Improve Hand Hygiene Compliance Research Articles

Rinse, gel, and foam – is there any evidence for a difference in their effectiveness in preventing infections?

BackgroundFollowing publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs).MethodsData regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted.ResultsThe amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs.ConclusionsCurrent evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.

Application of PDCA Cycle in Hand Hygiene Management of Psychiatric Medical Staff

Objective: To study the application effect of the plan-do-check-act (PDCA) cycle management in the hand hygiene management of psychiatric medical staff. Methods: One hundred and twenty medical staff from a psychiatric hospital from May 2023 to December 2023 were selected and divided into two groups. The control group (May 2023 to August 2023) applied the conventional management model, and the observation group (September 2023 to December 2023) applied the PDCA cycle management. The hand hygiene compliance, hand hygiene knowledge, and hygiene qualifications were compared, including the amount of hand sanitizer used. Results: The proportion of medical staff’s hand hygiene compliance and hand hygiene knowledge mastery scores in the observation group were higher than those in the control group (P < 0.05); the hand hygiene passing rate in the observation group was higher than that of the control group (P < 0.05); the daily amount of hand sanitizer per patient bed and the amount of hand sanitizer used was higher than that of the control group (P < 0.05). Conclusion: The PDCA cycle management model for psychiatric medical staff promoted the improvement of hand hygiene compliance and increased their hand hygiene qualifications. It is suitable for further popularization and application in future clinical practice.

Hand hygiene knowledge among nurses and nursing students–a descriptive cross-sectional comparative survey using the WHO's “Hand Hygiene Knowledge Questionnaire”

To determine the level of knowledge and explore the difference of hand hygiene between nursing students and nurses. Annually, 3.8 million people in Europe acquire healthcare-associated infections, highlighting the importance of hand hygiene. Despite WHO's emphasis on the fact that greater hand hygiene knowledge correlates with improved hand hygiene compliance, several studies have shown knowledge gaps among nurses and nursing students regarding hand hygiene. Descriptive cross-sectional comparative survey. A version of the WHO "Hand Hygiene Knowledge Questionnaire", translated into Swedish, was used for data collection among nursing students in the first and last semester, and registered nurses from a university and associated hospital. Data were analyzed by descriptive statistics, and comparison between groups with Fisher's exact test, one-way ANOVA, and post-hoc tests (Pairwise Z-Tests, Tukey HSD). The survey, conducted between December 2020 and January 2021, received responses from 201 participants, including 71 first semester students, 46 last semester students and 84 registered nurses, showing moderate (55.7% [50-74% correct answers]) to good (43.8% [75-100% correct answers]) knowledge levels. First-semester students scored lower (17.0 ± 2.1) than last-semester students (18.8 ± 1.8) and registered nurses (18.3 ± 2.1) out of 25 questions. It is necessary for all groups to receive proper education on hand hygiene knowledge and to have an educational program that does not separate the groups but combines them with continuing education, since the students will someday be influencing future hand hygiene knowledge as a peer, together with the nurse.

Targeted hand hygiene audits and training: an effective tool for improvement in hand hygiene compliance

Background: Hand hygiene (HH) is the simplest, but most effective infection prevention and control measure. This study was aimed to determine HH compliance among health care workers (HCWs) in a cancer hospital and the impact of targeted and phased training over changes in HH compliance and determination of Hawthorne effect among HCWs. Methods: Prospective observational study conducted in two phases by HH trained auditor (Overt observer) and ICN (Covert observer) performing 30 minutes HH audit at ICU, haemato-lymphoid (HL) ward and paediatric ward to observe the pattern of HH compliance among HCW for HH moments and its impact over Hawthorne effect for HH compliance. Results: Highest compliance for HH was observed at HL ward (59.34%) in first phase and at ICU (70.08%) in second phase. Gradual and significant improvement in HH compliance was observed for ICU (52.24% to 70.08%), HL ward (59.34% to 68.48%) and paediatric ward (43.42% to 53.46%). Profession specific Hawthorne effect was observed for nurses with higher compliance in covert observation in first phase and for doctors with higher compliance in overt observation in second phase of the study. Conclusions: Regular targeted HH audit with motivational training is the better influential tool for improving HH compliance. Regular audits also improve efficiency of auditor for effective HH compliance supervision. Decentralization and availability of workstation specific HH auditor is the most of effective cost saving approach for achieving significant progressive improvement in HH adherence.

