake and handwashing practices in Kenya, Uganda, and Tanzania in the context of COVID-19 prevention and control. We conducted an extensive literature search across PubMed, Science Direct, and Google Scholar databases following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Out of 391 reviewed articles, 18 were eligible for inclusion. Some of the common barriers to handwashing in Kenya, Uganda, and Tanzania included lack of trust in the government's recommendations or messaging on the benefits of hand hygiene and lack of access to water, while some of the barriers to vaccine uptake included vaccine safety and efficacy concerns and inadequate awareness of vaccination sites and vaccine types. Enablers of handwashing practices encompassed hand hygiene programs and access to soap and water while those of COVID-19 vaccine uptake included improved access to vaccine knowledge and, socio-economic factors like a higher level of education. This review underscores the pivotal role of addressing these barriers while capitalizing on enablers to promote vaccination and handwashing practices. Stakeholders should employ awareness campaigns and community engagement, ensure vaccine and hygiene resources' accessibility, and leverage socio-economic incentives for effective COVID-19 prevention and control. Clinical trial registration: [https://clinicaltrials.gov/], identifier [CRD42023396303].

Implementation of a quality improvement project using the patient as the observer to improve hand hygiene compliance in ambulatory care practices

Monitoring hand hygiene compliance in the ambulatory setting remains a challenge because a healthcare trained observer loses line of sight once the examination room door closes. This quality improvement project focused on the implementation of a hand hygiene compliance improvement programme that is amenable to the routines and work flows of the ambulatory setting. After a review of the literature, nursing leadership and infection prevention implemented the 'patient as the observer' hand hygiene programme across 32 ambulatory practices. Patients completed 281,000 observations with an overall compliance rate of ≥90%. The average overall compliance rate by role was 91% for providers, 89% for nurses, and 91% for medical assistants/technicians/others. A 92% compliance average was noted 'before caring for you' and 89% 'after caring for you' for providers, 90% and 87% for nurses, and 92% and 89% for medical assistants/technicians/others. This study demonstrated that the implementation of a hand hygiene compliance improvement programme using the patient as the observer can be adopted successfully in the ambulatory setting. Hand hygiene compliance can be monitored effectively in the ambulatory setting with the involvement of the patient as the observer.

Patient Safety: A Systematic Review of the Literature with Evidence based Measures to Improve Patient Safety in Healthcare Settings

Patient safety is a crucial component of healthcare delivery aimed at minimizing and preventing medical errors that can cause harm or injury to patients. This systematic review identified 50 studies that evaluated interventions aimed at improving patient safety in healthcare settings, including medication reconciliation, surgical safety checklists, hand hygiene programs, and electronic health record systems. The findings suggest that most interventions led to significant improvements in patient safety outcomes, including a reduction in adverse events and preventable harm. Evidence-based measures to improve patient safety include effective communication, hand hygiene, medication safety, patient identification, fall prevention, surgical safety, infection control, and staff training. The implementation of these measures can help improve patient safety and reduce the risk of harm to patients in healthcare settings. Further research is needed to identify the most effective interventions and to evaluate the long-term impact of these interventions on patient outcomes. Keywords: Adverse events, Interventions, Medical errors, Patient safety, Preventable harm.

Hand hygiene knowledge and demonstrated technique among Malawian kindergarten children: A quasi-experimental study.

To evaluate hand hygiene knowledge and demonstrated technique before and after implementation of the hand hygiene programme and its sustainability among Malawian kindergarten students. Quasi-experimental design, utilizing a repeated measure at three points, namely, before intervention (T0 ), soon after intervention (T1 ) and follow-up (T2 ). The hand hygiene programme consisted of integrating hand hygiene protocol into the school health curriculum, setting up proper handwashing facilities, training school teachers, health talks and developing reminders on hand hygiene. Fifty-three kindergarten children aged 3-6 years were enrolled in the programme. Data were collected at 3 months' intervals (T0 , T1 , and T2 ). Parents, teachers, school authorities and children were involved in the implementation and evaluation of the intervention, utilizing a multilevel approach. There was a significant difference in knowledge scores across three time points (T0 , T1 and T2 ), Chi-Square (2, n = 53) = 79.02, p < 0.005 and handwashing technique across the three time points, Chi-Square (2, n = 53) = 88.04, p < 0.005. There was a large effect size of 0.62 on the effect of handwashing technique scores from T0 to T1.

