Compliance Of Healthcare Workers Research Articles

Effectiveness of a Behavioral Approach to Improve Healthcare Worker Compliance With Hospital Dress Code.

BACKGROUND The VU University Medical Center, a tertiary-care hospital in the Netherlands, has adopted a dress code based on national guidelines. It includes uniforms provided by the hospital and a 'bare-below-the-elbow' policy for all healthcare workers (HCWs) in direct patient care. Because compliance was poor, we sought to improve adherence by interventions targeted at the main causes of noncompliance. OBJECTIVE To measure compliance with the dress code, to assess causes of noncompliance and to assess whether a behavioral approach (combing a nominal group technique with participatory action) is effective in improving compliance METHODS Between March 2014 and June 2016, a total of 1,920 HCWs were observed in hospital hallways for adherence to the policy, at baseline, and at follow-up measurements. Based on the outcome of the baseline measurement, a nominal group technique was applied to assess causes of noncompliance. The causes revealed served as input for interventions that were developed, prioritized, and tailored to specific groups of HCWs and specific departments through participatory action. RESULTS We identified lack of knowledge, lack of facilities, and negative attitudes as the main causes of noncompliance. The importance of each cause varied for different groups of HCWs. Tailored interventions targeted at these causes increased overall compliance by 39.6% (95% CI, 31.7-47.5). CONCLUSION The combination of a nominal group technique and participatory action approach is an effective method to increase and sustain compliance with hospital dress code. This combined approach may also be useful to improve adherence to other guidelines. Infect Control Hosp Epidemiol 2017;38:1435-1440.

A twenty-four-hour observational study of hand hygiene compliance among health-care workers in Debre Berhan referral hospital, Ethiopia

BackgroundHand hygiene (HH) is recognized as the single most effective strategy for preventing health care–associated infections. In developing countries, data on hand hygiene compliance is available only for few health-care facilities. This study aimed to assess hand hygiene compliance among health-care workers in Debre Berhan referral hospital, Ethiopia.MethodsThis study employed the WHO hand hygiene observation method. Direct observation of the health care workers (HCWs) was conducted using an observation record form in five different wards. Trained and validated observers watched HCWs while they had direct contact with patients or their surroundings, and the observers then recorded all possible hand hygiene opportunities and hand hygiene actions. Observation was conducted over a 24 h period to minimize selection bias. More than 200 opportunities per ward were observed according to WHO recommendation, except in neonatal intensive care unit. HH compliance was calculated by dividing the number of times hand hygiene was performed by the total number of opportunities for hand hygiene. A 95% confidence interval (CI) was computed for compliance with the exact binomial method.ResultsA total of 917 hand hygiene opportunities were observed during the study. Overall HH compliance was 22.0% (95% CI: 19.4–24.9). HH compliance was similar across all professional categories and did not vary by shift. Levels of compliance were lower before patient contact (2.4%; 95% CI: 0.9–5.3), before an aseptic procedure (3.6%; 95% CI: 1.6–7.6) and after contact with patient surroundings (3.3%; 95% CI: 1.2–7.9), whereas better levels of compliance were found after body fluid exposure (75.8%; 95% CI: 68.0–82.3) and after patient contact (42.8%; 95% CI: 35.2–50.7).ConclusionHH compliance of HCWs was found to be low in Debre Berhan referral hospital. Compliance with indications that protect patients from infection was lower than that protect the HCWs. The findings of this study indicate that HH compliance needs further improvement.

