Hand Hygiene Compliance Of Healthcare Workers Research Articles

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.

Improving Healthcare Worker Hand Hygiene Compliance: The Role of Behavior Change Theories

Improving Healthcare Worker Hand Hygiene Compliance: The Role of Behavior Change Theories

Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: a cross-sectional study.

BackgroundThe impact of sink location on hand washing compliance after contact with patients with Clostridium difficile infection (CDI) is poorly understood. The aim of this study is to determine the location of hand wash sinks available to healthcare workers (HCWs) after caring for patients with CDI and to assess the impact on hand washing compliance.MethodsWe performed a cross-sectional study in a 637-bed tertiary care hospital, Canada. HCW hand hygiene compliance after contact with CDI patients was measured through direct unobtrusive observations. Location of sinks in relation with the patients’ rooms was assessed on the day of diagnosis. Predictors of compliance were assessed through univariate and multivariate logistic regression.Results247 hand hygiene opportunities following care of a CDI patient were observed. Glove use compliance was 85.4 % (211/247), but hand washing compliance after care of CDI patients was only 14.2 % (35/247). Hand rubbing was performed instead of hand washing in 33.2 % of opportunities (82/247). The median distance between the patient zone of CDI patients and the nearest sink was 13.1 m (interquartile range, 7.6-23.2). Sinks were directly visible upon exiting the patient’s room on only 33.2 % (82/247) occasions. By multivariate analysis, an increasing distance between the patient zone and the nearest sink was inversely associated with hand washing compliance (adjusted OR, 0.90, 95 % CI, 0.84-0.97; P = 0.008), while proper timing of glove removal upon leaving the patient zone was directly associated with hand washing compliance (adjusted OR, 14.87; 95 % CI, 1.93-114.43; P = 0.01).ConclusionsHand washing compliance following contact with patients with C. difficile infections was low. Poor access to sinks is associated with decreased hand washing compliance. Improvement strategies are urgently needed.

Enhancing the evaluation of pathogen transmission risk in a hospital by merging hand-hygiene compliance and contact data: a proof-of-concept study.

BackgroundHand-hygiene compliance and contacts of health-care workers largely determine the potential paths of pathogen transmission in hospital wards. We explored how the combination of data collected by two automated infrastructures based on wearable sensors and recording (1) use of hydro-alcoholic solution and (2) contacts of health-care workers provide an enhanced view of the risk of transmission events in the ward.MethodsWe perform a proof-of-concept observational study. Detailed data on contact patterns and hand-hygiene compliance of health-care workers were collected by wearable sensors over 12 days in an infectious disease unit of a hospital in Marseilles, France.Results10,837 contact events among 10 doctors, 4 nurses, 4 nurses’ aids and 4 housekeeping staff were recorded during the study. Most contacts took place among medical doctors. Aggregate contact durations were highly heterogeneous and the resulting contact network was highly structured. 510 visits of health-care workers to patients’ rooms were recorded, with a low rate of hand-hygiene compliance. Both data sets were used to construct histories and statistics of contacts informed by the use of hydro-alcoholic solution, or lack thereof, of the involved health-care workers.ConclusionsHand-hygiene compliance data strongly enrich the information concerning contacts among health-care workers, by assigning a ‘safe’ or ‘at-risk’ value to each contact. The global contact network can thus be divided into ‘at-risk’ and ‘safe’ contact networks. The combined data could be of high relevance for outbreak investigation and to inform data-driven models of nosocomial disease spread.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1409-0) contains supplementary material, which is available to authorized users.

Effectiveness of interventions to healthcare worker hand hygiene compliance at two delivery suites of Hung Vuong hospital, Vietnam

Effectiveness of interventions to healthcare worker hand hygiene compliance at two delivery suites of Hung Vuong hospital, Vietnam

Assessment of hand hygiene resources and practices at the 2 children's hospitals in Greece.

