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Effective hand hygiene education with the use of flipcharts in a hospital in El Salvador
Abstract
In developing countries, continuing education for healthcare staff may be limited by staff shortages and lack of sophisticated means of delivery. These limitations have implications for compliance with an important infection control practice, namely good hand hygiene. A comparison was made between the efficacy of two educational tools commonly used in healthcare and practical sanitation settings in developing countries, i.e. videotapes and flipcharts, in delivering hand hygiene education to 67 nurses in a paediatric hospital in El Salvador. Efficacy was measured on the basis of scores obtained in pre- and post-training tests consisting of 10 multiple-choice questions. Half of the nurses received video-based instruction and half received instruction via flipcharts. Both methods of instruction increased participants' knowledge of good hand hygiene, and the extent of knowledge acquisition by the two methods was similar. Feedback obtained from flipchart users six months after training indicated that most of the respondents used the flipchart to teach hand hygiene to patients' families (62.5%), patients (50%) and healthcare workers (43.8%). Flipchart users ranked flipcharts as their favourite educational tool. Flipcharts offer an economical, easy-to-use, non-technological yet effective alternative to videotapes for delivering education in developing countries. Although the use of flipcharts requires a skilled and well-trained instructor, flipcharts could be used more widely to deliver education in resource-poor settings.
... In brief, the 16 selected unique studies assess primary outcomes before-and-after measures and one was an interrupted time-series design. 34 Three studies presented secondary outcomes measured before and after the intervention, [35][36][37] and one of the measured is several months after training. 38 Studies were published between 1993 and 2018 and covered a unique training intervention see (Table 3, Supplemental Digital Content 2, http:// links.lww.com/JCEHP/A137). ...
... 38 Studies were published between 1993 and 2018 and covered a unique training intervention see (Table 3, Supplemental Digital Content 2, http:// links.lww.com/JCEHP/A137). [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Targeted trainers were mostly nurses (n = 10) 36,[38][39][40][41]43,44,[47][48][49] and physicians (n = 5), 35,37,40,42,49 and one study involved county rescue squads. 35 ...
... 38 Studies were published between 1993 and 2018 and covered a unique training intervention see (Table 3, Supplemental Digital Content 2, http:// links.lww.com/JCEHP/A137). [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Targeted trainers were mostly nurses (n = 10) 36,[38][39][40][41]43,44,[47][48][49] and physicians (n = 5), 35,37,40,42,49 and one study involved county rescue squads. 35 ...
Introduction:
Train-the-trainer (TTT) programs are frequently used to facilitate knowledge dissemination. However, little is known about the effectiveness of these programs. Therefore, we sought to assess the impact of TTT programs on learning and behavior of trainers for educating health and social professionals (trainees).
Methods:
Guided by the Cochrane Effective Practice and Organisation of Care, we conducted a systematic review. We searched 12 databases until April 2018 and extracted data according to the Population, Intervention, Comparison, Outcome model. Population was defined as trainers delivering training program to health care professionals, and the intervention consists in any organized activity provided by a trainer. There were no restrictive comparators, and outcomes were knowledge, attitude, skill, confidence, commitment, and behavior of trainers. We estimated the pooled effect size and its 95% confidence interval using a random-effect model. We performed a narrative synthesis when meta-analysis was not possible.
Results:
Of 11,202 potentially eligible references, we identified 16 unique studies. Studies were mostly controlled before-and-after studies and covered a unique training intervention. Targeted trainers were mostly nurses (n = 10) and physicians (n = 5). The most frequent measured outcome was knowledge (n = 12). TTT programs demonstrated significant effect on knowledge (Standardized mean deviation = 0.58; 95% CI = 0.11-1.06; I2 = 90%; P < .01; 10 studies). No studies measured trainers' ability to deliver the training program.
Discussion:
TTT programs may improve the knowledge of trainers. However, the heterogeneity and small number of studies hamper our ability to draw conclusions that are more robust.
... Jude) has worked with clinicians worldwide to improve care capacity and prevent infections in children with cancer. 4,5 These efforts focused on strengthening suboptimal ICP programs in hospitals with PCCs, conducting specific subject training, and hosting clinical observerships of selected healthcare professionals. 4,6 A well-trained healthcare workforce is an essential component of programs seeking to increase access to care. ...
... St. Jude Global Academy-infectious disease training: timeline and components of distance and in-person learning.Caniza et al5 ...
Background
Skilled healthcare professionals are critical for providing quality healthcare for children with cancer globally. Training curricula addressing the knowledge needs in infection care and prevention (ICP) in cancer are scarce.
Program description
We implemented a 10-week blended course in ICP. The distance learning had four 2-week modules: Infectious Complications, Quality in Infection Care, Quality in Infection Prevention, and Sustainability, Research, and Dissemination. Each module had pre- and post-tests and weekly webinars. The 2-week in-person learning had lectures, group exercises, clinical observations, hospital and laboratory tours, and ended in an annual conference. An individual project developed during the distance learning was presented in the in-person workshop. Course attendance criteria were English language proficiency and participants’ role in ICP at their institutions.
Program evaluation and results
Twenty-two students from 17 hospitals in 10 countries completed the course, developed a project, and answered surveys covering knowledge assessments and satisfaction, and 6-month course and 1-year project follow-ups. Pretest and post-test scores revealed knowledge improvement ( P < .001). Participants rated the distance learning as outstanding (63%) or good (28%); and the in-person as outstanding (87%). In the follow-up survey, graduates felt more comfortable at managing infections and participated more in quality improvement and academics at their institutions. Seventeen participants (77%) took steps to implement their study projects, and 9 were successful. Collaboration and networking of trainees were notable outcomes.
Discussion
The ICP course is a resource to improve knowledge, engage graduates in network collaborations, and a reliable model to develop other thematic healthcare global training programs.
... Anketat dhe studimet tek PSH kanë treguar se informatat valide dhe njohuritë për higjienën e duarve ndikojnë në praktikat e mira. 335,814,[818][819][820] Kjo është në përputhje me zbulimin që fuqia e informatës është fuqia me ndikimin social më të madh në kontrollin e infeksionit. 821 Një program edukimi që ofron fakte të sakta është i domosdoshëm për të arritur sukses. ...
