Healthcare Worker Hand Hygiene Research Articles

What are the effects of performance feedback, education, and olfactory/visual cues on hand hygiene of healthcare workers?

What are the effects of performance feedback, education, and olfactory/visual cues on hand hygiene of healthcare workers?

Nail Care for Healthcare Workers during COVID-19 Pandemic.

Nail Care for Healthcare Workers during COVID-19 Pandemic.

A family empowerment strategy is associated with increased healthcare worker hand hygiene in a resource-limited setting.

Guidelines recommend empowering patients and families to remind healthcare workers (HCWs) to perform hand hygiene (HH). The effectiveness of empowerment tools for patients and their families in Southeast Asia is unknown. We performed a prospective study in a pediatric intensive care unit (PICU) of a Vietnamese pediatric referral hospital. With family and HCW input, we developed a visual tool for families to prompt HCW HH. We used direct observation to collect baseline HH data. We then enrolled families to receive the visual tool and education on its use while continuing prospective collection of HH data. Multivariable logistic regression was used to identify independent predictors of HH in baseline and implementation periods. In total, 2,014 baseline and 2,498 implementation-period HH opportunities were observed. During the implementation period, 73 families were enrolled. Overall, HCW HH was 46% preimplementation, which increased to 73% in the implementation period (P < .001). The lowest HH adherence in both periods occurred after HCW contact with patient surroundings: 16% at baseline increased to 24% after implementation. In multivariable analyses, the odds of HCW HH during the implementation period were significantly higher than baseline (adjusted odds ratio [aOR], 2.94; 95% confidence interval [CI], 2.54-3.41; P < .001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs evening or weekend), and HH moment. The introduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese PICU. Future research should explore acceptability and barriers to use of similar tools in low- and middle-income settings.

Impact of patient and visitor hand hygiene interventions at a pediatric hospital: A stepped wedge cluster randomized controlled trial

Patient and visitor hand hygiene has the potential to prevent health care-associated infections, but there are few data on the efficacy of interventions to improve patient/visitor hand hygiene. To determine whether conventional and front-line ownership (FLO) patient/visitor hand hygiene interventions improve patient/visitor and health care worker (HCW) hand hygiene rates. A stepped wedge cluster randomized controlled trial was conducted on inpatient units and the emergency department. A conventional intervention included pediatric-focused posters, which also served as reminders for HCWs. This was compared to a FLO intervention aimed at finding "positive deviants," staff who were already taking steps to improve patient/visitor hand hygiene. Patient/visitor and HCW hand hygiene rates were measured covertly by trained medical students. Patient/visitor hand hygiene rates increased from 9.2% at baseline to 13.9% in the post-intervention period. Hand hygiene rates on units randomized to the standard intervention changed from 7.3% to 10.9% (P = .46), but FLO intervention units significantly changed from 14.3% to 25% (P = .03). The baseline HCW hand hygiene rate was 68.2%, which increased to a greater extent in the FLO group (79.1%) than in the standard intervention (73.1%), but the change was not statistically significant for either intervention compared to control (P = .18 and P = .64, respectively). Hand hygiene interventions in hospitals can improve patient/visitor and HCW hand hygiene rates, and a FLO intervention appears to be more effective than a conventional intervention.

Efficacy of covert closed-circuit television monitoring of the hand hygiene compliance of health care workers caring for patients infected with multidrug-resistant organisms in an intensive care unit