Patients’ Family Empowering to Increase Hand Hygiene (HH) Compliance in Health-Care Workers (HCW) from a Hematology-Oncology Ward in Mexico City

BackgroundHH is a key component to decrease infections in hospitals, but compliance in HCW remains low. We present a six-month strategy to empower patients’ caregivers on HCW HH compliance.MethodsHH compliance in HCWs was evaluated between June 1 and August 31, 2017 as recommended by WHO. Between September 1, 2016 and March 31, 2017 we undertook the empowering in the hematology-oncology ward (50 beds) from Instituto Nacional de Cancerologia, a cancer referral, teaching hospital in Mexico. To empower patients and their caregivers, a member of the team visited the patient and their relatives during the first 24h of hospital admission. Standarized information on HH and the importance of HCW compliance was given, along with a printed cartoon on HH opportunities (5 moments from WHO). Patients and their caregivers were trained to observe and record HH opportunties, an were invited to remind HCWs if HH omissions were observed. Data on HH compliance was collected monthly during the empowerment and 1 month after. Data was compared with the HH compliance from the 6 previous. We compared overall compliance and for each 5 HH moments before and after the empowering (chi 2 test).ResultsWe empowered 82 caregivers (M: 25.6%) and F: 74.4%), mean age 44 years. 24.4% had completed primary education, and 13.1% had higher education. Mothers and spouses were the primary caregivers (28.1% and 36.6%). HH compliance increased in all 5 moments: Before touching a patient (M1) (B: 9.5%, A: 57.6%, P = 0.005); before a clean or aseptic procedure (M2) (B: 7.9%, A: 48%, P = 0.002); after body fluid exposure (M3) (B: 10%, A: 59%, P = 0.0005), after touching a patient (M4) (B: 7.4%, A: 57.9%, P = 0.0005), and after touching patient surroundings (M5) (B: 2.4%, A: 77.4%, P = 0.0008). Nurses achieved a higher increase on compliance compared with physicians. Caregivers recognition on HH increased for each opporunity, being more notorious for M2 (B:31.7%, A: 61.5%); M3 (B: 7.3%, A: 31.5%), and M4, (B: 36.5%, A: 68.7%). Perception on the importance of preventing health-care-related infections increased from 80.5% to 90.3%.ConclusionEmpowering patients’ primary caregivers was an effective intervention to increase HCWs HH compliance at a hematology-oncology ward. The effect of this intervention remains to be evaluated on the long-term basis, but demonstrate the importance of involving patients and their relatives on health-care delivery.Disclosures All authors: No reported disclosures.

Evaluation of infectious diseases and clinical microbiology specialists\u2019 preferences for hand hygiene: analysis using the multi-attribute utility theory and the analytic hierarchy process methods

BackgroundHand hygiene is one of the most effective attempts to control nosocomial infections, and it is an important measure to avoid the transmission of pathogens. However, the compliance of healthcare workers (HCWs) with hand washing is still poor worldwide. Herein, we aimed to determine the best hand hygiene preference of the infectious diseases and clinical microbiology (IDCM) specialists to prevent transmission of microorganisms from one patient to another.MethodsExpert opinions regarding the criteria that influence the best hand hygiene preference were collected through a questionnaire via face-to-face interviews. Afterwards, these opinions were examined with two widely used multi-criteria decision analysis (MCDA) methods, the Multi-Attribute Utility Theory (MAUT) and the Analytic Hierarchy Process (AHP).ResultsA total of 15 IDCM specialist opinions were collected from diverse private and public hospitals located in İzmir, Turkey. The mean age of the participants was 49.73 ± 8.46, and the mean experience year of the participants in their fields was 17.67 ± 11.98. The findings that we obtained through two distinct decision making methods, the MAUT and the AHP, suggest that alcohol-based antiseptic solution (ABAS) has the highest utility (0.86) and priority (0.69) among the experts’ choices.ConclusionIn conclusion, the MAUT and the AHP, decision models developed here indicate that rubbing the hands with ABAS is the most favorable choice for IDCM specialists to prevent nosocomial infection.

