An observational study of hand hygiene compliance in paediatric wards

Aims and objectives. To measure healthcare workers’, children’s and visitors’ hand hygiene compliance in a paediatric oncology ward and a paediatric respiratory ward in an English hospital. Background. Children are especially vulnerable to healthcare‐associated infections, yet few studies have reported on hand hygiene compliance in paediatric clinical areas. Design. This was an observational study. Method. We measured hand hygiene compliance over an eight‐hour period in two hospital wards using the ‘five moments of hand hygiene’ observation tool. We monitored a total of 407 hand hygiene opportunities. Results. Overall opportunities for compliance were 74% for healthcare workers (n = 315) and children and visitors 23% (n = 92). Compliance was 84% for allied health professionals, 81% for doctors, 75% for nurses and 73% for ancillary and other staff. Hand hygiene compliance varied depending on which of the five moments of hygiene healthcare workers were undertaking (p < 0·001), with compliance before child contact 90% (140/155); after child contact 78% (89/114); after body fluid exposure 75% (3/4); and after surroundings contact 36% (15/42). For healthcare workers and visitors, there was no evidence of an association between time of day and their hand hygiene compliance, and for visitors to the oncology ward, hand hygiene compliance was higher (p < 0·05). Conclusion. Owing to the nature of the clinical environments, we are unable to draw conclusions about children’s hand hygiene compliance; however, visitors’ compliance was low. Among healthcare workers, levels of compliance were higher compared with previous reported estimates. Relevance to clinical practice. Visitors had the lowest level of compliance yet owing to the nature of the clinical environments, nearly a quarter of care is delivered by them rather than healthcare workers, and so, this offers opportunities for specific future interventions aimed at families and carers.     

Reduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program

Purpose

Healthcare-associated infections (HCAIs) impact 10% of hospitalized patients. Some of these infections result from bacterial cross contamination and poor compliance with guidelines (Pittet D: Compliance with hand disinfection and its impact on hospital-acquired infections. J HospInfect 48 Suppl A:S40-S46, 2001); (Watanakunakorn C, Wang C, Hazy J: An observational study of hand washing and infection control practices by healthcare workers. Infect Control Hosp Epidemiol 19:858-860, 1998). Contamination of provider hands may be a modifiable risk factor. We instituted a novel multimodal system designed to improve hand hygiene by ICU providers.

Materials and Methods

A before and after study design was used to evaluate the impact on the incidence of CRBSI and VAP of a multi-modal program incorporating education, performance feedback, and a body worn hand hygiene device. Compliance was communicated quarterly. Primary outcomes were CRBSIs and VAPs per 1,000 line days or per 1,000 ventilator days and compliance rates. Secondary outcomes were hospital length of stay and mortality.

Results

A total of 1, 262 and 1,331 patients were evaluated during consecutive 12 month periods. VAP per 1000 vent days were significantly reduced after introduction of the program [3.7 vs. 6.9] P < .01. The reduction in CRBSI per 1000 line days was not significant [1.5 vs. 2.6], P = .09. Observed hand hygiene increased during the study period. There was no significant difference in mortality.

Conclusions

A novel multi-modal hand hygiene system resulted in a reduction in VAP. Provider hand contamination during patient care in the ICU is a modifiable risk factor for reducing ventilator associated pneumonias.     

临床护士手卫生依从率的现场调查研究

目的了解护士在临床实践中手卫生的执行情况。方法选择177名临床护士,应用护士手卫生观察记录表,在护士出现第1次手卫生指征后,持续观察20min,记录其手卫生执行情况。结果177名护士平均手卫生依从率为14．9％;依从率较高指征有处理污物后占69．7％,脱手套后占29．3％;护士执行手卫生最常用的方式为洗手占55．3％;影响护士手卫生依从率的因素有：观察时间内手卫生指征出现的次数、学历及工作科室性质。结论护士手卫生依从率较低,相关部门要重视含酒精擦手剂的应用,以提高护士手卫生依从率。     

强化手卫生控制ICU内MRSA感染的效果分析

目的探讨强化手卫生，包括改进医护人员洗手条件，加强洗手教育，提高洗手依从性等措施，对ICU内耐甲氧西林金葡菌（MRSA）感染控制的效果。方法监测分析强化手卫生前后ICU内痰标本MRSA菌株检出率的变化。结果强化手卫生使ICU内痰标本MRSA的检出率从16．9例／1000人天／月降低到9．3（P〈0．05），并且降低的程度与医护人员洗手依从率密切有关。结论强化手卫生对控制ICU内MRSA的医院感染切实有效，而合理安排工作量，加强教育和监督才能提高洗手依从性。     

