Hand Hygiene Compliance Rates Research Articles

Hand Hygiene Compliance among Healthcare Workers, Ministry of Health Hospitals, the Kingdom of Saudi Arabia for the Year 2018

Background: Microorganisms are mostly transmitted through the hands of healthcare workers in any healthcare setting. This transmission can be from healthcare workers to the patients and from their surrounding environment. This ultimately leads to increased healthcare-associated infections and to the resistance against the antimicrobials and the cost of healthcare-associated infections increases accordingly. Objectives: To observe the practice of hand hygiene and to calculate the hand hygiene compliance rate among healthcare workers of Ministry of Health Hospitals in the Kingdom of Saudi Arabia. Methods: The hand hygiene practice of healthcare workers in 318 Ministry of Health hospitals was observed by direct observation during the year 2018. This was done as a part of the National Hand Hygiene Program during the year 2018. The data was collected using the World Health Organization Hand Hygiene observation form. The compliance rate was calculated among different healthcare professionals, hospital departments and work shifts. Results: A total of 511,079 opportunities were observed over a period of one year. The overall hand hygiene compliance rate was found to be 70%. The compliance was found to be highest after the blood/body fluids exposure (85%), followed by after touching the patients (76%), followed by clean aseptic procedures (75%), after touching the patient’s surroundings (66%), and before touching the patients (64%). The overall hand hygiene compliance was found to be higher in nurses (73%) as compared to the doctors which was 67%. Conclusion: Our findings confirm that hand hygiene compliance is higher in the nurses as compared to the physicians and the rest of the health care workers in MOH health care settings. Initiatives such as improved monitoring and training healthcare facilities are needed to improve hand hygiene compliance in future.

Hand Hygiene Behaviors Monitored by an Electronic System in the Intensive Care Unit

Background Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. Methods An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. Results A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Conclusions Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance. Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance.

Impact of direct hand hygiene observations and feedback on hand hygiene compliance among nurses and doctors in medical and surgical wards: an eight-year observational study

The improvement of hand hygiene compliance (HHC) is vital for preventing healthcare-associated infections (HAIs). To determine whether observation and feedback influences HHC among nurses and doctors in surgical and medical wards, and whether these actions impact HAI incidence. In this longitudinal observational study, HHC and the incidence of HAIs were observed in six medical and seven surgical wards in a tertiary hospital in Finland from May 2013 to December 2020. Data of the observations of five hand hygiene (HH) moments were collected from the hospital HH and the HAI monitoring registries. For statistical analyses a multivariable logistic regression analysis and a Poisson regression model were used. HH monitoring included 24,614 observations among nurses and 6396 observations among doctors. In medical wards, HHC rates increased 10.8%, from 86.2% to 95.5%, and HAI incidence decreased from 15.9 to 13.5 per 1000 patient-days (P < 0.0001). In surgical wards, HHC increased 32.7%, from 67.6% to 89.7%, and HAI incidence decreased from 13.7 to 12.0 per 1000 patient-days (P < 0.0001). The overall HHC increased significantly among nurses (17.8%) and doctors (65.8%). The HHC was better among nurses than doctors (in medical wards, OR: 3.36; 95% CI: 2.90-3.90; P < 0.001; and in surgical wards, OR: 9.85; 95% CI: 8.97-10.8; P < 0.001). Direct observations and feedback of HH increased HHC significantly among nurses and doctors over an eight-year period. During the same period, the incidence of HAIs significantly decreased in both medical and surgical wards.

The long-term impact of immediate verbal feedback of hand hygiene compliance after overt observation sessions, as assessed by continuous closed-circuit television monitoring in an intensive care setting