... Në shumë studime, promovimi i higjienës së duarve nëpërmjet një strategjie multimodale, duke përfshirë fidbekun e të dhënave lokale në HCAI dhe praktikave të higjienës së duarve ishte një element thelbësor i seancave edukative dhe përbënte bazën për motivimin e stafit për përmirësimin e performancës së tyre. 60,494,657,663,714,716 Për të lehtësuar procesin e fillmit të projektit dhe zbatimin e mëtejshëm të aktiviteteve 705,820,834 është shumë e rëndësishme të sigurohet që seksionet e trajnimit të jenë të shoqëruara dhe të mbështetutra nga materialet edukative, siç janë përmbledhja e udhërrëfyesit, fletëpalosje, broshura, fleta informative dhe tabela. ...
... i hygienutbildningssyfte inom sjukvården i utvecklingsländer. Båda instruktionsmetoderna ledde till ökad kunskap om betydelsen av god handhygien och visade sig vara ungefär lika effektiva. Deltagarna i studien sade sig föredra utbildningsblocksmetoden eftersom denna gav mer utrymme till diskussion och inte krävde tillgång till teknisk utrustning. Caniza et.al. (2007) tillägger att även om kunskap och medvetenhet finns, kan handhygienen brista på grund av otillräckliga resurser, så som handfat, desinfektionsmedel, samt svagt stöd från ledningen. ...
... att aktiva försök att förändra hygienstandarden är endast möjliga genom medvetenhet och motivation. För detta krävs sakenlig utbildning vilket inte behöver kosta särskilt mycket eller vara tidskrävande. Odlingsplattor (AGA-plattor) kan till exempel användas som ett redskap för att påvisa vikten av god hygien på ett verkligt och handgripligt sätt. Caniza et.al. (2007) framhåller att enkla medel såsom utbildningsblock och gruppdiskussioner är lika effektivt som videoband och dessutom mer lättåtkomligt då dessa inte kräver någon teknisk utrustning. ...
... Visual images, the use of health educators, and face-to-face interaction is more effective at improving knowledge than printed brochures, particularly for low literacy audiences (Powe, Ntekop, & Barron, 2004). When utilized appropriately, such approaches can improve knowledge and are costeffective, especially in resource-poor settings (Caniza, Maron, Moore, Quintana, & Liu, 2007;Kim et al., 2005;Van Rompay et al., 2008). In Australia, flipcharts have been used to deliver health messages to Aboriginal people on diabetes foot care, petrol sniffing, dementia, sexual health, mental health, oral hygiene and eye health (Queensland Health, 2008;Watson, Obersteller, Rennie, & Whitbread, 2001) and as part of other interventions. ...
... Also, those that had undertaken C N C N C N C N Volume 46, Issue 1, December 2013 © eContent Management Pty Ltd ensuring the delivery of health education to Aboriginal people. Provision of training or workshopping health educational resources is crucial to ensure they are understood and utilized appropriately (Caniza et al., 2007;Kim et al., 2005). The challenge of producing and distributing resources for use with minority groups is even greater when the health issue concerned is not regarded a priority health 'need' for that community. ...
Background:
A culturally relevant educational flipchart targeting Aboriginal people was distributed across Western Australia to support education on bowel cancer screening and encourage participation in the National Bowel Cancer Screening Program.
Methods:
Respondents sampled from the flipchart distribution list were surveyed on the appropriateness, usefulness, and the extent to and manner in which they used the flipchart for educating Aboriginal clients.
Results:
Despite praising the resource, few respondents used the flipchart as intended for various reasons, including the view that Aboriginal health education was the responsibility of Aboriginal health workers.
Conclusions:
Greater recognition by all health service providers is needed of their potential role in Aboriginal health education. Promoting a national health program of under-appreciated importance for a marginalised population is challenging. Effective utilisation of an educational tool is predicated on factors beyond its production quality and wide dissemination. Intended users require awareness of the underlying problem, and adequate time for and specific training in implementation of the tool.
... Diet education for patients and families in LMICs is complicated by low literacy, limited availability of trained personnel, and a lack of materials (81). To provide successful education for low-literacy patients and caregivers, culturally appropriate instruments and pictorialbased material must be developed; this has been successfully done in several LMICs (82)(83)(84). To ensure that food provision and nutrition education are prioritized in LMIC cancer centers, research should be conducted to demonstrate if these low-cost and low-resource measures can effectively improve body composition and clinical outcomes. ...
There is a striking disparity in survival rates for children in low- and middle-income countries (LMICs) compared with high-income countries (HICs). Many of the contributing factors are preventable, including the comorbidity of malnutrition. There are emerging data that malnutrition, as reflected in body composition changes, impacts survival of cancer. However, not enough priority is given to nutrition management of children with cancer, particularly in LMICs. The primary purpose of this article is to review the current knowledge on childhood cancer and body composition in LMICs and identify priorities for future research into the interlinking associations between cancer, body composition, and clinical outcomes for childhood cancer patients. Evidence will ensure feasible and effective nutrition management is prioritized in childhood cancer centers in LMICs and contribute to improving outcomes for children with cancer.
... Three different educational instruments were used, as well as a lecture and printed educational tools in the form of a flip chart and pamphlet, with the intention to deliver a systematically structured and repetitive education on community sharp disposal in an interactive way. This locally adapted module with user-friendly instruments helped diabetic patients to absorb the information and thus resulted in a better understanding of it [14,40,41]. On top of that, the intervention session was conducted face-to-face between the researcher and the patients, which further enhanced the two-way communication [14,21,42]. ...
Background: Structured education is needed to cultivate safe sharp disposal behavior among diabetic patients. Thus, this study aimed to assess the effectiveness of the Diabetes Community Sharp Disposal Education Module in improving knowledge and sharp disposal practice among Malaysian Type 2 diabetic patients. Methods: This quasi-experimental study was conducted at primary health clinics in two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. A total of 132 Type 2 diabetic patients on insulin therapy were involved, with 68 participants in each control and intervention group. The health education intervention was based on the validated Diabetes Community Sharp Disposal Education Module. The knowledge and practices were measured using a validated questionnaire at baseline, one month, and three months after the intervention. Results: There was a significant increment in the mean knowledge score for intervention group; from baseline to one month follow up and from baseline to three months follow up [Greenhouse-Geisser; F(1.5, 199.7) = 62.38, p < 0.001; effect size (η2) = 0.318]. Intervention group had significantly higher mean knowledge score as compared to control group; at one month and three months follow up [F(1, 134) = 17.38, p < 0.001; effect size (η2) = 0.115]. There was a statistically significant increment in the proportion of participants in the intervention group who practiced the proper community sharp disposal method over time, X2(2) = 52.061, p < 0.001. Conclusions: The Diabetes Community Sharp Disposal Education Module was an effective health education tool to improve knowledge and encourage Malaysian diabetic patients to engage with proper sharp disposal practices.