IMPROVING HAND HYGIENE FOR CROSS-INFECTION CONTROL: GUARDING AGAINST HEALTHCARE-ASSOCIATED CLOSTRIDIUM DIFFICILE INFECTION

Healthcare-associated Clostridium difficile infection (HA-CDI) continues to pose a serious threat to healthcare environments across the globe. To reduce the pathogen's spread, effective control measures are necessary. Educating patients and healthcare professionals on the need of hand cleanliness is a crucial component of prevention. The critical significance that good hand hygiene plays in cross-infection prevention to avoid HA-CDI is examined in this research. It looks at the most effective methods, obstacles, and tactics for encouraging hand hygiene compliance in hospital settings. As a key component of HA-CDI prevention measures, the assessment emphasizes the critical necessity for extensive hand hygiene programs.

1213. The Effect of a Prospective Intervention Program with Automated Monitoring on Hand Hygiene Performance in Long-term and Acute Care Units at a Veteran Affairs Medical Center

Abstract Background There is emerging evidence that implementation of an automated hand hygiene monitoring system (AHHMS) must be part of a multimodal hand hygiene (HH) program that includes complementary strategies. There are few published studies describing in detail the intervention strategies used with an AHHMS. Methods An AHHMS that provides group HH performance rates (100 x HH product dispenses divided by the number of room entries plus exits) was implemented on two Acute Care (AC) units and six long-term care (LTC) units at a Veterans Affairs Medical Center from March 2021 through April 2022. After a 4-week baseline period and 2.5-week washout period, the 52-week intervention period included many components, such as weekly huddles, unit nurse manager engagement, vendor provided clinician-based training and feedback, leadership support, unit recognition, signage and development of a new slogan to remind colleagues to perform HH. Statistical analysis was performed with a Poisson general additive mixed model. Results During the 4-week baseline period, the median HH performance rate was 18.6 (95% CI: [16.5, 21.0]) for all 8 units. During the intervention period, the median HH rate increased to 21.6 [19.1, 24.4], and during the last 4 weeks of the intervention period (exactly 1 year after baseline), the 8 units exhibited a median HH rate of 25.1 [22.2, 28.4], (p &amp;lt; 0.0001) [Figure 1]. The median HH rate increased from 17.5 to 20.0 (p &amp;lt; 0.0001) in LTC units and from 22.9 to 27.2 (p &amp;lt; 0.0001) in AC units. The intervention increased the use of hand sanitizer from 57.5% during baseline to 65.1% (p &amp;lt; 0.0001). The increase in HH rates was due to HH events increasing from 88,758 dispenses during the baseline to 123,722 dispenses during the last 4 weeks of the intervention. Direct observation results during the same periods showed HH compliance ranging from 61-86%. Figure 1- Monthly Hand Hygiene Performance Rates for all Units The green curve shows the change in the median HH rate during the intervention period compared to the baseline and washout periods, with vertical bars showing 95% confidence intervals for the monthly HH rate. Conclusion The intervention increased hand sanitizer usage and HH performance rates for all units. AC units were consistently better than LTC units, which have more visitors and more mobile veterans. Further HH improvement will rely on continued implementation of complementary strategies and long-term monitoring. Disclosures James W. Arbogast, PhD, GOJO Industries, Inc.: employee Pamela Wagner, RN MSN CPPS, GOJO Industries, Inc: Employee of GOJO Gregory A. Robbins, BS, GOJO Industries, Inc.: Current employee of GOJO Industries, Inc. Albert E. Parker, PhD, GOJO Industries: Advisor/Consultant John M. Boyce, MD, Diversey: Advisor/Consultant|Diversey: Expert Testimony|Diversey: Travel support|GOJO Industries: Advisor/Consultant|GOJO Industries: Expert Testimony|GOJO Industries: Travel support|Sodexo Healthcare: Advisor/Consultant.

Behavioural intention of hand hygiene compliance in an average Ecuadorian hospital.

SUMMARYOBJECTIVE:This study aimed to characterize hand hygiene behavioural intention by hospital services clusters in a medium-sized hospital in an Ecuadorian city.METHODS:This is a cross-sectional study based on the World Health Organization Hand Hygiene Knowledge Questionnaire for Health-Care Workers. The responses on hand hygiene behavioural intention for the Five Moments for hand hygiene according to the World Health Organization were recorded in three categories: before patient contact, before and after sterile technique and management of body fluids, and after contact with the environment of the patient. The variables were the knowledge regarding the source of germs causing nosocomial infections, the optimal time to achieve disinfection with alcohol, hospital services clusters (clinical medicine, surgery, and therapeutic services), and history of previous formal hand hygiene training. The variables in each moment were analysed using a saturated log-linear model.RESULTS:The average age of participants was 34 years (Q1 32.1–Q3 36.4). Of them, 62% belonged to the clinic cluster and 87.6% had previous formal hand hygiene training. The incorrect response rates for before and after sterile technique and management of body fluids, before patient contact, and after contact with the environment of the patient were 30.2, 88.4, and 99.2%, respectively. In before patient contact, the incorrect responses for optimal time depended on the department (worse surgery cluster situation), and in before and after sterile technique and management of body fluids and after contact with the environment of the patient, the incorrect responses for source of germs depended on the previous formal hand hygiene training and the department (worse surgery and clinic clusters).CONCLUSION:The incorrect answer related to hand hygiene behavioural intention was high compared to other reports, and the worse situation was found in after contact with the environment of the patient and before patient contact. These data suggest the need of strengthening permanently the hand hygiene programme.