To compare covert closed-circuit television (CCTV) monitoring to standard overt observation in assessing the hand hygiene (HH) conduct of health care workers (HCWs) caring for patients infected with multidrug-resistant organisms (MDROs). This was a cross-sectional study in a general intensive care unit of a 1,000-bed university hospital. Forty-six general intensive care unit HCWs (staff physicians, registered nurses, and auxiliary workers) caring for contact isolation MDRO-infected patients. The study incorporated the following 3 phases: phase 1, establishment of interrater reliability between 2 simultaneous observers using the overt observation method; phase 2, establishment of interrater reliability between 2 simultaneous observers using the CCTV method; and phase 3, simultaneous monitoring of HH by both methods to evaluate the suitability of CCTV as an alternative to direct observation of the HH conduct of HCWs caring for MDRO-infected patients. Overall, 1,104 opportunities to perform HH were documented during 49 observation sessions. The compliance rate observed by the overt method (37.3%) was significantly higher than that observed when only the covert method was used (26.5%). However, simultaneous overt-covert observations were found to have intraclass correlation coefficients of >0.85. Covert CCTV observation of HCW HH compliance appears to provide a truer and more realistic picture than overt observation, probably because of its ability to neutralize the Hawthorne effect of overt observation. The high intraclass correlation coefficients between covert observation and overt observation supports this conclusion.

2418. Determining the Impact of Visitor Contact Precautions on Hospital-Onset Clostridioides difficile Infection Rates: An Agent-Based Simulation Modeling Approach

BackgroundVisitor contact precautions (VCP) have been suggested to reduce the transmission of Clostridiodes difficile at healthcare institutions. However, there are no data describing the impact of VCP on hospital-acquired C. difficile infection (HO-CDI) rates. Enforcing VCP for CDI control is also controversial, as VCP are poorly implemented and highly variable.MethodsWe developed an agent-based simulation model of C. difficile transmission at a model 200-bed acute-care adult hospital. Our agent-based simulation model represented interactions among the physicians, nurses, patients, visitors, and physical environment. We used the agent-based simulation model to evaluate the impact of VCP on reducing HO-CDI considering many different hospital settings and various assumptions on patient susceptibility, adherence rates to other infection control practices, interactions between healthcare workers and patients.ResultsVCP did not reduce the CDC-defined HO-CDI rates by more than 1% in any of the tested scenarios and hospital settings. Increasing the adherence of hand hygiene of healthcare workers to 56% from a baseline estimate of 55%, or compliance to room cleaning to 50% from a baseline estimate of 47% have led to higher rates of reduction in CDI compared with VCP.ConclusionThis is the first mathematical model to quantify the reduction in HO-CDI with VCP. The agent-based simulation model suggests that the impact of VCP on hospital-onset CDI is minimal and hospitals can achieve a higher rate of reduction for HO-CDI by implementing other interventions such as healthcare worker hand hygiene, environmental cleaning and healthcare worker contact precautions. Further studies are needed to evaluate the impact of VCP on C. difficile colonization in community.Disclosures All authors: No reported disclosures.

Effect of Frequency of Changing Point-of-Use Reminder Signs on Health Care Worker Hand Hygiene Adherence

Although hand hygiene (HH) is considered the most effective strategy for preventing hospital-acquired infections, HH adherence rates remain poor. To examine whether the frequency of changing reminder signs affects HH adherence among health care workers. This cluster randomized clinical trial in 9 US Department of Veterans Affairs acute care hospitals randomly assigned 58 inpatient units to 1 of 3 schedules for changing signs designed to promote HH adherence among health care workers: (1) no change; (2) weekly; and (3) monthly. Hand hygiene rates among health care workers were documented at entry and exit to patient rooms during the baseline period from October 1, 2014, to March 31, 2015, of normal signage and throughout the intervention period of June 8, 2015, to December 28, 2015. Data analyses were conducted in April 2018. Hospital units were randomly assigned into 3 groups: (1) no sign changes throughout the intervention period, (2) signs changed weekly, and (3) signs changed monthly. Hand hygiene adherence as measured by covert observation. Interrupted time series analysis was used to examine changes in HH adherence from baseline through the intervention period by group. Among 58 inpatient units, 19 units were assigned to the no change group, 19 units were assigned to the weekly change group, and 20 units were assigned to the monthly change group. During the baseline period, 9755 HH opportunities were observed at room entry and 10 095 HH opportunities were observed at room exit. During the intervention period, a total of 15 855 HH opportunities were observed at room entry, and 16 360 HH opportunities were observed at room exit. Overall HH adherence did not change from baseline compared with the intervention period at either room entry (4770 HH events [48.9%] vs 3057 HH events [50.1%]; P = .14) or exit (6439 HH events [63.8%] vs 4087 HH events [65.2%]; P = .06). In units that changed signs weekly, HH adherence declined from baseline at room entry (-1.9% [95% CI, -2.7% to -0.8%] per week; P < .001) and exit (-0.8% [95% CI, -1.5% to 0.1%] per week; P = .02). No significant changes in HH adherence were observed in other groups. The frequency of changing reminder signs had no effect on HH rates overall. Units assigned to change signs most frequently demonstrated worsening adherence. Considering the abundance of signs in the acute care environment, the frequency of changing signs did not appear to provide a strong enough cue by itself to promote behavioral change. ClinicalTrials.gov Identifier: NCT02223455.