... Studies showed that flipchart was an effective tool in poor resource setting for health education. [18] This could capture the student's interest and be a motivation for the positive behavior changes expected in them. Based on the evidence of the impact of using posters on imparting knowledge, a poster was also given for each school that had the key points of the module. ...
Background:
Schools are the best setting for health promotion activities, and in India, for many, the schools are in fact the only nurturing and supportive place where they learn health information and have positive behavior consistently reinforced. Therefore, health promotion addressing the nutrition and personal hygiene habits among school children would improve health of school children and mold them into healthy productive citizens of tomorrow.
Objectives:
The objective of the study is to find the effectiveness of multi-strategic health screening cum educational intervention model in promoting the health of school children.
Methods:
A school-based intervention was designed using multi-strategic approach to promote the health of 2500 school children in 13 schools in rural Coimbatore. Logic model was used to plan the intervention, and the approach included health screening, nutrition and personal hygiene assessment and educational intervention in three phases over a period of 1 year. The multi-strategic approach comprised of approach through doctors, teachers, and through peer educators. The effectiveness of the intervention was assessed with improved nutrition and personal hygiene habits, improved body mass index status, and reduction in sickness absenteeism.
Results:
There was a significant improvement in nutrition and personal hygiene habits among school children. There was also significant reduction in the proportion of underweight category. Furthermore, a slight increase in sickness absenteeism was observed.
Conclusion:
Our study shows evidently that a multi-strategic health screening cum educational intervention model can be implemented and can be effective in bringing changes in the nutrition and personal hygiene habits thereby promoting the health of school children.
... [8] Flipcharts are a practical media for providing educational material, which can be done simply and does not need complicated strategies, nor any electricity when using it. [17] The advantages here are booklets can be stored longer, can be read back during leisure time, and the reader also can adjust and learn independently. [18] The booklet is also a media for nurses to provide information about healthy food for their patients who are the school age children. ...
Background: Knowledge and attitudes towards healthy food intake influence the growth and development of school-aged children. Cangkringan district of Yogyakarta, Indonesia was the worst area affected by the Mount Merapi eruption in 2010 and has a long-term consequence of less healthy food available for school-age children. This study aimed to determine the effect of health education to increase knowledge and attitudes towards healthy food intake for elementary school children at Cangkringan.
Methods: Respondents of this study were 338 elementary school children (134 boys and 204 girls, ages between 8-10 years old) at Cangkringan. There were 20 elementary schools involved and participants were divided into 36 groups to make small groups of 6 to 8 students. Interventions of this study involved serial health education via ‘learning with fun’ approach using a student-centered learning method. The authors developed all tools and instruments based on the guidelines from The Food and Agriculture Organization (FAO). We analyzed the knowledge and attitude of the subjects after administering a pre and posttest using paired t-test and Wilcoxon range test.
Results: The results showed significant increase of knowledge and attitudes towards healthy food intake (p < .001 for both knowledge and attitude) of all subjects in this study.
Conclusions: Health education using ‘learning with fun’ method may increase knowledge and attitudes of elementary school children. Furthermore, a series of cooking-classes as a student-centered learning approach, which emphasized contextual, collaborative and constructive methods of learning served well to increase motivation and satisfaction of the students to learn about healthy food.
... Evidence suggests that baseline knowledge and knowledge gain after educational intervention varies with job category and perhaps years of experience. 9,10,[24][25][26] In our study using CNAs as baseline, nurses and rehabilitation personnel scored better in pretests, whereas environmental services staff scored lower. In a survey of HCP in France, baseline knowledge about hand hygiene and usefulness of alcoholbased hand hygiene was higher in physicians when compared with other HCP. 9 The benefits of traditional educational methods may also vary with job category. ...
Background:
The purpose of this study was to assess effectiveness of an interactive educational program in increasing knowledge of key infection prevention and control (IPC) principles with emphasis on indwelling device care, hand hygiene, and multidrug-resistant organisms (MDROs) among nursing home (NH) health care personnel (HCP).
Methods:
We conducted a multimodal randomized controlled study involving HCP at 12 NHs. Ten comprehensive and interactive modules covered common IPC topics. We compared intervention and control scores to assess differences in pretest scores as a result of field interventions, pre- and post-test scores to assess knowledge gain, and magnitude of knowledge gain based on job categories.
Results:
We conducted over 200 in-services across 10 topics at six intervention sites over 36 months. There were 4,962 tests returned over the course of the study, ranging from 389-633 per module. Participants were mostly female certified nursing assistants (CNAs). Score improvement was highest for modules emphasizing hand hygiene, urinary catheter care, and MDROs (15.6%, 15.9%, and 22.0%, respectively). After adjusting for cluster study design, knowledge scores were significantly higher after each educational module, suggesting the education delivery method was effective. When compared with CNAs, nursing and rehabilitation personnel scored significantly higher in their knowledge tests.
Conclusions:
Our intervention significantly improved IPC knowledge in HCP, especially for those involved in direct patient care. This increase in knowledge along with preemptive barrier precautions and active surveillance has enhanced resident safety by reducing MDROs and infections in high-risk NH residents.
... Evidence suggests that baseline knowledge and knowledge gain after educational intervention varies with job category and perhaps years of experience. 9,10,[24][25][26] In our study using CNAs as baseline, nurses and rehabilitation personnel scored better in pretests, whereas environmental services staff scored lower. In a survey of HCP in France, baseline knowledge about hand hygiene and usefulness of alcoholbased hand hygiene was higher in physicians when compared with other HCP. 9 The benefits of traditional educational methods may also vary with job category. ...
With changing health care delivery, patients receive care at various settings including acute care hospitals, nursing homes, outpatient primary care and specialty clinics, and at home, exposing them to pathogens in various settings. Various health care settings face unique challenges, requiring individualized infection control programs. Infection control programs in nursing homes should address surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs.
... The Cure4Kids Digital Library offers users full-text access to medical journals and textbooks, including Principles and Practice of Pediatric Oncology (Pizzo & Polack, 2006), a leading reference textbook. The digital library contains downloadable patient education material (Caniza et al., 2007) and relevant links to additional patient education materials in several languages. ...