知-信-行模式在实习护生手卫生培训中的应用

目的探讨知-信-行模式的手卫生培训提高实习护生的手卫生依从性的效果。方法对82名实习护生进行知-信-行模式的手卫生培训,培训前和培训后分别进行手卫生知识考评,并观察日常工作实际手卫生执行情况,检测手卫生合格率。结果培训后实习护生手卫生概念、洗手指征的知晓率分别92．68％,97．56％,均高于培训前46．34％,64．63％,差异有统计学意义（X2值分别为36．03,25．04;P〈0．01）;其他几项手卫生知识知晓率较培训前显著提高,差异有统计学意义（P〈0．01）;护生手卫生依从率从50．92％提高到82．97％,检测合格率从58．54％提高到92．68％,差异均具有统计学意义（X2值分别为316．08,25．92;P〈0．01）。结论知一信一行模式应用于手卫生培训对提高实习护生的手卫生依从性具有良好的效果。     

社区护士手卫生知识知晓情况及影响因素研究

目的 了解社区护士对手卫生知识的知晓率情况,深度分析影响社区护士手卫生的相关因素.方法 采用便利抽样的方法选取长春市的4个行政区,用整群抽样法抽取25家社区卫生机构的252名护士,对手卫生知识进行问卷调查.应用单因素和多元线性回归法对调查结果进行统计学分析.结果 社区护士手卫生知晓率总分为16.73±2.15,单因素分...     

Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit

Nosocomial infections are a significant problem in neonatal intensive care units (NICUs) and hand hygiene (HH) has been stated as an effective mean to prevent spread of infections. The aim of study was to assess the baseline compliance HH practices and to evaluate the impact of hand washing educational programme on infection rate in a NICU. Continuous surveillance of nosocomial infections was done. A total of 15 797 and 12 929 opportunities for HH were observed in pre‐intervention and postintervention phases, respectively. Compliance of health‐care workers for all HH opportunities combined was 46% before intervention and improved significantly to 69% in postintervention (RR 1.49, CI 1.46–1.52, P < 0.0001). Compliance for nurses and doctors was similar. Nosocomial sepsis rate showed a significant decline from 96 per 1000 patient‐days in pre‐intervention to 47 per 1000 patient‐days in postintervention phase (RR 0.44, CI 0.33–0.58, P < 0.0001). We conclude that effective HH practices can serve as an economical and effective nosocomial infection control approach especially important in developing nations.     

护理专业学生手卫生行为教育干预的效果研究

目的研究教育干预对护生手卫生知识及手卫生状况的影响。方法选取卫生学校护理专业二年级123名学生为研究对象,施行教育干预的措施,对干预前、干预后情况进行调查、评价。结果干预后学生手卫生知识明显改善,正确6步洗手法合格率和手卫生监测合格率均显著提高（P〈0.01）。结论对卫生学校护理专业学生开展手卫生行为教育早期干预,可以减少护生进入临床实习及工作后,由于手卫生不良医院感染的发生率,在实习前进行手卫生知识规范培训是可行的、有效的。     

手卫生干预措施提高新生儿重症监护室手消毒依从性的观察与效果

目的研究提高新生儿重症监护室的手消毒依从性。方法建立手卫生干预措施,并用视频监测手段观察干预前后共13个月的各类接触。结果实施手卫生干预措施后手消毒依从性从25．15％上升为88．20％;培训后护理员的手消毒依从性较医生和护士低,夜间护士和护理员的手消毒依从性低于白班（P〈0．01）。结论手卫生干预措施能有效提高手消毒的依从性。     

Physician report cards and rankings yield long-lasting hand hygiene compliance exceeding 90?%