EFEKTIVITAS PEMBERIAN SIMULASI HAND HYGIENE TERHADAP KEPATUHAN HAND HYGIENE PETUGAS NON MEDIS DI RUMAH SAKIT PKU MUHAMMADIYAH YOGYAKARTA UNIT II

Hospital Associated Infection (HAIs) is the world’s problem and one of the causes is hand hygiene compliance in healthcare workers are still low. Data showed 80% of HAIs spread by hands. Non medical healthcare workers are at risk for spreading the phatogen by hands, because although they don’t give intervention directly to the patients, they still have big possibilities to be in one of 5 moments hand hygiene. Hand hygiene simulation is one of training methods for heakthcare workers to create higher compliance in hand hygiene. This research was an experimental design with one group pre-posttest design. The population were all non medical healthcare workers in security department, nutritional department, and cleaning service department, the total sample is 37 persons. Paired T-test is used for stastitical analysis.The results obtained, the implementation of hand hygiene with proper procedure is 0,55%. The compliance rate increase after intervention by hand hygiene simulation 13,83%. Statistical analysis showed significant result p<0,05; p=0,026 for security department, p=0,027 for nutritional department, and p=0,002 for cleaning service department, meaning there is a difference in hand hygiene compliance of non medical healthcare workers before and after intervention by hand hand hygiene simulation.Hand hygiene simulation is effecticve to improve hand hygiene compliance. Therefore it can be used to improve hand hygiene compliance in non medical healthcare workers.

On the exponential stability of a stochastic model for transmission dynamics of antimicrobial‐resistant infections

In this research, a comprehensive stochastic model was developed to analyze the transmission dynamics of methicillin‐resistant Staphylococcus aureus (MRSA) in both hospital‐acquired and community‐acquired contexts. The study explored the existence and uniqueness of solutions and established the presence of a global solution. The investigation focused on assessing the boundedness, extinction, and persistence of MRSA strains in terms of their means. The analysis of the model revealed a noteworthy phenomenon known as competitive exclusion, where the community‐acquired MRSA strain gradually out‐competes the hospital‐acquired strain within hospital settings. In conclusion, effective interventions and preventive measures, such as improving hand hygiene compliance, implementing decolonization strategies, and enhancing disinfection rates, emerge as critical factors in controlling the transmission of these strains within hospital environments.

Hand hygiene compliance in a Brazilian COVID-19 unit: the impact of moments and contact precautions

BackgroundHealthcare-associated infections are among the most common complications during hospitalization. These infections increase morbidity and mortality and they increase length of hospital stay and the cost of healthcare. The aims of our study were to monitor hand hygiene (HH) compliance, HH technique quality and factors related to HH practice among health professionals in a COVID-19 Intensive Care Unit (ICU).MethodsAn observational, prospective study. Between September and December 2021, we observed 69 healthcare professionals in an eight-bed ICU for patients with COVID-19 in midwestern Brazil. We used the WHO observation form to collect data. The dependent variable was HH compliance and independent variables were professional category, sex, HH quality (3-step technique for at least 15 s), number of HH opportunities observed, observation shift and inappropriate glove use.ResultsWe observed 1185 HH opportunities. The overall compliance rate was 26.4%, but only 6.5% were performed with the correct 3-step technique for the minimum time. HH compliance was considerably lower for moments “before” tasks (6.7%; 95% CI 4.8%, 9.2%) compared with moments “after” tasks (43.8%; 95% CI 39.9%, 47.8%). The logistic model found that inappropriate glove use, night shift and physicians (p < 0.001) were associated with low HH compliance. The infrastructure analysis found that the unit had an insufficient number of alcohol-based handrub (ABHR) dispensers at the point of care and that the mechanism for activating them was poorly designed.ConclusionsHH compliance was very low. Inappropriate glove use was associated with low compliance and the unit’s infrastructure did not support good HH practice. The fact that healthcare professionals were more likely to do HH after tasks, suggests that they use HH to protect themselves rather than the patients. Adequate infrastructure and ongoing health education with a focus on HH while caring for patients in contact precautions are essential for improving HH compliance and patient safety.