Hand hygiene (HH) is the most effective way to prevent health care-associated infections and the spread of antimicrobial-resistant pathogens. The aim of our study was to assess the existing HH resources and current HH practices at 2 hospitals in Athens, Greece. Observational HH data and an inventory of HH resources were collected from 13 wards including medical/surgical, oncology/transplant and intensive care units, during 65, 1-hour observations periods. A total of 1271 HH opportunities were observed during the study period, including 944 of Health Care Workers (HCW) and 327 of visitors and parents. The nursing HH compliance was highest (49%) followed by medical compliance (24%, P < 0.001). HCW HH compliance was highest in intensive care units and the transplant unit (64-87%). The rate of appropriate HH for HCW was 22.6%. HCW most commonly used soap and water (76.1%). The HH procedure was more likely to be appropriate when soap and water were used as compared with alcohol based hand rub (64.6% and 47.5%, P = 0.006). A marginally significant association was identified between the HH compliance rate and the number of alcohol based hand rub dispensers per room (P = 0.057). In visitors and parents, the HH compliance was found to be 19%, whereas the rate of appropriate HH was 8.9%. Low levels of HH were observed.

Iranian healthcare workers' perspective on hand hygiene: a qualitative study.

Hand hygiene (HH) has been identified as one of the simplest, but most important, methods to prevent cross-infection in healthcare facilities. In spite of this fact, the HH compliance rate remains low among healthcare workers (HCWs). Several factors may affect HH behavior. In this study, we aimed to assess various aspects of HH from the perspective of HCWs. This qualitative study was conducted in two hospital settings in Shiraz, Iran. Eight focus group discussions (FGDs) and six in-depth interview sessions were held with ICU and surgical ward nurses, attending physicians, medical and nursing students and supporting staff. Each FGD and interview was transcribed verbatim, open codes were extracted, and thematic analysis was conducted. Three themes emerged from the thematic analysis including: "the relationship between personal factors and HH compliance," "the relationship between environmental factors and HH compliance" and "the impact of the health system on HH adherence, including the role of adequate health systems, administrative obligations and the effect of surveillance systems." Several factors played a significant role in improving HCWs HH compliance, such as the regular adherence to health system tenets. HH compliance may be improved through application of realistic policies and better supervision. In addition, appropriate education may positively affect HH behavior and attitudes.

Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia

BackgroundHand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia.MethodsThis study included a before-and-after assessment of health care worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs’ perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period.ResultsAt baseline, hand washing materials were infrequently available, with only 20% of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign (OR = 6.8, 95% CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95% CI 3.5-9.3), in the emergency department (aOR = 4.9, 95% CI 2.8-8.6), during patient care that did not involve Attending Physician Rounds (aOR = 2.4, 95% CI 1.2-4.5), and after patient contact (aOR = 2.1, 95% CI 1.4-3.3). In the perceptions survey, 64.0% of HCWs indicated preference for commercially manufactured hand sanitizer and 71.4% indicated their hand hygiene adherence would improve with commercial hand sanitizer.ConclusionsThere was a significant increase in hand hygiene adherence among Ethiopian HCWs following the implementation of a WHO-recommended multimodal hand hygiene campaign. Dissatisfaction with the current WHO-formulation for hand sanitizer was identified as a barrier to hand hygiene adherence in our setting.

Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study

Health-care-associated infections are a major threat to patient safety worldwide. Transmission is mainly via the hands of health-care workers, but compliance with recommendations is usually low and effective improvement strategies are needed. We assessed the effect of WHO's strategy for improvement of hand hygiene in five countries. We did a quasi-experimental study between December, 2006, and December, 2008, at six pilot sites (55 departments in 43 hospitals) in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia. A step-wise approach in four 3-6 month phases was used to implement WHO's strategy and we assessed the hand-hygiene compliance of health-care workers and their knowledge, by questionnaire, of microbial transmission and hand-hygiene principles. We expressed compliance as the proportion of predefined opportunities met by hand-hygiene actions (ie, handwashing or hand rubbing). We assessed long-term sustainability of core strategy activities in April, 2010. We noted 21,884 hand-hygiene opportunities during 1423 sessions before the intervention and 23,746 opportunities during 1784 sessions after. Overall compliance increased from 51.0% before the intervention (95% CI 45.1-56.9) to 67.2% after (61.8-72.2). Compliance was independently associated with gross national income per head, with a greater effect of the intervention in low-income and middle-income countries (odds ratio [OR] 4.67, 95% CI 3.16-6.89; p<0.0001) than in high-income countries (2.19, 2.03-2.37; p<0.0001). Implementation had a major effect on compliance of health-care workers across all sites after adjustment for main confounders (OR 2.15, 1.99-2.32). Health-care-workers' knowledge improved at all sites with an increase in the average score from 18.7 (95% CI 17.8-19.7) to 24.7 (23.7-25.6) after educational sessions. 2 years after the intervention, all sites reported ongoing hand-hygiene activities with sustained or further improvement, including national scale-up. Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide. WHO, University of Geneva Hospitals, the Swiss National Science Foundation, Swiss Society of Public Health Administration and Hospital Pharmacists.