1192. A Visual Family Empowerment Tool Is Associated with Increased Healthcare Worker Hand Hygiene in a Pediatric Intensive Care Unit in Vietnam

BackgroundHand hygiene (HH) is the most effective way to prevent healthcare-associated infections. The World Health Organization (WHO) recommends empowering patients and families to remind healthcare workers (HCWs) to perform HH. The effectiveness of patient and family empowerment tools in Southeast Asia is unknown.MethodsWe performed a prospective intervention study in an intensive care unit of a pediatric referral hospital in Vietnam. Using family and HCW input, we created a visual tool for families to use to remind HCWs to perform HH. For 2 weeks pre-intervention, we collected baseline data on HH performance, method (hand rub or soap and water), adequacy, HCW type (e.g., physician, nurse), and WHO 5 moments of HH using direct, unobtrusive observation. During a subsequent 3-week intervention period, consenting families were provided the visual tool and educated on its use to prompt HCW HH. Prospective collection of outcome data continued during the intervention period. The primary outcome was change in HCW HH between baseline and intervention periods. Multivariable logistic regression models were used to identify independent predictors of HH.ResultsA total of 2,014 pre-intervention and 2,498 intervention period HH opportunities were observed. During the intervention period, 73 families received visual reminder tools and education. Overall HCW HH was 46% pre-intervention, which increased to 73% in the intervention period (P < 0.001). Lowest HH adherence in both periods occurred after HCW contact with patient surroundings (WHO Moment 5; 16% pre-intervention and 24% intervention). In multivariable analyses, the odds of HCW HH during the intervention period were significantly higher than pre-intervention (OR 2.94 [95% CI 2.54 – 3.41], P < 0.001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs. evening/weekend), and HH moment. Among completed HH opportunities, HH adequacy was >90% in both periods.ConclusionIntroduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese pediatric intensive care unit. More research is needed to explore acceptability and barriers to the use of such tools in other low- and middle-income settings. Disclosures All authors: No reported disclosures.

Assessment of Knowledge, Attitude and Practice of Hand Hygiene in Healthcare Workers of Gulab Devi Chest Hospital Lahore, Pakistan

Background: Hand hygiene is a general term referring to any action of hand cleansing by using water and detergent and for the removal of transient microorganisms from hands. Hand hygiene is recognized as the leading measure to prevent cross-transmission of microorganisms and to reduce the incidence of healthcare associated infections. There are many experiences that the lack of knowledge, attitude and poor practice in hand hygiene in healthcare workers transmit infection in patients and in other healthcare workers.&#x0D; Methodology: This descriptive study was conducted in Gulab Devi Chest Hospital. I had taken 100 healthcare workers to complete my research. The sampling technique of my research was cross-sectional sampling technique, use to collect the data.&#x0D; Results: In this research knowledge was not good in all HCWs, Overall knowledge of hand hygiene by all HCWs was less than 50%. The attitude in nurses and medical student in this research was moderate doctors and technologists have poor attitude in hand hygiene. The practices among HCWs in Gulab Devi Chest Hospital were also poor which was less than 50%.&#x0D; Conclusion: The HCWs in Gulab Devi Hospital had poor knowledge, practices on hand hygiene. However, attitudes of medical student and nursing had satisfactory.

