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Abstract

Hand hygiene is the most important intervention to prevent infection in hospitals. Health care workers should clean their hands at least before and after contact with patients. Hand sanitizer dispensers are important to support hand hygiene because they can be made available throughout hospital units. The aim of this study was to determine whether the usability of sanitizer dispensers correlates with compliance of staff in using the sanitizer in a hospital. This study took place in a Midwest, 404-bed, private, nonprofit community hospital with 15 inpatient care units in addition to several ambulatory units. The usability and standardization of sanitizers in 12 participating inpatient units were evaluated. The hospital measured compliance of staff with hand hygiene as part of their quality improvement program. Data from 2010-2012 were analyzed to measure the relationship between compliance and usability using mixed-effects logistic regression models. The total usability score (P = .0046), visibility (P = .003), and accessibility of the sanitizer on entrance to the patient room (P = .00055) were statistically associated with higher observed compliance rates. Standardization alone showed no significant impact on observed compliance (P = .37). Hand hygiene compliance can be influenced by visibility and accessibility of dispensers. The sanitizer location should be part of multifaceted interventions to improve hand hygiene. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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... They include essential structural framework conditions through which competence resources of clinical personnel can be realized. They include personnel structures (sufficient number and competence of personnel, [24]), material and spatial conditions (sufficient number of disinfectant dispensers, reasonably placed sinks, hospital clothing, [14], [24], [40], [41]), and guidelines on the topics of clothing, jewelry, and fingernails (artificial nails, nail grooming, [14], [40], [41]). First and foremost, the provision of these enablers lies in the responsibility of the institution. ...
... They include essential structural framework conditions through which competence resources of clinical personnel can be realized. They include personnel structures (sufficient number and competence of personnel, [24]), material and spatial conditions (sufficient number of disinfectant dispensers, reasonably placed sinks, hospital clothing, [14], [24], [40], [41]), and guidelines on the topics of clothing, jewelry, and fingernails (artificial nails, nail grooming, [14], [40], [41]). First and foremost, the provision of these enablers lies in the responsibility of the institution. ...
... Such barriers include for example a very high workload, too few personnel, or high time pressure [24], [30], [33]. Also material and spatial structures, such as for example a lack of disinfection fixtures or impractically placed sinks, can be obstructing influence factors [24], [40]. Activities that carry a high risk of cross-transmission (germ spreading), as well as specific technical-medical procedures (in the OR, anesthesia theater, emergency room, or the ICU) seem to be risk factors for non-adherence of hygiene measures (31). ...
Article
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Adhering to hygiene standards in daily clinical work is an important characteristic of qualitatively high-value medical care. In this regards, hand hygiene is often focused on in the literature. From the viewpoint of medical education research, we argue that this focus is too narrow to explain how staff who are working clinically with patients implement and adhere to standards of hygiene across a wide variety of tasks of their daily clinical routine. We present basic features of a differentiated concept of hygiene competence, which includes specialized knowledge, corresponding inner attitudes, and action routines that are customized to the needs of specific situations. Building on that, we present a current simulation-based course concept aimed at developing hygiene competence in medical education. Furthermore, we describe a test instrument that is designed according to the principle of a situational judgment test and that appears promising for the assessment of hygiene competence. The course and the measurement instrument are discussed in regards to their fit to the competence model and the related perspectives for research and teaching.
... The data collection strategy was modeled on a method that was previously used by Cure and Van Enk [8]. The hand hygiene and low-level disinfection observations took place at 12 units during the morning shift and 8 units during the evening shift. ...
... The usability of hand sanitizer dispensers was measured based on the criteria described elsewhere [8] and comprised the following: (1) easily visible on entry, (2) easy, unobstructed access, (3) close to the point of care, (4) visible from point of care, (5) along the workflow path, (6) close to the entrance or exit, and (7) placed at optimal height (85 to 110 centimeters). A final criterion, (8) visible on exit, was also added. ...
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Background: Hand hygiene and low-level disinfection of equipment behaviors among hospital staff are some of the leading cost-effective methods to reduce hospital-acquired infections (HAI) among patients. Objective: The aim of this study is to examine hand hygiene and low-level disinfection of equipment practices in a central Texas hospital and to explore pertaining gaps, perceptions, and challenges. Methods: Data were collected using a multipronged mixed methods approach that included the following: (1) observation of hand hygiene and low-level disinfection practices (12 and 8 units during morning and evening shifts, respectively); (2) observation of usability/placement of hand sanitizer dispensers; (3) semistructured interviews; and (4) a follow-up email survey. Results: In total, 222 (156 morning shift and 66 evening shift) staff members were observed. Of 526 hand hygiene and 33 low-level disinfection opportunities, compliance was observed 410 (78%) and 17 (51%) times, respectively. Overall, 6 units (50%) had ≥0.80 (favorable) hand hygiene compliance during the morning shift and 2 units (25%) had ≥0.80 hand hygiene compliance during the evening shift. Aggregated low-level disinfection compliance was 0.54 during the morning and 0.33 during the evening. Overall, the odds of noncompliant hand hygiene behavior were 1.4 times higher among staff who worked during night shifts compared to day shifts; however, this relationship was not statistically significant (95% CI 0.86-2.18; P=.18). Noncompliant behavior was most likely among unit B staff during the evening; however, this relationship was not statistically significant (OR 5.3, 95% CI 0.84-32.9; P=.07) All units, except one, had similar hand sanitizer dispenser usability characteristics. In the qualitative part of the study, the following challenges were identified: “shortage of time while seeing patients,” “sometimes the staff forgets,” “concern about drying hands,” “behavior is difficult or requires reminders,” and “there may be issues with resources or access to supplies to perform these behaviors.” Staff also stated that “a process that is considered effective is the Stop the Line program,” and that the “behavior is easy and automatic.” Conclusions: Hand hygiene and low-level disinfection compliance is dependent on several personal and nonpersonal factors. Issues such as time constraints, peer pressure, work culture, available resources, and understanding of guidelines could influence staff behavior. The information collected through this study can be used to re-examine similar or related issues at a larger scale.
... Thus, HFE-based workplace modification that increases hand hygiene saliency-such as purposeful placement of hand sanitizer dispensers in convenient, noticeable locations-may increase adherence. Cure and Van Enk (2015) examined the effect of hand sanitizer dispenser usability on hand hygiene adherence. Usability included visibility and proximity to room entrance and point of care, easy and unobstructed access, location along the physical workflow path, and dispenser installation height. ...
... We would like to express our gratitude to the three reviewers whose feedback and comments helped to improve this manuscript. Identification of relationship between spatial layout and HH adherence (7) Optimization of dispenser visibility and location Cure & Van Enk (2015) Importance of mental models for task performance (2) Analysis and design of tasks to address user mental models ...
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Objective:: This article provides a review of areas that present significant challenges in infection prevention and control and describes human factors engineering (HFE) approaches that have been applied successfully to these areas. In addition, implications and recommendations for HFE use in future research are discussed. Background:: Infection prevention and control aims to prevent patients and health care personnel from acquiring preventable infections in healthcare. Effective infection control practices of healthcare-associated infections have recently become even more critical with the emergence of life-threatening infections. HFE could benefit infection prevention and control in addressing older and more recent challenges, but uptake has been limited. Method/results:: This literature review is an integration and synthesis of recently published research that describes HFE-based approaches in infection prevention and control to address the challenges for three specific topics. The results of the review suggests that HFE is in a position to support work in infection prevention and control and improve overall healthcare safety. Conclusion:: HFE provides conceptual frameworks and methods that have significant potential to improve infection prevention and control. Application:: The work reviewed can provide potential solutions for current infection prevention and control challenges by applying HFE based recommendations.
... Most studies on infection control and hand hygiene compliance in hospitals have, sensibly, concentrated on medical professionals because of the critical need for them to avoid spreading infections. 4,5 However-at least before hospitals began curtailing visitation in response to the COVID-19 pandemic-thousands of people entered hospitals to visit their ailing friends and relatives each day. Along with flowers, chocolates, and other gifts, they brought the potential for transmitting pathogenic microorganisms. ...
... Indeed, a 2015 analysis of a large hospital in the United States showed that inconveniently located sinks and hand sanitizer dispensers contribute to low hand hygiene compliance in many hospitals and other health care institutions. 4 Often these items are placed behind doors or otherwise out of immediate sight. ...
Article
Full-text available
Hand hygiene has taken on new importance as a key behavior for limiting the spread of COVID-19. In the study reported here, we tested ways to increase hand sanitizer use by hospital visitors. We placed dispensers at entrances to hospital units and compared the effect of simply having the dispenser readily accessible (the control condition) with the effects of two nudges: combining the dispenser with an eye-catching sign emphasizing that hand sanitizer use is the norm (“Here we use HAND DISINFECTANT”) or with the same sign except for the addition of an altruistic motive for the norm-emphasizing message (“Here we use HAND DISINFECTANT . . . to protect your relatives”). Both signs greatly improved compliance, although including the altruistic element did not significantly add to the impact of stating the norm. The results indicate that to improve hand hygiene, hospitals should go beyond locating hand sanitizer dispensers conveniently: they should make the dispensers more visible and stress that using hand sanitizer is the norm.
... These differ from the CDC precautions and from what is currently considered standard practice in hospitals in the United States. These evidence-based interventions (Boswell & Fox, 2006;Cure & Van Enk, 2015;Ijaz et al., 2016;Loutfy et al., 2004;Marthi et al., 1990;Mead & Johnson, 2004;Rutala et al., 1995) exceed Facility Guidelines Institute requirements for Healthcare Facilities and the American Society of Heating, Refrigerating, and Air Conditioning Engineers. They supplement (rather than replace) the CDC standards and contact precautions. ...
... Fraser et al. (1993) reported that among 3,574 hospital rooms in the United States, only 121 of those (from seven hospitals) had NP airflow. Cure and Van Enk (2015) demonstrated the most utilized sanitizer dispensers were located in the hallways that provided convenient access and were easily visible. Ijaz et al. (2016), Marthi et al. (1990), andWalter et al. (1990) demonstrated that intermediate RH (40%-60%) and associated droplet size decreases the viability of aerosolized bacteria. ...
Article
Objectives: Our goal was to optimize infection control of paired environmental control interventions within hospitals to reduce methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococci (VRE). Background: The most widely used infection control interventions are deployment of handwashing (HW) stations, control of relative humidity (RH), and negative pressure (NP) treatment rooms. Direct costs of multidrug-resistant organism (MDRO) infections are typically not included in the design of such interventions. Methods: We examined the effectiveness of pairing HW with RH and HW with NP. We used the following three data sets: A meta-analysis of progression rates from uncolonized to colonized to infected, 6 years of MDRO treatment costs from 400 hospitals, and 8 years of MDRO incidence rates at nine army hospitals. We used these data as inputs into an Infection De-Escalation Model with varying budgets to obtain optimal intervention designs. We then computed the infection and prevention rates and cost savings resulting from these designs. Results: The average direct cost of an MDRO infection was $3,289, $1,535, and $1,067 for MRSA, CRE, and VRE. The mean annual incidence rates per facility were 0.39%, 0.034%, and 0.011% for MRSA, CRE, and VRE. After applying the cost-minimizing intervention pair to each scenario, the percentage reductions in infections (and annual direct cost savings) in large, community, and small acute care hospitals were 69% ($1.5 million), 73% ($631K), 60% ($118K) for MRSA, 52% ($460.5K), 58% ($203K), 50% ($37K) for CRE, and 0%, 0%, and 50% ($12.8K) for VRE. Conclusion: The application of this Infection De-Escalation Model can guide cost-effective decision making in hospital built environment design to improve control of MDRO infections.