BackgroundHand hygiene compliance by health care workers (HCWs) is pivotal in controlling and preventing health care associated infections. The aim of this interventional study is to assess the long-term impact of personal verbal feedback on hand hygiene compliance of HCWs in an intensive care unit (ICU) immediately after overt observation by an infection control nurse.MethodsAn infection control nurse overtly observed HCWs’ hand hygiene compliance and immediately gave personal verbal feedback with emphasis on aseptic technique. Overt non-interventional sessions were also performed. We measured compliance rates using covert continuous closed-circuit television (CCTV) monitoring. We compared these rates to previously-published hand hygiene compliance data.ResultsOverall compliance rates in the first (41.5%) and third phases (42%) of the study, before and after the intervention were similar. The two moments that were lowest in the first phase, “before aseptic contact” and “after exposure to body fluids”, showed significant improvement, but two moments showed a significant decline in compliance: “before patient contact” and “after contact with patient surrounding”. The compliance rates during the intervention phase were 64.8% and 63.8% during the sessions with and without immediate verbal personal feedback, respectively.ConclusionThe overall hand hygiene compliance rate of HCWs did not show an improvement after immediate verbal personal feedback. Covert CCTV observational sessions yielded much lower hand hygiene compliance rates then overt interventional and non-interventional observations. We suggest that a single intervention of personal feedback immediately after an observational session is an ineffective strategy to change habitual practices.

Hand Hygiene Compliance in Pediatric Emergency of a Lower-Middle Income Country: A Quality Improvement Study.

BackgroundProspective data on hand hygiene compliance in pediatric emergency department (PED) settings is limited. We studied the impact of quality improvement measures on the overall and health care personnel wise hand hygiene compliance rates in a busy PED.MethodsThe baseline hand hygiene compliance rates were audited from May–July 2018. The quality improvement interventions included various structural changes to the environment, administrative changes, education and training. During the interventions, auditing was continued for 2 months (August – September 2018). Statistical Process control charts were created.ResultsWe observed a significant increase in overall compliance rates from 31.8 to 53.9% (p < 0.001). These improvements were observed in the children (29.6 to 46.4%, p < 0.001) as well as neonatal area (35.7% to 59.7, p < 0.001) of PED as well as amongst various health care personnel and in four out of the five moments of hand hygiene.ConclusionHand hygiene compliance improved significantly in a busy PED of a lower middle-income country following quality improvement interventions. Such improvement was observed amongst all categories of health care personnel and different types of hand hygiene opportunities. This study demonstrates the feasibility and efficacy of simple quality improvement interventions in a challenging hospital environment.

Increased Rate of Hand Hygiene Compliance During COVID -19 Pandemic: Myths and Facts

Introduction: Hand Hygiene is the cheapest, easiest and the single most effective measure to reduce cross-transmission of infection from one patient to another and from the healthcare workers to patients and vice versa. Multiple studies have shown a decrease in healthcare-associated infections (HCAIs) rates after improvement in hand-hygiene compliance. Despite being the simplest procedure adherence to the hand hygiene recommendations remains well below 50% and healthcare workers repeatedly observed as being poor compliers. Objective: This study was planned to access the impact of covid-19 pandemic on the compliance of infection control practices at a tertiary health care centre in India. Methods: Institution-based cross-sectional study was used to assess the impact of covid-19 pandemic on attitude, knowledge and on the compliance of hand hygiene practices at a tertiary health care centre in India. Results: A marked difference was observed in the availability of resources for hand hygiene i.e., 48 (96%) locations and the display of instructions for hand hygiene 50 (100%). A significant difference was also observed among the knowledge of the steps of hand hygiene {2019: 16(32%; 2020: 33 (66%)} and of the moments of hand hygiene {2019: 27 (54%); 2020; 44 (88%)}. (ϰ2 = 79.2, df =1, p = 0). In 2020 (during COVID -19 pandemic) a significant increase in compliance was noted in most of the departments with highest compliance rate of ICUs (100%), followed by OTs (91.7%), paediatrics (95.8%) obstetrics and gynaecology (90.6%), surgery (86.5%), blood bank and laboratories (85.7%). However, unlike the other parameters, the compliance of hand hygiene during the previous year (2019) and during 2020 (COVID -19 pandemic, was poor with no significant difference in compliance of hand hygiene practices even during the pandemic. Of all the 5 moments suggested by WHO, maximum compliance (36% in 2019 and 60% in 2020 pandemic) was after body fluid exposure. Conclusions: Hand Hygiene should be made a national priority. Active involvement by healthcare administrators, national and local governments should be committed to make hand hygiene a mandate for patient safety. Accessibility to hand hygiene products like soap and water and/or alcohol-based hand rubs and written and verbal reminders to staff are essential to improve the compliance of hand hygiene. Thrust should also be given to hand hygiene as a research subject.