Development of a standardised approach to observing hand hygiene compliance in Australia

Abstract Background Evidence indicates that improved hand hygiene compliance can lead to reductions in healthcare associated infection. However, there are few papers that clearly document the observation method used to collect the hand hygiene compliance data. This article describes the Hand Hygiene Australia 5 Moments for Hand Hygiene observation method in detail. Methods The Australian Commission for Safety and Quality in Health Care funded Hand Hygiene Australia (HHA) to implement the National Hand Hygiene Initiative (NHHI) to improve hand hygiene compliance (HHC) and establish a national validated system of HHC auditing. Based on the World Health Organisation (WHO) World Alliance for Patient Safety campaign ‘Clean Care is Safer Care', HHA adapted the WHO hand hygiene compliance data collection form to suit Australian healthcare facilities. Results Hand Hygiene Australia developed a standardised approach to direct observation of HHC of healthcare workers by developing a uniform suite of tools and a data management system for accurate data collection and report generation. Conclusion Implementation of the HHA 5 Moments HHC audit method has facilitated standardised, reliable and meaningful collection of hand hygiene compliance data that is driving HHC improvement across many different healthcare settings around Australia.

Monitoring Hand Hygiene via Human Observers: How Should We Be Sampling?

To explore how hand hygiene observer scheduling influences the number of events and unique individuals observed. We deployed a mobile sensor network to capture detailed movement data for 6 categories of healthcare workers over a 2-week period. University of Iowa Hospital and Clinic medical intensive care unit (ICU). We recorded 33,721 time-stamped healthcare worker entries to and exits from patient rooms and considered each entry or exit to be an opportunity for hand hygiene. Architectural drawings were used to derive 4 optimal line-of-sight placements for observers. We ran simulations for different observer movement schedules, all with a budget of 1 hour of total observation time. We considered observation times of 1-15, 15-30, 30, and 60 minutes per station. We stochastically generated healthcare worker hand hygiene compliance on the basis of all data and recorded the total unit compliance as it would be reported by each simulated observer. Considering a 60-minute total observation period, aggregate simulated observers captured 1.7% of the average total number of opportunities per day at best and 0.5% at worst. The 1-15-minute schedule captures, on average, 16% fewer events than does the 60-minute (ie, static) schedule, but it samples 17% more unique individuals. The 1-15-minute schedule also provides the best estimator of compliance for the duration of the shift, with a mean standard deviation of 17%, compared with 23% for the 60-minute schedule. Our results show that observations are sensitive to different observers' schedules and suggest the importance of using data-driven approaches to schedule hand hygiene audits.

Quality-Improvement Initiative Sustains Improvement in Pediatric Health Care Worker Hand Hygiene

To use quality-improvement (QI) methods to develop and test a multimodal intervention to improve hand-hygiene compliance among health care workers (HCWs) to >90%. We used a quasi-experimental staggered intervention that was conducted on 2 similar general pediatric units within a 475-bed tertiary children's hospital. Compliance was defined as acceptable hand hygiene both before and after contact with the patient or the patient's care environment. Measurement of HCW hand-hygiene compliance was performed by covert observations made during routine patient care. Twelve months of preintervention data were collected. QI methods were used to test and implement interventions sequentially in each unit. Interventions addressed leadership support, improving HCW knowledge, hand-hygiene supply availability, and HCW behavior. Interventions began on unit A on November 10, 2008. Similar interventions were later tested on unit B starting March 23, 2009. By April 1, 2009, compliance increased on unit A (from 65% to 91%) and unit B (from 74% to 92%). Improvement on each unit occurred only after the interventions were introduced. Identifying HCWs who failed to perform hand hygiene and offering alcohol-based hand rub to them before patient contact resulted in the greatest improvement. Improvements were sustained on both units for 18 months. Use of QI methods to implement a multimodal intervention resulted in sustained improvement in hand-hygiene compliance. Real-time individual performance feedback or other high-reliability human-factor interventions seem to be necessary to reach and sustain high levels of hand-hygiene compliance.