Hand Hygiene Knowledge and Perception Survey for Healthcare Workers in Government Hospitals (GHs) in Bahrain.

Introduction and aim Healthcare-associated infections (HAIs) are a serious concern in all healthcare facilities as they may lead to many serious consequences, like prolonged hospitalization, increased mortality and morbidity, and extra costs. Effective hand hygiene (HH) is the primary proven measure known to be effective in reducing the risk of HAIs in all healthcare settings. This study aimed to measure the healthcare workers' (HCWs) knowledge and perception of HH at government hospitals (GHs) in Bahrain. Subjects and methods This cross-sectional study was conducted among HCWs working in GHs in the Kingdom of Bahrain. A self-administered questionnaire was distributed among the targeted population using a Google survey (Google LLC, California, USA). The questionnaire includes socio-demographic data (e.g., age, gender, nationality, etc.) and a validated WHO questionnaire measuring perceptions and knowledge toward HH. Results Of the 285 HCWs, 75.4% were females, and 48.1% were aged between 31 and 40 years old. The overall mean perception was 35.9 (SD 6.93) out of 42 points, with nearly 80% of HCWs considered to have good perception levels. The overall mean knowledge score was 11.4 (SD 1.37) out of 14 points. Accordingly, 75.4% were considered to have good knowledge levels. Factors associated with increased perception include increasing age, female gender, non-Bahraini, being a nurse with increasing years of working experience, and receiving formal training in HH. Being a nurse was the sole significant predictor of increased knowledge. Conclusion The knowledge and perception of HH among HCWs were sufficient. Being a nurse was a significant predictor of both knowledge and perception. Further, a significant positive correlation was noted between the knowledge and perception scores. Maintaining the level of knowledge and perception of HH could lead to improved HH compliance among HCWs.

Development of Hand Hygiene Monitoring System Based on Android Mobile Application and User Perspective

Hand hygiene plays a crucial role in promoting overall health and preventing the spread of diseases. The World Health Organization reported that the prevalence of healthcare-associated infections (HAIs) ranges from 3-12% in high-income countries and 5-19% in low-and middle-income countries. Improved hand hygiene compliance can substantially reduce HAI rates. In Indonesia, the Ministry of Health has designated handwashing compliance as a compulsory quality indicator for hospitals. Introducing a mobile app can improve hand hygiene practices. This study aims to develop and design an Android mobile application that serves as an easy-to-operate hand hygiene monitoring system and to understand user perspectives. The study used Agile Methods for app development and a qualitative approach to know users' perspectives. Respondents (n=10) from AMC Muhammadiyah Hospital, including the IPC team, department heads, and administrators, were interviewed. The result revealed that mobile application is easy to use and have an attractive user interface. Users expressed the application's user-friendliness and utility in conducting observations. Nonetheless, they identified some drawbacks, such as lagging issues and a complicated manual installation process due to the app's unavailability on Playstore. Users expect the app's future inclusion on Play Store for simplified installation and request its development for iOS to cater to hospital staff using iPhones.