Increased Rate of Hand Hygiene Compliance During COVID -19 Pandemic: Myths and Facts

Introduction: Hand Hygiene is the cheapest, easiest and the single most effective measure to reduce cross-transmission of infection from one patient to another and from the healthcare workers to patients and vice versa. Multiple studies have shown a decrease in healthcare-associated infections (HCAIs) rates after improvement in hand-hygiene compliance. Despite being the simplest procedure adherence to the hand hygiene recommendations remains well below 50% and healthcare workers repeatedly observed as being poor compliers. Objective: This study was planned to access the impact of covid-19 pandemic on the compliance of infection control practices at a tertiary health care centre in India. Methods: Institution-based cross-sectional study was used to assess the impact of covid-19 pandemic on attitude, knowledge and on the compliance of hand hygiene practices at a tertiary health care centre in India. Results: A marked difference was observed in the availability of resources for hand hygiene i.e., 48 (96%) locations and the display of instructions for hand hygiene 50 (100%). A significant difference was also observed among the knowledge of the steps of hand hygiene {2019: 16(32%; 2020: 33 (66%)} and of the moments of hand hygiene {2019: 27 (54%); 2020; 44 (88%)}. (ϰ2 = 79.2, df =1, p = 0). In 2020 (during COVID -19 pandemic) a significant increase in compliance was noted in most of the departments with highest compliance rate of ICUs (100%), followed by OTs (91.7%), paediatrics (95.8%) obstetrics and gynaecology (90.6%), surgery (86.5%), blood bank and laboratories (85.7%). However, unlike the other parameters, the compliance of hand hygiene during the previous year (2019) and during 2020 (COVID -19 pandemic, was poor with no significant difference in compliance of hand hygiene practices even during the pandemic. Of all the 5 moments suggested by WHO, maximum compliance (36% in 2019 and 60% in 2020 pandemic) was after body fluid exposure. Conclusions: Hand Hygiene should be made a national priority. Active involvement by healthcare administrators, national and local governments should be committed to make hand hygiene a mandate for patient safety. Accessibility to hand hygiene products like soap and water and/or alcohol-based hand rubs and written and verbal reminders to staff are essential to improve the compliance of hand hygiene. Thrust should also be given to hand hygiene as a research subject.

Health Care Workers' Adherence to Hand Hygiene Guidelines in Emergency Surgical Room of a Tertiary Care Hospital.

Background Out of every 100 hospitalized patients, 7 patients in advanced countries and 10 patients in emerging countries acquire health care-associated infections (HCAIs). Hand hygiene (HH) procedures are the simple and cost-effective solution to significantly reduce HCAI. We wanted to know the compliance rate of HH procedures among health care workers (HCWs) working in emergency surgical room (ESR) of our institute, so that feedback can be given to them and further interventions can be planned. Methodology This is a cross-sectional observational study conducted in ESR. Resident doctors and faculties, interns, and nurses were directly observed for all the five moments of HH recommended by World Health Organization (WHO). The data have been recorded with the WHO recommended form for observation and basic compliance calculation for HH. Results In total, 1,370 HH opportunities were observed and recorded, of which 690 were for resident doctors and faculties, and 340 each for interns and nurses. The overall total HH compliance rate among all HCWs was 41.3% and resident doctors and faculties had the poorest compliance. Poorest compliance was observed for moment 1, whereas maximum compliance was for moment 3 among all the HCWs. Conclusion HCWs' adherence to HH guidelines in ESR of this tertiary care hospital is low and is least in resident doctors and faculties.

Hand hygiene compliance among healthcare workers before and during the COVID-19 pandemic

BackgroundHealthcare workers’ (HCWs) adherence to hand hygiene is vital in combatting COVID-19 in hospitals. We aimed to investigate HCWs hand hygiene compliance before and during the COVID-19 pandemic and hypothesised that hand hygiene compliance would increase during the pandemic.MethodsWe conducted a prospective observational study in three medical departments at the Regional Hospital of West Jutland, Denmark from April 2019 to August 2020. A total of 150 HCWs participated before the COVID-19 pandemic and 136 during the pandemic. Hand hygiene observations were assessed using an automated hand hygiene monitoring system. Students unpaired t-test was used to assess differences in hand hygiene compliance rates in each department.ResultsComparison analyses showed, that hand hygiene compliance in department A and B was significantly higher before the COVID-19 pandemic than during the pandemic; a 7% difference in department A and a 5% difference in department B. For department C, the total hand hygiene compliance was unchanged during the pandemic compared to before.ConclusionThe COVID-19 pandemic did not raise hand hygiene compliance. Further studies are needed to verify these findings and further identify barriers to hand hygiene compliance among HCWs.