Active surveillance culturing impacts methicillin-resistant Staphylococcus aureus acquisition in a pediatric intensive care unit*

To determine whether active surveillance culturing for methicillin-resistant Staphylococcus aureus (MRSA) decreases nosocomial MRSA acquisition in the pediatric intensive care unit. Before and after observational study. A tertiary care, 20-bed, pediatric intensive care unit. All patients admitted to the pediatric intensive care unit. Anterior nares cultures for MRSA were obtained on admission and weekly in the pediatric intensive care unit from January 2007 to December 2009 as part of a hospital quality improvement project. MRSA admission prevalence and nosocomial incidence density were determined retrospectively for 2006 and prospectively for 2007-2009. Nosocomial MRSA incidence density during the intervention period was determined monthly and analyzed by trend analysis by using a general linear model. The correlation of active surveillance culturing compliance with nosocomial acquisition of MRSA was analyzed. Possible confounding by healthcare worker hand hygiene compliance observed during the intervention period was also analyzed by multivariate linear regression analysis. The yearly MRSA incidence density significantly decreased from 2006 to 2009 (6.88 per 1,000 patient days to 1.45 per 1,000 patient days, p < .001) and from 2007 to 2009 (7.32 per 1,000 patient days to 1.45 per 1,000 patient days, p < .001). Trend analysis demonstrated a significant decline in MRSA acquisition over time following the introduction of active surveillance culturing (p < .001). Surveillance culturing was significantly associated with the decline in MRSA acquisition observed in the pediatric intensive care unit by multivariate regression analysis when controlling for hand hygiene (p = .01). Active surveillance culturing resulted in significantly decreased nosocomial acquisition of MRSA in a pediatric intensive care unit setting. Admission and weekly active surveillance culturing appears to be an effective tool to decrease the spread of MRSA in the pediatric intensive care unit, independent of improvement in hand hygiene compliance. The impact on hospital-acquired MRSA infections and the cost benefit of active surveillance culturing require further study.

Improvement in hand hygiene compliance. The impact of a regional strategy

Health-care workers (HCWs) adherence to hand hygiene (HH) guidelines is usually low. According to WHO recommendations, the key strategy components to improve the compliance is evaluation and feed-back.In this study we monitored HH compliance of HCWs by direct observation in Madrid and to asses the impact of an interventional strategy.