... Several studies highlighted that HH compliance may improve if the ABHR-Ds are visible and easily accessible, whereas standardized locations have no significant impact [3][4][5]. Hence, the ABHR consumption depends on the hospital type (higher in university hospitals) but Open Access *Correspondence: andreas.widmer@usb.ch 1 Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031 Basel, Switzerland Full list of author information is available at the end of the article also on the availability of ABHR-Ds on the wards [6,7] Consistent with this finding, adding dispensers on a medical ward lead to an increase in HH events; two dispensers per bed were considered to be optimal [8]. Various factors can influence HH compliance including ABHR-D location, teaching and promotion of hygiene measures and time-saving applications (ABHR vs. hand washing with soap) [9][10][11][12][13][14]. Regardless of whether ABHR is provided by pocket-sized dispensers or permanently mounted dispensers, accessibility plays the key role in HH compliance [15) However, the optimal location may also depend on the workflow in a patient's room and the preferences of the healthcare workers [16]. ...
... In contrast to several other studies that highlight the importance of the positioning of ABHR-Ds at the pointof-care to improve HH compliance [4,5,13,15,17,23], our study revealed that ABHR-Ds are frequently located at the entrance of the patients' room and near the sink. Hence, these locations reflect the workflow in a patient room, which plays an important role in HH compliance [15]. ...
Article
Full-text available
Background Accessibility to alcohol-based handrub (ABHR) dispenser is crucial to improve compliance to hand hygiene (HH), being offered as wall-mounted dispensers (ABHR-Ds), and/or pocket bottles. Nevertheless, information on the distribution and density of ABHR-Ds and their impact on HH have hardly been studied. Institutions such as the World Health Organisation or the Centers for Disease Control and Prevention do not provide guidance. The Robert-Koch-Institute (RKI) from Germany recommends an overall density of > 0.5 dispensers per patient bed. We aimed to investigate current conditions in hospitals to develop a standard on the minimal number of ABHR-D. Methods Between 07 and 09/2019, we applied a questionnaire to 178 hospitals participating in the Swissnoso National Surveillance Network to evaluate number and location of ABHR-Ds per bed in acute care hospitals, and compared the data with consumption and compliance with HH. Results 110 of the 178 (62%) hospitals provided data representing approximately 20,000 hospital beds. 83% hospitals provided information on both the total number of ABHR-Ds and patient beds, with a mean of 2.4 ABHR-Ds per bed (range, 0.4–22.1). While most hospitals (84%) had dispensers located at the room entrance, 47% reported also locations near or at the bed. Additionally, pocket-sized dispensers (100 mL) are available in 97% of hospitals. Conclusions Swiss hospitals provide 2.4 dispensers per bed, much more than governmental recommendation. The first study on the number of ABHR-Ds in hospitals may help to define a minimal standard for national and international recommendations
... 17 Hand hygiene utilization can be influenced by visibility and accessibility of ABHR dispensers. 18 Even in the time of COVID-19 epidemic, training on ABHR was not adequately provided for pharmacy professionals. Among the study participants, only 65 pharmacy professionals (21.4%) took training on ABHR production and utilization. ...
Article
Full-text available
Purpose: Rubbing the hands with alcohol-based handrub (ABHR) is globally recommended as the preferred approach to prevent healthcare-associated infections in most routine encounters with patients, except in cases handwashing with soap and water is advised. Inappropriate utilization of ABHR could have detrimental effects, most importantly during the coronavirus disease (COVID-19) pandemic, which include exposure of healthcare professionals to healthcare-associated infections and the development of resistant microorganisms. In a hospital setting, the utilization of ABHR among frontline healthcare workers including pharmacy professionals is low. Therefore, the purpose of this study was to explore the current practice of hand rubbing among pharmacy professionals in public hospitals of Addis Ababa during the pandemic of COVID-19. Methods: The study was a cross-sectional study using a self-reported questionnaire conducted among pharmacy professionals in public hospitals found in Addis Ababa from 10th May to 9th June, 2020 to recognize ABHR utilization rate. Data were collected on a sample of 384 pharmacy professional by a self-administered questionnaire. Data analysis was done using software for the statistical package for social science version 25.0. To identify the significant predictors of ABHR utilization practice bivariable and multivariable logistic regressions were carried out. Crude odds ratio and adjusted odds ratio with 95% confidence interval were calculated to determine the predictors. Results: Out of 384 participants, three hundred and four participants were included in the final analyses after the exclusion of incomplete responses. Female participants represented 41.4% of the study participants. More than half (58.9%) of the pharmacy professionals had sufficient knowledge on ABHR utilization for COVID-19 prevention. Similarly, 56.6% of pharmacy professionals had positive attitude towards ABHR for COVID-19 prevention. But only 35.9% of the study participants had good ABHR utilization practice. Conclusion: Despite the modest level of knowledge and attitude towards ABHR, pharmacy professionals' utilization practice of ABHR for COVID-19 prevention was found to be suboptimal. Provision of ABHR solutions through hospitals and increasing the awareness of pharmacy professionals on ABHR needs to be encouraged.
... In line with the literature, the frequency of pediatric chemical eye injury patients increased eightfold during the pandemic period compared to the pre-pandemic period in our data. In most public places, the hand sanitizers are placed at a waist-level height of an adult but at approximately eye level of a child, being approximately 85-110 cm [23]. Thus, especially children in younger ages (3-5 years-old, 85-120 cm height) are at a high risk of serious eye injuries due to the accidental ocular exposure during hand sanitizing [21,22]. ...
Article
Full-text available
Objectives To evaluate the etiological cause distribution in chemical eye injuries during COVID-19 pandemic. Methods In this retrospective case series, the medical records of patients, who presented with chemical eye injuries between March 30, 2020, and March 1, 2021, were evaluated and compared with the data covering 10 years before the pandemic. Results Twenty-seven eyes of twenty-three patients (19 adults, 4 children) who presented in pandemic period were included. Alcohol-based hand sanitizer was one of the two most common agents (n = 6 eyes) in the pandemic era. In the last 10 years before the pandemic, 137 eyes of 102 patients were treated for chemical eye injuries. Injuries due to alcohol-based hand sanitizer increased from 3.1 to 21.1% among all patients, and from 0 to 75% among pediatric patients during the pandemic era compared to the pre-pandemic period. The increase was statistically significant both in all patients (p = .003) and in the pediatric patient group (p = .048). Conclusion Due to COVID-19 pandemic, alcohol-based hand sanitizer use became more common. Consequently, the frequency of hand sanitizer related chemical injuries showed a 13-fold increase and the age group affected by such accidents is altered during the pandemic. Three out of four pediatric patients (75%) were injured with alcohol-based hand sanitizers, which draws attention to the fact that improperly placed hand sanitizer stations, being just at the eye level of children, can cause chemical eye injuries in the pediatric population even more.
... Birnbach et al increased compliance at their hospital entrance from 0.52% to 11.67% by locating freestanding hand sanitizer dispensers and adding signs in the lobby. 2 Cure et al looked specifically at the characteristics of various dispensers and found visibility and accessibility were significant factors affecting compliance. 3 We previously established that increasing the conspicuity of alcohol-gel dispensers with a flashing red light over a 1-week period doubled hand hygiene rates from 12.4% to 25.3%. 1 It was uncertain whether our intervention for increasing attention to alcohol-gel dispensers would have a durable effect on handwashing beyond 1 week. Individuals could become accustomed to the change in environment and return to baseline hand hygiene rates. ...
Article
Background: Multiple factors affect compliance with hand hygiene, including conspicuity of alcohol-gel dispensers. Previous studies have shown that flashing lights increase hand hygiene compliance; however, the durability of this effect has not been studied. Methods: We affixed flashing lights to hand sanitizer dispensers for a total of 6 weeks. Regression analysis was used to compare compliance rates between the beginning and end of the intervention. Our secondary objective was to determine whether compliance rates in cold weather could be improved by adding a sign separated in time and space from the dispensers. Results: Flashing lights improved hand hygiene compliance from 11.8% to 20.7%, and this effect was unchanged over the 6-week study period. Fully charged lights resulted in a greater compliance increase. A preemptive sign did not have a significant effect on hand hygiene rates nor did absolute temperatures. Conclusions: Flashing lights are a simple, inexpensive way of improving hand hygiene. Brighter lights appear to have a greater effect; however, this must be balanced with annoyance in specific settings. Temperature did not have a significant effect; however, this may be because the relationship does not fit a linear model. Other interventions, such as signs, may need to be tailored specifically to individual hospital environments.
... However, in the nursing home setting, change processes towards improved hand hygiene outcomes are often non-transparent [8,9,14,23]. While a large proportion of multidrug-resistant infections in nursing homes could be avoided through appropriate hand hygiene behaviour of nurses, this behaviour is influenced by organisational factors such as hygiene training, availability of resources and improved role modelling of nursing managers [24][25][26][27][28]. ...
Article
Full-text available
Background: Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Infections with multi-resistant bacteria's, associated with healthcare, is a known problem. The nursing home setting differs from other healthcare environments in individual and organisational factors such as knowledge, behaviour, and attitude to improve hand hygiene and it is therefore difficult to research the influential factors to improve hand hygiene. Studies have shown that increasing knowledge, behaviour and attitudes could enhance hand hygiene compliance in nursing homes. Therefore, it may be important to examine individual and organisational factors that foster improvement of these factors in hand hygiene. We aim to explore these influences of individual and organisational factors of hand hygiene in nursing home staff, with a particular focus on the function of role modelling by nursing managers. Methods: We conducted a mixed-methods study surveying 165 nurses and interviewing 27 nursing managers from nursing homes in Germany. Results: Most nurses and nursing managers held the knowledge of effective hand hygiene procedures. Hygiene standards and equipment were all generally available but compliance to standards also depended upon availability in the immediate work area and role modelling. Despite a general awareness of the impact of leadership on staff behaviour, not all nursing managers fully appreciated the impact of their own consistent role modelling regarding hand hygiene behaviours. Conclusion: These results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.
... Hand hygiene practices do vary by unit, patient room configuration, and type of care provided. 15 Future research could investigate these variables. ...
Article
Full-text available
Background: Hand hygiene at the point of care is recognized as a best practice for promoting compliance at the moments when hand hygiene is most critical. The objective of this study was to compare knowledge, attitudes, and practices of US and Canadian frontline health care personnel regarding hand hygiene at the point of care. Methods: Physicians and nurses in US and Canadian hospitals were invited to complete a 32-question online survey based on evidence supporting point of care hand hygiene. Eligible health care personnel were in direct clinical practice at least 50% of the time. Results: Three hundred fifty frontline caregivers completed the survey. Among respondents, 57.1% were from the United States and 42.9% were from Canada. Respondents were evenly distributed between physician and nurses. The US and Canadian respondents gave identical ranking to their perceived barriers to hand hygiene compliance. More than half of the respondents from both the United States and Canada agreed or strongly agreed that they would be more likely to clean their hands when recommended if alcohol-based handrub was closer to the patient. Conclusion: This survey demonstrates that similarities between Canada and the United States were more common than not, and the survey raises, or suggests, potential knowledge gaps that require further illumination.
... These studies found that over-crowding and lack of hand hygiene led to infection transmission [10,11]. A number of studies described how infection could be prevented through improving hand hygiene practices, the availability of resources and improved role modelling [12][13][14][15][16]. In addition, these studies also found that education and training could effectively increase hygiene practices in nursing homes [11,16,17]. ...
