Improve Hand Hygiene Research Articles

Vaccinations, Not Vaccines, Save Lives: Quality Improvement for Newborn Vaccination.

Across the world, in medical journals, news media, social media, and personal discussions, one of the hottest topics of discussion is the coronavirus disease 2019 (COVID-19) vaccine. The rapid development of effective vaccines for COVID-19 is a remarkable success story of modern science, and it is a reminder for all of us about the significant health benefits of vaccines in general, benefits we often take for granted. Although the COVID-19 vaccine is the media star of the day, children receive numerous other routine vaccinations, including the hepatitis B vaccine, which significantly reduces the risk of hepatitis B virus infection. However, with all vaccines, including the hepatitis B vaccine, there are significant gaps in coverage, with high percentages of eligible children either not receiving the vaccine at all or receiving it late, thus exposing them to the risk of infectious diseases. A quotation from Orenstein1 has recently surfaced in discussions about the COVID-19 vaccine: “vaccines don’t save lives, vaccinations save lives.” Gaps in vaccine coverage generate the need for quality improvement (QI) projects to close these gaps. In this issue of the journal, Sarathy et al2 describe the results of a QI project in which they aimed to increase the monthly percentage of eligible newborn infants receiving the first dose of the hepatitis B vaccine within 24 hours of life to ≥80% within 9 months of project initiation. This article contains some important lessons that deserve to be highlighted about the conduct, description, and publication of QI projects. In 2008, the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines were first published. They were updated in 2015 as the SQUIRE …

Hand hygiene during the COVID‐19 pandemic among people experiencing homelessness—Atlanta, Georgia, 2020

People experiencing homelessness are at risk for coronavirus disease 2019 (COVID‐19) and may experience barriers to hand hygiene, a primary recommendation for COVID‐19 prevention. We conducted in‐depth interviews with 51 people experiencing sheltered and unsheltered homelessness in Atlanta, Georgia during May 2020 to August 2020 to (1) describe challenges and opportunities related to hand hygiene and (2) assess hand hygiene communication preferences. The primary hand hygiene barrier reported was limited access to facilities and supplies, which has disproportionately impacted people experiencing unsheltered homelessness. This lack of access has reportedly been exacerbated during COVID‐19 by the closure of public facilities and businesses. Increased access to housing and employment were identified as long‐term solutions to improving hand hygiene. Overall, participants expressed a preference for access to facilities and supplies over hand hygiene communication materials.

"If the glove fits": Hospital-wide universal gloving is associated with improved hand hygiene and may reduce Clostridioides difficile infection.

To determine whether a hospital-wide universal gloving program resulted in increased hand hygiene compliance and reduced inpatient Clostridioides difficile infection (CDI) rates. We carried out a multiple-year before-and-after quasi-experimental quality improvement study. Gloving and hand hygiene compliance data as well as hospital-acquired infection rates were prospectively collected from January 1, 2015, to December 31, 2017, by secret monitors. The University of Rochester Strong Memorial Hospital, an 849-bed quaternary-care teaching hospital. All adult inpatients with the exception of patients in the obstetrics unit. A hospital-wide universal gloving protocol was initiated on January 1, 2016. Hand hygiene compliance increased from 68% in 2015 reaching an average of 88% by 2017 (P < .0002). A 10% increase in gloving per unit was associated with a 1.13-fold increase in the odds of hand hygiene (95% credible interval, 1.12-1.14). The rates of CDI decreased from 1.05 infections per 1,000 patient days in 2015 to 0.74 in 2017 (P < .04). A universal gloving initiative was associated with a statistically significant increase in both gloving and hand hygiene compliance. CDI rates decreased during this intervention.

Checklist of African Soapy Saponin-Rich Plants for Possible Use in Communities' Response to Global Pandemics.