689. Significant Improvement in Hand Hygiene Compliance and Decline in Clostridioides difficile Infections with Implementation of Infection Prevention Interventions

Abstract Background Per CDC, C. difficile is an urgent microbial threat. Despite use of CDC diagnostic criteria, 2-step testing protocol and antimicrobial stewardship interventions limiting broad spectrum antimicrobial use, we witnessed an increase in infections in 2022, therefore, additional interventions were implemented. Methods A multifaceted QI intervention program to improve IPC (infection prevention and control) practices was implemented in July 2022 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Interventions included: auditing and real time observations for health care personnel (HCP) hand hygiene compliance; monitoring soap/sanitizer usage; educational interventions including posters posted throughout the hospital emphasizing hand hygiene, “A clean in and clean out” approach and contact precautions reminders posted in patient rooms/nursing stations, weekly nursing huddles focused on nursing and ancillary staff education, provider counseling and continued coaching. Pre-intervention period (P1: 1/10/2021- 6/30/2022) was compared with Intervention period (P2: 07/01/2022-3/31/2023) for hand hygiene compliance and C. difficile infection rates. Results Overall adequate hand hygiene compliance rates for all health care personnel (HCP) increased from 71% during P1 to 85% during P2 (P&amp;lt; 0.05). All categories of HCP showed a significant improvement in hand hygiene compliance from P1 to P2, with rates for physicians increasing from 74% to 92% (p&amp;lt; 0.05), nurses from 68% to 94% (p&amp;lt; 0.001); nurse practitioners/physician assistants from 75% to 90% (p&amp;lt; 0.05), ancillary staff (chaplain, medical technicians, social workers) from 60% to 89% (p&amp;lt; 0.01)]. Hand hygiene product use increased significantly and soap usage alone increased from 45% to 75% in P2 (p&amp;lt; 0.05). C. difficile infections declined significantly from a mean of 1.9 infections per 1000 patient days during P1 to 0.5 infections per 1000 patient days during P2 (p&amp;lt; 0.001); SIR (Standardized infection ratio) decreased from 1.14 during P1 to 0.4 during P2 (p&amp;lt; 0.01). No C. difficile related mortality was observed. Conclusion With implementation of multifaceted IPC interventions, significantly improved hand hygiene rates and a significant decline in C. difficile infections were observed. Disclosures All Authors: No reported disclosures

Empowering health care workers with personalized data-driven feedback to boost hand hygiene compliance

Achieving high hand hygiene compliance among healthcare workers is a challenge, requiring effective interventions. This study investigated the impact of individualized feedback on hand hygiene compliance using an electronic monitoring system. A quasi-experimental intervention design with pretest-posttest was conducted in an orthopedic surgical ward. Participants served as their own controls. A 3-month baseline was followed by a 3-month intervention period. Hand hygiene events were recorded through sensors on dispensers, name tags, and near patient beds. Healthcare workers received weekly email feedback reports comparing their compliance with colleagues. Nineteen healthcare workers (17 nurses, two doctors) were included. Hand hygiene compliance significantly improved by approximately 15% (P < 0.0001) across all rooms during the intervention. The most substantial improvement occurred in patient rooms (17%, P < 0.0001). Compliance in clean and contaminated rooms increased by 10% (P = 0.0068) and 5% (P = 0.0232). The average weekly email open rate for feedback reports was 46%. Individualized feedback via email led to significant improvements in hand hygiene compliance among healthcare workers. The self-directed approach proved effective, and continuous exposure to the intervention showed promising results.

Development of virtual reality educational clips for improving hand hygiene compliance among healthcare providers: a pilot study

The usefulness of virtual reality (VR) technology for healthcare practitioners has been increasingly investigated, but that of infection prevention and control (IPC) training is yet to be well described in the literature. We developed patient-view VR clips to promote hand hygiene compliance in healthcare settings and conducted a pilot study to evaluate their effectiveness and safety in hospitals. In December 2022, we held a hands-on IPC workshop at Marugame Medical Center (Kagawa, Japan). We recruited 20 nurses and five nursing aids for the VR experience using a fully immersive 360-degree head-mounted display. Participants were evaluated using a self-administered questionnaire and a short nursing care scenario based on the direct observation method. All the participants answered that the VR experience was helpful for increasing awareness of the 5 Moments for Hand Hygiene. However, 37.5% and 4.2% reported little or heavy VR sickness, respectively. Hand hygiene compliance among nurses was considerably high, at 95.0% for "Before touching a patient," 95.0% for "Before clean/aseptic procedure," 85.0% for "After body fluid exposure risk," 92.5% for "After touching a patient," and 95.0% for "After touching patients’ surroundings." The results of this pilot study suggest the educational utility of VR clips. Future collaboration between IPC practitioners and digital technology experts is required to develop better educational devices and content.