Article
Full-text available
Introduction Ethnic Malaysian Chinese used to observe the 1-month postpartum confinement period at home and many families would engage a traditional postpartum carer to help care for the mother and newborn. A recent trend has been the development of confinement centres (CCs) which are private non-healthcare establishments run by staff not trained in health care. Concerns about hygiene in CCs arose after infections were reported. We describe the practice of hand hygiene observed in CCs, the availability of resources for hygiene, and the prevalence of health-related problems in CCs. Methods This is a cohort study of ethnic Chinese mothers intending to breastfeed their healthy infants. They were recruited post-delivery along with a comparison group who planned to spend their confinement period at home. After their 1-month confinement period, they were contacted for a structured telephone interview about their experience. To avoid any alteration in behaviour, mothers were not told at recruitment that they had to observe hygiene practices. Multiple logistic regression was used to assess the effect of place of confinement on rates of infant health problems. Results Of 187 mothers, 88(47%) went to 27 different CCs while 99(53%) stayed at home. Response rates for the 1-month interviews were 88%(CC) versus 97%(home). Mothers in CC group stayed in one to four-bedded rooms and 92% of them had their baby sleeping separately in a common nursery described to have up to 17 babies at a time; 74% of them spent less than six hours a day with their babies; 43% noticed that CC staff had inadequate hand hygiene practices; 66% reported no hand basins in their rooms; 30% reported no soap at hand basins; 28% reported inexperienced or inadequate staff and 4% reported baby item sharing. Among the mothers staying at home, 35% employed a traditional postpartum carer for her baby; 32% did not room-in with their babies, but only 11% spent less than 6 hours a day with their babies. Of mothers who employed traditional postpartum carers, 32% did not know if their carer washed hands after changing diapers and 18% reported that their carer did not. Health problems that were probably related to infection (HPRI) like fever and cough were similar between the groups: 14%(CC) versus 14%(home) (p = 0.86). Multiple logistic regression did not show that CCs were a factor for HPRI: aOR 1.28 (95% CI 0.36 to 4.49). Three mothers reported events that could indicate transmission of infection in CCs. Conclusion We found unsatisfactory hygiene practices in CCs as reported by mothers who spent their confinement period there. Although we were not able to establish any direct evidence of infection transmission but based on reports given by the mothers in this study, it is likely to be happening. Therefore, future studies, including intervention studies, are urgently needed to establish an appropriate hygiene standard in CCs as well as the best method to implement this standard. Training CC staff with hygiene knowledge so that they can be empowered to contribute to the development of these standards would be important.
... Hand hygiene has been reported to differ by professional group, hand hygiene indication (before and after patient contact) and perceived severity of illness [2][3][4] . Potential reasons explaining inadequate hand hygiene include overcrowding, understaffing, shift type, unavailability of hand rub dispensers and the perception that hand hygiene is time-consuming [5][6][7] . ...
Article
Full-text available
Background Healthcare 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. Methods We 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. Results Comparison 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. Conclusion The 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.
... Based on these models, researches provide many interventions and recommendations to increase compliance towards health protective measures. For promoting hand hygiene, attractive messages that convey the feeling of disgust(Porzig-Drummond et al., 2009) and persistent cues to action (e.g., placing sanitisers at public places)(Cure & van Enk, 2015) should be used. Cues to action for social distancing are mostly posters and informative advertisements which not only inform people about the correct preventive behaviour, but also highlight the consequences of non-compliance on identifiable people and the potential transmission.Preventive responses are not just correlated with awareness or perceptions but also depend on demographic factors. ...
... 17 Hand hygiene utilization can be influenced by visibility and accessibility of ABHR dispensers. 18 Even in the time of COVID-19 epidemic, training on ABHR was not adequately provided for pharmacy professionals. Among the study participants, only 65 pharmacy professionals (21.4%) took training on ABHR production and utilization. ...
Article
Full-text available
Purpose: Rubbing the hands with alcohol-based handrub (ABHR) is globally recommended as the preferred approach to prevent healthcare-associated infections in most routine encounters with patients, except in cases handwashing with soap and water is advised. Inappropriate utilization of ABHR could have detrimental effects, most importantly during the coronavirus disease (COVID-19) pandemic, which include exposure of healthcare professionals to healthcare-associated infections and the development of resistant microorganisms. In a hospital setting, the utilization of ABHR among frontline healthcare workers including pharmacy professionals is low. Therefore, the purpose of this study was to explore the current practice of hand rubbing among pharmacy professionals in public hospitals of Addis Ababa during the pandemic of COVID-19. Methods: The study was a cross-sectional study using a self-reported questionnaire conducted among pharmacy professionals in public hospitals found in Addis Ababa from 10th May to 9th June, 2020 to recognize ABHR utilization rate. Data were collected on a sample of 384 pharmacy professional by a self-administered questionnaire. Data analysis was done using software for the statistical package for social science version 25.0. To identify the significant predictors of ABHR utilization practice bivariable and multivariable logistic regressions were carried out. Crude odds ratio and adjusted odds ratio with 95% confidence interval were calculated to determine the predictors. Results: Out of 384 participants, three hundred and four participants were included in the final analyses after the exclusion of incomplete responses. Female participants represented 41.4% of the study participants. More than half (58.9%) of the pharmacy professionals had sufficient knowledge on ABHR utilization for COVID-19 prevention. Similarly, 56.6% of pharmacy professionals had positive attitude towards ABHR for COVID-19 prevention. But only 35.9% of the study participants had good ABHR utilization practice. Conclusion: Despite the modest level of knowledge and attitude towards ABHR, pharmacy professionals' utilization practice of ABHR for COVID-19 prevention was found to be suboptimal. Provision of ABHR solutions through hospitals and increasing the awareness of pharmacy professionals on ABHR needs to be encouraged.
... Hobbs, Robinson, Neyens, and Steed (2016) claimed that HHC increased significantly by 5.28 times when the AHS dispenser was placed at a noticeable spot at the center of the lobby. This emphasizes the need to consider visibility and accessibility of visual stimulation to increase HHC, aside from signage merely suggesting the use of HHC (Cure & Van Enk, 2015). ...
Article
Purpose: This study aimed to identify the differences in interventional effects on hand hygiene compliance (HHC) among families and visitors in pediatric wards. Design & methods: A total of 2787 family and non-family visitors entering through the glass sliding door of 6 pediatric wards at a university children's hospital were observed for 4 h, respectively, before and after interventions between April 27 and May 20, 2018. In the first intervention, a visual stimulus emphasized the location of the hand sanitizer. In the second intervention, an additional auditory stimulus transmitted a cue through a motion sensor speaker. Results: During the preliminary observation, the HHC rates of family and non-family visitors were 0.0% and 1.5%, respectively; after the visual stimulus, they were 0.6% and 5.4%, and after the audio-visual stimulus, 1.8% and 8.2%. There was a significant increase in the overall HHC with the visual (OR, 5.22; 95% CI, 1.76-20.90) and audio-visual (OR, 8.67; 95% CI, 3.08-33.70) stimuli (Fisher's exact test, p < .05). Conclusions: The HHC of family and non-family visitors entering pediatric wards was very low and the audio-visual stimulus was found to be more effective than was the visual stimulus alone. Practice implications: To reduce healthcare-associated infection, pediatric wards must actively implement effective interventions. Using audio-visual stimulation to increase HHC among visitors will provide advantages. Follow-up research should examine the current state of HHC among visitors in various locations and conditions.
... These include access to hand hygiene facilities, the use of posters, and education to improve hand hygiene (Kretzer & Larson, 1998;Naikoba & Hayward, 2001;Pittet, 2000;Teare et al., 1999). Other studies have found that placing alcohol-based hand sanitizers or dispensers at more visible, proximate, and convenient locations increased usage significantly (Cure & Van Enk, 2015;Gould et al., 2018;Hobbs et al., 2016). ...
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In the absence of a vaccine, the adoption of responsible behavior is critical to the fight against COVID-19. Practicing preventive etiquettes such as hand washing, hand disinfection, wearing a face mask, practicing physical distancing, disinfection of surfaces and objects can help curb the transmission of the virus at the workplace. This paper focuses on interventions and behaviors required to curb the spread of COVID-19 at workplaces. We undertook a detailed multi-disciplinary literature search on the following topics: hand hygiene, respiratory hygiene, physical distancing, quarantine and isolation, disinfection of objects and surfaces, behavior change, and health crisis communication. We identified interventions that are effective for preventing the spread of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) at workplaces. These findings present very useful non-clinical interventions for preventing COVID-19 in the work environment.
... -"The dirty bottle in contact with my clean clothes all the time." by reducing errors using blood glucose meters and increase compliance using hand sanitizers [23,24]. Properties of a medical product can act as 'forcing functions'. ...
Article
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Background Hand Hygiene (HH) compliance was shown to be poor in several studies. Improving the availability of alcohol-based hand rub (ABHR) is a cornerstone for increasing HH compliance. Methods In this study, we introduced wearable dispensers for ABHR in an Emergency Department (ED) well equipped with mounted ABHR dispensers and accompanied this single-modal intervention by a quasi-experimental mixed-method study. The study was performed in the ED of the University Hospital Zurich, Switzerland, a 950-bed tertiary teaching hospital. During a five-week baseline period and a seven-week intervention period, we observed HH compliance according to the WHO ‘Five Moments’ concept, measured ABHR consumption, and investigated perceived ABHR availability, self-reported HH compliance and knowledge of HH indications by questionnaire. Multivariable logistic regression was used to identify independent determinants for HH compliance. In addition, semi-structured interviews were conducted and thematically analyzed to assess barriers and facilitators for the use of the newly introduced dispensers. Results Across 811 observed HH opportunities, the HH compliance for all moments was 56% (95% confidence interval (CI), 51–62%) during baseline and 64% (CI, 59–68%) during intervention period, respectively. In the multivariable analysis adjusted for sex, profession, and WHO HH moment, there was no difference in HH compliance between baseline and intervention (adjusted Odds ratio: 1.22 (0.89–1.66), p = 0.22), No significant changes were observed in consumption and perceived availability of ABHR. During intervention, 7.5% ABHR was consumed using wearable dispensers. HCP perceived wearable dispensers as unnecessary since mounted dispensers were readily accessible. Poor ergonomic design of the wearable dispenser emerged as a main barrier, especially its lid and fastening mechanism. Interviewees identified two ideal situations for wearable dispensers, HCP who accompany patients from ED to other wards, and HCP approaching a patient from a non-patient areas in the ED such as the central working station or the meeting room. Conclusion The introduction of wearable dispensers did not increase observed hand hygiene compliance or ABHR consumption in an ED already well equipped with mounted dispensers. For broader acceptance and use, wearable dispensers might benefit from an optimized ergonomic design.
... Placing an AHS stand in the middle (versus the side) of a hospital entrance lobby increased usage substantially (Hobbs et al., 2016). More visible, proximate, and convenient locations for AHS dispensers increases their use (Cure & Enk, 2015), more so than increasing the number of dispensers (Chan, Homa, & Kirkland, 2013). Another study increased use by deploying flashing lights to draw attention to the AHS (Rashidi et al., 2016). ...
Article
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This rapid, narrative review summarizes useful evidence from behavioral science for fighting the COVID-19 outbreak. We undertook an extensive, multi-disciplinary literature search covering five issues: handwashing, face touching, self-isolation, public-spirited behavior, and responses to crisis communication. The search identified more than 100 relevant papers. We find effective behavioral interventions to increase handwashing, but not to reduce face touching. Social supports and behavioral plans can reduce the negative psychological effects of isolation, potentially reducing the disincentive to isolate. Public-spirited behavior is more likely with frequent communication of what is “best for all”, strong group identity, and social disapproval of noncompliance. Effective crisis communication involves speed, honesty, credibility, empathy, and promoting useful individual actions. Risks are probably best communicated through numbers, with ranges to describe uncertainty – simply stating a maximum may bias public perception. The findings aim to be useful not only for government and public health authorities, but for organizations and communities.