Plants that exhibit foaming properties when agitated in aqueous solutions are commonly referred to as soapy plants, and they are used in different communities for washing, bathing, and hair shampooing. The frothing ability of these plants is attributed to saponins which are also well-documented to possess antimicrobial attributes. In the light of COVID-19, soap and hand hygiene have taken center stage. The pandemic has also revealed the low access to running water and commercial soaps in many marginalized and poor communities to the detriment of global health. Thus, soapy plants, either in their natural form or through incorporation in commercial products, may be a relevant additional weapon to assist communities to improve hand hygiene and contribute to curbing COVID-19 and other communicable infections. This review paper was compiled from a review of literature that was published between 1980 and 2020. We found 68 plant species, including those which are already used as traditional soaps. Our findings support the potential use of extracts from soapy plants because of their putative viricidal, bactericidal, and fungicidal activities for use in crude home-based formulations and possibly for developing natural commercial soap products.

Hand hygiene skills of the health care workers and the effect of training and educational intervention: A single center cross-sectional study

Background: Hand hygiene is one of the most effective preventive measures in the transmission of infection. Proper hand hygiene strategies in health care facilities can reduce nosocomial infections and antimicrobial resistance.&#x0D; Objectives: This study aims to assess the baseline hand hygiene skills among health care workers and the impact of education and training on it.&#x0D; Design: Interventional cross-sectional single center study.&#x0D; Method: It was conducted among 181 health care workers of Alka Hospital Pvt. Ltd. During both pre and post-test, participants were asked to perform hand hygiene with soap and water as per WHO guidelines. Pretest was conducted to assess baseline skills of health care workers regarding hand hygiene. An observer would score whether each of the steps were performed correctly, using a checklist. It was followed by intervention in the form of training, education and demonstration of hand hygiene. Post-test was conducted to assess the changes in skills after intervention.&#x0D; Results: There was an overall improvement in the hand washing skills post intervention indicated by an increase in median score, which was 8 for pre-intervention and 9 for post-intervention. Doctors and nurses had better practice regarding hand hygiene in comparison to other participants. Those participants who had prior training on infection prevention and control, were found to have better hand hygiene skills post-intervention.&#x0D; Conclusion: Training and educational interventions are the effective tools to improve hand hygiene skills of the health care workers. Performing such interventions at regular intervals can be helpful.&#x0D; Bangladesh Crit Care J March 2021; 9(1): 12-15

Information technology on hand hygiene compliance among health care professionals: A systematic review and meta-analysis.

To determine the effectiveness of information technology interventions on hand hygiene compliance among health care professionals. Performing hand hygiene is the optimal approach to prevent the transmission of health care-associated infections. However, results regarding the effectiveness of information technology interventions on hand hygiene compliance were inconsistent to date. A search for studies published up to May 2020 was undertaken. A meta-analysis was conducted using RevMan 5.3 software. The most commonly used information technology systems were as follows: automated training, electronic counting devices and remote monitoring, real-time hand hygiene reminders and feedback, and automated monitoring. These four types of technology systems can significantly improve hand hygiene compliance among health care professionals (odds ratio=3.06, p<.001). The four types of information technology can be effectively used to change the hand hygiene behaviour. Because the information systems can monitor personnel and conduct statistical analyses automatically, they save labour costs of human monitors, are more time efficient and eliminate accompanying human error. The use of the four types of information technology is convenient and could reduce health care-associated infections; thus, they could be widely used in the future as the key to increase hand hygiene compliance rate.

P123 The effect of having volunteers and face masks present at hospital entrances on the wearing of face masks and hand washing