Management of Latent Tuberculosis Infection Among Healthcare Workers: 10-Year Experience at a Single Center

The risk of infection with Mycobacterium tuberculosis among healthcare workers (HCWs) is estimated to be higher than the general population. However, HCW acceptance and compliance with available latent tuberculosis infection (LTBI) treatment regimens has been problematic. Recently, regimens have become available that might improve HCW acceptance and compliance with LTBI treatment. A retrospective single-center review of Employee Health and Wellness Services records of all HCWs diagnosed with LTBI was conducted. HCWs diagnosed with LTBI were offered 9-month isoniazid (INH), 4-month rifampin (RIF), weekly rifapentine/isoniazid (RPT/INH) for 12 weeks, or no treatment. Acceptance, completion rates, and side effects were reported for each regimen. Comparisons of regimens were assessed using Fisher exact test. Between 2005 and 2014, 363 of 927 (39%) HCWs diagnosed with LTBI accepted treatment. Of 363, 202 chose INH, 106 RIF, and 55 RPT/INH. Completion rates for each regimen were 58%, 80%, and 87%, respectively. HCWs were significantly more likely to have completed treatment with RIF (P < .0001) or RPT/INH (P < .0001) than INH. Rates of discontinuation owing to side effects were 35% for INH, 21% for RIF, and 10% for RPT/INH. Discontinuation of therapy due to side effects was significantly more frequent in the INH than the RPT/INH group (P = .0042). Completion of RIF and RPT/INH for LTBI in an HCW population is more likely than INH. Rates of discontinuation due to side effects were lower among those taking RPT/INH. Shorter LTBI treatment regimens should be more widely considered for HCWs in the United States.

Epidemiological surveillance of multidrug-resistant gram-negative bacteria in a solid organ transplantation department.

We assessed the impact of intensified infection control measures (ICM) on colonization and infection caused by carbapenem-resistant (CR) Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii in a solid organ transplantation (SOT) department. A quasi-experimental methodology was followed. The study was divided into three periods: pre-intervention, intervention with implementation of an ICM bundle including active surveillance program (ASP) and gradually enhanced measures, and post-ASP without ASP. The bundle included active surveillance cultures, contact precautions, hand hygiene, education of health care workers (HCWs), monitoring of compliance, and environmental cleaning. Incidence of colonization and infection caused by CR gram-negative bacteria was recorded. Molecular analysis of CR bacteria was performed for a certain period. During the intervention, incidence of colonization reduced from 19% to 9% (P<.001). The compliance of HCWs with contact precautions and hand hygiene also improved. Monthly incidence of infections caused by these CR bacteria increased from 2.8 to 6.9/1000 bed-days (P<.001). However, this increase did not have such a strong trend after the intervention. Most K.pneumoniae isolates, the commonest pathogen, carried the blaKPC gene. Colonization and infection rates by CR K.pneumoniae, P.aeruginosa, and A.baumannii were high among SOT recipients. In settings where CR gram-negative bacteria are endemic, colonization and infection rates by these bacteria are high among SOT recipients. Implementation of enhanced ICM in all related units of a hospital, although challenging, reduces colonization rates by CR gram-negative bacteria.

Monitoring the hand hygiene compliance of health care workers in a general intensive care unit: Use of continuous closed circle television versus overt observation

A variety of hand hygiene monitoring programs (HHMPs) have come into use in hospitals throughout the world. In the present study, we compare continuous closed circle television (CCTV) with overt observation for monitoring the hand hygiene compliance of health care workers (HCWs) in a general intensive care unit (GICU). This is a cross-sectional and comparative study. In this study, we use a novel hand hygiene CCTV monitoring system for hand hygiene performance monitoring. The study population incorporated all the GICU HCWs, including registered nurses, staff physicians, and auxiliary workers. All HCWs of our GICU were observed, including ICU registered nurses, ICU staff physicians, and auxiliary workers participated in the present study. Overall, each observer team did 50 sessions in each arm of the study. Total number of hand hygiene opportunities was approaching 500 opportunities. The compliance rates when only overt observations were performed was higher than when only covert observations were performed with a delta of approximately 10% (209 out of 590 [35.43%] vs 130 out of 533 [24.39%]; P < .001). Both methods of observations (overt and covert [CCTV]) demonstrated excellent reliability (intraclass correlation coefficient [ICC], 0.96 [0.93-0.98] of overt and ICC, 0.81 [0.69-0.89] for covert, respectively). However, the correlation between both methods was found weak in simultaneous sessions (ICC, 0.40 [0.62-0.107]). We demonstrated that CCTV is an appropriate, reliable, and neutral method for observation of hand hygiene. However, there is no clear basis for incorporating a CCTV observation modality into a health care system that already operates an overt observation program. We have shown that CCTV methodology records a different distribution of opportunities for performing hand hygiene and of actual performances of hand hygiene compared with overt observation.