... In the entertainment industry, for example, autonomous robots with tablets on their chests are now responsible for scanning various codes on tickets at entrances to cinemas and theaters [54,55]. Many institutions are also enforcing hygiene practices by providing hand sanitizers at entrances for public use [56,57]; however, humans under time constraints hardly give these isolated gadgets the attention needed and ignore them. In the CleanMeAI Project, a humanoid robot [58] will be trained using Machine learning to welcome visitors, providing them with doses of hand sanitizer, detecting (see Figures 4 and 5) and disinfecting door handles-a common source of virus contagion [59]. ...
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From caretaking activities for elderly people to being assistive in healthcare setup, mobile and non-mobile robots have the potential to be highly applicable and serviceable. The ongoing pandemic has shown that human-to-human contact in healthcare institutions and senior homes must be limited. In this scenario, elderlies and immunocompromised individuals must be exclusively protected. Robots are a promising way to overcome this problem in assisted living environments. In addition, the advent of AI and machine learning will pave a way for intelligent robots with cognitive abilities, while enabling them to be more aware of their surroundings. In this paper, we discuss the general perspectives, potential research opportunities, and challenges arising in the area of robots in assisted living environments and present our research work pertaining to certain application scenarios, i.e., robots in rehabilitation and robots in hospital environments and pandemics, which, in turn, exhibits the growing prospects and interdisciplinary nature of the field of robots in assisted living environment.
... Attempts have been made to implement several strategies to improve compliance, including: increasing awareness of the significance of hand hygiene through signs and education [17], real-time monitoring through technologies that provide visual (or other) cues to direct attention to hand hygiene during routine work [18], and making it easier to clean hands by installing sinks and sanitizer dispensers in convenient locations [19]. A multicenter study by Bischoff et al. [20] assessing HHC among healthcare workers found that an education/feedback system coupled with sink and soap handwashing failed to improve HHC, but HHC increased significantly when easily accessible and easy-to-use, waterless sanitizer dispensers were introduced [21][22][23]. ...
Article
Aim: We present a touch-activated, sanitizer dispensing (TSD) device, intended to be mounted on high-touch surfaces, that aims to reduce nosocomial infections. It disinfects the person’s hand touching its surface while being self-sterilizing. Materials & methods: The TSD device consists of an array of 3D-printed, passive, miniaturized, mechanical valves that dispense a small amount of liquid sanitizer when touched. Its mechanical performance and disinfecting efficiency were quantified using simulations and experimental tests. Results & conclusion: The TSD device has a disinfecting efficiency comparable to the standard hand sanitizing approach, reducing the microbiological load by approximately 30-times. It can be easily mounted on high-touch surfaces in a healthcare setting and it is expected to greatly reduce the spread of nosocomial infections.
... The study participants reported that access to appropriate hand hygiene products was problematic during some clinical cases. Similar to recommendations from other research, 3,40 consideration should be given to improved visibility and accessibility of ABHR dispensers, and the development of products for use in paramedic-led health care, that minimize skin reactions and do not impede the changing of gloves. A recent study 3 has shown that when hand hygiene is poor, the hands of up to 77% of paramedics are heavily contaminated with pathogens on arrival at hospital, and up to 47% remained heavily contaminated after hand hygiene. ...
Article
Background: Noncompliance with recommended hand hygiene and gloving practices by workers in the emergency medical services may contribute to the transmission of health care-associated infections and lead to poor patient outcomes. The aim of this study was to explore the self-reported behaviors and perceptions of Australian paramedics in relation to their hand hygiene and gloving practices in paramedic-led health care. Methods: A national online survey (n = 417; 17% response rate) and 2 semistructured focus groups (6 per group) were conducted with members of Paramedics Australasia. Results: Although most of the study participants perceived hand hygiene and gloving to be important, the findings suggest poor compliance with both practices, particularly during emergency cases. All participants reported wearing gloves throughout a clinical case, changing them either at the completion of patient care or when visibly soiled or broken. Hand hygiene was missed at defined moments during patient care, possibly from the misuse of gloves. Conclusions: Paramedic hand hygiene and gloving practices require substantial improvement to lower potential transmission of pathogens and improve patient safety and clinical care. Further research is recommended to explore how to alleviate the barriers to performing in-field hand hygiene and the misuse of gloves during paramedic-led health care.
... [13] In any way, under any circumstances, the health workers have to eliminate possible contamination of hands before and after patient's contact. [14] This is possible just with hand washing. [15] The essential point is that the medical personnel believed the effects of hand washing in such time and places. ...
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The aim of this review is to show the historical aspects of hands washing for healthy life and explains how can reduce the transmission of community-acquired infectious agents by healthcare workers and patients. This review article is prepared based on available database. The key words used were hands washing, risk assessment, hands hygiene, bacterial flora, contamination, infection, nosocomial, tap water, sanitizer, bacterial resistance, hands bacterial flora, washing methods, antiseptics, healthcare workers, healthcare personnel, from PubMed, ScienceDirect, Embase, Scopus, Web of Sciences, and Google Scholar. Data were descriptively analyzed. The insistence on hand washing has a history of 1400 years. The research results indicate that the bacteria released from the female washed hands in wet and dry condition was lower than from the male's hands with a significance level (3 CFU vs. 8 CFU; confidence interval 95%, P ≤ 0.001). The valuable results of the study indicated that released amount of bacterial flora from wet hands is more than 10 times in compared to dry hands. In addition, established monitoring systems for washing hands before and after patient's manipulation as well as after toilet were dominant indices to prevent the transfer of infectious agents to the patients. Increasing awareness and belief of the healthcare workers have shown an important role by about 30% reduction in the transfection. Hand washing could reduce the episodes of transmission of infectious agents in both community and healthcare settings. However, hand washing is an important key factor to prevent transmission of infectious agents to patients. There is no standard method for measuring compliance. Thus, permanent monitoring of hand washing to reduce the transmission of infections is crucial. Finally, the personnel must believe that hand washing is an inevitable approach to infection control.
... We did not identify any studies investigating on the impact of the location of handrub dispensers on healthcare-associated infection rates. However, the results of this review indicate that sustainable improvement of hand hygiene compliance can be supported by locating the hand rub dispenser in the point of care and facilitate its accessibility for healthcare workers [31][32][33]. Therefore, this review confirms the conclusions made by Kendall et al. who suggest to ensure the availability of the hand rub dispenser in the point of care [33]. ...
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Background The influence of the hospital’s infrastructure on healthcare-associated colonization and infection rates has thus far infrequently been examined. In this review we examine whether healthcare facility design is a contributing factor to multifaceted infection control strategies. Methods We searched PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) from 1990 to December 31st, 2015, with language restriction to English, Spanish, German and French. ResultsWe identified three studies investigating accessibility of the location of the antiseptic hand rub dispenser. Each of them showed a significant improvement of hand hygiene compliance or agent consumption with the implementation of accessible dispensers near the patient bed. Nine eligible studies evaluated the impact of single-patient rooms on the acquisition of healthcare-associated colonization and infections in comparison to multi-bedrooms or an open ward design. Six of these studies showed a significant benefit of single-patient bedrooms in reducing the healthcare-associated colonization and infection rate, whereas three studies found that single-patient rooms are neither a protective nor risk factor. In meta-analyses, the overall risk ratio for acquisition of healthcare-associated colonization and infection was 0.55 (95% CI: 0.41 to 0.74), for healthcare-associated colonization 0.52 (95% CI: 0.32 to 0.85) and for bacteremia 0.64 (95% CI: 0.53 to 0.76), all in favor of patient care in single-patient bedrooms. Conclusion Implementation of single-patient rooms and easily accessible hand rub dispensers located near the patient’s bed are beneficial for infection control and are useful parts of a multifaceted strategy for reducing healthcare-associated colonization and infections.
... A study carried out in a 404-bed hospital in the Midwestern United States found that visibility and accessibility to the hand hygiene disinfectant at the entrance to the patient's room was statistically associated with higher compliance rates (25) . ...
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Background/Objective. After wearing powdered gloves, healthcare workers (HCW) are supposed to wash their hands instead of using alcohol-based hand-rub (ABHR). Washing hands takes longer than using ABHR, and the use of powdered gloves may be an obstacle to hand-hygiene compliance. This study aimed to evaluate the impact of replacing powdered gloves with powder-free gloves on hand-hygiene compliance among HCW of an intensive care unit (ICU). Methods. A quasi-experimental study was conducted in a general ICU of a tertiary care university hospital in Brazil. From June 1st to July 15th, 2017, all HCW were provided with powdered latex gloves only for all clinical procedures. From July 15th to August 31st, 2017, HCW were provided with nitrile powder-free gloves only. Hand-hygiene compliance was assessed through direct observation, and evaluated according to the World Health Organization (WHO) Hand Hygiene guidelines. We calculated that a sample size of 544 hand hygiene opportunities needed to be observed per period. Data analysis were performed using the STATA SE® version 14, and we compared the individual’s percentage of compliance using the t test for paired data before and after the intervention. Results. Overall, 40 HCW were assessed before and after the introduction of nitrile powder-free gloves, with 1114 and 1139 observations of hand hygiene opportunities, respectively. The proportion of compliance with hand hygiene was 55% (95% Confidence Interval [CI]: 51-59%) using powdered latex gloves and 60% (95% CI: 57-63%) using powder-free gloves. The difference in proportions between the two types of gloves was 5.1% (95% CI: 2.5-7.6%, p<0.001). Conclusion. Our data indicate that replacing powdered gloves with powder-free gloves positively influenced hand-hygiene compliance by HCW in an ICU setting.
Article
Background: Anesthesia providers commonly cross-contaminate their workspace and subsequently put patients at risk for a health care-acquired infection. The primary objective of this project was to determine if education and implementation of standardized infection control guidelines that address evidence-based best practices would improve compliance with infection control procedures in the anesthesia workspace. Methods: Patient care-related hand hygiene of nurse anesthetists was observed in 3 areas of anesthesia practice before and 3 weeks and 3 months after staff education, placement of visual reminders, and the implementation of infection control guidelines. After the observation periods, the percent compliance on the part of the providers was calculated for each of the 3 areas of anesthesia practice, and the results were compared using the Fisher exact test. Results: There were a total of 95 observations performed during the 3 observation periods. When compared with preimplementation baseline data, there was a 26.2% increase in the number of providers compliant with hand hygiene practices after airway instrumentation (P = .029) and a 71.9% increase in the number of providers who separated clean from contaminated items in the workspace (P = .0001). Conclusions: Education, visual reminders, and standardized infection control guidelines were shown to improve compliance with infection control best practices in a group of nurse anesthetists.
Article
Even before the discovery of germs, the practice of hand hygiene had revealed itself as a crucial element in the fight against infectious diseases. In fact, supported by the historical discoveries and more recent evidence based data, the World Health Organization considers hand hygiene as the pillar of infection control, particularly when related to nosocomial infections. Therefore, the World Health Organization has a strong focus on “Clean Hands Save Lives” campaigns, a principle that is easily translatable into “Clean Hands Save Horses”. Considering the recognised importance given to skin health and integrity as the first principle of good hand hygiene, using decontamination methods and products that are the least harmful to the skin is mandatory. This is why the currently accepted presurgical hand preparation methods do not involve aggressive brushing and disinfecting soaps anymore. Rather, hands should be washed with a neutral pH friendly soap first before a hydroalcoholic solution is applied. Although the principles and benefits of proper hand hygiene have been recognised in the healthcare world, one of the major drawbacks remains the lack of compliance with established protocols. To increase compliance, equine clinics should work on improving product accessibility, enhancing staff and client education as well as helping each other to remember to actually do it. This article reviews historical and current facts on hand hygiene and relates it to equine practice. Clean equine care is safer equine care: it's all in your hands!