BackgroundThe spread of COVID-19 has put inpatients lives at risk and increased stress on hospital. Simple, cost effective measures such as mask wearing and hand hygiene have been shown to reduce the spread of droplet borne viruses. Compliance with these measures is variable and when performed improperly, reduce efficacy.ObjectiveIn this paper we aim to determine whether the provision of masks at hospital entrances and the use of volunteers to ensure correct mask wearing and hand hygiene can improve compliance with infection prevention measures for COVID-19.MethodVisitor and staff compliance with mask wearing and hand hygiene measures were observed with and without the presence of masks and volunteers at hospital entrances at a District General Hospital.ResultsA total of 519 people were observed entering the hospital. Mask wearing went from 71% to 99% (P = <0.001) with the addition of volunteers. Provision of masks increased mask wearing from 56% to 97% (P = <0.001). Hand hygiene was improved from 9% to 84% (P = <0.001) with the presence of volunteers.DiscussionA statistically significant improvement in hand hygiene and correct mask wearing was seen with both the presence of volunteers at hospital entrances and with the provision of masks. This is a relatively small study with heterogenous cohorts of staff and visitors. However, these results appear to indicate that use of volunteers and provision of masks at entrances may improve the compliance with the measures that been shown to reduce the in-hospital transmission of COVID-19.

Efficacy of Infection Control Measures in Managing Outbreaks of Multidrug-Resistant Organisms in Burn Units.

Multidrug-resistant organisms (MDROs) pose a significant threat to severe burn victims and represents a clear epidemic hazard in burn units. Several infection control measures have been implemented to control and manage the outbreaks of MDRO. The efficiency of those measures, however, remains controversial and an area of debate. A systematic review was conducted to evaluate the efficacy of infection control measures and the necessity of closing burn units in dealing with MDRO outbreaks. Peer-reviewed articles were identified using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases, focusing on infection control measures to manage MDRO outbreaks in burn units. Twenty-one studies that reported MDRO outbreaks in burn units met the inclusion criteria. The outbreaks were successfully controlled with interventions in 17 units (81%), partially controlled in 1 unit (4.7%), and uncontrolled in 3 units (14.3%). Infection control measures were implemented by screening patient (19 units), screening health care worker (17 units), obtaining environmental cultures (16 units), providing ongoing staff education (13 units), cohort or isolation (17 units), preemptive barrier precautions (10 units), improving hand hygiene (15 units), and enhanced cleaning and environmental disinfection (17 units). Closure of burn units occurred in 8 units, with outbreaks controlled in 6 of the units (75%). The reasons for unit closure include decontamination (4 units; 50%), outbreak investigation (1 unit; 12.5%), and uncontrolled outbreaks (3 units; 37.5%). The incidence of infection was significantly decreased in 4 units after the closure but rose again after reopening in 1 of the units. In 3 units, the spread was halted by other control measures, including change of hydrotherapy facilities, identification of staff transmission, and unit structure remodeling. Proper infection control measures play an important role in managing MDRO outbreaks in burn units. Temporary closure of burn units may be necessary to control the spread of nosocomial, and this option should be considered when other measures are ineffective.

Effects of dental hygienist's cognition of behavior related to the improvement of hand hygiene on performance of dental infection control

Objectives: The purpose of this study is to understand the effect of perception of behavior related to hand hygiene improvement on dental infection management performance among dental hygienists. Methods: A survey was conducted among 230 dental hygienists working in Busan, Ulsan, and Gyeongnam. The collected data were analyzed through descriptive statistics, correlation analysis and multiple regression analysis using the IBM SPSS 26.0 statistical program. Results: The findings indicated that dental hygienist s hand hygiene education showed the most significant value to the regular hand hygiene feedback(r=.736). The factors that positively influence the perception of hand hygiene-related behavior on dental infection management performance were hand hygiene education (p<.001), regular feedback on hand hygiene(p<.01), and patient’ hand hygiene requirements before contact(p<.05) appeared in order. Conclusions: The importance of hand hygiene by dental hygienists should be recognized, and basic data on the development and operation of infection control programs should be provided.