Have Hand Hygiene Practices in Two Tertiary Care Hospitals, Freetown, Sierra Leone, Improved in 2023 following Operational Research in 2021?

In 2021, an operational research study in two tertiary hospitals in Freetown showed poor hand hygiene compliance. Recommended actions were taken to improve the situation. Between February-April 2023, a cross-sectional study was conducted in the same two hospitals using the World Health Organization hand hygiene tool to assess and compare hand hygiene compliance with that observed between June-August 2021. In Connaught hospital, overall hand hygiene compliance improved from 51% to 60% (p < 0.001), and this applied to both handwash actions with soap and water and alcohol-based hand rub. Significant improvements were found in all hospital departments and amongst all healthcare worker cadres. In 34 Military Hospital (34MH), overall hand hygiene compliance decreased from 40% to 32% (p < 0.001), with significant decreases observed in all departments and amongst nurses and nursing students. The improvements in Connaught Hospital were probably because of more hand hygiene reminders, better handwash infrastructure and more frequent supervision assessments, compared with 34MH where interventions were less well applied, possibly due to the extensive hospital reconstruction at the time. In conclusion, recommendations from operational research in 2021 contributed towards the improved distribution of hand hygiene reminders, better handwash infrastructure and frequent supervision assessments, which possibly led to improved hand hygiene compliance in one of the two hospitals. These actions need to be strengthened, scaled-up and guided by ongoing operational research to promote good hand hygiene practices elsewhere in the country.

Quality Improvement Project to Improve Hand Hygiene Compliance in a Level III Neonatal Intensive Care Unit.

This quality improvement project aimed to improve hand hygiene (HH) compliance in a Level III Neonatal Intensive Care Unit. The project was conducted over three Plan-Do-Study-Act (PDSA) cycles, with each cycle lasting two months. The interventions included healthcare worker (HCW) education on HH, repetition of education, and immediate feedback to HCWs. Compliance data were collected through covert observations of HCWs in the NICU. The overall compliance rate increased from 31.56% at baseline to 46.64% after the third PDSA cycle. The HH compliance was noted to be relatively low after touching patient care surroundings, at entry and exit from the NICU main unit, before wearing gloves and after removing gloves, at baseline and throughout the three PDSA cycles. HCW education alone did not result in significant improvements, highlighting the need for additional interventions. The study underscores the importance of involving NICU leadership and providing immediate feedback to promote HH compliance. Further efforts should focus on addressing the false sense of security associated with glove usage among HCWs, individual rewards and involving the healthcare staff in the shared goal of increasing HH compliance. Consideration of workload metrics and their impact on compliance could steer future interventions.

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

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

Effect and Process Evaluation of an Intervention to Improve Hand Hygiene Compliance in Long-Term Care Facilities