Article
Objectives: The objective of this study is to determine the optimal allocation of budgets for pairs of alterations that reduce pathogenic bacterial transmission. Three alterations of the built environment are examined: handwashing stations (HW), relative humidity control (RH), and negatively pressured treatment rooms (NP). These interventions were evaluated to minimize total cost of healthcare-associated infections (HAIs), including medical and litigation costs. Background: HAIs are largely preventable but are difficult to control because of their multiple mechanisms of transmission. Moreover, the costs of HAIs and resulting mortality are increasing with the latest estimates at US$9.8 billion annually. Method: Using 6 years of longitudinal multidrug-resistant infection data, we simulated the transmission of pathogenic bacteria and the infection control efforts of the three alterations using Chamchod and Ruan's model. We determined the optimal budget allocations among the alterations by representing them under Karush-Kuhn-Tucker conditions for this nonlinear optimization problem. Results: We examined 24 scenarios using three virulence levels across three facility sizes with varying budget levels. We found that in general, most of the budget is allocated to the NP or RH alterations in each intervention. At lower budgets, however, it was necessary to use the lower cost alterations, HW or RH. Conclusions: Mathematical optimization offers healthcare enterprise executives and engineers a tool to assist with the design of safer healthcare facilities within a fiscally constrained environment. Herein, models were developed for the optimal allocation of funds between HW, RH, and negatively pressured treatment rooms (NP) to best reduce HAIs. Specific strategies vary by facility size and virulence.
Article
Although the evidence overwhelmingly supports hand hygiene as the most effective intervention to prevent infections, suboptimal hand hygiene practices continue. However, the COVID-19 pandemic has brought infection control to the forefront in every healthcare setting. As a result, this manuscript proposes adoption of universal hand hygiene, the practice in which all who enter the healthcare setting regardless of role perform hand hygiene as indicated. Adopting universal hand hygiene promotes high quality care, a clean and safe environment, and individual involvement. Issues regarding hand hygiene adherence may include lack of management support, ambiguity, ability, or agreement. As a result, this manuscript will address the role of management, knowledge, skills, and agreement related to universal hand hygiene in this multimodal, evidence-based practice (EBP) by modifying the previously published “Position on Healthcare Client Hand Hygiene.”
Article
Background: Hand hygiene compliance (HHC) among health care workers remains suboptimal, and good monitoring systems are lacking. We aimed to evaluate HHC using an automated monitoring system. Methods: A prospective, observational study was conducted at 2 Danish university hospitals employing a new monitoring system (Sani nudge). Sensors were located on alcohol-based sanitizers, health care worker name tags, and patient beds measuring hand hygiene opportunities and sanitations. Results: In total, 42 nurses were included with an average HHC of 52% and 36% in hospitals A and B, respectively. HHC was lowest in patient rooms (hospital A: 45%; hospital B: 29%) and highest in staff toilets (hospital A: 72%; hospital B: 91%). Nurses sanitized after patient contact more often than before, and sanitizers located closest to room exits and in hallways were used most frequently. There was no association found between HHC level and the number of beds in patient rooms. The HHC level of each nurse was consistent over time, and showed a positive correlation between the number of sanitations and HHC levels (hospital A: r = 0.69; hospital B: r = 0.58). Conclusions: The Sani nudge system can be used to monitor HHC at individual and group levels, which increases the understanding of compliance behavior.
Article
Background Hand hygiene plays a crucial role in the prevention of healthcare-associated infections and transmission of pathogens. In 2008 the national campaign ‘Aktion Saubere Hände’ was launched in Germany. It is based on the World Health Organization (WHO) ‘Clean Care is Safer Care’ initiative. Direct observation and feedback of the results are key components in the improvement of hand hygiene compliance. In 2014 a voluntary national surveillance electronic tool for the documentation of directly observed compliance to hand hygiene was introduced. Aim Description and evaluation of compliance with the WHO model ‘my 5 moments’ in German hospitals after implementation. Methods Direct observation was performed in the participating hospitals by trained local staff according to the WHO recommendations. We evaluated wards that reported annually at least 150 hand hygiene opportunities (HHOs) of hand hygiene per observation period from January 1st, 2015 until December 31st, 2018. Findings In all, 1,485,622 HHOs observed on 3337 wards in 525 hospitals were included into analysis. Overall compliance increased from 72% (interquartile range: 61–82) to 76% (66–84). Compliance significantly increased for all individual moments of the WHO model except moment 2. In the multivariate logistic regression analysis the following parameters were independently associated with a high compliance in hand hygiene: intensive care unit, nurse, opportunity observed in 2017 or 2018, as well as all moments except moment 2. Conclusion Overall compliance in German hospitals increased over time. To improve HH compliance ‘before aseptic procedures’ appears to be difficult and should be addressed explicitly. Underlying reasons need to be the focus of future investigations.
Article
Background Patient handling policy intends to decrease the risk of musculoskeletal injury for nurses. Many factors influence nurses’ adherence to patient handling policy, including the context in which the activities take place. The aim of this study was to investigate emergency nurses’ beliefs and experiences with patient handling in the emergency department. Methods A phenomenological approach was used to explore the participants’ experience of patient handling in the ED. Focus group interviews were held in a Victorian emergency department. The interviews were audio-recorded, transcribed, and the data were analysed using thematic analysis. Results Five interviews were held with 40 nurse participants. Four themes were identified that described participants beliefs and experiences of patient handling: ‘Putting the patient first’ describes participants prioritisation of patient safety over their own; ‘Patient -related challenges’ describes the patient factors (e.g. language, mobility, size) that make patient handling more difficult; ‘Staff knowledge’ of policy and procedure; and ‘Inadequate resources’ which describes the physical and human resource limitations that made patient handling more difficult. Conclusions Issues with equipment, education and patient handling culture are widespread, and this study reaffirms the importance of considering context in developing interventions to improve practice. Introduction of a Safe Patient Handling Program in the ED, that addresses multiple barriers simultaneously, may improve adherence to policy, and reduce the risk of musculoskeletal injury in emergency nurses.
Article
Objectives: This study aims to explore the impacts of visibility and accessibility of alcohol gel-based hand sanitizer dispensers (HSDs) on healthcare workers' hand-hygiene (HH) behaviors. Background: Despite the importance of HH in reducing nosocomial infection, few empirical studies have quantitatively investigated the impacts of unit shape and size, and the resulted visibility and accessibility on HH, due to the lack of consistent methods to measure and evaluate visibility. Methods: The research was developed as a cross-sectional comparative study of two nursing units (Units A and B) with similar patient acuity and nursing care model but different shape and layout. The study applied quantitative research methods including visibility and accessibility analysis using space syntax, 1-week on-site observation, and secondary data analysis on HH compliance rates. Results: Results indicate that the unit with higher visibility and accessibility is associated with higher HH frequencies. Unit B has significantly higher visibility of HSDs, p < .001, t(60) = 4.615, and significantly higher frequency of HH activity occurrences, 5.17% versus 1.52%; p < .001, t(16.750) = 5.332, than Unit A, even though Unit B has lower HSD to bed ratio (0.708:1 vs. 1.375:1). The linear regression models also demonstrate that visibility and accessibility of HSDs are significant predictors of HH behavior. Conclusions: Overall, this exploratory study identified the importance of visibility of HSDs to improve the chances of HH. It also points out the impacts of nursing unit typology on the visibility of HSDs and in turn affects HH behavior.
Chapter
The goal of this chapter is to discuss the demand of taxpayers, employers, and employees that medicine deliver better value. Physicians need evidence-based medicine to establish which interventions are truly beneficial and modern management techniques to implement those interventions optimally. 1. Perioperative interventions are investments, each with its costs and, it is hoped, its benefits. The benefits of perioperative interventions are often difficult to quantify in precise dollar amounts (e.g., pain relief). 2. Three ways of measuring the benefits of interventions are by improved clinical results (i.e., effects), by increased quality-adjusted life-years (QALYs), or by monetary benefit. 3. Any new intervention being considered must be evaluated in comparison with the best existing alternative. As a result, the fundamental concept is the incremental cost-to-effectiveness ratio. 4. Because of the multiplicity of health-care stakeholders (i.e., patients, providers, payers, and society as a whole), an economic study in health-care must specify ahead of time and be consistent in its point of view. 5. Costs of perioperative interventions are direct, indirect, and intangible. Direct costs are the easiest to define and quantify, but vary depending on the costing method used. Direct costs decrease over time, because of competition, the learning curve, technological progress, work process redesign, and the bundling of interventions. 6. Much more attention should be directed toward identifying and addressing barriers to implementation of beneficial interventions. These barriers include lack of awareness (the physician does not know about the new intervention), of familiarity (knows intervention exists but not the details), of agreement (physician does not agree with proposed intervention), of self-efficacy (does not think they can do it), of outcome expectancy (does not think it will work), as well as system factors not allowing successful implementation.
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The study objective assessed the energy demand and economic cost of two hospital-based COVID-19 infection control interventions: negative pressure (NP) treatment rooms and xenon pulsed ultraviolet (XP-UV) equipment. After projecting COVID-19 hospitalizations, a Hospital Energy Model and Infection De-escalation Models quantified increases in energy demand and reductions in infections. The NP intervention was applied to 11, 22, and 44 rooms for small, medium, and large hospitals, while the XP-UV equipment was used eight, nine, and ten hours a day. For small, medium, and large hospitals, the annum kWh for NP rooms were 116,700 kWh, 332,530 kWh, 795,675 kWh, which correspond to annum energy costs of $11,845 ($1,077/room), $33,752 ($1,534/room), and $80,761 ($1,836/room). For XP-UV, the annum-kilowatt-hours (and costs) were 438 ($45), 493 ($50), and 548 ($56) for small, medium, and large hospitals. While energy efficiencies may be expected for the large hospital, the hospital contained more energy-intensive use rooms (ICUs) which resulted in higher operational and energy costs. XP-UV had a greater reduction in secondary COVID-19 infections in large and medium hospitals. NP rooms had a greater reduction in secondary SARS-CoV-2 transmission in small hospitals. Early implementation of interventions can result in realized cost savings through reduced hospital-acquired infections
Article
Introducción: La adherencia a la higiene de manos (HM) por parte del personal de salud es de 38% a nivel mundial. Con la estrategia multimodal de la OMS se incluyeron los preparados de base alcohólica como un componente para la mejora de la HM. La campaña “los 5 momentos de la HM” incentiva a utilizar este producto que, entre otros beneficios, su aplicación ocupa menor tiempo en comparación con el lavado de manos. Objetivo: Conocer cuáles son los factores facilitadores o las barreras que favorecen o dificultan el uso de preparados de base alcohólica por el personal de salud para aumentar la adherencia a la HM según la estrategia multimodal de la OMS. Métodos: Fueron utilizadas dos bases de datos PubMed y CINHAL (años 2009 - 2019). Los artículos fueron seleccionados según criterios de inclusión - exclusión. Resultados: De 30 artículos se seleccionaron 12, los que tenían como tema central la adherencia a la HM, personal de salud y preparados de base alcohólica. Se organizaron en facilitadores y barreras: infraestructura, presentación del producto y capacitación del personal. Discusión: Los facilitadores y barreras que más impacto reportan en aumentar la adherencia a la HM son la infraestructura, acceso, disponibilidad en el punto de atención, presentación del producto y capacitación al personal de salud sobre los productos de base alcohólica para la desinfección de las manos, con el fin de disminuir las IAAS y brindar una atención segura.