Bacteria contamination of touch surfaces in Polish hospital wards.

The objective of the study has been to evaluate the pathogenic bacteria contamination of touch surfaces in hospital wards. Samples were taken from frequently touched surfaces in the hospital environment in 13 units of various types. Culturing was carried out on solid blood agar and in growth broth (tryptic soy broth - TSB). Species identification was performed using the analytical profile index (API) biochemical testing and confirmed with matrix assisted laser desorption ionization time-flight mass spectrometry (MALDI-TOF-MS) system. The total of 161 samples were taken for the study. Fifty-two of them, after 24 h of culture on a solid medium, demonstrated bacterial growth and further 60 samples had growth after prior multiplication in TSB. Overall, 69.6% of samples exhibited growth of 19 bacterial species. Pathogenic species - representing indicator organisms of efficiency of hospital cleaning - was demonstrated by 21.4% of samples. Among them Acinetobacter spp., Enterocococci spp. and Staphylococcus aureus were identified. Coagulase-negative staphylococci (CNS) were predominant. The proportion of various groups of bacteria significantly varied in respective hospitals, and in various types of wards. Disturbing observation is a large proportion of resistance of isolated CNS strains as a potential reservoir of resistance genes. The results show that touch surfaces in hospital units are contaminated by both potentially pathogenic and pathogenic bacterial species. In connection with the reported, also in Poland, frequent omission or incorrect execution of hand hygiene by hospital staff, and probably patients, touch surfaces still constitute important reservoir of pathogenic bacteria. Improving hand hygiene compliance of health-care workers with recommendations is necessary for increasing biological safety of hospital environment. Med Pr 2017;68(3):459-467.

Modeling Nosocomial Infections of Methicillin-Resistant Staphylococcus aureus with Environment Contamination*

In this work, we investigate the role of environmental contamination on the clinical epidemiology of antibiotic-resistant bacteria in hospitals. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It is tougher to treat than most strains of Staphylococcus aureus or staph, because it is resistant to some commonly used antibiotics. Both deterministic and stochastic models are constructed to describe the transmission characteristics of MRSA in hospital setting. The deterministic epidemic model includes five compartments: colonized and uncolonized patients, contaminated and uncontaminated health care workers (HCWs), and bacterial load in environment. The basic reproduction number R0 is calculated, and its numerical and sensitivity analysis has been performed to study the asymptotic behavior of the model, and to help identify factors responsible for observed patterns of infections. A stochastic epidemic model with stochastic simulations is also presented to supply a comprehensive analysis of its behavior. Data collected from Beijing Tongren Hospital will be used in the numerical simulations of our model. The results can be used to provide theoretical guidance for designing efficient control measures, such as increasing the hand hygiene compliance of HCWs and disinfection rate of environment, and decreasing the transmission rate between environment and patients and HCWs.

Questionnaire-based analysis of infection prevention and control in healthcare facilities in Saudi Arabia in regards to Middle East Respiratory Syndrome.