The Cure4Kids Website (www.Cure4Kids.org) brings the latest medical knowledge and continuing education on the treatment of pediatric catastrophic diseases to thousands of health care providers worldwide. The website offers a digital library, on-demand seminars with slides and audio in several languages, and online meeting rooms for international collaborations. In this paper, we describe the design challenges of the Cure4Kids Website as an online learning and collaboration center, including the web interface design, content organization, and usability. The solutions to these design challenges may help other web designers facing similar issues in the design of international web-based projects.
... Several additional studies using education as a key element of the intervention have been published since those included in these systematic reviews [23][24][25][26][27][28][29][30][31][32]. Similar to previous studies, different educational strategies were used, often more than one, and some had also other integrated interventions. ...
The education of healthcare workers is essential to improve practices and is an integral part of hand hygiene promotional strategies. According to the evidence reviewed here, healthcare worker education has a positive impact on improving hand hygiene and reducing healthcare-associated infection. Detailed practical guidance on steps for the organization of education programmes in healthcare facilities and teaching-learning strategies are provided using the World Health Organization (WHO) Guidelines for Hand Hygiene in Health Care as the basis for recommendations. Several key elements for a successful educational programme are also identified. A particular emphasis is placed on concepts included in the tools developed by WHO for education, monitoring and performance feedback.
... E-learning was also investigated by Bryce et al. (2008) who reported high rates of user satisfaction and effective transferral of knowledge to practice. In a less developed country (El Salvador), Caniza et al. (2007) reported that there were less sophisticated methods of educational delivery. There was still a difference in multiple choice responses between staff receiving education by video and those by flip chart. ...
This paper discusses a literature review which was undertaken prior to a research study about student nurses' and midwives' experiences of learning infection control in clinical practice. Its aim is to identify the role of education in the prevention and control of infection, with a specific focus on compliance with infection control precautions and reduction in infection rates. It also identifies the methods used for teaching infection control. The review concludes that there is no rigorous and convincing evidence that education improves compliance with infection control precautions or reduces rates of infection, particularly in the long-term. Areas for future research are identified.
... The St. Jude Infectious Diseases-International Outreach Program (ID-IOP) has previously provided training to the IC staff. 8,9 To facilitate effective infrastructure improvement and assessment, a local HH program coordinator was hired to act as liaison among the alcohol gel vendor, the hospital staff who maintain ABHH stations, users, the IC program, and St. Jude. ...
Resource-poor hospitals have many barriers to proper hand hygiene (HH). Alcohol-based HH can compensate for inadequate infrastructure and supplies. We describe the implementation of alcohol-based HH in five high-risk wards of a pediatric hospital in El Salvador.
In 5 high-risk wards for nosocomial infections, we evaluated the accessibility, supplies, and cleanliness of the hand-washing sinks at 132 time points. We then installed gel dispensers, identified a local gel supplier, and trained nursing staff to maintain the dispensers. We evaluated user acceptance, costs, and the practice and technique of HH before and after installation.
Access and cleanliness were adequate at 18.9% and 11.3% of observation points, and towels and soap were available at 61.3% and 93.18% of points. Placement of 35 gel dispensers increased the ratio of HH stations to beds from 1:6.2 to 1:1.8. Alcohol gel was better tolerated than hand washing among 60 surveyed staff. Installation cost $2558 (US) and the monthly gel supply, $731 (US). HH practice increased from 33.8% to 40.5%; use of correct technique increased from 73.8% to 95.2%.
Alcohol gel can address some of the barriers to effective HH at resource-poor institutions, and its cost may be offset by reduction of nosocomial infection.
... El yıkama ile ilgili bilgi ve beceri eğitiminin çocuklarda özellikle toplu yerlerde yaşayanlarda erken yaşlarda verilmesi uygundur. Ayrıca; el yıkama gibi davranışların öğrenilmesi sürecinde "beceri eğitimlerinin" yapılması ve bu eğitim kapsamında çeşitli araç-gereçlerin de kullanılması (video, flip-chart) önerilmektedir (12). Bu çalışmada da kullanılmış olan video gösterimi, çoğunlukla destekleyici bir gereç olarak kullanılmaktadır (13). ...
BACKGROUND: In this intervention study which competency based training approach was used, it was aimed to determine behaviors of 6-14 years of age children about hand hygiene and to change their hand-washing skills in the positive way after the training. METHODS: Ninety children participated in the study (participation rate= %88.2). A standard check-list was used for both training and evaluation of the behaviors. The data were processed and statistically analyzed with the SPSS for Windows 15.0 software. Mc Nemar and chi square tests were used for analysis of the data. RESULTS: Mean age of the children was found to be 9.76±2.02. Fifty six point seven percent of the participants were females and 43.3% of them were males. Nine out of ten steps of the hand washing check-list was found higher in percentage among participants in the post-training evaluation compared to the pre-training assessment (p<0.05). CONCLUSION: Hand washing training is recommended for the children at younger ages especially in the settlements where communities live. [TAF Prev Med Bull. 2008; 7(1): 65-70]
... The IOP-ID also provides educational assistance to any interested international healthcare provider, especially those at St. Jude partner sites. Assistance (such as case consultations and guidance in establishing or improving infection control programs) is provided through online meetings, 5 e-mail, educational materials, 6 and online lectures and conferences available via the Cure4Kids Web site. 7 Web-based training. ...
The lack of well-trained, dedicated infection control personnel prevents optimal control of nosocomial infections in Latin American pediatric oncology centers. We collaboratively planned and implemented a multinational training course in San Salvador, El Salvador, to address this need.
The course relied on its organizers' experience in training international healthcare providers, the availability of the International Training Center for Nurses, previous infection control collaboration with the Hospital Nacional de Ninos Benjamin Bloom, and resources available at the University of El Salvador. The 4-week course consisted of lecture sessions combined with practical laboratory and hospital experience.
Two courses, one conducted in 2005 and one in 2006, trained 44 professionals from 15 Latin American countries. Evaluations showed that course content and teacher performance met the trainees' needs and that all trainees acquired the necessary knowledge and skills.
The course met the need for the training of Latin American infection control practitioners. Our experience can serve as a model for other organizations interested in strengthening infection control and prevention at international sites.
