Effects of an Intervention on Hand Hygiene Compliance in a Radiography Unit

O’Donoghue, M. et al. Antimicrobial Resistance & Infection Control. Published online: 19 October 2016

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Background: Whilst numerous studies have investigated nurses’ compliance with hand hygiene and use of alcohol-based hand rub (ABHR), limited attention has been paid to these issues in allied health staff. Reports have linked infections to breaches in infection control in the radiography unit (RU). With advances in medical imaging, a higher proportion of patients come into contact with RU staff increasing the need for good hand hygiene compliance. This study aimed to evaluate effectiveness on compliance of an intervention to improve awareness of hand hygiene in the RU of a district hospital.

Methods: A quasi-experimental study design including questionnaires assessing knowledge and attitudes of hand hygiene and direct observation of participants was used to evaluate an educational programme on hand hygiene of the RU of a large district hospital. All healthcare workers (HCW), comprising 76 radiographers, 17 nurses, and nine healthcare assistants (HCA), agreed to participate in the study. Of these, 85 completed the initial and 76 the post-test anonymous questionnaire. The hand hygiene compliance of all 102 HCW was observed over a 3-week period prior to and after the intervention. The 2-month intervention consisted of talks on hand hygiene and benefits of ABHR, provision of visual aids, wall-mounted ABHR dispensers, and personal bottles of ABHR.

Results: Before the intervention, overall hand hygiene compliance was low (28.9 %). Post-intervention, compliance with hand hygiene increased to 51.4 %. This improvement was significant for radiographers and HCA. Additionally, knowledge and attitudes improved in particular, understanding that ABHR can largely replace handwashing and there is a need to perform hand hygiene after environmental contact. The increased use of ABHR allowed HCW to feel they had enough time to perform hand hygiene.

Conclusions: The educational intervention led to increased awareness of hand hygiene opportunities and better acceptance of ABHR use. The reduced time needed to perform hand rubbing and improved access to dispensers resulted in fewer missed opportunities. Although radiographers and other allied HCW make frequent contact with patients, these may be mistakenly construed as irrelevant with respect to healthcare associated infections. Stronger emphasis on hand hygiene compliance of these staff may help reduce infection risk.

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Automated hand hygiene auditing with and without an intervention

Kwock, Y.L.A. et al. American Journal of Infection Control. Published online: 21 October 201

Highlights

  • The subtraction of 1 percentage from another results in a percentage point (PP) difference that provides the size of the difference; overt human auditing inflates compliance by 20 PPs to 37 PPs compared with covert automated auditing.
  • Overt human auditing did not sustain inflated compliance estimates once auditing ceased.
  • Neither overt human nor automated auditing changes hand hygiene compliance per se, but automated auditing improves the validity of compliance estimates.
  • Daily feedback from automated auditing with peer nudging assisted a cooperative ward to improve, but practice was not sustained once the intervention ceased.

Abstract

Background: Daily feedback from continuous automated auditing with a peer reminder intervention was used to improve compliance. Compliance rates from covert and overt automated auditing phases with and without intervention were compared with human mandatory audits.

Methods: An automated system was installed to covertly detect hand hygiene events with each depression of the alcohol-based handrub dispenser for 5 months. The overt phase included key clinicians trained to share daily rates with clinicians, set compliance goals, and nudge each other to comply for 6 months. During a further 6 months, the intervention continued without being refreshed. Hand Hygiene Australia (HHA) human audits were performed quarterly during the intervention in accordance with the World Health Organization guidelines. Percentage point (PP) differences between compliance rates were used to determine change.

Results: HHA rates for June 2014 were 85% and 87% on the medical and surgical wards, respectively. These rates were 55 PPs and 38 PPs higher than covert automation rates for June 2014 on the medical and surgical ward at 30% and 49%, respectively. During the intervention phase, average compliance did not change on the medical ward from their covert rate, whereas the surgical ward improved compared with the covert phase by 11 PPs to 60%. On average, compliance during the intervention without being refreshed did not change on the medical ward, whereas the average rate on the surgical ward declined by 9 PPs.

Conclusions: Automation provided a unique opportunity to respond to daily rates, but compliance will return to preintervention levels once active intervention ceases or human auditors leave the ward, unless clinicians are committed to change.

A mixed methods study to understand patient expectations for antibiotics for an upper respiratory tract infection

Gaarslev, C. et al. Antimicrobial Resistance & Infection Control. Published online: 20 October 2016

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Background: Antimicrobial resistance is a public health challenge supplemented by inappropriate prescribing, especially for an upper respiratory tract infection in primary care. Patient/carer expectations have been identified as one of the main drivers for inappropriate antibiotics prescribing by primary care physicians. The aim of this study was to understand who is more likely to expect an antibiotic for an upper respiratory tract infection from their doctor and the reasons underlying it.

Methods: This study used a sequential mixed methods approach: a nationally representative cross sectional survey (n = 1509) and four focus groups. The outcome of interest was expectation and demand for an antibiotic from a doctor when presenting with a cold or flu.