A survey of commercially available electronic hand hygiene monitoring systems and their impact on reducing healthcare-associated infections

Although the benefits of electronic hand hygiene monitoring systems (EHHMSs) are well described, uptake has been poor since they were first introduced over 10 years ago. There is considerable published evidence on the association between the introduction of EHHMSs and improved hand hygiene (HH) compliance rates. However, their impact on healthcare-associated infection (HCAI) reduction is much less clear-cut. Commercial EHHMS identification was undertaken using a Google internet search and all relevant websites and marketing materials were reviewed. A structured literature search was undertaken to identify evidence of HCAI reduction through EHHMS implementation. Structured interviews were undertaken with a number of Directors of Infection Prevention and Control (DIPCs) from acute NHS Trusts in the North West of England to seek opinions on HH improvement strategies and the use of EHHMSs. Twenty-nine commercial EHHMSs were identified, 20 of which are currently market active. Six EHHMSs had supporting evidence, across nine published studies, demonstrating their ability to reduce HCAIs. However, most evaluation designs were quasi-experimental with only one study using a high-quality stepped-wedge cluster randomized controlled trial design. In this study the EHHMS was part of a wider HH multi-modal improvement strategy. Structured interviews were undertaken with five DIPCs who consistently expressed a reluctance to support financial investment into this type of technology until EHHMS cost-effectiveness was better established. The evidence base for the ability of EHHMSs to reduce HCAIs needs to improve before NHS trusts will consider procuring them.

Knowledge, socio-cognitive perceptions and the practice of hand hygiene and social distancing during the COVID-19 pandemic: a cross-sectional study of UK university students

BackgroundDuring the first wave of the COVID-19 pandemic, social distancing and hand hygiene have been the primary means of reducing transmission in the absence of effective treatments or vaccines, but understanding of their determinants is limited. This study aimed to investigate knowledge and socio-cognitive perceptions, and their associations with such protective behaviours, in UK university students.MethodsA cross-sectional online survey of 293 students was undertaken on 13 May 2020. Survey questions addressed demographics, knowledge of the disease and effectiveness of the protective measures, risk perception, socio-cognitive perceptions (e.g. attitude, social support, and self-efficacy), habit, time factors and trust, as well as the hand hygiene and social distancing behaviours. Multiple linear regression was used to identify the strongest associations of potential determinants with behaviour.ResultsParticipants reported high levels of social distancing with 88.9% answering “Mostly” or “Always” for every activity, but only 42.0% reporting the same for all hand hygiene activities. Knowledge of the effectiveness of each activity in preventing transmission was high, with 90.7% and 93.5% respectively identifying at least 7 of 8 hand hygiene or 9 of 10 social distancing activities correctly. Habit (β = 0.39, p = 0.001) and time factors (β = 0.28, p = 0.001) were the greatest contributors to unique variance in hand hygiene behaviour, followed by ethnicity (β = − 0.13, p = 0.014) and risk perception (β = 0.13, p = 0.016). For social distancing behaviour, the determinants were self-efficacy (β = 0.25, p < 0.001), perceived advantages (β = 0.15, p = 0.022), trust in policy (β = 0.14, p = 0.026) and gender (β = − 0.14, p = 0.016). Regression models explained 40% hand hygiene and 25% social distancing variance.ConclusionsThis study indicated that communications about effectiveness of hand hygiene and social distancing behaviours had been effective in terms of knowledge acquisition. However, in the light of likely second waves of COVID-19, attention to maintaining social distancing behaviour and improving hand hygiene behaviour may need to address more difficult areas of changing habits, overcoming time factors and building trust, as well as interventions to increase self-efficacy and address risk perception concerns.

Patient, family, and visitor hand hygiene knowledge, attitudes, and practices at pediatric and maternity hospitals: A descriptive study