Article
Background To limit the spread of the new coronavirus disease 2019 (COVID-19), the World Health Organization recommends the use of face mask as a part of the pandemic control strategy. It has published also “best practices” in which it advises to avoid touching the mask while wearing it. This might be challenging. The purpose of this study was to investigate the frequency of mask-touching behavior in public transportation. Methods Observational study using data collected in real life. This survey was conducted in subways and local trains of the greater Paris region, France, between May 4th and 25th, 2020. Public Transportation users were covertly observed. Demographic characteristics, type of mask and the main activity were collected by the investigator. The duration of observation, the frequency of touching face mask, hair and the uncovered area of the face were also recorded. Frequency of mask-touching per hour was determined. Results One hundred eighty two persons were observed. The median of estimated age [1st and 3rd interquartile] was 35 [30;45] years and 87 (48%) were women. One hundred forty three (79%) were wearing surgical mask. The median time of observation was 8 [4;12] minutes. During this period, 87 (48%) persons touched their mask 15 [7.5;30] times per hour of whom only two (8%) have used hydroalcoholic solution to disinfect their hands. Conclusions Mask touching is frequent and is rarely followed by hand disinfection. Actions regarding mask use should be taken to improve compliance.
Article
Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.
Article
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Introduction: The numbers of COVID-19 sufferers in various countries are continuing to increase, including in Indonesia. COVID-19 has a wide impact, including on the online transportation service sector. Since 2015 in Samarinda City, there has been an online transportation service, namely Gojek Indonesia, which provides services to customers in the form of shuttle passengers, food delivery, and other necessities, including goods delivery services. The online transportation driver group is one of the groups at high risk of transmitting COVID-19. Objective: This study aimed to obtain information about COVID-19 prevention behavior including driver's knowledge of COVID-19, perceptions, and customer service on online transportation drivers in Samarinda. Methods: This study used a qualitative design with a phenomenological approach. The informants in this study were selected as many as 5 people. The Gojek at Cendana Street was chosen because it is the main entrance and exit route of tourists in Samarinda. The data technique was an interview and used qualitative data analysis. Results: COVID-19 is a respiratory disease. Drivers considered that COVID-19 is a dangerous disease, frightening, and causes excessive panic in the community because of its rapid spread and risks to all groups of people, including online transportation drivers. Serving customers remains a priority even though they understand the risk of contracting COVID-19. Efforts to prevent the transmission of COVID-19 carried out by Gojek drivers including using masks, washing hands with flowing water and soap, or hand sanitizer, also cleaning helmets or replacing them with spare helmets. Conclusion: The transmission of COVID-19 can be prevented by behaving cleanly and healthy also prioritize the prevention of transmission of COVID-19, such as wearing masks while doing activities, keeping passenger helmets clean, and washing hands after serving customers.
Article
As veterinary nurses, our role as set out in the professional conduct guidance by the RCVS states that when providing care, veterinary surgeons and veterinary nurses should ‘ensure a hygienic and safe environment’. This means that we should actively contribute to the careful consideration of day-to-day practices within the clinic that safeguard patients to ensure that when they enter they clinics, they are not exposed to increased risk from infection. Understanding the need for good hand hygiene in clinic, along with the appropriate considerations, means that we are able to implement good practice.
Article
The coronavirus disease (COVID-19) pandemic has highlighted the link between individual behavior and public health, along with the importance of evidence-based efforts to promote prosocial individual behavior. Insights from behavioral science can inform the design of effective behavior change techniques, or nudges, to influence individual behavior. The MINDSPACE framework organizes 9 behavioral science principles that can be used to guide policy design: Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitments, and Ego. Using MINDSPACE as an organizing framework, this article provides a review of the literature on nudges to influence prosocial behaviors relevant during a pandemic: handwashing, avoidance of social gatherings, self-isolation and social distancing, and sharing public health messages. Additionally, empirical evidence on the use of nudges during the first several months of the COVID-19 pandemic in 2020 is summarized. Recommendations regarding the use of nudges to achieve public health policy goals during pandemics are provided. Organizational leaders, policymakers, and practitioners can use nudges to promote public health when mandates are not politically feasible or enforceable.
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A rise in COVID-19 transmission risk led people, industries, and the government to adopt different approaches for controlling the spread rate of the virus. This project uses Arduino-Nano, Servo motor, and a servo motor. While each approach has its advantages, one approach in particular -- Arduino-based sanitizing systems -- has played a key role in preventing the spread of Coronavirus due to its cost-effectiveness and flexibility. According to our information, an automatic sanitizer for door handles and knobs that uses IR sensors and servo motors has not been reported so far. Therefore, we have demonstrated an automatic door handle sanitizer which is commonly used in hospitals, houses, and other places to sanitize the handles and knobs. Efforts have been made to prevent Coronavirus infection. A person who gets infected by touching a contaminated doorknob of any organization, house, hospital, etc., will suffer serious repercussions as well as the country in which he lives. By sanitizing the door handle, the said system removes the virus it contains from the door handle as the person touches it. An IR sensor is used to demonstrate the mechanism. To prevent the spread of COVID-19, it can be implemented in places such as hospitals and businesses where the doors are used frequently.
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Hand hygiene has proven to be one of the most effective practices to prevent the spread of infectious microorganisms. Povidone-iodine (PVP-I) is one of the most effective antiseptics for this purpose. In this study, bigels (hybrid systems of oleogel and hydrogel) loaded with PVP-I were prepared varying the oleogel:hydrogel ratio 40:60 and 60:40 (called: BPVP-I O:H40:60 and BPVP-I O:H60:40 respectively). The oleogel was prepared with a base of extra virgin olive oil, beeswax, and α-tocopherol; the hydrogel was prepared with deionized water, hydroxyethylcellulose, and PVP-I at 5% (w/v). Bigels were characterized by visual appearance, microstructure, rheological behavior, and molecular ordering. Iodine (I2) release from the bigels was analyzed through kinetic models. The antibacterial effectiveness was evaluated with the in vivo finger-streak technique on an agar surface, using ten volunteers for treatment. Results show that BPVP-I O:H40:60 had a soft and smooth texture, while BPVP-I O:H60:40 presented a harder and firmer texture. Microscopic studies showed an interconnected network of pores and the continuous phase formation of bigels for BPVP-I O:H40:60 and hydrogel-in-oleogel type bigels for BPVP-I O:H60:40. Structural differences altered the viscoelastic behavior of the bigels. Bigels with a higher hydrogel concentration (BPVP-I O:H40:60) were less rigid, while bigels with a higher oleogel concentration (BPVP-I O:H60:40) had the greatest resistance to deformation. The Weibull model equation best fitted the release data of I2. I2 release kinetic data showed a Fickian diffusion behavior. The antiseptic action of bigels reduces bacterial growth on the fingers 1 h after application. These results suggest that both bigels formulated can act as promising alternatives to hand antiseptic products.
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Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.
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Background The National University Hospital, Singapore routinely undertakes standardized Hand Hygiene auditing with results produced by ward and by staff type. In 2010 concern was raised over consistently low compliance by nursing students averaging 45% (95% CI 42%–48%) prompting us to explore novel approaches to educating our next generation of nurses to improve their hand hygiene practice. We introduced an experiential learning assignment to final year student nurses on attachment to NUH inclusive of hand hygiene auditor training followed by a period of hand hygiene observation. The training was based on the World Health Organisation (WHO) “My 5 moments for hand hygiene” approach. Upon completion students completed an anonymous questionnaire to evaluate their learning experience. Findings By 2012, nursing students were 40% (RR: 1.4, 95% CI 1.3–1.5, p<0.001) more likely to comply with hand hygiene practices. 97.5% (359/368) of nursing students felt that the experience would enhance their own hand hygiene practice and would recommend participating in audits as a learning instrument. Conclusions With consideration of all stakeholders a sustainable, flexible, programme was implemented. Experiential learning of hand hygiene was a highly valued educational tool and in our project was directly associated with improved hand hygiene compliance. Feedback demonstrated popularity amongst participants and success in achieving its program objectives. While this does not guarantee long term behavioural change it is intuitive that instilling good habits and messages at the early stages of a career will potentially have significant long-term impact.
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BACKGROUND: and hygiene compliance is generally assessed by observation of adherence to the "WHO five moments" using numbers of opportunities as the denominator. The quality of the activity is usually not monitored since there is no established methodology for the routine assessment of hand hygiene technique. The aim of this study was to objectively assess hand rub coverage of staff using a novel imaging technology and to look for patterns and trends in missed areas after the use of WHO's 6 Step technique. METHODS: A hand hygiene education and assessment program targeted 5200 clinical staff over 7 days at the National University Hospital, Singapore. Participants in small groups were guided by professional trainers through 5 educational stations, which included technique-training and UV light assessment supported by digital photography of hands. Objective criteria for satisfactory hand hygiene quality were defined a priori. The database of images created during the assessment program was analyzed subsequently. Patterns of poor hand hygiene quality were identified and linked to staff demographic. RESULTS: Despite the assessment taking place immediately after the training, only 72% of staff achieved satisfactory coverage. Failure to adequately clean the dorsal and palmar aspects of the hand occurred in 24% and 18% of the instances, respectively. Fingertips were missed by 3.5% of subjects. The analysis based on 4642 records showed that nurses performed best (77% pass), and women performed better than men (75% vs. 62%, p < 0.001). Further risk indicators have been identified regarding age and occupation. CONCLUSION: Ongoing education and training has a vital role in improving hand hygiene compliance and technique of clinical staff. Identification of typical sites of failure can help to develop improved training. OPEN ACCESS: http://www.biomedcentral.com/1471-2334/13/249/abstract
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To evaluate the effectiveness of a multimodal intervention in primary care health professionals for improved compliance with hand hygiene practice, based on the World Health Organization's 5 Moments for Health Hygiene. Cluster randomized trial, parallel 2-group study (intervention and control). Primary healthcare centers in Madrid, Spain. Eleven healthcare centers with 198 healthcare workers (general practitioners, nurses, pediatricians, auxiliary nurses, midwives, odontostomatologists, and dental hygienists). Methods. The multimodal hand hygiene improvement strategy consisted of training of healthcare workers by teaching sessions, implementation of hydroalcoholic solutions, and installation of reminder posters. The hand hygiene compliance level was evaluated by observation during regular care activities in the office visit setting, at the baseline moment, and 6 months after the intervention, all by a single external observer. The overall baseline compliance level was 8.1% (95% confidence interval [CI], 6.2-10.1), and the healthcare workers of the intervention group increased their hand hygiene compliance level by 21.6% (95% CI, 13.83-28.48) compared with the control group. This study has demonstrated that hand hygiene compliance in primary healthcare workers can be improved with a multimodal hand hygiene improvement strategy.