IntroductionHand hygiene is an effective, low-cost intervention that prevents the spread of multidrug-resistant bacteria. Despite mandatory education and reminders, compliance by physicians in our hospital remained stubbornly low. Our objective was to study whether surveillance by our unit coordinator (secretary) paired with regular feedback to chiefs of service would increase physician hand hygiene compliance in the ICU.MethodThe ICU unit coordinator was trained to observe and measure hand hygiene compliance. Data were collected on hand hygiene compliance at room entry and exit for 9 months. Percentage compliance for each medical and surgical subspecialty was reported to chiefs of service at the end of each month. Comparative rankings by service were widely distributed throughout the physician organization and the medical center.ResultsThe hand hygiene compliance rate among physicians increased from 65.1 % to 91.6 % during the study period (p <0.0001). More importantly in the succeeding 24 months after study completion, physician hand hygiene compliance remained >90 % in every month.ConclusionsPhysician hand hygiene compliance increased as a consequence of the surveillance conducted by a full-time ICU team member, leading to a highly significant increase in the number of observations. In turn, this allowed for specific comparative monthly feedback to individual chiefs of service. Over the next 2 years after the study ended, these gains were sustained, suggesting an enduring culture change in physician behavior.     

The new dirt on hand hygiene

Brown et al.'s (2003) study supported that the use of alcohol-based hand rubs would improve hand hygiene compliance and decrease the incidence of cross-infection. The results of this study can be used to support a group research utilization project that would educate nurses about the use of alcohol-based hand rubs as an effective technique for hand hygiene. Feasibility issues could include cost of the antiseptic and dispensers, placement of dispensers in relation to patient care, and education sessions with the nurses on how and when to use the antiseptic. Future research could be done to examine various nations' compliance with hand hygiene through use of a alcohol-based hand rubs, while also using a more discrete means of observation.     

护理人员手卫生知识和对手卫生设施需求调查

目的 了解护理人员手卫生知识掌握情况和对手卫生设施的需求,为提高护理人员手卫生依从性提供依据.方法 采用自行设计的问卷对135名临床护士进行调查,内容包括手卫生知识测评、手卫生执行状况自评和对洗手设施的需求.结果 95.6%的护理人员能够掌握六步洗手法,31.9%对洗手的时间不明确,对先洗手、后进行手卫生消毒的指征掌握情况最差;22.2%的护士每天手卫生行为超过50次;导致护理人员手卫生依从性低的最主要原因有担心洗手液伤害皮肤、工作忙碌,顾不上洗手、洗手设施不够充足;对洗手设施的需求主要为干手纸巾和非接触式水龙头.结论 医院应采取宣传、培训、考核、监督等联合干预策略强化手卫生知识和意识,提供必要的手卫生设施,切实提高手卫生行为的依从性.     

Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit

OBJECTIVE: To determine whether electronic monitoring of hand hygiene and voice prompts can improve hand hygiene and decrease nosocomial infection rates in a surgical intermediate care unit. DESIGN: Three-phase quasi-experimental design. Phase I was electronic monitoring and direct observation; phase II was electronic monitoring and computerized voice prompts for failure to perform hand hygiene on room exit; and phase III was electronic monitoring only. SETTING: Nine-room, 14-bed intermediate care unit in a university, tertiary-care institution. All patient rooms, utility room, and staff lavatory were monitored electronically. PARTICIPANTS: All healthcare personnel including physicians, nurses, nursing support personnel, ancillary staff, all visitors and family members, and any other personnel interacting with patients on the intermediate care unit. All patients with an intermediate care unit length of stay >48 hrs were followed for nosocomial infection. INTERVENTIONS: Electronic monitoring during all phases, computerized voice prompts during phase II only. MEASUREMENTS AND MAIN RESULTS: We evaluated a total of 283,488 electronically monitored entries into a patient room with 251,526 exits for 420 days (10,080 hrs and 3,549 patient days). Compared with phase I, hand hygiene compliance in patient rooms improved 37% during phase II (odds ratio, 1.38; 95% confidence interval, 1.04-1.83) and 41% in phase III (odds ratio, 1.41; 95% confidence interval, 1.07-1.84). When adjusting for patient admissions during each phase, point estimates of nosocomial infections decreased by 22% during phase II and 48% during phase III; when adjusting for patient days, the number of infections decreased by 10% during phase II and 40% during phase III. Although the overall rate of nosocomial infections significantly decreased when combining phases II and III, the association between nosocomial infection and individual phase was not significant. CONCLUSIONS: Electronic monitoring provided effective ongoing feedback about hand hygiene compliance. During both the voice prompt phase and post-intervention phase, hand hygiene compliance and nosocomial infection rates improved suggesting that ongoing monitoring and feedback had both a short-term and, perhaps, a longer-term effect.     

Hand hygiene compliance and behavioural determinants in a paediatric intensive care unit: An observational study

Background

Hand hygiene is considered the single most effective means of reducing healthcare-associated infections, but improving and sustaining hand hygiene compliance remains a great challenge.