BackgroundPatient, family, and visitor hand hygiene can prevent health care-associated infections, but little is known about their hand hygiene knowledge, attitudes, and practices. We aimed to assess patient, family, and visitor hand hygiene knowledge, attitudes, and practices at a pediatric and maternity hospital in Vancouver, British Columbia, Canada. MethodsSurveys based on the Theoretical Domains Framework were distributed to patients, families, and visitors to provide cross-sectional qualitative and quantitative data. This was supplemented with covert observations by trained medical students to determine patient, family, and visitor hand hygiene rates. ResultsOf 348 survey respondents, there was a clear preference for hand washing with soap and water over use of alcohol-based hand rub. Beliefs about consequences were the main driver for hand hygiene. Self-reported hand hygiene rates were higher than observed rates. The overall hand hygiene rate was observed to be 10.3% (72/701), with soap and water used for 75% of hand hygiene events. ConclusionThere are misconceptions regarding hand hygiene practices and low hand hygiene rates among patients, families, and visitors. Development of interventions to improve hand hygiene should focus on correcting misconceptions and emphasizing consequences of failing to perform hand hygiene in the health care setting.

All Hands on Deck: Sustaining Improved Hand Hygiene Compliance in the Operating Room

Hand hygiene is an essential component of infection prevention in the health care setting. Despite diligent efforts, clinicians can be susceptible to hand hygiene misses in fast-paced, complex environments such as the operating room due to systemic factors such as the physical environment, workflow, and sporadic interactions with other personnel. Through the use of human factors and resilience engineering concepts, work-as-done were studied to identify barriers to hand hygiene compliance in the operating rooms of a pediatric hospital in an urban area. The saliency, effort, expectancy, value model was applied to design a multifaceted intervention that resulted in a sustained 95% hand hygiene compliance.

Association of Visitor Contact Precautions With Estimated Hospital-Onset Clostridioides difficile Infection Rates in Acute Care Hospitals

Visitor contact precautions (VCPs) are commonly used to reduce the transmission of Clostridioides difficile at health care institutions. Implementing VCPs requires considerable personnel and personal protective equipment resources. However, it is unknown whether VCPs are associated with reduced hospital-onset C difficile infection (HO-CDI) rates. To estimate the association between VCPs and HO-CDI rates using simulation modeling. This simulation study, conducted between July 27, 2020, and August 11, 2020, used an established agent-based simulation model of C difficile transmission in a 200-bed acute care adult hospital to estimate the association between VCPs and HO-CDI while varying assumptions about factors such as patient susceptibility, behavior, and C difficile transmission. The model simulated hospital activity for 1 year among a homogeneous, simulated adult population. No VCP use vs ideal use of VCPs under different hospital configurations. The rate of HO-CDI per 10 000 patient-days according to the Centers for Disease Control and Prevention's definition of HO-CDI. With use of the simulation model, the baseline rate of HO-CDI was 7.94 10 000 patient-days (95% CI, 7.91-7.98 per 10 000 patient-days) with no VCP use compared with 7.97 per 10 000 patient-days (95% CI, 7.93-8.01 per 10 000 patient-days) with ideal VCP use. Visitor contact precautions were not associated with a reduction of more than 1% in HO-CDI rates in any of the tested scenarios and hospital settings. Independently increasing the hand-hygiene compliance of the average health care worker and environmental cleaning compliance by no more than 2% each was associated with greater HO-CDI reduction compared with all other scenarios, including VCPs. In this simulation study, the association between VCPs and HO-CDI was minimal, but improvements in health care worker hand hygiene and environmental cleaning were associated with greater reductions in estimated HO-CDI. Hospitals may achieve a higher rate of reduction for HO-CDI by focusing on making small improvements in compliance with interventions other than VCP.

A two-component intervention to improve hand hygiene practices and promote alcohol-based hand rub use among people who inject drugs: a mixed-methods evaluation