Kehamilan dengan HIV (Human Immunodefisiensy Virus) merupakan penyakit menular. Hasil studi pendahuluan yang dilakukan masih banyak ibu hamil yang belum melakukan tes HIVdan kurangnya pengetahuan ibu hamil.Untuk itu perlu diberikan informasi mengenai Eliminasi penularan HIV dari Ibu ke Anak. Penelitian ini bertujuan untuk mengetahui perbedaan pengetahuan ibu hamil sebelum dan sesudah diberikan pendidikan kesehatan menggunakan media flipchart di Desa Brosot Wilayah Puskesmas Galur I Kabupaten Kulon Progo. Penelitian ini menggunakan rancangan one group pretest-posttest. Populasi dalam penelitian ini adalah seluruh ibu hamil trimester I di Desa Brosot yang berjumlah 30 orang. Pengembilan sampel menggunakan Sampling Jenuh berjumlah 30 orang yang terbagi menjadi 15 orang kelompok eksperimen dan 15 orang kelompok kontrol. Instrumen yang digunakan yaitu flipchart dan kuesioner tentang Eliminasi Penularan HIV dari Ibu ke Anak. Hasil penelitian menunjukkan ada pengaruh yang signifikan antara pendidikan kesehatan terhadap pengetahuan ibu hamil tentang penularan HIV dari ibu ke anak dengan menggunakan media flipchart di Desa Brosot Wilayah Puskesmas Galur I Kabupaten Kulon Progo dengan hasil uji Z pada kelompok control menunjukkan Z hitung sebesar -2,781 pada signifikansi 0,000 (sig.p < 0,05) sedangkan pada kelompok eksperimen terdapat peningkatan pengetahuan nilai Z test dari hasil pengujian ialah -2,761 dengan asymp.sig sebesar 0,005 (asymp.sig < 0,05). Tenaga Kesehatan dapat memberikan informasi kepada ibu hamil tentang Penularan HIV dari Ibu ke Anak, agar ibu hamil dapat melakukan pemeriksaan sedini mungkin/pada Trimester I. Kata kunci : HIV, Flipchart,ibu hamil.
This chapter describes participatory processes among an indigenous group in Panama, the Ngäbe-Buglé people, to develop appropriate health education and promotion interventions and increase the acceptability and positive impact of educational interventions. We illustrate how the application of formative research—focus groups, community visits, and meetings with institutional stakeholders and community key leaders—provides necessary information to develop a health education intervention responding to the Ngäbe-Buglé health-related learning needs, including prenatal care, working with lay midwives, and detection of high-risk pregnancies. Community participants identified the main health priorities—hygiene, nutrition, healthy environments, prenatal care, the role of the lay midwife in the community, and domestic violence. Most of these are relevant to reduce disease burden and mortality rates, mainly pregnancy issues in poor rural settings. Responding to the Ngäbe-Buglé needs, the material included community pictures with local residents and trained 78 health promoters at a centralized location in the Comarca. During the active phase of the project, community health promoters reached over 8000 people at their remote communities, ten times higher than anticipated! Community involvement and participation resulted in community empowerment and adoption of the project. The Ngäbe-Buglé community has continued to implement the intervention, and 6 months after its conclusion, they reported reaching over 11,000 people in their communities. We conclude that inclusion of community members, community participation to develop appropriate educational material, and reinforcement of empowerment is an effective manner to reach indigenous communities with health-related messages, including pregnancy, prenatal care, and the role of the midwife.
Introduction:
The Australian Aboriginal and Torres Strait Islander (Aboriginal) population has a higher age-standardised cancer mortality rate and a significantly lower 5-year survival rate for all cancers than the non-Aboriginal population. Aboriginal people from regional and remote South Australia and the Northern Territory, are often required to travel to Adelaide to access specialist cancer care services. The burden and expenses associated with transport and accommodation and cultural and linguistic factors have been identified as barriers to accessing medical treatment and health services. In collaboration with community and stakeholders, Cancer Council South Australia led the development of the Cancer Healing Messages flipchart and patient flyer to assist health professionals in explaining cancer and the cancer journey to Aboriginal cancer patients and their families. This study examined the usage, acceptability and perceived usefulness of the resources, barriers to uptake, and strategies to improve their utilisation and sustainability.
Methods:
An evaluation survey was conducted among Aboriginal Health Workers (AHWs) and other health professionals working with Aboriginal clients in South Australia (n=18). Participants indicated whether they agreed that the resources are valuable, culturally appropriate, helpful for explaining aspects of cancer to Aboriginal cancer patients, and useful with regard patient outcomes, how frequently they used or would use the resources for information, and how they use the flipchart in practice. Participants were also asked to report any usage barriers.
Results:
The resources were considered useful, valuable and culturally appropriate by almost all participants; however, there was a discrepancy between intentions to use the resources and actual uptake, which was low. The most commonly reported barriers related to appropriateness for certain patients and lack of availability of resources in some contexts.
Conclusion:
The Cancer Healing Messages flipchart and patient flyer are perceived as appropriate, valuable, and useful tools for AHWs. A long-term strategy and clear implementation plan involving education, training and promotion of the materials, is required to achieve broad reach and sustainable utilisation of the Cancer Healing Messages flipchart and patient flyer.
Purpose: In this study, it was aimed to improve the hand washing behaviors of a group of secondary school students. Material and Methods: The study group comprised of 212 secondary school students (6th, 7th and 8th grades) in the catchment area of Yeşiltepe Health Care Center in November 2006. Onehundredand eightyfour students participated in this study (participation rate= 86.7%). The students were divided into "intervention" and "control" groups. A checklist including 10 steps was used to evaluate the hand washing behaviors of the students. .Before and after. assessment was applied for analyzing the success of the intervention. McNemar and chi square tests were used for data analysis. Results: There was no statistically significant difference between the age, gender, having sibling, family type, education status of parents between intervention and control groups. Students in the intervention group did five out of 10 steps in the check list successfully compared to the students in the control group. There was no statistically significant difference between control and intervention groups in terms of hand washing steps before the training whereas the groups differed after the training. Conclusion: The students. hand washing skills were increased. Skill-based training methods are recommended to be used for teaching.
Contaminated hands, particularly those of healthcare-workers (HCWs), are among the most common transmission route for many pathogens. Hand hygiene is the primary measure to prevent the spread of a variety of pathogens, especially those causing healthcare-associated infections (HAI). However, compliance with hand hygiene measures remains around 40% among HCWs. Promotion strategies based on multimodal interventions can lead to HCWs' behavioral change and improvement of hand hygiene practices. Essential elements of successful multimodal strategies recommended in the recent WHO Guidelines on Hand Hygiene in Health Care are: a) provision of effective, well-tolerated alcohol-based handrubs; b) staff education; c) monitoring of hand hygiene compliance and feedback performance; d) reminders in the workplace; and e) the implementation of an institutional patient safety climate. Studies published over the last decade have demonstrated the effectiveness of hand hygiene promotion to reduce the occurrence of HAI.