Internet of things in healthcare for patient safety: an empirical study

IntroductionThis study evaluates the impact of an Internet of Things (IoT) intervention in a hospital unit and provides empirical evidence on the effects of smart technologies on patient safety (patient falls and hand hygiene compliance rate) and staff experiences.MethodWe have conducted a post-intervention analysis of hand hygiene (HH) compliance rate, and a pre-and post-intervention interrupted time-series (ITS) analysis of the patient falls rates. Lastly, we investigated staff experiences by conducting semi-structured open-ended interviews based on Roger’s Diffusion of Innovation Theory.ResultsThe results showed that (i) there was no statistically significant change in the mean patient fall rates. ITS analysis revealed non-significant incremental changes in mean patient falls (− 0.14 falls/quarter/1000 patient-days). (ii) HH compliance rates were observed to increase in the first year then decrease in the second year for all staff types and room types. (iii) qualitative interviews with the nurses reported improvement in direct patient care time, and a reduced number of patient falls.ConclusionThis study provides empirical evidence of some positive changes in the outcome variables of interest and the interviews with the staff of that unit reported similar results as well. Notably, our observations identified behavioral and environmental issues as being particularly important for ensuring success during an IoT innovation implementation within a hospital setting.

An observational study of hand hygiene compliance of surgical healthcare workers in a Nigerian teaching hospital.

Patients sometimes contract healthcare associated infections (HCAI) which are unrelated to their primary reasons for hospital admission. Surgical site infections are the most investigated and most recurrent type of HCAI in developing countries, affecting up to one-third of surgical patients. This study aimed to assess and offer context to the hand hygiene resources available in a Nigerian teaching hospital through ward infrastructure survey, and to determine the hand hygiene compliance rate among surgical healthcare workers (HCWs) in a Nigerian teaching hospital through hand hygiene observations. Ward infrastructure survey was conducted in the two adult surgical wards of the hospital using the World Health Organisation (WHO) hand hygiene ward infrastructure survey form. Hand hygiene observations were monitored over seven days in the surgical wards using a modified WHO hand hygiene observation form. Hand hygiene resources were insufficient, below the WHO recommended minimum standards. Seven hundred hand hygiene opportunities were captured. Using SPSS version 24.0, we conducted a descriptive analysis of audit results, and results were presented according to professional group, seniority and hand hygiene opportunities of the participants. Overall hand hygiene compliance was 29.1% and compliance was less than 40% across the three professional groups of doctors, nurses and healthcare assistants. Hand hygiene compliance rates of the surgical HCWs are comparable to those in other Sub-Saharan African countries as well as in developed countries.

Compliance to hand hygiene and its determinant factors among Community Health Care Providers in Community Clinics: an observational study in Bangladesh.

Healthcare-associated infections caused by poor hand hygiene (HH) practices can affect both the care seekers and the health care providers (HCPs) while providing primary health care. No study has been conducted on the compliance of HH practices among the primary level HCPs in Bangladesh. The study aimed to assess the compliance rates of HH and its determinant factors among Community Health Care Providers (CHCPs) in Community Clinics (CC). A cross-sectional study was conducted from September 2019 to February 2020 among 150 randomly selected CHCPs with functional HH facilities in Patuakhali district, Bangladesh. Structured interviews and observation tools were used to collect data. Good HH compliance among CHCPs was found to be 16.7% (95% CI: 11.3-21.3). Out of all 1218 possible HH opportunities, only 255 (20.9%) resulted in any HH action. Presence of 70% alcohol-based hand sanitiser at the point of care (aOR: 6.4, 95% CI: 1.1-38.3), HH training (aOR: 4.6, 95% CI: 1.1-18.9), displayed visual cues (aOR: 4.4, 95% CI: 1.1-17.7), knowledge about HH (aOR: 3.8, 95% CI: 1.1-13.6) and number of HH opportunities (aOR: 0.6, 95% CI: 0.4-0.8) were factors associated with HH compliance. Overall HH compliance among CHCPs was relatively low. It was recommended to implement multimodal HH improvement strategies, including a continuous training program, supply of alcohol-based hand rub, reminder, provision of five moments of HH in the training modules and feedback on HH performance.