Hand Hygiene Compliance among Healthcare Workers, Ministry of Health Hospitals, the Kingdom of Saudi Arabia for the Year 2018

Background: Microorganisms are mostly transmitted through the hands of healthcare workers in any healthcare setting. This transmission can be from healthcare workers to the patients and from their surrounding environment. This ultimately leads to increased healthcare-associated infections and to the resistance against the antimicrobials and the cost of healthcare-associated infections increases accordingly. Objectives: To observe the practice of hand hygiene and to calculate the hand hygiene compliance rate among healthcare workers of Ministry of Health Hospitals in the Kingdom of Saudi Arabia. Methods: The hand hygiene practice of healthcare workers in 318 Ministry of Health hospitals was observed by direct observation during the year 2018. This was done as a part of the National Hand Hygiene Program during the year 2018. The data was collected using the World Health Organization Hand Hygiene observation form. The compliance rate was calculated among different healthcare professionals, hospital departments and work shifts. Results: A total of 511,079 opportunities were observed over a period of one year. The overall hand hygiene compliance rate was found to be 70%. The compliance was found to be highest after the blood/body fluids exposure (85%), followed by after touching the patients (76%), followed by clean aseptic procedures (75%), after touching the patient’s surroundings (66%), and before touching the patients (64%). The overall hand hygiene compliance was found to be higher in nurses (73%) as compared to the doctors which was 67%. Conclusion: Our findings confirm that hand hygiene compliance is higher in the nurses as compared to the physicians and the rest of the health care workers in MOH health care settings. Initiatives such as improved monitoring and training healthcare facilities are needed to improve hand hygiene compliance in future.

Successful Implementation of an Electronic Application in Reinvigorating a Healthcare Organization's Hand Hygiene Program

<h3>Background</h3> Our organization prioritizes the importance of a comprehensive hand hygiene program in promoting patient safety but found it challenging to meet regulatory requirements and to operationalize an efficient program. Recognizing that manual observations were labor intensive and automated hand hygiene was cost prohibitive, we looked to an innovative, inexpensive electronic application (app) to reinvigorate our hand hygiene program. <h3>Methods</h3> In 2021, our facility's hand hygiene committee, with support from senior leadership, developed and led a strategic plan to develop and implement a meaningful hand hygiene campaign with timeline for completion. This plan included a beta pilot to implement an innovative, affordable electronic app in all licensed inpatient and outpatient departments including nursing units, and surgical services over a five-month time period. Each area is required to submit a minimal number of observations per month which was calculated using regulatory guidelines. Manual tallies are no longer required. Data is submitted and analyzed electronically and available to act upon in real time. The strategic plan included comprehensive training, education, and continued feedback at all levels from bedside staff to administration. <h3>Results</h3> Upon complete implementation of our electronic application our monthly hand hygiene observations went from averaging a few hundred per month to 9000 observations per month. Transitioning from a manual to an electronic program has also resulted in a staggering cost savings of four full time employees for an approximated cost savings of 250,000 dollars annually. Additionally, a survey of all staff observers revealed that ninety three percent found the app to improve their workflow and save them time. <h3>Conclusions</h3> Through development, and implementation of this comprehensive electronic hand hygiene initiative our organization was able to meet all regulatory requirements, engage staff, increase patient safety, and recognize a significant cost savings for our organization. Senior leadership's support was key in the success of this program.

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.

Gap between self-evaluation and actual hand hygiene compliance among health-care workers.