Issue addressed:
Flipcharts are widely used as education tools in Indigenous health but there is no published quantitative data on their use. As respiratory illness is the most frequent reason for hospitalisation of young children, we developed culturally sensitive flipcharts to educate carers of children on the 3 most common serious respiratory illness (bronchiolitis, pneumonia and bronchiectasis) affecting Indigenous children in the Northern Territory. In this study, we aimed to determine if use of these flipcharts improved the knowledge of these respiratory conditions among carers of Indigenous children admitted to the Royal Darwin Hospital.
Methods:
We assessed the knowledge of 60 carers pre- and post-flipchart education using a questionnaire. Pre- and post-flipchart education scores for the three illnesses were combined and were compared using non-parametric analyses.
Results:
Most carers were mothers (n = 43, 72%) aged between 20-40 years (n = 54, 90%) and lived in a remote community (n = 53, 88%). Knowledge of all respiratory conditions improved post education: median scores pre = 8 (Interquartile range 6, 10); post = 12 (10, 14), P = < 0.0001.
Conclusions:
The use of culturally appropriate educational flipcharts improves the knowledge of respiratory conditions among carers of Indigenous children hospitalised with common serious respiratory illness. SO WHAT? In the first paediatric quantitative study on the use of flipcharts as a means of providing health education to Indigenous Australians, we have shown that the use of culturally-appropriate flipcharts is an effective method of providing health education.
Objective
To estimate the impact of educational intervention on hand washing and gloves use.
Healthcare waste (HCW) management and segregation are essential to ensure safety, environmental protection and cost control. Poor HCW management increase risks and costs for healthcare institutions. On-going surveillance and training are important to maintain good HCW practices. Our objectives were to evaluate and improve HCW practices at Hospital Bloom, San Salvador, El Salvador. We studied HCW disposal practices by observing waste containers, re-segregating waste placed in biohazardous waste bags, and administering a seven-itemsknowledge survey before and after training in waste management at Hospital Bloom. The training was based on national and international standards. We followed total biohazardous waste production before and after the training. The hospital staff was knowledgeable about waste segregation practices, but had poor compliance with national policies. Re-segregating waste in biohazardous waste bags showed that 61% of this waste was common waste, suggesting that the staff was possibly unaware of the cost of mis-segregating healthcare waste. After staff training in HCW management, the correct responses increased by 44% and biohazardous waste disposal at the hospital reduced by 48%. Better segregation of biohazardous waste and important savings can be obtained by HCW management education of hospital staff. Hospitals can benefit from maximising the use of available resources by sustaining best practices of HCW, especially those in hospitals in lower-middle-income countries.
Background:
Printed educational materials are widely used passive dissemination strategies to improve the quality of clinical practice and patient outcomes. Traditionally they are presented in paper formats such as monographs, publication in peer-reviewed journals and clinical guidelines.
Objectives:
To assess the effect of printed educational materials on the practice of healthcare professionals and patient health outcomes.To explore the influence of some of the characteristics of the printed educational materials (e.g. source, content, format) on their effect on professional practice and patient outcomes.
Search methods:
For this update, search strategies were rewritten and substantially changed from those published in the original review in order to refocus the search from published material to printed material and to expand terminology describing printed materials. Given the significant changes, all databases were searched from start date to June 2011. We searched: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), HealthStar, CINAHL, ERIC, CAB Abstracts, Global Health, and the EPOC Register.
Selection criteria:
We included randomised controlled trials (RCTs), quasi-randomised trials, controlled before and after studies (CBAs) and interrupted time series (ITS) analyses that evaluated the impact of printed educational materials (PEMs) on healthcare professionals' practice or patient outcomes, or both. We included three types of comparisons: (1) PEM versus no intervention, (2) PEM versus single intervention, (3) multifaceted intervention where PEM is included versus multifaceted intervention without PEM. There was no language restriction. Any objective measure of professional practice (e.g. number of tests ordered, prescriptions for a particular drug), or patient health outcomes (e.g. blood pressure) were included.
Data collection and analysis:
Two review authors undertook data extraction independently, and any disagreement was resolved by discussion among the review authors. For analyses, the included studies were grouped according to study design, type of outcome (professional practice or patient outcome, continuous or dichotomous) and type of comparison. For controlled trials, we reported the median effect size for each outcome within each study, the median effect size across outcomes for each study and the median of these effect sizes across studies. Where the data were available, we re-analysed the ITS studies and reported median differences in slope and in level for each outcome, across outcomes for each study, and then across studies. We categorised each PEM according to potential effects modifiers related to the source of the PEMs, the channel used for their delivery, their content, and their format.
Main results:
The review includes 45 studies: 14 RCTs and 31 ITS studies. Almost all the included studies (44/45) compared the effectiveness of PEM to no intervention. One single study compared paper-based PEM to the same document delivered on CD-ROM. Based on seven RCTs and 54 outcomes, the median absolute risk difference in categorical practice outcomes was 0.02 when PEMs were compared to no intervention (range from 0 to +0.11). Based on three RCTs and eight outcomes, the median improvement in standardised mean difference for continuous profession practice outcomes was 0.13 when PEMs were compared to no intervention (range from -0.16 to +0.36). Only two RCTs and two ITS studies reported patient outcomes. In addition, we re-analysed 54 outcomes from 25 ITS studies, using time series regression and observed statistically significant improvement in level or in slope in 27 outcomes. From the ITS studies, we calculated improvements in professional practice outcomes across studies after PEM dissemination (standardised median change in level = 1.69). From the data gathered, we could not comment on which PEM characteristic influenced their effectiveness.
Authors' conclusions:
The results of this review suggest that when used alone and compared to no intervention, PEMs may have a small beneficial effect on professional practice outcomes. There is insufficient information to reliably estimate the effect of PEMs on patient outcomes, and clinical significance of the observed effect sizes is not known. The effectiveness of PEMs compared to other interventions, or of PEMs as part of a multifaceted intervention, is uncertain.