Effective implementation of infection prevention and control in healthcare facilities depends on training, awareness and compliance of healthcare workers. In Saudi Arabia recent significant hospital outbreaks, including Middle East Respiratory Syndrome Coronavirus (MERS-CoV), have resulted from lack of, or breakdown in, infection prevention and control procedures. This study was designed to assess attitudes to, and awareness of, infection prevention and control policies and guidelines among healthcare workers of different professions and institution types in Saudi Arabia. A questionnaire was administered to 607 healthcare workers including physicians (n = 133), nurses (n = 162), laboratory staff (n = 233) and other staff (n = 79) in government hospitals, private hospitals and poly clinics. Results were compared using Chi square analysis according to profession type, institution type, age group and nationality (Saudi or non-Saudi) to assess variability. Responses suggested that there are relatively high levels of uncertainty among healthcare workers across a range of infection prevention and control issues, including institution-specific issues, surveillance and reporting standards, and readiness and competence to implement policies and respond to outbreaks. There was evidence to suggest that staff in private hospitals and nurses were more confident than other staff types. Carelessness of healthcare workers was the top-cited factor contributing to causes of outbreaks (65.07% of total group), and hospital infrastructure and design was the top-cited factor contributing to spread of infection in the hospital (54.20%), followed closely by lack and shortage of staff (53.71%) and no infection control training program (51.73%). An electronic surveillance system was considered the most effective by staff (81.22%). We have identified areas of concern among healthcare workers in Saudi Arabia on infection prevention and control which vary between institutions and among different professions. This merits urgent multi-factorial actions to try to ensure outbreaks such as MERS-CoV can be minimized and contained.

Smartphone text message service to foster hand hygiene compliance in health care workers.

Health care-associated infections are a major worldwide public health issue. Hand hygiene is a major component in the prevention of pathogen transmission in hospitals, and hand hygiene adherence by health care workers is low in many studies. We report an intervention using text messages as reminders and feedback to improve hand hygiene adherence. The study is a historical comparison proof-of-concept study. Eighteen health care workers were monitored during 12 months by a radiofrequency identification system. Afterward we sent 2 types of text messages, congratulation or encouragement, and we studied the evolution of hand hygiene adherence. We recorded 15,723 hand hygiene opportunities, 8,973 before intervention and 6,750 during and after the intervention. Using a multilevel logistic regression analysis, we found a significant increase in hand hygiene adherence during the intervention (odds ratio, 1.68) compared with the historical period. Despite limitations due to the type of study, a text message encouraging personnel to be more vigilant is effective in increasing hand hygiene adherence in health care workers. Text message feedback should be incorporated into multimodal approaches for improving hand hygiene compliance.

Role of quality control circle in sustained improvement of hand hygiene compliance: an observational study in a stomatology hospital in Shandong, China.

BackgroundHand hygiene is an important element of the WHO multimodal strategy for healthcare-associated infection control, whereas compliance of hand hygiene among healthcare workers (HCWs) remains a challenge to sustain. In order to increase the hand hygiene compliance of HCWs, a quality control circle (QCC) program was carried out in our hospital, and the plan-do-check-act (PDCA) method was applied for 12 months.FindingsHand hygiene compliance rates improved over time, with significant improvement between preintervention (60.1%) and postintervention (97.2%) periods (P < 0.001). Nurses (88.3%) exhibited higher compliance than dentists (87.3%), and female (88.4%) HCWs were more likely to perform hand hygiene than males (85.6%), both P < 0.001. Overall hand hygiene compliance and observance of the five indications exhibited significant linear increases over time (P < 0.005).ConclusionThis study highlights the success of a multifaceted intervention, conducted by QCC program and PDCA method, which led to a significant improvement of hand hygiene compliance. Though training is the most basic intervention element, surveillance, evaluation and feedback should be explored as additional interventions to ensure that hand hygiene compliance is achieved and sustained at high levels.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-016-0160-1) contains supplementary material, which is available to authorized users.

Continued direct observation and feedback of hand hygiene adherence can result in long-term improvement.