ObjectivesThis study evaluated the effect of a tailored, multifaceted improvement strategy on hand hygiene compliance in long-term care facilities (LTCFs). We also performed a process evaluation to explore the mechanisms through which our strategy brought about change. DesignWe conducted a stepped-wedge cluster-randomized controlled trial with a sequential rollout of the improvement strategy to all participating LTCFs. The strategy consisted of education, training, reminders, observation sessions (including feedback), and team meetings (including feedback). Setting and ParticipantsThe study included nursing professionals from 14 LTCFs (23 wards) in the Netherlands. MethodsHand hygiene compliance was observed during 5 measurement periods using WHO's “Five Moments for Hand Hygiene.” Multilevel analyses and corresponding tests were completed on an intention-to-treat basis. ResultsThe absolute intervention effect of overall hand hygiene compliance (primary outcome measure) was 13% (95% CI 9.3-16.7, P < .001), adjusted for time and clustering. The adjusted absolute effect was 23% (95% CI 7-39, P < .002) before a clean and aseptic procedure, 18% (95% CI 10-26, P < .001) after touching a resident, 14% (95% CI 7-22, P < .003) before touching a resident, 10% (95% CI 5-15, P < .001) after contact with body fluid, and 1% (95% CI –11 to 13, P = .8) after touching a resident's surroundings.With the exception of leadership, participants at LTCFs with more exposure to the intervention components showed statistically significantly more improvement than those at facilities with lower exposure scores. Conclusions and ImplicationsOur strategy was successful in improving hand hygiene compliance. LTCFs with more team members exposed to the different intervention components, demonstrated a greater effect from the intervention. To strengthen the impact of our intervention, we recommend that future improvement strategies provide more support to managers to ensure they are better equipped to take on their leadership roles and enable their teams to improve and maintain hand hygiene compliance.

Implementing Supplemental Interventions to Improve Hand Hygiene Compliance in an Acute Care Hospital

Implementing Supplemental Interventions to Improve Hand Hygiene Compliance in an Acute Care Hospital

P40 The effectiveness of contextualizing multimodal strategy on doctors to improve hand hygiene compliance in surgical wards at Ahmadu Bello University Teaching Hospital Zaria, Nigeria

Abstract Background Hospital acquired infection (HAI) is a major problem in healthcare delivery worldwide despite medical advances. A low HH compliance rate of 17.1% was found among surgical health workers at Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria. Although hand hygiene (HH) is a proven low-cost means to curtail HAI, low HH compliance is a global reality. The WHO multimodal strategy attempts to address low HH compliance within the frame of contextual realities. Methods This was an interventional study utilizing action research through a mixed method approach to investigate the effectiveness of employing a contextualized multimodal strategy to enhance the HH compliance rate of doctors at ABUTH Zaria. The study was from August to October 2022. A behavioural change campaign (BCC) HH workshop was carried out on doctors, and data collection followed immediately in the surgical wards (i.e. clusters) that had received environmental modification through the provision HH posters and nurses for visual and verbal reminders, respectively. The four clusters were: visual reminders only, verbal reminders only, visual and verbal reminders combined and neither visual nor verbal reminders (i.e. control). All clusters received an uninterrupted supply of alcohol-based hand rubs (ABHR) throughout the study period. The HH observation proforma for ‘five moments of HH’ template was used to collect the quantitative data through direct observation while qualitative data were by one-on-one interviews on doctors in surgical wards at ABUTH Zaria. Results The cumulative HH compliance rate by doctors was 69% (N = 1774). This was significantly different from the baseline HH compliance rate of 17.1% before this study’s intervention (P &amp;lt; 0.0001, C. I. 45.5% to 57.7%). HH was observed from doctors most in wards with both visual and verbal reminders (78%) while lowest (59%) where visual and verbal reminders were not provided, i.e. C4 (n = 444). Compared with the baseline HH compliance, all interventions were significant. However, compared with C4, visual reminders only (C1) had insignificant effect on influencing the HH practice of doctors while visual and verbal reminders combined. Verbal reminders only (C2) were found to be as effective as when combined with visual reminders (78%) as the difference was statistically insignificant (P = 0.4791, CI −3.5% to 7.5%, χ2 = 0.5). However, all doctors reported being motivated to perform HH by the presence of ABHR which was similar to the significance found even in the ward where no verbal or visual reminders (59%, n = 444) were used compared with the baseline (17%, n = 286) before this intervention study (P &amp;lt; 0.0001, CI 35% to 48%, χ2 = 125). All respondents reported hearing about the HH behavioural change workshop even though only one attended. Conclusions Continuous workshop on HH is necessary to sustain awareness of health workers on the importance of hand hygiene. The presence of ABHRs alone was enough motivation for doctors to perform HH but verbal reminders were significant in sustaining this positive attitude towards HH. A scaling of this intervention is needed in other departments so that staff can have changes made to their values towards healthcare delivery as well at ABUTH Zaria. Contextualizing the WHO multimodal strategy is an efficient and acceptable means of addressing the problem of low HH compliance.