Report of a Multimodal Strategy for Improvement of Hand Hygiene Compliance in a Latin American Hospital. How Far From Excellence?

The aim of the study was to report the results of a multimodal strategy for improvement of hand hygiene (HH) compliance in a third-level hospital in Mexico. This is an epidemiological study in a public, acute care, academic, tertiary referral center from 2009 to 2019. Healthcare worker (HCW) compliance with HH was assessed after implementation of the World Health Organization multimodal strategy that included permanent and widespread access to alcohol-based hand rubs; educational activities for staff, students, patients, and relatives; reminders in healthcare areas; patient empowerment; water quality surveillance; frequent evaluation of compliance; and feedback. The primary outcome was HH compliance rate (measured by direct observation). The association of HH with healthcare-associated infections was the secondary outcome. A total of 60,685 HH opportunities were evaluated. The HH compliance rate increased significantly from 39.83% (95% confidence interval [CI] = 38.83%-40.84%) to 64.81% (95% CI = 64.08%-65.54%), mostly due to HH compliance in World Health Organization moments 3 to 5 (r = 0.86, P = 0.001). A statistically significant inverse association was found between HH compliance rates and surgical site infection rates (incidence rate ratio = 0.9977, 95% CI = 0.9957-0.9997, P = 0.029). A multimodal strategy in a Latin American setting showed an increase in HH compliance over 10 years of follow-up that should nonetheless be improved. An association between HH compliance and surgical site infection rates was noticed, but this did not occur with other healthcare-associated infections; this underscores the need for a comprehensive bundled approach in their prevention.

Hand hygiene behaviours monitored by an electronic system in the intensive care unit – a prospective observational study

It is difficult to improve compliance with hand hygiene (HH), and underlying behaviours are not clearly understood among healthcare workers. To study HH behaviours among healthcare workers. This was a prospective observational study. A Sanibit electronic HH system was installed in a 10-bed surgical intensive care unit (ICU) that detected HH opportunities automatically when healthcare workers entered or exited a patient room, andtracked the HH compliance of healthcare workers. The HH compliance rate and patient contact time were calculated and analysed at both ICU level and individual level over time. In total, 27,692 HH opportunities were recorded over this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered patient rooms (37.3% vs 26.1%; P<0.001). Full, partial and total HH compliance rates of 'quick in and quick out' (in room for <3s) events were significantly lower than those of 'long in and long out' (in room for >30s) events (23.45% vs 32.77%, 21.44% vs 35.03% and 44.88% vs 67.81%, respectively; P<0.001). There were also significant differences in HH compliance between individual healthcare workers (P<0.001). No significant differences in overall HH compliance rate and patient contact time were found between hours of the day or days of the week, except partial HH compliance rates. Patterns of HH behaviours among healthcare workers are complex and variable, which could facilitate targeted and personalized interventions to improve HH compliance. NCT03948672.

The impact of the hand hygiene role model project on improving healthcare workers’ compliance: A quasi-experimental observational study

BackgroundThe World Health Organization (WHO)’s multimodal strategy for improving hand hygiene (HH) compliance was endorsed in 2009 and was implemented by every hospital in Oman. There was variation in adherence to the practice even within the same facility and in sustaining improvement after the intervention. ObjectivesEvaluate the impact of national HH role model project on health care worker's immediate and long term compliance with HH practices. Material and methodsA pretest–posttest quasi-experimental observational study was conducted in four hospitals, including 16 (medical/surgical/psychiatry) departments. The study consisted of four phases: Baseline assessment, intervention, three-month post-intervention assessment, and follow-up assessment after 15 months for sustainability. The intervention (role model in hand hygiene) consisted of four components: Leadership involvement as a role model for HH, posting HH messages with photos of role model leaders, a weekly selection of staff as HH role models, and conducting HH education and training from the focal point of each ward/department. ResultsThere were 5796 observations recorded during the study for Moments 1 and 4 of HH. HCWs’ overall compliance rate significantly increased from a baseline of 52.6% before the intervention to 74.1% after three months from the intervention, and 70.0% on follow-up after more than one year (p < 0.001). All the hospitals included, regardless of their baseline compliance, had a significant improvement in HH compliance post-intervention and were able to sustain compliance (> 60%) after 15 months from the start of the intervention. The likelihood of improvement in HH compliance with the intervention remained low for the moment before patient contact (AOR, 0.34; 95% CI = 0.27–0.44) during the weekend (AOR, 0.44; 95% CI = 0.32–0.59) in the psychiatry wards (AOR, 0.22; 95% CI = 0.15–0.34) and by the non-medical and nursing professions (AOR, 0.99; 95% CI = 0.61–1.66). ConclusionsImplementation of a role model as a behavioral intervention, in addition to the WHO’s multimodal strategy, successfully improved and sustained HCWs’ HH compliance rates. Understanding healthcare culture in the context of the driving factors of behavioral changes and regular follow-ups are essential to sustain adherence to safe HH practices.