Assessment of Knowledge, Attitude and Practice of Hand Hygiene in Healthcare Workers of Gulab Devi Chest Hospital Lahore, Pakistan

Assessment of Knowledge, Attitude and Practice of Hand Hygiene in Healthcare Workers of Gulab Devi Chest Hospital Lahore, Pakistan

Increasing Patient Accessibility and Use of Hand Sanitizer Through Introduction of a Single-Dose Packet

BACKGROUND Preventing pathogen transmission via healthcare worker (HCW) hand hygiene (HH) is well-established. Emerging evidence suggests patients contaminate their environment with their flora and acquire pathogens on their hands through HCW and environment contact; therefore, there has been increasing interest in patient HH despite lack of guidance. Single-dose hand sanitizer packets (SDP) were evaluated as a solution for accessible patient HH. METHODS In a 270-bed hospital, Infection Preventionist randomly solicited patient participation in a study during daily rounds. Patients between September 4–17, 2018 were assigned to the control group (n=32), patients between September 18–November 28, 2018 were assigned to the intervention (n=35). A 7-question baseline survey assessing sanitizer accessibility and HH practices was distributed to the control group. The intervention group received a 24-count SDP via admission kit. Participants were not instructed how/when to use the SDP. A 9-question survey was distributed to the intervention group, including questions on hand cleaning practices, sanitizer accessibility, and evaluation of SDP. Results were analyzed with an independent samples t-test (α=0.05). RESULTS The intervention group reported higher access to hand sanitizer than the control (mean of 5-point scale, 4.8 and 3.5, respectively; p˂0.001). Patients in the intervention group had higher sanitizer usage (mean of 4-point scale, 3.8 and 2.7, respectively; p˂0.001) and rated higher that they were able to keep their hands germ-free (mean of 5-point scale, intervention 4.7 and control 3.7; p˂0.001). Soap and water usage was higher in the control group (mean of 4-point scale, control 3.2 and intervention 2.4; p=0.003). CONCLUSIONS Patients reported that SDP increased sanitizer accessibility, helped keep their hands germ-free, and increased their hand sanitizer usage. Considering limitations around sink and wall dispenser accessibility and cost constraints with providing patients individual sanitizer bottles, SDP could be a promising solution for admission kits.

IN4 REDUCING HOSPITAL-ONSET CLOSTRIDIUM DIFFICILE INFECTION: AN AGENT-BASED MODELING APPROACH TO EVALUATE INTERVENTION COST-EFFECTIVENESS

Clostridium difficile infection (C. difficile; CDI) is the most common hospital-acquired infection in the United States, where it is responsible for over 15,000 deaths and five billion dollars in direct healthcare costs annually. This study evaluates the cost effectiveness of nine infection control interventions at reducing the rates of hospital-onset CDI. Cost-effectiveness analyses were conducted from the hospital perspective, where all costs were converted into 2017 US dollars and effectiveness was measured using quality-adjusted life years (QALYs). The nine tested interventions include daily and terminal cleaning with sporicidal product, patient, visitor, and healthcare worker hand hygiene, reducing patient room transfers, screening for C. difficile colonization at admission, and visitor and healthcare worker contact precautions. Rates of hospital-onset CDI were estimated using our recently published agent-based simulation model of C. difficile transmission in a general 200-bed adult hospital. Cost and utility estimates were derived from the literature. Six interventions were dominant, compared to baseline standard hospital practices: daily cleaning (saved an average of $407,853 and 26.8 QALYs annually in a 200-bed hospital), screening at admission ($9,143; 13.5 QALYs), patient hand hygiene ($25,699; 4.6 QALYs), healthcare worker hand hygiene ($181,784; 12.9 QALYs), terminal cleaning ($65,007; 9.3 QALYs), and patient transfer ($25,677; 2.3 QALYs). Healthcare worker contact precautions had a mean ICER of $147,666/QALY. Visitor hand hygiene had a mean ICER of $8,541,937/QALY. Visitor contact precautions was dominated. Healthcare facilities are a major source of CDI and hospital prevention is critical to decreasing its overall incidence. This is the first study to compare the cost-effectiveness of patient-centered interventions, such as patient hand hygiene and screening at admission, with conventional hospital-centered strategies. Prioritizing highly effective, cost saving interventions such as daily and terminal cleaning is a promising strategy that should be further emphasized in future C. difficile prevention guidelines.