BackgroundInconsistent hand hygiene puts people who inject drugs (PWID) at high risk of infectious diseases, in particular skin and soft tissue infections. In healthcare settings, handwashing with alcohol-based hand rubs (ABRH) is recommended before aseptic procedures including intravenous injections. We aimed to evaluate the acceptability, safety and preliminary efficacy of an intervention combining ABHR provision and educational training for PWID.MethodsA mixed-methods design was used including a pre-post quantitative study and a qualitative study. Participants were active PWID recruited in 4 harm reduction programmes of France and followed up for 6 weeks. After baseline assessment, participants received a face-to-face educational intervention. ABHR was then provided throughout the study period. Quantitative data were collected through questionnaires at baseline, and weeks 2 (W2) and 6 (W6) post-intervention. Qualitative data were collected through focus groups with participants who completed the 6-week study.ResultsAmong the 59 participants included, 48 (81%) and 43 (73%) attended W2 and W6 visits, respectively. ABHR acceptability was high and adoption rates were 50% (W2) and 61% (W6). Only a minority of participants reported adverse skin reactions (ranging from 2 to 6%). Preliminary efficacy of the intervention was shown through increased hand hygiene frequency (multivariable linear mixed model: coef. W2 = 0.58, p = 0.002; coef. W6 = 0.61, p = 0.002) and fewer self-reported injecting-related infections (multivariable logistic mixed model: AOR W6 = 0.23, p = 0.021). Two focus groups were conducted with 10 participants and showed that young PWID and those living in unstable housing benefited most from the intervention.ConclusionsABHR for hand hygiene prior to injection are acceptable to and safe for PWID, particularly those living in unstable housing. The intervention’s educational component was crucial to ensure adoption of safe practices. We also provide preliminary evidence of the intervention’s efficacy through increased hand hygiene frequency and a reduced risk of infection.

Reported healthcare workers knowledge and practices of hand hygiene in specialist hospitals of Kano, Northwest Nigeria

Compliance with recommended hand hygiene among healthcare providers is important in the prevention of morbidity and mortality associated with hospitalacquired infections including drug resistant microorganisms. This study aimed to determine the reported knowledge and hand hygiene practices among healthcare workers in Specialist Hospitals in Kano, Nigeria. Descriptive cross-sectional study design was used to study 302 healthcare workers in the specialist hospitals in Kano. Data was collected using semi-structured self-administered questionnaire and analyzed at univariate, bivariate and multivariate levels using IBM SPSS version 22. The age of the respondents ranged from 18 to 59 years with a mean of 31.4±9 years. Up to onethird (36.1%) of the respondents had poor knowledge despite the reported hand hygiene practice of 78%. Use of Alcohol Based Hand Rub and soap and water constituted 26.7% and 15.7% respectively. There was statistically significant association between working in MMSH, working in Pediatrics wards, CHEW cadre, and attendance of hand hygiene training in the last 3 years and having good knowledge of hand hygiene. Hand hygiene training was found to improve hand hygiene knowledge [AOR=1.58, 95% CI= (1.01-2.5)] and practice [AOR=1.12 95%CI= (0.64-1.99)]. Reported knowledge of hand hygiene was poor but the practices were encouraging and associated with formal training of healthcare workers on hand hygiene. Therefore, Hospital management should ensure regular hand hygiene training and re-training among healthcare workers.

Development of a behaviour change intervention using a theory-based approach, Behaviour Centred Design, to increase nurses\u2019 hand hygiene compliance in the US hospitals

BackgroundA behaviour change campaign is unlikely to be effective if its intervention is not carefully designed. While numerous frameworks are widely used to develop and evaluate interventions, the steps detailing how to create an intervention are not as clear because the process of linking behaviour analysis to the intervention design is seldom discussed. We document the application of the Behaviour Centred Design (BCD) approach to the development of an intervention to improve hand hygiene (HH) rates among nurses’ hospital units in the USA.MethodsIntervention development is divided into the first three steps of the BCD approach: Assess, Build, and Create. The Assess step centres on understanding the target behaviour. The Build step expands the knowledge of the target behaviour and population through formative research which leads to a creative brief that explains the focus of the intervention. In the Create step, the creative brief guides the intervention design.ResultsDrawing from the main findings of the Asses and Build steps, a focal insight was developed positing that nurses can rediscover the meaning and purpose of their role as a nurse and thus as a caregiver by practicing HH; in the process of cleaning their hands, nurses are living up to their ideal nurse-self. The focal insight was linked linguistically into a theory and change. The outcome was a simple intervention, called the Mainspring Intervention, which consisted of three major parts: a self-affirmation exercise to reduce defensiveness, a message that challenged nurses’ perceptions about their HH practice, and an implementation intention activity to help nurses link HH behaviour to a cue.ConclusionsWe detailed the creation of an original HH intervention that used the BCD approach. The intervention is relatively simple compared to most HH initiatives in the literature, both in terms of having relatively few components to the intervention and relatively easy field implementation. This intervention will allow us to test how specific psychological processes contribute to the problem of low HH rates, how our proposed intervention changes these processes in the hospital setting, and how the expected change in nurses’ cognition transforms over time because of the intervention.