Hand hygiene (HH) compliance among health-care workers has not satisfactorily improved despite multiple educative approaches. Between October 2019 and February 2020, we performed a self-evaluation test and a direct observation for the compliance of the 5 Moments for Hand Hygiene program advocated by the World Health Organization at two Japanese hospitals. Average percentages of self-evaluated HH compliance were as follows: (i) 76.9% for "Before touching a patient," (ii) 85.8% for "Before clean/aseptic procedures," (iii) 95.9% for "After body fluid exposure/risk," (iv) 84.0% for "After touching a patient," and (v) 69.2% for "After touching patient surroundings." On the other hand, actual HH compliance was 11.7% for "Before touching a patient" and 18.0% for "After touching a patient or patient surroundings." The present study demonstrated a big gap between self-evaluation and actual HH compliance among nurses working at hospitals, indicating the need of further providing the education in infection prevention.

Sustainability of a well-established hand hygiene program during the coronavirus disease 2019 (COVID-19) pandemic

Sustainability of a well-established hand hygiene program during the coronavirus disease 2019 (COVID-19) pandemic

Sustainability of a well-established hand hygiene program during the coronavirus disease 2019 (COVID-19) pandemic.

Overall, engagement and compliance from the crowd-sourced hand hygiene observation program, Clean-In-Clean-Out (CICO), were similar between 2019 (96.6%) and 2020 (96.7%) despite fluctuations within 2020 that reflected our hospital's coronavirus disease 2019 (COVID-19) experience. Shared responsibility and just-in-time reminders can allow manual hand hygiene observation models to be sustainable.

Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections.

We previously demonstrated that a hand hygiene program, including hand sanitizer and educational measures, for day care center (DCC) staff, children, and parents was more effective than a soap-and-water program, with initial observation, in preventing respiratory infections (RIs) in children attending DCCs. We analyzed the cost-effectiveness of these programs in preventing RIs. A cluster, randomized, controlled and open study of 911 children aged 0 to 3 years, attending 24 DCCs in Almeria. Two intervention groups of DCC-families performed educational measures and hand hygiene, one with soap-and-water (SWG) and another with hand sanitizer (HSG). The control group (CG) followed usual hand-washing procedures. RI episodes, including symptoms, treatments, medical contacts, complementary analyses, and DCC absenteeism days, were reported by parents. A Bayesian cost-effectiveness model was developed. There were 5201 RI episodes registered. The adjusted mean societal costs of RIs per child per study period were CG: €522.25 (95% confidence interval [CI]: 437.10 to 622.46); HSG: €374.53 (95% CI: 314.90 to 443.07); SWG: €494.51 (95% CI: 419.21 to 585.27). The indirect costs constituted between 35.7% to 43.6% of the total costs. Children belonging to the HSG had an average of 1.39 fewer RI episodes than the CG and 0.93 less than the SWG. It represents a saving of societal cost mean per child per study period of €147.72 and €119.15, respectively. The HSG intervention was dominant versus SWG and CG. Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents are more effective and cost less than a program with soap and water and initial observation in children attending DCCs.

Observational bias within a hospital-wide hand hygiene program.

We assessed the extent to which healthcare workers report more favorable hand hygiene rates when observing members of their own professional group versus other groups' observations of them. Healthcare workers consistently reported higher compliance rates for their own group compared to others' observations of them (97 vs 92%; P ≤ .001).

Multimodal Strategy to Improve Hand Hygiene Compliance to Practices among Staff Nurses

Introduction and Background: Healthcare-acquired infections [HCAI] account for 10-30% of all hospitaladmissions, according to the World Health Organization [WHO]. An estimated 1.4 million people are infected withHCAI at any given time.1 As the burden of health-care-associated infections grows, so does the seriousness of diseaseand treatment difficulty, which is exacerbated by multi-drug-resistant pathogen infections.2 Health care providersare reverting to the fundamentals of infection control by employing common steps such as hand hygiene.3 TheWHO’s global initiative on patient safety programmers has made “Clean Care is Safer Care” a top priority.it is timefor developing countries to formulate the much-needed policies for implementation of basic infection preventionpractices in health care set-up.4Nurses, the “nucleus of the health-care system,” spend more time with patients than any other health-care worker, andtheir adherence to hand-washing protocols appears to be more important in preventing disease transmission amongpatients. Hand hygiene is thought to be the most important factor in preventing healthcare-associated infections(HAI). Hand hygiene programmes with a variety of components have been shown to increase compliance amonghealthcare workers and, as a result, minimise infections. One such initiative is the World Health Organization’simplementation of an evidence-based definition called “My five moments for hand hygiene.”5The investigator seeks to study the compliance to hand hygiene practices among staff nurses, working in the obstetricaland gynaecological wards. The research is an endeavour to increase the awareness and educate nurses about the needfor compliance to hand hygiene practices.Aim: A.The aim of this study was to see how well health care workers in the intensive care unit kept their handsclean (ICU)B. To determine the causes of noncompliance, andC. To investigate the effectiveness of a multimodal intervention approach in enhancing compliance.Methodology: This Quasi experimental one group pre-intervention and post intervention study compares thecompliance to hand hygiene practices before and after a multimodal interventional strategySetting: The study was conducted in ICU ward in hospitalResult: The study needed a sample size of 64 nurses to achieve an 80 percent power and a 5% error rate. A t testwas used to compare the mean pre- and post-test scores. ANOVA was used to examine the relationships betweenthe baseline variables. Hand hygiene enforcement among staff nurses increased dramatically from 45.31 percentto 65.78 percent following multimodal intervention strategies. (P0.0001) Hand hygiene techniques have improvedsignificantly (hand wash technique mean score increased from 5.97 + 1.284 to 8.16 + 1.158 (p 0.05) and hand rubtechnique score increased from 4.52 + 0.992 to 6.69 + 1.489 (p 0.05)).The private wards had considerably better handhygiene than the general wards.XI. Conclusion: The results of this study show that when multimodal interventional interventions were used, handhygiene compliance improved.