Microbiological colonization of healthcare workers’ mobile phones in a tertiary-level Italian intensive care unit

BackgroundCareful hand hygiene of healthcare workers is recommended to reduce transmission of pathogenic microorganisms to patients. Mobile phones are commonly used during work shifts and may act as vehicles of pathogens. ObjectiveTo assess the colonizsation rate of intensive care unit healthcare workers’ mobile phones before and after work shifts. MethodsProspective observational study conducted in an academic, tertiary-level intensive care unit. Healthcare workers (including doctors, nurses and healthcare assistants) had their mobile phones sampled for microbiology before and after work shifts. Samples were taken with a swab in a standardizsed modality. ResultsFifty healthcare workers participated in the study (91% of the department staff). One hundred swabs were taken from 50 mobile phones. Forty-three healthcare workers (86%) reported a habitual use of their phones during the work shift. All phones (100%) were positive for bacteria. The most frequently isolated bacteria were Coagulase Negative Staphylococci, Bacillus sp. and Methicillin-resistant Staphylococcus aureus (97%, 56%, 17%, respectively). No patient admitted to the intensive care unit during the study period was positive for bacteria found on healthcare workers’ mobile phones. No difference in bacteria types and burden was found between the beginning and the end of work shifts. ConclusionHealthcare workers’ mobile phones are colonized even before the work shift and irrespective of the patients’ microbiological flora.

Application of the Theoretical Domains Framework to identify factors that influence hand hygiene compliance in long-term care

Healthcare worker (HCW) hand hygiene compliance is key to patient safety; however, compliance is suboptimal. Nevertheless hand hygiene compliance is not well studied in the long-term care setting. To apply a behaviour change framework, the Theoretical Domains Framework (TDF), to identify modifiable facilitators and barriers for HCW hand hygiene compliance in long-term care settings. HCW hand hygiene compliance facilitators and barriers were examined using a questionnaire for HCWs from long-term care homes in Ontario, Canada. The questionnaire was informed by the TDF, which is based on a synthesis of constructs from a number of relevant psychological theories of behaviour change. Barriers identified from the questionnaire aligned with the TDF domain environmental context and resources (time pressure, workload, and environmental controls). Facilitators identified from questionnaire results aligned with the TDF domains social/professional role and identity (it is what is expected of HCWs), and beliefs about consequences (risk of transmission of micro-organisms to self or others). There are several barriers to hand hygiene compliance that persist in long-term care. A behaviour change theory-informed framework such as the TDF can be helpful to identify those barriers. This study identified several key behavioural constructs aligned with the TDF that can be targeted when developing novel hand hygiene interventions.