Hand hygiene and glove use in nursing homes before and after an intervention.

We investigated whether an intervention to improve hand hygiene compliance in nursing homes changed glove use. Hand hygiene compliance increased, but substitution of hand hygiene with gloves did not decrease. We observed a reduction of inappropriately unchanged gloves after exposure to body fluids.Clinical trials identifier: Netherlands Trial Register, trial NL6049 (NTR6188): https://www.trialregister.nl/trial/6049.

The Process and Outcomes of Peripheral Venous Cannulation in a Tertiary Care Center: a Prospective Completed Audit Loop Study

Peripheral venous cannulations are one of the most common procedures carried out in today’s healthcare setting. It is an invasive procedure and carries with it the risk of bloodstream infections. There are guidelines for insertion and management of peripheral venous cannulas. One such guideline is the standards of infusion therapy from the Royal College of Nursing. In this study, we aim to assess the process and outcomes of peripheral venous cannulation in our institution against these guidelines. We conducted a prospective completed audit loop study on the process and outcomes of peripheral venous cannulation in our institution. The preliminary audit was conducted in the month of December 2019. The staff were trained on various aspects of cannulation based on the guidelines in the following month. A reaudit was conducted between May and August 2020, and the data were analyzed. A total of 362 cannulations were audited for the study. Forty-seven cannulations were observed during the initial audit, and 315 cannulations were included for the reaudit. On comparative analysis, there was a statistically significant improvement in hand hygiene, use of gloves, appropriate site selection, flushing of the cannula, and documentation in the reaudit in comparison with the initial audit. There was also a statistically significant reduction in the number of recannulations. Peripheral intravenous cannulation although a simple procedure can cause significant morbidity if not performed properly. Auditing such procedures shows deficiencies in performance. Reaudit, after adequate retraining of staff, shows significant improvement in performance and outcome.

Compliance with Hand Hygiene Among Healthcare Workers in Preventing Healthcare Associated Infections

Introduction: Healthcare associated infections (HCAIs) represent a major public health issue. In Europe, 37 000 patients are affected annually by some sort of HCAI. HCAIs are preventable, and hand hygiene is an important measure in their prevention. During daily clinical practice, hands of healthcare workers (HCWs) are exposed to surfaces, various substances and objects; therefore, proper hand hygiene is the first step in preventing microorganism transmission. Aim: To determine the HCWs hand hygiene compliance with the guidelines of the World Health Organization through a systematic review of literature. Methods: A systematic review of literature based on the PRISMA statement guidelines using the PubMed database in a search for articles that evaluate the hand hygiene compliance among HCWs. Results: Six articles were taken into consideration by the availability of full-text articles and years of publication between 2010 and 2020. Results showed that compliance rate was the highest in studies that implemented World Health Organisation’s Multimodal Hand Hygiene Improvement Strategy or its modifications. Conclusion: The multimodal approach, as World Health Organisation’s multimodal strategy or its local modifications, has been shown as the best approach addressing the problem of hand hygiene compliance. Further areas for research include finding a better method of measuring compliance, technology-driven solutions for both delivery of alcohol-based handrub and monitoring of its use, a greater focus on evaluating proper hand hygiene techniques, and insuring longer-term programs of training and education to achieve the best effectiveness of hand hygiene compliance among HCWs.