Results: The study found 19.5 % of survey respondents reported that they would expect the doctor to prescribe antibiotics for a cold or flu. People younger than 65 years of age, those who never attended university and those speaking a language other than English at home were more likely to expect or demand antibiotics for a cold or flu. People who knew that ‘antibiotics don’t kill viruses’ and agreed that ‘taking an antibiotic when one is not needed means they won’t work in the future’ were less likely to expect or demand antibiotics. The main reasons for expecting antibiotics were believing that antibiotics are an effective treatment for a cold or flu and that they shortened the duration and potential deterioration of their illness. The secondary reason centered around the value or return on investment for visiting a doctor when feeling unwell.

Conclusion: Our study found that patients do not appear to feel they have a sufficiently strong incentive to consider the impact of their immediate use of antibiotics on antimicrobial resistance. The issue of antibiotic resistance needs to be explained and reframed as a more immediate health issue with dire consequences to ensure the success of future health campaigns.

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Promoting health workers’ ownership of infection prevention and control: using Normalisation Process Theory as an interpretive framework

Gould, D.J. et al. Journal of Hospital Infection. Published online: October 13 2016

boy-1299626_960_720Background: All health workers should take responsibility for infection prevention and control (IPC). Recent reduction in key reported healthcare-associated infections in the United Kingdom is impressive but determinants of success are unknown. It is imperative to understand how IPC strategies operate as new challenges arise and threats of antimicrobial resistance increase.

Methods: We undertook a retrospective, independent evaluation of an action plan to enhance IPC and ‘ownership’ (individual accountability) for IPC introduced throughout a healthcare organisation. Twenty purposively selected informants were interviewed. Data were analysed inductively. Normalisation Process Theory (NPT) was applied to interpret the findings and explain how the action plan was operating.

Findings: Six themes emerged through inductive analysis. Theme 1: ‘Ability to make sense of ownership’ provided evidence of the first element of NPT (Coherence). Regardless of occupational group or seniority, informants understood the importance of IPC ownership and described what it entailed. They identified three prerequisites: ‘Always being vigilant’ (Theme 2), ‘The importance of access to information’ (Theme 3) and ‘Being able to learn together in a no blame culture’ (Theme 4) Data relating to each theme provided evidence of the other elements of NPT that are required to embed change: planning implementation (cognitive participation), undertaking the work necessary to achieve change (collective action) and reflection on what else is needed to promote change as part of continuous quality improvement (reflexive monitoring). Informants identified barriers (e.g. workload) and facilitators (clear lines of communication and expectations for IPC).

Conclusion: Eighteen months after implementing the action plan incorporating IPC ownership there was evidence of continuous service improvement and significant reduction in infection rates. Applying a theory that identifies factors that promote/inhibit routine incorporation (‘normalisation’) of IPC into everyday healthcare can help explain success of IPC initiatives and inform implementation.

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Treatment of Clostridium difficile infection: a national survey of clinician recommendations and the use of faecal microbiota transplantation

Prior, A-R. et al. Journal of Hospital InfectionPublished online: October 14 2016

Adherence to Clostridium difficile infection treatment guidelines is associated with lower recurrence rates and mortality as well as cost savings. Our survey of Irish clinicians indicates that patients are managed using a variety of approaches. FMT is potentially underutilised despite its recommendation in national and European guidelines.

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Does Using Same Hospital Bed as Prior Patient Who Received Antibiotics Increase C. diff Risk?

Infection Control Today | Published online: 10 October 2016

11563-2Antibiotics are a risk factor for Clostridium difficile infection, the most common cause of diarrhea in the hospital that is responsible for about 27,000 deaths annually in the United States. Exposure to C. difficile is common in hospitals because spores can persist in the environment for months. Antibiotics are one of many factors that increase a host’s susceptibility to C. difficile. In a new study published online by JAMA Internal Medicine, Daniel Freedberg, MD, MS, of the Columbia University Medical Center, New York, and coauthors examined whether the receipt of antibiotics by prior occupants of a hospital bed was associated with increased risk for C. difficile infection in subsequent patients who used the same bed.

The study at four affiliated hospitals in the New York City metropolitan area used patients admitted from 2010 to 2015 if they had spent 48 hours in their first hospital bed after being admitted. The study required the prior patient to have spent at least 24 hours in the bed and to have left the bed less than one week before the next patient’s admission.

Because the study focused on incident cases of C. difficile infection, subsequent patients with a known history of CDI were excluded and they also were excluded if they tested positive for C. difficile infection within the first 48 hours after admission. The receipt of antibiotics by prior patients was assessed using data from a computerized clinician order entry system.

The study reports that among 100,615 pairs of patients who sequentially occupied a given hospital, there were 576 pairs where the subsequent patients developed C. difficile infection within two to 14 days after arriving at their bed. The median time from bed admission to C. difficile infection in the subsequent patients was 6.4 days. Subsequent patients who developed incident were more likely to have traditional C. difficile infection risk factors, including old age, increased creatinine, decreased albumin and the receipt of antibiotics.

The cumulative risk of C. difficile infection in subsequent patients was 0.72 percent when the prior occupant of the hospital bed received antibiotics compared with 0.43 percent when the prior occupant of the bed did not receive antibiotics, according to the results.

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