Decolonization of hospital patients may aid efforts to reduce transmission of carbapenem-resistant Enterobacterales

Background: Multimodal approaches are often used to prevent transmission of antimicrobial-resistant pathogens among patients in healthcare settings; understanding the effect of individual interventions is challenging. We designed a model to compare the effectiveness of hand hygiene (HH) with or without decolonization in reducing patient colonization with carbapenem-resistant Enterobacterales (CRE). Methods: We developed an agent-based model to represent transmission of CRE in an acute-care hospital comprising 3 general wards and 2 ICUs, each with 20 single-occupancy rooms, located in a community of 85,000 people. The model accounted for the movement of healthcare personnel (HCP), including their visits to patients. CRE dynamics were modeled using a susceptible–infectious–susceptible framework with transmission occurring via HCP–patient contacts. The mean time to clearance of CRE colonization without intervention was 387 days (Zimmerman et al, 2013). Our baseline included a facility-level HH compliance of 30%, with an assumed efficacy of 50%. Contact precautions were employed for patients with CRE-positive cultures with assumed adherence and efficacy of 80% and 50%, respectively. Intervention scenarios included decolonization of culture-positive CRE patients, with a mean time to decolonization of 3 days. We considered 2 hypothetical intervention scenarios: (A) decolonization of patients with the baseline HH compliance and (B) decolonization with a slightly improved HH compliance of 35%. The hospital-level CRE incidence rate was used to compare the results from these intervention scenarios. Results: CRE incidence rates were lower in intervention scenarios than the baseline scenario (Fig. 1). The baseline mean incidence rate was 29.1 per 10,000 patient days. For decolonization with the baseline HH, the mean incidence rate decreased to 14.5 per 10,000 patient days, which is a 50.2% decrease relative to the baseline incidence (Table 1). The decolonization scenario with a slightly improved HH compliance of 35% produced a relative reduction of 71.9% relative to the baseline incidence. Conclusions: Our analysis shows that decolonization, combined with modest improvement in HH compliance, could lead to large decreases in pathogen transmission. In turn, this model implies that efforts to identify and improve decolonization strategies for better patient safety in health care may be needed and are worth exploring.Disclosures: None

Effectiveness of educational and training intervention for improving hand hygiene compliance amongst nurses: a systematic review and meta-analysis of randomised controlled trials.

Developing and implementing an educational and training programmes for improving hand hygiene compliance of the nursing personnel might help in increasing their knowledge, promoting positive attitude and follow adequate practice measures. Systematic search was done in PubMed, SCOPUS, CENTRAL, EMBASE, ScienceDirect, Clinicaltrials.gov and Google Scholar databases for articles published between 1964 and December 2022. Meta-analysis was carried out using a random-effects model, and the results were reported as pooled risk ratio (RR) with 95% confidence intervals (CIs), pooled standardised mean differences (SMD) or risk ratios (RR). Eight studies were included in the analysis. Most studies had higher risk of bias. Nurses receiving educational and training programmes had significantly higher compliance to hand hygiene practices (pooled RR of 1.69 [95% CI: 1.23-2.31; I2 = 99.1%], p = 0.001). The pooled analysis based on studies reporting the compliance to hand hygiene as continuous outcome has reported the pooled SMD as 1.28 with 95% CI: 0.62 to 1.95 and I2 = 74.5%. There were no single-study effects with respect to this outcome, since the sensitivity analysis showed no difference in either direction or strength of effect estimate. Educational and training programmes are effective in improving the hand hygiene compliance amongst the nursing professionals.