Impact of observation and analysis methodology when reporting hand hygiene data

ArticleinThe Journal of hospital infection 77(4):358-9 · February 2011with4 Reads
DOI: 10.1016/j.jhin.2010.12.008 · Source: PubMed
    • "We used the WHO observation method, as this facilitates comparison between studies. The method is comprehensive and covers more HHOs than other methods that usually measure HH only before and after a procedure [60]. This becomes evident when we change from observing before and after a procedure to including all " My five moments for hand hygiene " . "
    [Show abstract] [Hide abstract] ABSTRACT: More knowledge is needed about task intensity in relation to hand hygiene in the operating room during anesthetic care in order to choose effective improvement strategies. The aim of this study was to explore the indications and occurrence of hand hygiene opportunities and the adherence to hand hygiene guidelines during routine anesthetic care in the operating room. Structured observational data on hand hygiene during anesthetic care during 94 surgical procedures was collected using the World Health Organization's observational tool in a surgical department consisting of 16 operating rooms serving different surgical specialties such as orthopedic, gynecological, urological and general surgery. A total of 2,393 opportunities for hand hygiene was recorded. The number of hand hygiene opportunities when measured during full-length surgeries was mean = 10.9/hour, SD 6.1 with an overall adherence of 8.1%. The corresponding numbers for the induction phase were, mean =77.5/h, SD 27.4 with an associated 3.1% adherence to hand hygiene guidelines. Lowest adherence was observed during the induction phase before an aseptic task (2.2%) and highest during full-length surgeries after body fluid exposure (15.9%). There is compelling evidence for low adherence to hand hygiene guidelines in the operating room and thus an urgent need for effective improvement strategies. The conclusion of this study is that any such strategy should include education and practical training in terms of how to carry out hand hygiene and aseptic techniques and how to use gloves correctly. Moreover it appears to be essential to optimize the work processes in order to reduce the number of avoidable hand hygiene opportunities thereby enhancing the possibilities for adequate use of HH during anesthetic care.
    Full-text · Article · Feb 2015
    • "Hand touch sites with the highest risk to patients are those which are next to the patient, for example, bedrails , lockers, over bed tables and door handles [22]. This instinctive tendency toward privileging of oneself rather than toward patient protection has been identified repeatedly232425 . It is mandatory to tailor programs in the future to show HCWs their actual behavior and responsibilities and to call for accountability with regard to patient safety. "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this study is to measure the degree of compliance with hand hygiene practices among health-care workers (HCWs) in intensive care facilities in Aseer Central Hospital, Abha, Saudi Arabia, before and after a multimodal intervention program based on WHO strategies. Data were collected by direct observation of HCWs while delivering routine care using standardized WHO method: “Five moments for hand hygiene approach”. Observations were conducted before (February–April 2011) and after (February–April 2013) the intervention by well-trained, infection-control practitioners during their routine visits. The study included 1182 opportunities (observations) collected before and 2212 opportunities collected after the intervention. The overall, hand hygiene compliance increased significantly from 60.8% (95% CI: 57.9–63.6%) before the intervention to reach 86.4% (95% CI: 84.9–97.8%) post-intervention (P = 0.001). The same trend was observed in different intensive care facilities. In logistic regression analyses, HCWs were significantly more compliant (aOR = 3.2, 95% CI: 2.6–3.8) after the intervention. Similarly, being a nurse and events after patient contact were significant determinants of compliance. It is important to provide sustained intensified training programs to help embed efficient and effective hand hygiene into all elements of care delivery. New approaches like accountability, motivation and sanctions are needed.
    Full-text · Article · Jun 2014
    • "Indeed, in the field of HH evaluation, it is necessary to use indicators for benchmarking or for evaluation of campaigns [15]. All indicators could be biased: HH compliance measured by observation could also be biased if different methods of observation or analysis are used [16]. Local customs can also interfere: interpretation of five moments of the WHO guidelines seems to differ between services , for example, or encouraging the use of products by patients and visitors can increase consumption [17]. "
    [Show abstract] [Hide abstract] ABSTRACT: The 3ml volume currently used as the hand hygiene (HH) measure has been explored as the pertinent dose for an indirect indicator of HH compliance. A multicenter study was conducted in order to ascertain the required dose using different products. The average contact duration before drying was measured and compared with references. Effective hand coverage had to include the whole hand and the wrist. Two durations were chosen as points of reference: 30s, as given by guidelines, and the duration validated by the European standard EN 1500. Each product was to be tested, using standardized procedures, by three nosocomial infection prevention teams, for three different doses (3, 2 and 1.5ml). Data from 27 products and 1706 tests were analyzed. Depending on the product, the dose needed to ensure a 30-s contact duration in 75% of tests ranging from 2ml to more than 3ml, and to ensure a contact duration exceeding the EN 1500 times in 75% of tests ranging from 1.5ml to more than 3ml. The aftermath interpretation is the following: if different products are used, the volume utilized does not give an unbiased estimation of the HH compliance. Other compliance evaluation methods remain necessary for efficient benchmarking.
    Full-text · Article · Dec 2012
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