Hospital-wide multifaceted approaches can improve hand hygiene compliance in health care workers. However, the true effects of monitoring and feedback interventions are not clear. Hand hygiene compliance was evaluated by applying direct observation techniques over 5 years (2005-2009) in a tertiary care general hospital in Japan. The observed results were periodically reported as feedback to the health care workers. The overall hand hygiene compliance rate increased from 50.8% in 2005 to 61.0% in 2006 (P = .004) and was sustained at approximately 60% through the completion of the study. The compliance rate for the indication before entering the room increased from 2005 to 2009 (P = .005). The compliance rates for 4 before patient contact indications increased from 2005 to 2009 (P = .002). The combined compliance rate for the 6 indications with the lowest compliance rates in 2005 increased from 2005 to 2009 (P = .001). Direct observation and feedback methods are effective strategies that resulted in a long-lasting improvement in hand hygiene compliance that was sustained over 5 years through the completion of the study. Focusing on the procedures with high baseline noncompliance rates can be an effective way to improve the overall compliance.

Reducing post-cesarean wound infection at Muhororo Hospital by increasing hand hygiene practice

Purpose Post-cesarean wound infection (PCWI) is a common post-operative complication that can negatively affect patients and health systems. Poor hand hygiene practice of health care professionals is a common cause of PCWI. This case study aims to describe how strategic problem solving was used to introduce an alcohol-based hand rub in a district hospital in Rwanda to improve hand hygiene compliance among health care workers and reduce PCWI. Design/methodology/approach Pre- and post-intervention study design was used to address the poor hand hygiene compliance in the maternity unit. The hospital availed an alcohol-based hand rub and the team provided training on the importance of hand hygiene. A chart audit was conducted to assess the PCWI, and an observational study was used to assess hand hygiene compliance. Findings The intervention successfully increased hand hygiene compliance of health care workers from 38.2 to 89.7 per cent, p &lt; 0.001, and was associated with reduced hospital-acquired infection rates from 6.2 to 2.5 per cent, p = 0.083. Practical implications This case study describes the implementation process of a quality improvement project using the eight steps of strategic problem solving to introduce an alcohol-based hand rub in a district hospital in Rwanda. The intervention improved hand hygiene compliance among health care workers and reduced PCWI using available resources and effective leadership skills. Originality/value The results will inform hospitals with similar settings of steps to create an environment that enables hand hygiene practice, and in turn reduces PCWI, using available resources and strategic problem solving.

Enhanced performance feedback and patient participation to improve hand hygiene compliance of health-care workers in the setting of established multimodal promotion: a single-centre, cluster randomised controlled trial

Hand hygiene compliance of health-care workers remains suboptimal despite standard multimodal promotion, and evidence for the effectiveness of novel interventions is urgently needed. We aimed to assess the effect of enhanced performance feedback and patient participation on hand hygiene compliance in the setting of multimodal promotion. We did a single-centre, cluster randomised controlled trial at University of Geneva Hospitals (Geneva, Switzerland). All wards hosting adult, lucid patients, and all health-care workers and patients in these wards, were eligible. After a 15-month baseline period, eligible wards were assigned by computer-generated block randomisation (1:1:1), stratified by the type of ward, to one of three groups: control, enhanced performance feedback, or enhanced performance feedback plus patient participation. Standard multimodal hand hygiene promotion was done hospital-wide throughout the study. The primary outcome was hand hygiene compliance of health-care workers (according to the WHO Five Moments of Hand Hygiene) at the opportunity level, measured by direct observation (20-min sessions) by 12 validated infection control nurses, with each ward audited at least once every 3 months. This trial is registered with ISRCTN, number ISRCTN43599478. We randomly assigned 67 wards to the control group (n=21), enhanced performance feedback (n=24), or enhanced performance feedback plus patient participation (n=22) on May 19, 2010. One ward in the control group became a high-dependency unit and was excluded from analysis. During 1367 observation sessions, 12 579 hand hygiene opportunities were recorded. Between the baseline period (April 1, 2009, to June 30, 2010) and the intervention period (July 1, 2010, to June 30, 2012), mean hand hygiene compliance increased from 66% (95% CI 62-70) to 73% (70-77) in the control group (odds ratio [OR] 1·41, 95% CI 1·21-1·63), from 65% (62-69) to 75% (72-77) in the enhanced performance feedback group (1·61, 1·41-1·84), and from 66% (62-70) to 77% (74-80) in the enhanced performance feedback plus patient participation group (1·73, 1·51-1·98). The absolute difference in compliance attributable to interventions was 3 percentage points (95% CI 0-7; p=0·19) for the enhanced performance feedback group and 4 percentage points (1-8; p=0·048) for the enhanced performance feedback plus patient participation group. Hand hygiene compliance remained significantly higher than baseline in all three groups (OR 1·21 [1·00-1·47] vs 1·38 [1·19-1·60] vs 1·36 [1·18-1·57]) during the post-intervention follow-up (Jan 1, 2013, to Dec 31, 2014). Hand hygiene compliance improved in all study groups, and neither intervention had a clinically significant effect compared with control. Improvement in control wards might reflect cross-contamination, highlighting challenges with randomised trials of behaviour change. Swiss National Science Foundation.