The effect of incorporating covert observation into established overt observation-based hand hygiene promotion programs

Covert observation (CO) is reliable for measuring hand hygiene compliance (HHC). However, the benefit of adding CO to overt observation (OO) is uncertain. We evaluated whether incorporating CO into an OO-based hand hygiene (HH) promotion program improves HH rate. Health care worker's HH activities were observed through 5 monitoring sessions (2 in phases 1 and 2 and 1 in phase 3) of simultaneous CO and OO. An intervention was applied-barrier identification interview-only in phase 2. Overall HHC was 91.0% for OO, and 49.3% for CO. HHC in phase 1 was not changed by repeated CO (34.7% and 34.0%, P = .70). HHC based on CO increased to 66.9% in phase 2 after the application of an intervention (P < .01), but decreased to 57.5% in phase 3 (P < .01). HHC based on OO increased significantly between only the first and second sessions in phase 2 (90.8% and 94.5%, respectively, P = .01). Although CO did not significantly change behavior, HHC with CO responded promptly to the application and cessation of a new intervention. CO reflects HHC change more reliably than does OO. However, it is uncertain whether CO will improve HHC.

Interventions to improve healthcare workers' hand hygiene compliance: A systematic review of systematic reviews.

To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness. This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.

534. Clostridium difficile Reduction: An Agent-Based Simulation Modeling Approach to Evaluating Intervention Comparative Effectiveness at Pediatric Hospitals

Background Clostridium difficile surveillance data are lacking from pediatric facilities and there are few pediatric-centered guidelines or studies evaluating C. difficile targeted pediatric interventions. Compared with the adult setting, C. difficile control in pediatric healthcare facilities is also further complicated by epidemiologic variability across the age spectrum and increased patient-to-patient and patient-to-family interactions.MethodsWe constructed an agent-based simulation model of C. difficile transmission at a freestanding children’s hospital. The 80-bed hospital model included interactions between the physical environment, patients, visitors, family caregivers, nurses, and physicians. The model was then used to evaluate the comparative effectiveness of nine infection control interventions and six multiple-intervention bundles at reducing hospital-onset C. difficile infections and asymptomatic C. difficile colonization.ResultsThe most effective two-intervention bundle, composed of daily cleaning with sporicidal disinfectant and an asymptomatic C. difficile screening protocol, reduced hospital-onset C. difficile infection by 62.0% and asymptomatic colonization by 88.4%. Six of the nine single-intervention strategies also significantly reduced both outcomes, including daily and terminal cleaning, asymptomatic C. difficile screening, healthcare worker and patient hand hygiene, and reducing room transfers. The remaining three single-intervention strategies, visitor hand hygiene and visitor and healthcare worker contact precautions, did not significantly reduce either measure.ConclusionThis is the first mathematical model to evaluate pediatric C. difficile transmission. Hospitals can achieve a high rate of reduction for hospital-onset C. difficile infections by prioritizing implementation of a small number of interventions with high fidelity.Disclosures All authors: No reported disclosures.

2309. Promoting Healthcare Worker (HCW) Use of Personal Protective Equipment in Pediatric Ambulatory Settings

BackgroundExisting Centers for Disease Control (CDC) and American Academy of Pediatrics (AAP) guidelines promote HCW personal protective equipment (PPE) use to prevent respiratory virus transmission in pediatric clinics; however, adherence to recommendations is inconsistent. We evaluated the effectiveness of two strategies designed to cue HCW use of PPE in a pediatric primary care clinic.MethodsWe implemented two HCW-focused interventions: (1) prompt for front desk respiratory symptom screen with placement of droplet signs on examination room door for symptomatic patients and (2) universal masking of healthcare workers during all patient encounters. Each intervention was implemented over a 2-week period and preceded by a washout period. We obtained caregiver report of HCW hand hygiene and mask use during patient encounters and measured differences in the proportion of behavior observed compared with washout periods.ResultsWe obtained 217 caregiver reports of clinician handwashing and mask use before, during and after the patient encounter. There was no difference in nurse pre- or post-encounter hand hygiene behavior before and after each intervention (Baseline 65.9%; Droplet: 73.3%, P = 0.34; Universal masking: 77.5%, P = 0.16 and Baseline 53.3%; Droplet: 66.6%, P = 0.14; Universal masking: 55%, P = 0.85, respectively). There was also no difference in pre- or post-encounter MD hand hygiene behavior before and after each intervention: (Baseline 86.9%; Droplet: 77.8, P = 0.17; Universal masking: 87.5%; P = 0.92 and Baseline 75%; Droplet: 71.1%, P = 0.62; Universal masking: 80.0%; P = 0.53, respectively). However, there was a significant difference in observed mask use during encounters among both RNs and MDs before and after each intervention: (Baseline: 17.4%; Droplet: 44.4%, P <0.05; Universal masking: 42.5%, P < 0.05 and Baseline: 20.6%; Droplet: 51.1%, P < 0.05; Universal masking: 62.5%, P < 0.05, respectively).ConclusionRespiratory symptom screening with visual prompts to use PPE and universal masking may not significantly impact hand hygiene behavior in a setting with high hand hygiene use but may increase mask use. Such interventions could provide a useful and low cost tool to help prevent the spread of respiratory viruses in primary care settings.Disclosures S. E. Coffin, Merck, Inc.: Investigator, Research support.