Nosocomial Infections in Non-COVID-19 Pediatric Patients Prior to and During the Pandemic in a Pediatric Intensive Care Unit.

Background: Nosocomial infections are a global threat to human health worldwide.Aim: This study aimed to investigate the change of nosocomial infection factors in equivalent historical periods in pediatric patients without COVID-19 before and during the pandemic in the pediatric intensive care unit.Method: The study was planned retrospectively. Data on hospital infection rates, incidence densities, invasive device-associated infections, infectious agents, comorbid diseases, and invasive procedures in non-COVID-19 pediatric patients were obtained from the medical records for the periods of April-September 2019 and April-September 2020 in the pediatric intensive care unit. Hand hygiene compliance rates of healthcare workers were evaluated.Results: Prior to the pandemic, the number of patients was 332, comprising 2,377 patient days with a nosocomial infection rate of 5.12, and an incidence density of 7.15. During the pandemic, the number of patients was 221, comprising 2,260 patient days with a nosocomial infection rate of 4.52, and incidence density of 4.43. Prior to the pandemic, there were 28.80% cases of Klebsiella pneumoniae, 23.81% of Pseudomonas aeruginosa, 9.52% of Enterococcus faecium, and 4.76% of Enterococcus faecalis. During the pandemic, there were decreased 14.29% cases of Klebsiella pneumoniae while Pseudomonas aeruginosa, Enterococcus faecium, and Enterococcus faecalis was not seen. Prior to the pandemic, the hand hygiene compliance rate was 94.83%, and during the pandemic, it was found to be 99.44%.Conclusion: This study showed that the spread of bacteria such as Klebsiella pneumoniae, Pseudomonas aeruginosa, vancomycin-resistant enterococci, and Stenotrophomonas maltophilia, which are a major public health threat, can be decreased by applying simple standard methods.

Analysis of the Effect of Systematic Pre-Job Training for Nurses in Isolation Wards during the COVID-19 Pandemic

Objective: To explore the effect of systematic pre-job training for isolation ward nurses during the Corona Virus Disease 2019 (COVID-19) pandemic. Methods: Establish a pre-job training program for the isolation ward for COVID-19, standardize the content of theoretical and skill training, formulate training SOPs, and conduct training for the nurses using online teaching assessment, video teaching, on-site scenario simulation operation drills, as well as real-time protection guidance and supervision. 60 nurses from non-infectious departments temporarily selected by the hospital were trained; the theoretical knowledge scores, quarantine techniques, and nursing quality of nurses before and after the training were compared, and the effect of the intervention was evaluated. Results: The scores of the COVID-19 protection theory test were 81.17 ± 8.46 after the nurses were trained for 3 days. The pass rates of hand hygiene compliance tests and protective clothing putting-on and taking-off practices were 96.67% and 100%, respectively. There was no significant difference between the scores of the COVID-19 protection theory test for the nurses that were trained for 3 days and the scores for the nurses originally at the quarantine zone (81.59 ± 7.59, P > 0.05). The pass rate of hand hygiene compliance and the pass rate of protective clothing putting-on and taking-off practices were significantly improved compared with those before training (81.67% and 56.67% respectively, P 0.05). The comprehensive nursing ability scores of bedside nurses in the first month of training were 80.14 ± 5.63, which were lower than those of nurses originally in the isolation wards (86.88 ± 4.53, P Conclusion: Systematic pre-job training for nurses in isolation wards can help improve nurses’ knowledge of the COVID-19, self-protection awareness, and protection skills, and can quickly train nurses who are competent for work in isolation wards. It is an important guarantee of “zero infection” for medical staff, and it can quickly and effectively help medical institutions respond to the COVID-19 pandemic in an emergency.