Increasing patient participation in hand hygiene practices in adult surgical wards in a tertiary institution: a best practice implementation project

The WHO states that hospital-acquired infections may be transmitted through contaminated hands. Practicing hand hygiene using alcohol-based handrub or soap and water reduces harmful organisms. The Joanna Briggs Institute (JBI) best practice recommends empowering patients with hand hygiene knowledge and engaging their involvement to strengthen hand hygiene practices. The aim of this project was to improve hand hygiene among surgical inpatients. This evidence-based quality improvement project was conducted in three phases: the baseline audit, implementing best practice, and the postimplementation audit. Participants were patients hospitalized in three surgical wards of a 1200-bed acute care tertiary hospital. This project utilized the online JBI Practical Application of Clinical Evidence System and The Getting Research into Practice program to identify barriers and strategies. Nurses provided patients with an education pamphlet and regularly reminded them to improve their hand hygiene practices. Ninety-four patients were audited between April and June 2018. Patients' hand hygiene practices improved from 19.1% at baseline audit to 61.7% (P < 0.01) at first follow-up audit. Patients' hand hygiene improved from 48.9 to 72.3% (P = 0.03) before meals, and from 92.6 to 98.9% (P = 0.65) after toileting. The proportion of patients who received a hand hygiene information leaflet in an appropriate language increased from 64.9 to 89.4% (P < 0.01). Patients' involvement in the hand hygiene program has significantly improved their hand hygiene practices. Patient education and patient information leaflet continue to be an effective strategy to improve knowledge and practices.

Building on the Foundation of a Sustainable Hand Hygiene Program During the COVID-19 Pandemic

Background: Hand hygiene is essential to preventing the spread of disease in hospitals. Renewed emphasis has been placed on hand hygiene during the COVID-19 pandemic. We investigated whether UNC Medical Center’s well-established Clean-In Clean-Out (CICO) program for hand hygiene observations was sustainable throughout a public health and healthcare crisis and whether the COVID-19 pandemic had an effect on hand hygiene compliance. Methods: UNC Medical Center utilizes a crowd-sourced hand-hygiene audit application, CICO, to track hand-hygiene observations, compliance, and feedback. This application encourages participation from all staff and promotes providing real-time feedback in the form of a compliment or reminder when performing hand hygiene observations. During this evaluation, hand hygiene data were queried from the CICO application on the number of observations performed, hand hygiene compliance percentage, and feedback compliance percentage from July 2019 to December 2020. Hand hygiene data were compared to patient volumes in different care settings and the number of hospitalized patients being treated for COVID-19. Results: Initial increases in hand hygiene observations, compliance, and feedback were detected in the months leading up to UNC Medical Center receiving its first SARS-CoV-2–positive patient. Observations were highest when patient volumes were low due to closed clinics and restrictions on elective surgeries (Figure 1). When patient volumes returned to pre–COVID-19 levels coupled with treating more COVID-19 patients, the number of observations and compliance rate metrics declined. Feedback compliance percentage remained relatively stable through the entire period (Figure 2). Conclusions: Despite the additional strain on healthcare staff during COVID-19, the CICO model was a sustainable method to track hand hygiene observations and compliance. Notably, however, engagement was highest when patient census was lower, demonstrating that operating at a high capacity is not beneficial for patient safety. Due to the success and sustainment of the CICO program, UNC Medical Center used this model to create a Mask-On Mask-Up campaign to engage staff to submit observations, track compliance, and encourage feedback to promote the appropriate use of masks during COVID-19.Funding: NoDisclosures: None