Impact of observation and analysis methodology when reporting hand hygiene data

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
The Journal of hospital infection (Impact Factor: 2.54). 02/2011; 77(4):358-9. DOI: 10.1016/j.jhin.2010.12.008
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    • "Hand touch sites with the highest risk to patients are those which are next to the patient, for example, bedrails , lockers, over bed tables and door handles [22]. This instinctive tendency toward privileging of oneself rather than toward patient protection has been identified repeatedly [23] [24] [25]. It is mandatory to tailor programs in the future to show HCWs their actual behavior and responsibilities and to call for accountability with regard to patient safety. "
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    ABSTRACT: The aim of this study is to measure the degree of compliance with hand hygiene practices among health-care workers (HCWs) in intensive care facilities in Aseer Central Hospital, Abha, Saudi Arabia, before and after a multimodal intervention program based on WHO strategies. Data were collected by direct observation of HCWs while delivering routine care using standardized WHO method: “Five moments for hand hygiene approach”. Observations were conducted before (February–April 2011) and after (February–April 2013) the intervention by well-trained, infection-control practitioners during their routine visits. The study included 1182 opportunities (observations) collected before and 2212 opportunities collected after the intervention. The overall, hand hygiene compliance increased significantly from 60.8% (95% CI: 57.9–63.6%) before the intervention to reach 86.4% (95% CI: 84.9–97.8%) post-intervention (P = 0.001). The same trend was observed in different intensive care facilities. In logistic regression analyses, HCWs were significantly more compliant (aOR = 3.2, 95% CI: 2.6–3.8) after the intervention. Similarly, being a nurse and events after patient contact were significant determinants of compliance. It is important to provide sustained intensified training programs to help embed efficient and effective hand hygiene into all elements of care delivery. New approaches like accountability, motivation and sanctions are needed.
    Journal of Epidemiology and Global Health 06/2014; 4(4). DOI:10.1016/j.jegh.2014.05.002
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    ABSTRACT: Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of multidisciplinary hand hygiene improvement programs. Observational surveys conducted by trained personnel are currently considered the "gold standard" method for establishing compliance rates, but they are time-consuming and have a number of shortcomings. Monitoring hand hygiene product consumption is less time-consuming and can provide useful information regarding the frequency of hand hygiene that can be used to give caregivers feedback. Electronic counting devices placed in hand hygiene product dispensers provide detailed information about hand hygiene frequency over time, by unit and during interventions. Electronic hand hygiene monitoring systems that utilize wireless systems to monitor room entry and exit of healthcare workers and their use of hand hygiene product dispensers can provide individual and unit-based data on compliance with the most common hand hygiene indications. Some systems include badges (tags) that can provide healthcare workers with real-time reminders to clean their hands upon entering and exiting patient rooms. Preliminary studies suggest that use of electronic monitoring systems is associated with increased hand hygiene compliance rates and that such systems may be acceptable to care givers. Although there are many questions remaining about the practicality, accuracy, cost, and long-term impact of electronic monitoring systems on compliance rates, they appear to have considerable promise for improving our efforts to monitor and improve hand hygiene practices among healthcare workers.
    Infection Control and Hospital Epidemiology 10/2011; 32(10):1016-28. DOI:10.1086/662015 · 4.18 Impact Factor
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    ABSTRACT: Objective: To determine the degree of compliance with hand hygiene measures, predictors, and change over time in an emergency department. Methods: Cross-sectional study between 2005 and 2010 in the emergency department of Hospital General Universitario de Alicante, Spain. An observer assessed staff compliance with the World Health Organization's 5-moments approach to hand hygiene. We also studied the association between compliance and such potential predictors as age, sex, availability of pocket-sized alcohol hand rubs, and attendance at training sessions; the χ2 test was used to compare compliance between the 2005-2007 and 2008-2010 periods. A multivariate logistic regression model was then constructed. Results: Compliance was observed in 41.1% in the 2005-2007 period and 42.3% in the 2008-2010 period. Hygiene at the moment before touching a patient improved significantly (16.3% in 2005-2007 and 29.8% in 2008-2010). The moment of best compliance was after touching patient surroundings (67.1% in 2008-2010). Factors associated with hand hygiene compliance changed over time with the exception of a stable association in both periods between hygiene at the moment before touching a patient and the availability of pocket-sized alcohol hand rubs. Conclusions: Emergency departments should seek improvements in hygiene by providing training on the importance of hand hygiene before a patient is touched, particularly before clean/aseptic procedures, and by promoting the use of pocket-sized alcohol rubs.
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