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A quantitative methodology that enhances design of patient-safe healthcare facilities is presented. The prevailing paradigm of evaluating the design of healthcare facilities relies mainly on postconstruction criticism of design flaws; by then, design flaws may have already negatively affected patient safety. The methodology presented here utilises simulation-based testing in real-size replicas of proposed hospital designs. Other simulations to assess design solutions generated mainly qualitative data about user experience. To assess the methodology, we evaluated one patient safety variable in a proposed hospital patient room. Fifty-two physicians who volunteered to participate were randomly assigned to examine a standardised patient in two hospital room settings using a replica of the proposed architectural plan; the two settings differed only by the placement of the alcohol-based hand-rub dispenser. The primary outcome was the hand hygiene compliance rate. When the dispenser was in clear view of the physicians as they observed the patient, 53.8% sanitised their hands. When the dispenser was not in their field of view (as in the original architectural plan), 11.5% sanitised their hands (p=0.0011). Based on these results, the final architectural plans were adjusted accordingly. The methodology is an effective and relatively inexpensive means to quantitatively evaluate proposed solutions, which can then be implemented to build patient-safe healthcare facilities. It enables actual users to proactively identify patient safety hazards before construction begins.
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To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care. A systematic review of studies published before January 1, 2009, on observed or self-reported compliance rates. Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed. We included 96 empirical studies, the majority (n = 65) in intensive care units. In general, the study methods were not very robust and often ill reported. We found an overall median compliance rate of 40%. Unadjusted compliance rates were lower in intensive care units (30%-40%) than in other settings (50%-60%), lower among physicians (32%) than among nurses (48%), and before (21%) rather than after (47%) patient contact. The majority of the time, the situations that were associated with a lower compliance rate were those with a high activity level and/or those in which a physician was involved. The majority of the time, the situations that were associated with a higher compliance rate were those having to do with dirty tasks, the introduction of alcohol-based hand rub or gel, performance feedback, and accessibility of materials. A minority of studies (n = 12) have investigated the behavioral determinants of hand hygiene, of which only 7 report the use of a theoretical framework with inconclusive results. Noncompliance with hand hygiene guidelines is a universal problem, which calls for standardized measures for research and monitoring. Theoretical models from the behavioral sciences should be used internationally and should be adapted to better explain the complexities of hand hygiene.
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We investigated whether rubbing with an alcohol solution increases compliance with hand disinfection in a medical intensive care unit (MICU). During a first period (P1), hand disinfection was achieved only through conventional washing, whereas during a second period (P2), hand disinfection could be achieved either through conventional washing or rubbing with an alcohol solution. There were 621 opportunities for hand disinfection during P1 and 905 opportunities during P2. General compliance during P1 was 42.4%, and reached 60.9% during P2 (p < 0.001). This improvement was observed among nurses (45.3% versus 66.9%, p < 0.001), senior physicians (37. 2% versus 55.5%, p < 0.001), and residents (46.9% versus 59.1%, p = 0.03). Acceptability and tolerance were evaluated through the answers to an anonymous questionnaire distributed to all 53 health care workers in the MICU. Rubbing with alcohol solution was an easy procedure (100% of responses) and induced mild side effects in less than 10% of respondents. In a complementary study conducted 3 mo after the first one, compliance remained better than during P1 (51. 3% versus 42.4%, p = 0.007). These findings suggest that rubbing with alcohol solution increases compliance with hand disinfection, and that it could be proposed as an alternative to conventional handwashing in the MICU.
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Hand hygiene is one of the cornerstones of the prevention of health care-associated infection, but health care worker (HCW) compliance with good practices remains low. Alcohol-based handrub is the new standard for hand hygiene action worldwide and usually requires a system change for its successful introduction in routine care. Product acceptability by HCWs is a crucial step in this process. We conducted a prospective intervention study to compare the impact on HCW compliance of a liquid (study phase I) versus a gel (phase II) handrub formulation of the same product during daily patient care. All staff (102 HCWs) of the medical intensive care unit participated. Compliance with hand hygiene was monitored by a single observer. Skin tolerance and product acceptability were assessed using subjective and objective scoring systems, self-report questionnaires, and biometric measurements. Logistic regression was used to estimate the association between predictors and compliance with the handrub formulation as the main explanatory variable and to adjust for potential risk factors. Overall compliance (phases I and II) with hand hygiene practices among nurses, physicians, nursing assistants, and other HCWs was 39.1%, 27.1%, 31.1%, and 13.9%, respectively (p = 0.027). Easy access to handrub improved compliance (35.3% versus 50.6%, p = 0.035). Nurse status, working on morning shifts, use of the gel formulation, and availability of the alcohol-based handrub in the HCW's pocket were independently associated with higher compliance. Immediate accessibility was the strongest predictor. Based on self-assessment, observer assessment, and the measurement of epidermal water content, the gel performed significantly better than the liquid formulation. Facilitated access to an alcohol-based gel formulation leads to improved compliance with hand hygiene and better skin condition in HCWs.
Article
Context Under routine hospital conditions handwashing compliance of health care workers including nurses, physicians, and others (eg, physical therapists and radiologic technicians) is unacceptably low.Objectives To investigate the efficacy of an education/feedback intervention and patient awareness program (cognitive approach) on handwashing compliance of health care workers; and to compare the acceptance of a new and increasingly accessible alcohol-based waterless hand disinfectant (technical approach) with the standard sink/soap combination.Design A 6-month, prospective, observational study.Setting One medical intensive care unit (ICU), 1 cardiac surgery ICU, and 1 general medical ward located in a 728-bed, tertiary care, teaching facility.Participants Medical caregivers in each of the above settings.Interventions Implementation of an education/feedback intervention program (6 in-service sessions per each ICU) and patient awareness program, followed by a new, increasingly accessible, alcohol-based, waterless hand antiseptic agent, initially available at a ratio of 1 dispenser for every 4 patients and subsequently 1 for each patient.Main Outcome Measure Direct observation of handwashing for 1575 potential opportunities monitored over 120 hours randomized for both time of day and bed locations.Results Baseline handwashing compliance before and after defined events was 9% and 22% for health care workers in the medical ICU and 3% and 13% for health care workers in the cardiac surgery ICU, respectively. After the education/feedback intervention program, handwashing compliance changed little (medical ICU, 14% [before] and 25% [after]; cardiac surgery ICU, 6% [before] and 13% [after]). Observations after introduction of the new, increasingly accessible, alcohol-based, waterless hand antiseptic revealed significantly higher handwashing rates (P<.05), and handwashing compliance improved as accessibility was enhanced—before 19% and after 41% with 1 dispenser per 4 beds; and before 23% and after 48% with 1 dispenser for each bed.Conclusions Education/feedback intervention and patient awareness programs failed to improve handwashing compliance. However, introduction of easily accessible dispensers with an alcohol-based waterless handwashing antiseptic led to significantly higher handwashing rates among health care workers.
Article
Positive deviance (PD) can be a strategy for the improvement of hand hygiene (HH) compliance. This study was conducted in 8 intensive care units and 1 ward at 7 tertiary care, private, and public hospitals. Phase 1 was a 3-month baseline period (from August to October 2011) in which HH counts were performed by observers using iPods (iScrub program). From November 2011 to July 2012, phase 2, a PD intervention was performed in all the participating centers. We evaluated the consumption of HH products (alcohol gel and chlorhexidine) and the incidence density of health care-associated infections. There was a total of 5,791 HH observations in the preintervention phase and 11,724 HH observations in the intervention phase (PD). A statistically significant difference was found in overall HH compliance with 46.5% in the preintervention phase and 62.0% in the PD phase (P < .001). There was a statistically significant reduction in the incidence of density of device-associated infections per 1,000 patient-days and also in the median of length of stay between the preintervention phase and the PD phase (13.2 vs 7.5 per 1,000 patient-days, respectively, P = .039; and 11.0 vs 6.8 days, respectively, P < .001, respectively). PD demonstrated great promise for improving HH in multiple inpatient settings and was associated with a decrease in the median length of stay and the incidence of device-associated HAIs.
Article
Hand hygiene (HH) is widely regarded as the most effective preventive measure for health care-associated infection. However, there is little robust evidence on the best interventions to improve HH compliance or whether a sustained increase in compliance can reduce rates of health care-associated infection. To evaluate the effectiveness of a real-time feedback to improve HH compliance in the inpatient setting, we used a quasiexperimental study comparing the effect of real-time feedback using wireless technology on compliance with HH. The study was conducted in two 20-bed step-down units at a private tertiary care hospital. Phase 1 was a 3-month baseline period in which HH counts were performed by electronic handwash counters. After a 1-month washout period, a 7-month intervention was performed in one step-down unit while the other unit served as a control. HH, as measured by dispensing episodes, was significantly higher in the intervention unit (90.1 vs 73.1 dispensing episodes/patient-day, respectively, P = .001). When the intervention unit was compared with itself before and after implementation of the wireless technology, there was also a significant increase in HH after implementation (74.5 vs 90.1 episodes/patient-day, respectively, P = .01). There was also an increase in mean alcohol-based handrub consumption between the 2 phases (68.9 vs 103.1 mL/patient-day, respectively, P = .04) in the intervention unit. We demonstrated an improvement in alcohol gel usage via implementation of real-time feedback via wireless technology.
Article
Background: Although hand hygiene is the most effective method for preventing healthcare-associated infections, hand hygiene practice falls short in many healthcare facilities. The compliance rate is mostly linked to system design and easily accessible hand hygiene products. System change, healthcare worker motivation, and complex behavioral considerations seem to play a significant role. Summary: This article discusses the application of behavioral theories in hand hygiene promotion in a theoretical manner. The program relies on the transtheoretical model (TTM) of health behavior change, John Keller's (ARCS) Model of Motivational Design, and the theory of planned behavior (TPB). Thus, the program links attitudes and behavior to hand hygiene promotion. Conclusions: The TTM of health behavior change helps to tailor interventions to predict and motivate individual movement across the pathway to change. A program could be based on this theory with multiple intercalations with John Keller's ARCS and the TPB. Such a program could be strengthened by linking attitudes and behavior to promote hand hygiene. The program could utilize different strategies such as organization cultural change that may increase the attention as well as fostering the movement in the ARCS stages. In addition, modeling TPB by creating peer pressure, ability to overcome obstacles, and increasing knowledge of the role of hand hygiene may lead to the desired outcome. The understanding and application of behavior change theories may result in an effective program to improve awareness and raise intention and thus may increase the potential for success of hand hygiene promotion programs.
Article
Hand hygiene is one of the most effective measures for preventing infections. The annual NHS staff survey in England provides national and local data on how staff feel about working in the NHS. It also provides staff with the opportunity to give their views on the availability of hand-washing materials. The infection prevention and control team at an NHS trust decided a review was required on this issue. This review assessed the availability of hand-washing materials and alcohol handrub on wards and at ward entrances. Three community buildings and 31 wards were reviewed. The audit results showed the availability of hand-washing materials was good in 30 out of 34 areas. Staff on both wards and in the community buildings highlighted what other materials were required for hand hygiene, and steps were made to provide these. The audit allowed hand-hygiene practices to be benchmarked across the trust and increased staff awareness of improving hand hygiene. As a result of this audit, the hand-hygiene compliance score increased from 80% to 95%.
Article
Infections and antimicrobial resistance (AMR) in long-term care facilities (LTCFs) are a public health challenge and a future infectious disease threat. More and more data show the dimension and impact of AMR and of inappropriate use of antimicrobials in this setting. Recently, the spread of carbapenemase-producing Enterobacteriaceae has provided new insights into the dangerous role the long-term care sector may play in the AMR problem in a community. Implementation of effective infection and surveillance control programs in LTCFs is challenging, due to scarce resources (personnel, expertise, diagnostic and supportive services), and no or poor coordination of medical care. However, interventions in LTCFs have been proven to be effective: inappropriate use of antibiotics for asymptomatic bacteriuria may be reduced; hand hygiene compliance may be improved; and the transmission of multidrug-resistant organisms may be halted. This paper reviews the most recent epidemiological information on this issue, providing references to valuable intervention programs.