Healthcare associated infections (HCAI) are huge problem all over the world, and 5-10% of all hospitalized patients will develop infection during hospitalization. From the times of I. P. Semelweiss we know that clean hands are the most important single factor that can decrease the number of HCAI. World Health Organization (WHO) has recognised this problem and developed Guidelines for hand hygiene in healthcare institutions. This also was the reason of developing Croatian national Guidelines. The main goal of the Guidelines was to decrease number of HCAI associated with the hands of healthcare workers. These Guidelines are meant for all healthcare workers and other hospital staff who come to the direct contact with patients. An interdisciplinary team of experts developed these Guidelines using WHO Guidelines, other existing guidelines and literature reviews for hand hygiene. Grades of evidence for specific recommendations were determined using CDC/HICPAC grading system. Categorization is based on existing data, theoretical basis, applicability and economic impact. After a broad discussion in different professional societies, Guidelines were accepted. Guidelines include recommendations for hand hygiene indications, hand hygiene technique, surgical hand preparation, choosing hand hygiene preparations, skin care, nails, glove use, patients and visitors hand hygiene, role of education, as well as role of healthcare institution and role of government. Furthermore, in the Guidelines the concept of "Five moments for hand hygiene" is explained in detail, and main literature data are presented.
The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative. The Guidelines represent the contribution of more than 100 international experts and provide a comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensus-based recommendations, and lessons learned from testing their Advanced Draft and related implementation tools.
To estimate the impact of educational intervention on hand washing and gloves use.
The educational intervention consisted of a one-hour weekly workshop aimed at doctors and nurses, with a previous questionnaire on hand-washing, a presentation talk on three key points (hand washing, use of gloves, alcohol-based solutions). Adherence to hand washing and use of gloves was re-evaluated 6-9 months after the intervention.
We conducted 34 workshops for 296 health care workers, 239 (80.4%) women and 57 (19.6%) men, with an average age of 40.1 years (range, 18-62 years). Most were nurses (41.2%), nursing assistants (37.8%) and physicians (8.2%). Compliance to hand washing ranged between 29% and 87%. The gloves were used in maneuvers not indicated (19% before giving meals and a 27.7% when performing an ECG). Compliance with hand washing 6-9 months after the workshop improved significantly (p < 0.05) in three of the 5 items. The use of gloves was not significantly different. The intensity of the intervention was inversely related to the incidence of nosocomial infections (RR for every 100 workers intervened in the previous month = 0.89; 95% CI, 0.789-1.003; p = 0.057).
The training workshops had a positive impact on hand washing compliance, but there was no significant change in the use of gloves. The introduction of education has an inverse relationship to the incidence of nosocomial infections.
Survival of preterm and low birth weight neonates in increasingly advanced neonatal units has resulted in the rising incidence of healthcare-associated infections. This paper reviews recent trends in infection and its prevention in neonatal intensive care units.
Emerging pathogens in the developed world are predominantly Gram positive of which coagulase-negative staphylococci are the commonest organisms, accounting for 45-75% of all late-onset bloodstream infections. In the developing world, Gram-negative pathogens have persisted, but there is an increasing incidence of coagulase-negative staphylococci there too. Both settings have reported increases in multiresistant organisms including Candida spp. Interventions to combat these infections include renewed efforts to educate healthcare staff, national surveillance programmes and the use of prophylaxis against Candida spp. Despite many interventions, outbreaks continue to occur in both resource-rich and resource-poor settings and many lessons remain to be learnt by reviewing these reports.
Good infection control remains the mainstay of prevention of healthcare-associated infections in neonatal intensive care units. Whether in resource-rich or resource-poor settings, the key issues are emerging multiresistant pathogens and education of healthcare staff about prevention of infection particularly in preterm and low birth weight infants.
The frequency of handwashing in two intensive care units (ICUs) was observed. Handwashing after direct contact with patients or their support equipment was recorded. The ratio of beds to sinks was 1:1 in the medical ICU and 4:1 in the surgical ICU. Surveillance of physicians, nurses, and other personnel demonstrated a greater frequency of handwashing by nurses (63%) compared with physicians (19%) and other personnel (25%). The nurses in the unit with one sink per bed had a significantly greater number of handwashes (76%) than those in the unit with fewer sinks (51%).
This paper proposes an extension of generalized linear models to the analysis of longitudinal data. We introduce a class of
estimating equations that give consistent estimates of the regression parameters and of their variance under mild assumptions
about the time dependence. The estimating equations are derived without specifying the joint distribution of a subject's observations
yet they reduce to the score equations for niultivariate Gaussian outcomes. Asymptotic theory is presented for the general
class of estimators. Specific cases in which we assume independence, m-dependence and exchangeable correlation structures from each subject are discussed. Efficiency of the pioposecl estimators
in two simple situations is considered. The approach is closely related to quasi-likelihood.
Handwashing is the single most important procedure in the prevention of nosocomial infections and yet it remains the most violated of all infection control procedures. With a sequential intervention study in an intensive care unit we have demonstrated that poor handwashing practices are associated with a high nosocomial infection rate, whereas good handwashing practices are associated with a low nosocomial infection rate. An educational and enforcement program designed to improve handwashing procedures can significantly reduce endemic nosocomial infection rates.
Interpatient transfer of microorganisms by the hands of medical personnel is a well-known cause of hospital-acquired infection. Although handwashing is regarded as one of the most important measures in preventing nosocomial infections, it is frequently not done or ineffectively performed after patient contact. The purpose of this study was to determine the frequency and duration of handwashing in a neonatal intensive care unit (NICU).
The frequency of handwashing in two intensive care units (ICUs) was observed. Handwashing after direct contact with patients or their support equipment was recorded. The ratio of beds to sinks was 1:1 in the medical ICU and 4:1 in the surgical ICU. Surveillance of physicians, nurses, and other personnel demonstrated a greater frequency of handwashing by nurses (63%) compared with physicians (19%) and other personnel (25%). The nurses in the unit with one sink per bed had a significantly greater number of handwashes (76%) than those in the unit with fewer sinks (51%).
Factors that are important in influencing individuals to wash or not wash their hands were studied in 193 health care personnel. The most important factor favoring handwashing (HW) was the prevention of spread of infection among patients; the most important factor against HW was busy-ness. Physicians reported HW significantly less frequently than did nurses (p = 0.04). Individuals who washed infrequently, less than eight times per day, placed significantly more value on detrimental effects of frequent HW on their own skin and on the HW practices of their work colleagues than did individuals who washed frequently, more than 16 times per day (p less than 0.005). Frequent and infrequent washers did not differ significantly in their values regarding the factors favoring HW. Identifying factors that are determinants of whether one decides to wash one's hands or not are important in planning intervention strategies to improve practice. It appears that more emphasis should be placed on minimizing deterrents (especially detrimental effects on skin and peer pressure) rather than on emphasizing the importance of HW.