Using Gamification Combined with Indoor Location to Improve Nurses' Hand Hygiene Compliance in an ICU Ward.

Healthcare acquired infections are among the biggest unsolved problems in healthcare, implying an increasing number of deaths, extra-days of hospital stay and hospital costs. Performing hand hygiene is a simple and inexpensive prevention measure, but healthcare workers compliance with it is still far from optimal. Recognized hurdles are lack of time, forgetfulness, wrong technique and lack of motivation. This study aims at exploring gamification to promote nurses' HH compliance self-awareness and action. Real-time data collected from an indoor location system will provide feedback information to a group of nurses working in an ICU ward. In this paper both the research's motivation and methods is presented, along with the first round of results and its discussion.

Compliance with the Use of Medical and Cloth Masks Among Healthcare Workers in Vietnam.

Masks are often worn in healthcare settings to prevent the spread of infection from healthcare workers (HCWs) to patients. Masks are also used to protect the employee from patient-generated infectious organisms but poor compliance can reduce efficacy. The aim of this study was to examine the factors influencing compliance with the use of medical and cloth masks amongst hospital HCWs. HCWs compliance with the use of medical and cloth masks was measured over a 4-week period in a randomized controlled trial in Vietnam. HCWs were instructed to record their daily activities in diary cards. Demographic, clinical, and diary card data were used to determine the predictors of compliance and the relationship of compliance with infection outcomes. Compliance rates for both medical and cloth masks decreased during the 4 weeks: medical mask use decreased from 77 to 68% (P < 0.001) and cloth masks from 78 to 69% (P < 0.001). The presence of adverse events (adjusted RR 0.90, 95% CI 0.85-0.95), and performing aerosol-generating procedures (adjusted RR 0.78, 95% CI 0.73-0.82) were negatively associated with compliance, while contact with febrile respiratory illness patients was positively associated (adjusted RR 1.14, 95% CI 1.07-1.20). Being compliant with medical or cloth masks use (average use ≥70% of working time) was not associated with clinical respiratory illness, influenza-like illness, and laboratory-confirmed viral infection. Understanding the factors that affect compliance is important for the occupational health and safety of HCWs. New strategies and tools should be developed to increase compliance of HCWs. The presence of adverse events such as discomfort and breathing problems may be the main reasons for the low compliance with mask use and further studies should be conducted to improve the design/material of masks to improve comfort for the wearer.

