Barriers, perceptions, and adherence: Hand hygiene in the operating room and endoscopy suite

Pederson, L. et al. American Journal of Infection Control. Published online: 8 February 2017

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Highlights: 

  • Barriers and perceptions of nonsurgical scrubbed hand hygiene were examined.
  • Hand hygiene role modeling by health care workers is poor.
  • Self-awareness of hand hygiene practices is inadequate.

Read the full abstract here

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Hand Hygiene in Intensive Care Units: A Matter of Time?

Stahmeyer, J.T. The Journal of Hospital Infection. Published online: January 28, 2017

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Background: Healthcare-associated infections are a frequent threat to patient safety and cause significant disease burden. The most important single preventive measure is hand hygiene (HH). Barriers to adherence with HH recommendations include structural aspects, knowledge gaps, and organizational issues, especially a lack of time in daily routine.

Conclusion: Complying with guidelines is time consuming. Sufficient time for HH should be considered in staff planning.

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Smartphone text message service to foster hand hygiene compliance in health care workers

Kerbaj, J. et al. American Journal of Infection Control. Published online 9 December 2016

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Background: Health care-associated infections are a major worldwide public health issue. Hand hygiene is a major component in the prevention of pathogen transmission in hospitals, and hand hygiene adherence by health care workers is low in many studies. We report an intervention using text messages as reminders and feedback to improve hand hygiene adherence.

Conclusions: Text message feedback should be incorporated into multimodal approaches for improving hand hygiene compliance.

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Reducing infections in the NHS

Plans to prevent hospital infections include more money for hospitals who reduce infection rates and publishing E. coli rates by local area.

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New plans to reduce infections in the NHS have been announced by the government at an infection control summit. Health Secretary Jeremy Hunt announced the plan to halve the number of gram-negative bloodstream infections by 2020.

Infection rates can be cut with better hygiene and improved patient care in hospitals, surgeries and care homes, such as ensuring staff, patients and visitors regularly wash their hands. People using insertion devices such as catheters, which are often used following surgery, can develop infections like E. coli if they are not inserted properly, left in too long or if patients are not properly hydrated and going to the toilet regularly.

These new plans build on the progress made in infection control since 2010 – the number of MRSA cases has been reduced by 57% and C. difficile by 45%.

Read more via Department of Health

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.

Impact of observing hand hygiene in practice and research: a methodological reconsideration

Gould, D.J. et al. Journal of Hospital Infection. Published online: August 18, 2016

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Healthcare-associated infection is often spread by direct contact, and the importance of hand hygiene to break the chain of infection is recognised internationally. In many countries hand hygiene is regularly audited as part of quality assurance based on recommendations issued by the World Health Organization (WHO).

Direct observation is the recommended audit method but is associated with a number of disadvantages, including potential for being observed to alter usual behaviour. The Hawthorne effect in relation to hand hygiene is equated with productivity by increasing the frequency that hand hygiene is undertaken. Unobtrusive and/or frequent observation to accustom staff to the presence of observers is considered an acceptable way of reducing the Hawthorne effect but little has been written about how to implement these techniques or assess their effectiveness. There is evidence that awareness of being watched can disrupt the usual behaviour of individuals in complex and unpredictable ways other than simple productivity effect. In the presence of auditors health workers might defer or avoid activities that require hand hygiene, but these issues are not addressed in guidelines for practice or research studies. This is an important oversight with implications for the validity of hand hygiene audit findings. It needs to be considered if such findings are taken as indicators of quality of care and if the results of hand hygiene research are used to inform future policy and practice.

Measuring hand hygiene product use overcomes avoidance tactics. It is cheaper and generates data continuously to give a 24 hour picture of compliance for all clinicians without disrupting patient care. Disadvantages are the risk of over-estimating uptake through spillage, wastage or use by visitors and non-clinical staff entering patient care areas. Electronic devices can overcome Hawthorne and avoidance effects but are costly and are not widely used outside research studies.

Read the abstract here