Improving hand hygiene compliance with comprehensive interventions over time

ISSUE: Proper hand hygiene (HH) by healthcare workers (HCWs) is a well-established method to prevent nosocomial pathogen transmission. Despite this, HCW HH compliance is not ideal. Alcohol-based hand rub was introduced and multiple interventions were also implemented to improve HH practices. PROJECT: 1) Data collection: In June 2003, an observational, interventional study with five phases (baseline, separate staggered intervention periods) was initiated. Trained members of infection control staff recorded data on patient encounters, including whether or not HCWs washed hands before (HH pre) and after (HH post) patient care. Twenty observation sessions per week were randomly distributed during the hours of 7am to 5pm, Monday through Friday; each session lasted about 30 minutes. 2) Interventions: Alcohol-based hand rub was selected utilizing staff input; decisions regarding placement and labeling gave consideration to feedback from multidisciplinary rounds and focus groups of clinical staff. Placement was standardized wherever possible. During mandatory introductory inservices, HCWs were educated on benefits and appropriate use of hand rub. Importance of HH in preventing infection was re-emphasized and common misconceptions about HH were addressed. Surveys and follow-up surveys were conducted to assess HCW attitudes, beliefs, and knowledge about HH as well as satisfaction with the hand-rub product. Education included an interactive component and a Web-based module. Two separate HH poster campaigns were launched. Refresher inservices provided feedback on floor-specific HH rates, fingertip culture results, and self-assessments of HH practices. Nurse leaders subsequently received monthly feedback on floor-specific HH rates. RESULTS: During 1,476 sessions (total of about 738 hrs of observation over 67 weeks), observers recorded 12,814 opportunities for HH (6,407 complete episodes). Ongoing review of continuous monitoring data has shown overall improvement at the end of each campaign phase. Overall, rates of HH compliance before patient care almost tripled (6.4% at baseline, 16.5% during Phase 4, p < 0.01), and rates of HH post doubled (23.4% to 46.6%, p < 0.01). LESSONS LEARNED: Improving HH practices is difficult but possible with a comprehensive program of multiphased interventions over time. Our experience has shown that intervention components addressing physical environment, cognitive factors, clinical, and administrative buy-in and HCW involvement are beneficial. ISSUE: Proper hand hygiene (HH) by healthcare workers (HCWs) is a well-established method to prevent nosocomial pathogen transmission. Despite this, HCW HH compliance is not ideal. Alcohol-based hand rub was introduced and multiple interventions were also implemented to improve HH practices. PROJECT: 1) Data collection: In June 2003, an observational, interventional study with five phases (baseline, separate staggered intervention periods) was initiated. Trained members of infection control staff recorded data on patient encounters, including whether or not HCWs washed hands before (HH pre) and after (HH post) patient care. Twenty observation sessions per week were randomly distributed during the hours of 7am to 5pm, Monday through Friday; each session lasted about 30 minutes. 2) Interventions: Alcohol-based hand rub was selected utilizing staff input; decisions regarding placement and labeling gave consideration to feedback from multidisciplinary rounds and focus groups of clinical staff. Placement was standardized wherever possible. During mandatory introductory inservices, HCWs were educated on benefits and appropriate use of hand rub. Importance of HH in preventing infection was re-emphasized and common misconceptions about HH were addressed. Surveys and follow-up surveys were conducted to assess HCW attitudes, beliefs, and knowledge about HH as well as satisfaction with the hand-rub product. Education included an interactive component and a Web-based module. Two separate HH poster campaigns were launched. Refresher inservices provided feedback on floor-specific HH rates, fingertip culture results, and self-assessments of HH practices. Nurse leaders subsequently received monthly feedback on floor-specific HH rates. RESULTS: During 1,476 sessions (total of about 738 hrs of observation over 67 weeks), observers recorded 12,814 opportunities for HH (6,407 complete episodes). Ongoing review of continuous monitoring data has shown overall improvement at the end of each campaign phase. Overall, rates of HH compliance before patient care almost tripled (6.4% at baseline, 16.5% during Phase 4, p < 0.01), and rates of HH post doubled (23.4% to 46.6%, p < 0.01). LESSONS LEARNED: Improving HH practices is difficult but possible with a comprehensive program of multiphased interventions over time. Our experience has shown that intervention components addressing physical environment, cognitive factors, clinical, and administrative buy-in and HCW involvement are beneficial.

Hand Hygiene Compliance in a Hematology Unit

Transmission of pathogens from the hands of health care workers (HCWs) is the main cause of nosocomial infections, and hand hygiene is the single most important procedure to prevent it. At present, little is known about the adherence of HCWs to hand hygiene procedures in hematology units, where the patients are at high risk for acquiring hospital infections. In a prospective observational study, two observers monitored the hand hygiene compliance of HCWs in a hematology unit during 30-min observation periods distributed randomly during the daytime over 2 months. The prevalence of compliance with hand hygiene was 26% on 638 observed occasions. The noncompliance was higher among nurses [odds ratio (OR) 3.52, 95% confidence interval (CI) 1.85–6.70] and other HCWs (OR 1.72, 95% CI 0.98–3.02) compared to physicians. The compliance rate differed from 4 to 60% depending on the activity. The lowest compliance rate (4%) was observed before patient care and the highest (60%) was after insertion of invasive devices. When we classified the occasions for hand hygiene into ‘before’ and ‘after’ activities, the compliance rates were 9 and 36%, respectively (OR 5.6, 95% CI 3.4–9.0). In conclusion, noncompliance with hand hygiene was high in this hematology unit, especially among nurses and before activities. Variations with the type of HCW and activity suggest that targeted educational programs and feedback control may be useful.

Influence of role models and hospital design on hand hygiene of healthcare workers.

We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) were observed in the old hospital and 417 (58%) in the new hospital. Hand-hygiene compliance was significantly better in the old hospital (161/304; 53%) compared to the new hospital (97/417; 23.3%) (p<0.001). Health-care workers in a room with a senior (e.g., higher ranking) medical staff person or peer who did not wash hands were significantly less likely to wash their own hands (odds ratio 0.2; confidence interval 0.1 to 0.5); p<0.001). Our results suggest that health-care worker hand-hygiene compliance is influenced significantly by the behavior of other health-care workers. An increased number of hand-washing sinks, as a sole measure, did not increase hand-hygiene compliance.