Health Care Personnel’s Attitude toward Hand Hygiene in Regard to the Prevention of Health-Care Associated Infections: A Cross Sectional Study at the University Hospital Pristine

Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low in most settings. Objective: The main aim of this paper is to determine findings and start drafting policies in implementing them into practice after finding out nurses’ opinions, beliefs and attitudes toward hand hygiene (HH). Methodology and methods: A cross sectional descriptive and observational study during November 2009. Results: From the total number of 175 health care workers employed in this unit, 67 (38.3%) were observed regarding adherence to hand hygiene. Regarding the knowledge, practices and attitudes of the nurses, data were collected from 54 (50.0%) among 108 nurses in four intensive care units within the University Clinical Centre of Kosovo (UCCK). From research findings, it was concluded that hand hygiene compliance in the intensive care units was low (51.3%). Conclusion: Research results show the necessity of organizing multimodal programs with intensive care units of University Clinical Centre of Kosovo (UCCK) on increase of knowledge level on health-care associated infections (HAI).

Introduction of a Hand-hygiene Automated Monitoring System：Accuracy in Monitoring Hand Hygiene Compliance and Its Effect in Promoting Hand Hygiene Behaviour

Hand hygiene is important in the prevention of healthcare-associated infection in hospitals, but the compliance rate of healthcare workers for hand hygiene is lower than expected. Hand hygiene compliance is usually monitored employing visual methods that are open to the Hawthorne effect and limited in terms of time and place. An automated monitoring system may provide the hand-hygiene compliance rate automatically and continuously, without suffering from the Hawthorne effect. An automated monitoring system may also improve hand hygiene by providing feedback data and real-time reminders. We report herein on an automated monitoring system that permits the tracking of hand hygiene opportunities and the disinfection compliance of healthcare workers. The aim is to establish the accuracy of the system in monitoring hand hygiene compliance and to estimate the effect of the system in promoting hand hygiene behaviour. Two studies were conducted. First, to evaluate the accuracy of hand hygiene compliance recorded by the automated monitoring system, we compared the hand hygiene compliance rate recorded by the automated monitoring system with that recorded by direct visual observation for 3 days during the same period in the same ward. For the overall period of simultaneous automated and human observations, the hand hygiene compliance rate was automatically observed to be 78% and visually observed to be 75.4%. Second, to estimate the effect of the automated monitoring system in improving health workers' compliance with hand hygiene, we installed monitoring equipment in one ward and measured the compliance rate via the automated monitoring system for 13 weeks. This study included Phase 1 with a reminder only, Phase 2 with a reminder and feedback, and Phase 3 again with a reminder only. A significant increase in hand hygiene performance was observed during phase 2, and a high rate was sustained over phase 3. In phase 1, however, there was no increase in the hand hygiene compliance rate. We found the automated monitoring system to be a useful tool for not only monitoring hand hygiene but also for improving hand hygiene compliance.

An assessment of hand hygiene practices of healthcare workers of a semi-urban teaching hospital using the five moments of hand hygiene.

Background:Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients. The objectives of this study were to access healthcare workers compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices.Methods:The study was an observational, cross-sectional one. Hand hygiene compliance was monitored using the hand hygiene observation tool developed by the WHO. A nonidentified observer was used for monitoring compliance with hand hygiene. The observational period was over a 60-day period from August 2015 to October 2015.Results:One hundred and seventy-six observations were recorded from healthcare personnel. The highest number of observations were seen in surgery, n = 40. The following were found to be in noncompliance before patient contact – anesthetist P = 0.00 and the Intensive Care Unit P = 0.00 while compliance was seen with senior nurses (certified registered nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the removal of gloves, the following were areas of noncompliance - the emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance was seen with surgery P = 0.01. With regards to compliance after touching the patient, areas of noncompliance were the anesthetists P = 0.00, as opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P = 0.02 that were compliant. Overall, the rates of compliance to hand hygiene were low.Discussion:The findings however from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, healthcare workers in developing settings such as ours regard such programs as being mundane.Conclusion:The observance of hand hygiene is still low in our local environment. Handwashing practices in our study show that healthcare workers pay attention to hand hygiene when it appears there is a direct observable threat to their wellbeing. Educational programs need to be developed to address the issue of poor hand hygiene.