Article
Background: The anesthesia working area represents an environment with a high density of invasive and, thus, infection-prone procedures. The 2 primary goals of this study were (1) to perform a precise analysis of anesthesia-related hand hygiene (HH) procedures and (2) to optimize HH compliance. Methods: We conducted a prospective, triphase before/after study to determine opportunities for and compliance with hand disinfection (World Health Organization definition) in an anesthesia working area. Standard operating procedures were optimized for invasive procedures during 2 predefined intervention periods to improve work flow practices. Results: Seven hundred fifty anesthesia procedures were evaluated with 12,142 indications for HH. Compliance significantly increased from 10% (465/4,636) to 30% (1,202/4,029) and finally to 55% (1,881/3,477; all P < .001) in phases I, II, and III, respectively. We identified a significant increase in the number of hand rubs performed during 1 anesthesia procedure (2 to 8, respectively; P < .001) in parallel with a significant decrease in number of opportunities needing a hand rub (24 to 14, respectively; P < .0001) because of improved work flow practices. Notably, the greatest improvement was seen before aseptic tasks (8% to 55%, respectively). Conclusion: Our study provides the first detailed data on anesthesia-related and indication-specific HH. Importantly, HH compliance improved significantly without a noticeable increasing workload.
Article
One hospital targeted surgical-site infections, another MRSA, a third CLAUTI, a fourth CLABSI. The results are all remarkable.
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Clin Microbiol Infect ABSTRACT: Implementation of care bundles for prevention of ventilator-associated pneumonia (VAP) and its impact on patient outcomes requires validation with long-term follow-up. A collaborative multi-centre cohort study was conducted in five Spanish adult intensive-care units. A care bundle approach based on five measures was implemented after a 3-month baseline period, and compliance, VAP rates, intensive-care unit length of stay (ICU LOS) and duration of mechanical ventilation were prospectively recorded for 16 months. There were 149 patients in the baseline period and 885 after the intervention. Compliance with all measures after intervention was <30% (264/885). In spite of this, VAP incidence decreased from 15.5% (23/149) to 11.7% (104/885), after the intervention (p <0.05). This reduction was significantly associated with hand hygiene (OR = 0.35), intra-cuff pressure control (OR = 0.21), oral hygiene (OR = 0.23) and sedation control (OR = 0.51). Use of the care bundle was associated with an incidence risk ratio of VAP of 0.78 (95% CI 0.15-0.99). We documented a reduction of median ICU LOS (from 10 to 6 days) and duration of mechanical ventilation (from 8 to 4 days) for patients with full bundle compliance (intervention period). Efforts on VAP prevention and outcome improvement should focus on achieving higher compliance in hand and oral hygiene, sedation protocols and intracuff pressure control.
Article
Haemodialysis patients are at high risk for developing healthcare-associated infections as well as acquiring multidrug-resistant microorganisms. Hand hygiene is considered to be the single most effective tool to prevent healthcare-associated infections. The number of indications and the extent of indication-specific compliance with hand rubs in the haemodialysis setting are currently unknown. We conducted a prospective, three-phase, observational intervention study on hand hygiene during haemodialysis treatments. Optimized hand hygiene standard operating procedures (SOPs) for dialysis connections (Intervention I) and disconnections (Intervention II) were compiled and implemented during two predefined intervention periods. A total of 8897 indications for hand rubs were observed throughout this study. In the course of the study, we identified an increase in the number of hand rubs performed (6-9, mean number per dialysis procedure), parallelled by a decrease in the indications for hand rubs (21-15), resulting in a significant increase of overall hand rub compliance (30-62%). The greatest improvement was seen before aseptic tasks (21-52%), the indication with the greatest impact on preventing healthcare-associated infections. There was no difference between haemodialysis via central venous catheter access or arterio-venous (AV) fistulas. This study provides the first detailed data on the number of and indications for hand rubs during dialysis. An >100% increase in overall hand hygiene compliance could be achieved by a comparably moderate increase in hand rubs performed in combination with optimized hand hygiene SOPs.
An important cause of nonoptimal hand hygiene may be lack of "user friendliness" of hand hygiene resources due to violation of ergonomic principles in the design of the hospital environment and lack of timely replenishment of consumable resources. An ergonomics-based tool, SWAG (for the four main hand hygiene resources-sinks, waste receptacles, alcohol-based hand rub dispensers, and gloves) was developed and implemented to assess the intensive care units and 59 individual rooms in the hospital for structural ergonomic characteristics that facilitate usage of these resources. Several deficiencies in the structural layout of hand hygiene resources were identified that hinder their usage, such as poor visibility, difficulty of access, placement at undesirable height, lack of redundancy, and wide spatial separation of resources that are used sequentially. Consumable hand hygiene resources were often not available because of lack of timely replenishment. Many simple inexpensive changes using ergonomic principles can be implemented to promote hand hygiene in hospitals.
Article
Health care worker hand hygiene (HH) is a major quality and safety concern since poor hand hygiene has been linked with hospital associated infections. Dartmouth-Hitchcock Medical Center has been involved in a 4-year initiative to improve hand hygiene. In 2006, HH compliance occurred 41% of the time and by 2009, it had improved to 91%. We wanted to understand some of the unexplained variability in HH to help determine where to target more specific strategies. To help determine where some of the variability in HH compliance rates occurred, an analysis of means chart was used to determine whether role type of the health care worker and hospital areas had significantly different HH rates compared with the overall HH rate. The overall HH rate between March 2008 and December 2009 was 87%. There was a wide and significant variation between the 16 groups of 2 types of health care workers in 8 hospital areas from the lowest rate of 64% to a high of 96%. Analysis of means revealed significant differences in HH rates relative to the type of worker and hospital areas. Although the method does not inform the organization of what type of intervention will work where and why, it allows high and low performing groups to be identified, so that organizations can learn from them to generate and test theories.
Article
To increase and sustain hospital-wide compliance with hand hygiene through a long-term ongoing multidimensional improvement program emphasizing behavioral factors. Quasi-experimental short study (August 2000-November 2001) and descriptive time series (April 2003-December 2006). A 450-bed teaching tertiary-care hospital. An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital-wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives. A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities;P <.001, compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%-84% of 6,420 opportunities 2 years after hospital-wide dissemination, and remained improved at 59%-81% of 4,990 opportunities during year 6 of the program. This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution-wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.
Article
Despite recognition that implementation of evidence-based clinical practices (EBPs) usually depends on the structure and processes of the larger health care organizational context, the dynamics of implementation are not well understood. This project's aim was to deepen that understanding by implementing and evaluating an organizational model hypothesized to strengthen the ability of health care organizations to facilitate EBPs. CONCEPTUAL MODEL: The model posits that implementation of EBPs will be enhanced through the presence of three interacting components: active leadership commitment to quality, robust clinical process redesign incorporating EBPs into routine operations, and use of management structures and processes to support and align redesign. In a mixed-methods longitudinal comparative case study design, seven medical centers in one network in the Department of Veterans Affairs participated in an intervention to implement the organizational model over 3 years. The network was selected randomly from three interested in using the model. The target EBP was hand-hygiene compliance. Measures included ratings of implementation fidelity, observed hand-hygiene compliance, and factors affecting model implementation drawn from interviews. Analyses support the hypothesis that greater fidelity to the organizational model was associated with higher compliance with hand-hygiene guidelines. High-fidelity sites showed larger effect sizes for improvement in hand-hygiene compliance than lower-fidelity sites. Adherence to the organizational model was in turn affected by factors in three categories: urgency to improve, organizational environment, and improvement climate. Implementation of EBPs, particularly those that cut across multiple processes of care, is a complex process with many possibilities for failure. The results provide the basis for a refined understanding of relationships among components of the organizational model and factors in the organizational context affecting them. This understanding suggests practical lessons for future implementation efforts and contributes to theoretical understanding of the dynamics of the implementation of EBPs.
Article
Hand washing is considered the single most important nosocomial infection-control strategy, yet compliance rarely meets levels recommended by infection control authorities. To determine whether placement of hand hygiene foam dispensers in more conspicuous positions and closer proximity to patients would increase use of infection control agents as measured by volume of product used. Further, to ascertain the influence of dispenser placement vs the number of dispensers available on usage by volume. This prospective, observational study conducted in an intensive care unit was composed of three observation periods. A control period with standard agent dispenser location (8 dispensers) was followed by two experimental periods: (1) "conspicuous and immediate proximity to patient" placement (16 dispensers) and (2) standard locations with a dramatic increase in the number of dispensers (36 dispensers). Results: Volume of use for alcohol-based hand hygiene agent during the three observation periods revealed a statistically significant increase in daily consumption after conspicuous and proximate positioning of dispensers (P<.001). However, increasing the number of dispensers did not increase agent use (P=.196). More conspicuous placement of dispensers containing alcohol-based hand hygiene agent (ie, immediate proximity to patients) resulted in statistically and clinically significant increases in product usage. An increase in the number of dispensers did not increase usage. The impact of dispenser positioning on usage by volume for these highly effective products should be considered when planning and implementing intensive care unit infection-control policies.
Article
Hand hygiene prevents cross-infection in hospitals, but adherence to guidelines is poor among healthcare workers. Although some interventions to improve compliance have been successful, none had achieved lasting improvement until very recently. Reasons for non-compliance with recommendations occur at individual, group and institutional levels. The complexity of the process of behavioural change would suggest that the application of multimodal, multidisciplinary strategies are necessary. Both easy access to hand hygiene in a timely fashion and skin protection appear necessary prerequisites for satisfactory hand hygiene behaviour. Alcohol-based hand-rub may be superior to traditional handwashing as it requires less time, acts faster, irritates hands less often, and recently proved significantly to contribute to sustained improvement in compliance associated with decreased infection rates. This paper reviews barriers to appropriate hand hygiene and describes the results of the first successful experience of sustained hand hygiene promotion and its effectiveness on hospital-acquired infection.
Article
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Article
Transmission of microorganisms from the hands of health care workers is the main cause of health care-acquired infections. Recent studies on bacterial contamination of hands by medical care specialty found the highest bacterial contamination on the hands of health care workers from rehabilitation units. The objective of this study is to determine the effect of a patient education model on hand hygiene (HH) compliance in a rehabilitation unit. A 6-week pre- and post-intervention study with a 3-month follow-up using a patient education model was conducted in a 24-bed inpatient rehabilitation unit located in an acute care hospital. Thirty-five patients were enrolled in the intervention phase of the study after agreeing to ask all health care workers who had direct contact with them, "Did you wash/sanitize your hands?" Compliance with the program was measured through soap/sanitizer usage per resident-day before, during, and after the intervention. Usage increased from 5 HH per resident-day during the preintervention to 9.7 HH per resident-day during the intervention (P <.001), 6.7 HH per resident-day postintervention (6 weeks) (P <.001), and 7.0 HH per resident-day at 3 months (P <.001). Patient education increased HH compliance in an inpatient rehabilitation unit by 94% during the 6-week intervention, 34% during the 6 week post intervention, and 40% at 3-month follow-up. This program empowers patients with responsibility for their own care and provides ongoing HH education.
Article
This report distills our experiences coordinating the installation of a new commercial line of hand hygiene products in a large, integrated health care region in Western Canada into a practical guide that can benefit infection control professionals. Some key considerations while managing such a large hand hygiene products installation are stakeholder collaboration, management of occupational hand dermatitis, housekeeping support, and communication. © 2007 Association for Professionals in Infection Control and Epidemiology, Inc.