Hand hygiene compliance by nurses and midwives during the COVID-19 pandemic: An observational study in Southern Iran

Background: Despite frequent recommendations from the World Health Organization (WHO), hand hygiene compliance (HHC) is an ongoing challenge among health care workers (HCWs). Objectives: This study aimed to evaluate the HHC in Iranian nurses and midwives during the COVID-19 pandemic. Methods: This observational study was conducted on 200 nurses and midwives working in two hospitals in Jiroft, Iran in 2021. Data were collected using a demographic information checklist and the WHO Hand Hygiene Observation Form. Data analysis was performed using the MannWhitney U, Chi-square, Kruskal-Wallis, and Spearman correlation coefficient tests. Results: The average percentage of HHC in the nurses and midwives was 51.3%. HHC before touching the patient and before doing a clean/aseptic procedure was at the lowest rate (33.5% and 49%, respectively) but was at the highest rate (81.8%) after a body fluid exposure risk. Conclusions: The HHC rates were low among nurses and midwives during the COVID-19 pandemic. It is essential to implement interventions to promote HHC in HCWs, especially in pandemic conditions.

Comparing human to electronic observers to monitor hand hygiene compliance in an intensive care unit.

We sought to determine whether an electronic hand hygiene (HH) system could monitor HH compliance at similar rates to direct human observation. This 4-year proof-of-concept study was conducted in an intensive care unit (ICU) of a private tertiary-care hospital in São Paulo, Brazil, where electronic HH systems were installed in 2 rooms. HH compliance was reported respectively using direct observation and electronic counter devices with an infrared system for detecting HH opportunities. In phase 1, HH compliance by human observers was 56.3% (564 of 1,001 opportunities), while HH compliance detected by the electronic observer was 51.0% (515 of 1,010 opportunities). In phase 2, human observers registered 484 HH opportunities with a HH compliance rate of 64.7% (313 of 484) versus 70.6% (346 of 490) simultaneously detected by the electronic system. In addition, an enhanced HH electronic system monitored activity 24 hours per day and HH compliance without the presence of a human observer was 40.3% (10,642 of 26,421 opportunities), providing evidence for the Hawthorne effect. The electronic HH monitoring system had good correlation with human HH observation, but compliance was remarkably lower when human observers were not present due to the Hawthorne effect (25%-30% absolute difference). Electronic monitoring systems can replace direct observation and can markedly reduce the Hawthorne effect.

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

BackgroundHand hygiene (HH) is a cost-effective measure to reduce health care-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among health care providers during the COVID-19 pandemic provided evidence for targeted HH intervention measures. AimTo systematically review the literature and conduct a meta-analysis of studies investigating the rate of HHC and the characteristics of HH during the COVID-19 pandemic. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were searched. All the original articles with valid HHC data among health care providers during the COVID-19 pandemic (from January 1, 2020 to October 1, 2021) were included. Meta-analysis was performed using a DerSimonian and Laird model to yield a point estimate and a 95% CI for the HHC rate. The heterogeneity of the studies was evaluated using the Cochrane Q test and I2 statistics and a random-effects model was used to contrast between different occupations, the WHO 5-moments of HH and different observation methods. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. FindingsSeven studies with 2,377 health care providers reporting HHC were identified. The estimated overall HHC was 74%, which was higher than that reported in previous studies (5%-89%). Fever clinic has become a new key place for HHC observation. Nurses had the highest HHC (80%; 95% CI:74%-87%) while auxiliary workers (70%; 95%CI:62%-77%) had the lowest. For the WHO 5-moments, the health care providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%-94%), while before contact with patient's health care providers had the lowest HHC (68%; 95% CI:62%-74%) which was consistent with before the pandemic. There existed great HHC differences among different monitoring methods (automatic monitoring system:53%; 95% CI:44%-63% versus openly and secretly observation: 91%; 95% CI: 90%-91%). ConclusionsDuring the COVID-19 pandemic, the compliance of health care providers’ HH showed a great improvement. The fever clinics have become the focused departments for HH monitoring. The HHC of auxiliary workers and the HH opportunity for “before contact with patients” should be strengthened. In the future, it will be necessary to develop standardized HH monitoring tools for practical work.