The influence of religious and cultural beliefs on hand hygiene behaviour in the United Arab Emirates.

Behavioural theory is crucial to develop effective hand hygiene interventions. While studies have explored the behavioural determinants of hand hygiene in healthcare workers (HCWs) using the Theory of Planned Behaviour (TPB), none of these have incorporated religious and cultural beliefs about hand hygiene behaviour. This study aimed to explore HCWs' and Islamic scholars' perceptions of the religious and cultural beliefs influencing hand hygiene behaviours in the United Arab Emirates. A mixed methods design employed interviews with Islamic scholars, nurses, doctors and allied health professionals, followed by survey. Six themes related to standard TPB variables and six themes related to religious and cultural beliefs emerged. 349 participants (26.1%) responded to the survey: 171 (49%), 111 (31.8%) and 67 (19.2%) were from nurses, doctors and allied health professionals respectively. Direct logistic regression revealed the strongest predictors of alcohol-based hand rubbing were cultural beliefs (OR=1.15; p<0.001), followed by attitudes (OR=0.87; p<0.001), when controlling for other factors in the model. Addressing determinants related to cultural beliefs and attitudes and exploring alcohol-based hand rub use using a TPB model with integrated cultural beliefs is an important strategy to improve compliance with alcohol-based hand rubbing behaviour.

Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis

SummaryBackgroundMulti-modal interventions are effective in increasing hand hygiene (HH) compliance among healthcare workers, but it is not known whether such interventions are cost-effective outside high-income countries.AimTo evaluate the cost-effectiveness of multi-modal hospital interventions to improve HH compliance in a middle-income country.MethodsUsing a conservative approach, a model was developed to determine whether reductions in meticillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSIs) alone would make HH interventions cost-effective in intensive care units (ICUs). Transmission dynamic and decision analytic models were combined to determine the expected impact of HH interventions on MRSA-BSI incidence and evaluate their cost-effectiveness. A series of sensitivity analyses and hypothetical scenarios making different assumptions about transmissibility were explored to generalize the findings.FindingsInterventions increasing HH compliance from a 10% baseline to ≥20% are likely to be cost-effective solely through reduced MRSA-BSI. Increasing compliance from 10% to 40% was estimated to cost US$2515 per 10,000 bed-days with 3.8 quality-adjusted life-years (QALYs) gained in a paediatric ICU (PICU) and US$1743 per 10,000 bed-days with 3.7 QALYs gained in an adult ICU. If baseline compliance is not >20%, the intervention is always cost-effective even with only a 10% compliance improvement.ConclusionEffective multi-modal HH interventions are likely to be cost-effective due to preventing MRSA-BSI alone in ICU settings in middle-income countries where baseline compliance is typically low. Where compliance is higher, the cost-effectiveness of interventions to improve it further will depend on the impact on hospital-acquired infections other than MRSA-BSI.