Handwashing is the most important and least expensive measure to prevent transmission of nosocomial infections. However, compliance rarely exceeds 40% under study conditions. Alcoholic hand disinfection (AHD) generally is used in Europe. In contrast, handwashing with medicated soap is practiced most frequently in the United States. Healthcare workers often explain the failure to comply with handwashing or AHD as due to the limited time available for this practice. We calculated a time consumption for handwashing and AHD in a representative model intensive-care unit with 12 healthcare workers, based on different compliance levels (40%, 60%, and 100%), duration of handwashing (40-80 seconds), and AHD (20 seconds). Comparing the extremes of our model, given 100% compliance, handwashing consumes 16 hours of nursing time per day shift, whereas AHD from a bedside dispenser requires only 3 hours (P = .01). We conclude that 100% compliance with handwashing may interfere with patient care and parltly explains the low compliance. In contrast, AHD, with its rapid activity, superior efficacy, and minimal time commitment, allows 100% healthcare-worker compliance without interfering with the quality of patient care.
It is well-known that Ignác Semmelweis discovered the etiology and prophylaxis of puerperal sepsis. However, few historians have focused on his understanding of the pathophysiology of fetal and neonatal sepsis. Based on several key observations, Semmelweis realized that puerperal fever (also known as "childbed fever") could be transmitted to the fetus, especially when the first stage of labor was prolonged and multiple examiners performed vaginal examinations while their fingers were contaminated. This insight was particularly valuable in that it helped him decipher the mystery of puerperal sepsis. This paper presents some of these concepts and supporting evidence.
Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel.
We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant.
We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001).
The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
Handwashing is widely accepted as being key to the prevention of hospital-acquired infection but the frequency of handwashing by healthcare workers has been found to be low. A systematic critical literature review was conducted to establish the effectiveness of interventions aimed at increasing compliance with handwashing in healthcare workers. The results showed that one-off educational interventions have a very short-term influence on handwashing behaviour. Use of strategically placed reminders, or asking patients to remind staff of the need to conduct handwashing can have a modest but more sustained effect. Feedback of performance can increase levels of handwashing but if feedback is not repeated regularly, then this effect is not maintained over long periods. Automated sinks increase the quality of handwashing but healthcare workers can be discouraged from using these because of the additional time involved. Provision of moisturized soaps appears to make little difference to handwashing behaviour but providing 'dry' hand rubs near patient beds may lead to a minimal increase in the frequency with which staff decontaminate their hands. Multifaceted approaches which combine education with written material, reminders and continued feedback of performance can have an important effect on handwashing compliance and rates of hospital-acquired infection.
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.
Patients admitted to hospitals are at risk of acquiring nosocomial infections. Many peer-reviewed studies show that handwashing (HW) significantly reduces hospital infections and mortality. Our objective was to evaluate the effects of HW by health care workers (HCW) before contact with patients in 3 Argentinean hospitals. We performed an observational study of HCW to measure the effect of 2 interventions: education alone and education plus performance feedback.
A total of 3 hospitals were studied for adherence to a HW protocol. The observed HCW included physicians, nursing personnel, and ancillary staff. After initial observations to establish baseline rates of HW (phase 1), we evaluated the effect of education alone (phase 2), followed by education plus performance feedback (phase 3). We also evaluated the relationship between the administrative support and HW adherence.
We observed 15,531 patient contacts in 3 hospitals. The baseline rate of HW before contact with patients was 17%. With education, HW before contact with the patients increased to 44% (relative risk 2.65; 95% confidence interval 2.33-3.02; P <.001). Using education and performance feedback HW further increased to 58% (relative risk 1.86; 95% confidence interval 1.38-2.51; P <.001). In the private hospitals where administrative support for the HW program was significantly greater, HW compliance was significantly higher (logistic regression analysis: odds ratio 5.57; 95% confidence interval 5.25-6.31; P <.001).
In this study, HW policies and education of HCW significantly improved HCW adherence to the HW protocol, however, when performance feedback was incorporated, the HW compliance increased to a greater degree. We identified that administrative support provides a positive influence in efforts to improve HW adherence.
The purpose of our study was to examine the effectiveness of general health-promotion teaching for patients in the waiting room of a clinic, using focused videotape instruction.
An experimental design was used.
Subjects were patients (N = 215) in the waiting rooms of clinics in a university medical center in the Midwest.
Patients were randomly assigned to two groups: focused videotape instruction in the clinic (n = 106) and control (no instruction in the clinic waiting area) (n = 109). The outcome measures included patient learning about a health education topic and patient satisfaction with overall care, explanations by the provider, and education received during the clinic visit.
There was a significant gain in knowledge for patients who viewed the videotape in the waiting room (t = 5.43, df = 213, p < .0001), and they were more satisfied with their education compared with the control group (t = 4.73, df = 213, p < .0001).
This study supports focused video instruction as an effective and efficient teaching intervention for disseminating health information in the waiting area.
International trade and travel have rendered political and geographic boundaries irrelevant when it comes to diseases. HIV and SARS are among the more recent examples of deadly viruses that spread swiftly from one continent to the next before international health experts can identify them, much less begin to search for a cure. This snapshot of global health issues looks at payer systems from a cross section of nations, lists the world's eight most infectious diseases and their rate of incidence by region, and pays special attention to the shortage of health care workers, which has reached crisis proportions in many areas and is pitting nation against nation in the competition for qualified staff.
The Healthcare Infection Control Practices Advisory Committee released hand hygiene guidelines recommending that hospitals educate personnel to increase compliance with hand hygiene. However, few educational tools are available to assist hospitals in this effort. Eight hospitals were recruited to implement hand hygiene educational tools. Key informant interviews were conducted with infection control professionals (ICPs) at 5 participating hospitals. Lack of personnel time was the primary barrier to implementing the educational tools. Multimodal, prepackaged educational tools are needed to decrease barriers and facilitate implementation of interventions locally by ICPs.
Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the
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Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/ SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002;23(Suppl.):S3eS40.
Frequency and duration of handwashing in a neonatal intensive care unit
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