基于PDSA循环实施手卫生观察APP的应用效果评估

[目的]基于PDSA循环探讨手卫生观察APP的应用对手卫生依从性和数据统计时间的影响。[方法]根据PDSA(plan,do,study,act)循环设计实验过程。基于“WHO手卫生观察监督表”开发手卫生观察APP,对医务人员手卫生执行情况进行观察,观察结果实时上传至手卫生网站进行自动存储与统计。比较采用此方法前后医务人员手卫生依从性的变化以及医院感染管理人员在手卫生数据统计分析方面花费时间的变化情况。[结果]医务人员手卫生依从性在试验前后分别为78.57%和52.38%,差异有统计学意义(P<0.001);医院感染管理人员在试验前后统计分析手卫生数据月均花费时间分别为(196.67±15.28)min和(105.00±18.03)min,差异有统计学意义(P<0.001)。[结论]采用手卫生观察APP技术对医务人员手卫生行为进行观察隐蔽性好,能够明显降低霍桑效应对观察结果的影响,观察到的依从性更加客观真实。同时,采用互联网自动进行数据传输、存储和统计能够明显减少医院感染管理人员的统计分析时间,提高工作效率。     

Factors influencing the provision of oral hygiene care following stroke: an application of the Theory of Planned Behaviour

Objectives: This study aimed to examine “intention to” and “performance of” oral hygiene care to stroke patients using the Theory of Planned Behavior.

Materials and methods: A large scale survey of 13 centers in Malaysia was conducted involving 806 nurses in relation to oral hygiene care intentions and practices. In addition, information on personal and environmental factors was collected.

Results: The response rate was 95.6% (778/806). The domains of the Theory of Planned Behavior were significantly associated with general intention to perform oral hygiene care: attitudes (β?=?0.21, p?p?p?p?<0.01), controlling for other factors. Knowledge scores, training, access to oral hygiene guidelines and kits, as well as working ward type were identified as key factors associated with intention and practice of oral hygiene care.

Conclusion: The Theory of Planned Behavior provides understanding of “intention to” and “performance of” oral hygiene care to stroke patients. Several provider and environmental factors were also associated with intentions and practices. This has implications for understanding and improving the implementation of oral hygiene care in stroke rehabilitation.

• Implications for Rehabilitation

• Oral hygiene care is crucial for stroke patients as it can prevent oral health problems and potentially life threatening events (such as aspiration pneumonia).

• Despite oral hygiene care being relative simple to perform, it is often neglected during stroke rehabilitation.

• A large-scale national survey was conducted to understand “intentions to” and “performance of” oral hygiene care to stroke patients using the Theory of Planned Behavior social cognition model.

• These study findings may have implications and use in promoting oral hygiene care to stroke patients:i) by understanding the pathways and influences to perform oral hygiene care.ii) to conduct health promotion and health education based on behavioral models such as Theory of Planned Behavior.

     

护理人员手卫生认知及洗手行为的调查分析

了解我院护理人员对手卫生的认知情况、洗手行为现状及其影响因素,为提高护理人员手卫生状况提供参考。方法：采用问卷调查方式对我院120名临床护理人员进行手卫生认知、行为的调查,并对结果进行分析。结果：19．17％的护理人员掌握洗手方法,50．83％的人员了解;16．67％的护理人员掌握洗手指征,64．17％的人员了解;高达90％的护理人员对手卫生相关知识不清楚;63．33％的人员不清楚自我防护知识。护理操作前42．50％的护理人员从不洗手;完成操作后68．33％的人员能做到每次洗手;80．oo％的护理人员在每次接触患者体液、血液、污染物后按时洗手;51．67％的护理人员能在工作结束下班前洗手,仅9．17％的人员从不洗手。结论：医护人员应加强洗手意识及对洗手卫生知识的学习,医院加强对洗手的管理,根据当地实际条件改善洗手设施,坚持正确洗手,从而避免经手传播医院感染的发生。     

Long-Term Risk for Readmission,Methicillin-Resistant Staphylococcus aureus (MRSA) Infection,and Death among MRSA-Colonized Veterans

While numerous studies have assessed the outcomes of methicillin-resistant S. aureus (MRSA) colonization over the short term, little is known about longer-term outcomes after discharge. An assessment of long-term outcomes could provide information about the utility of various MRSA prevention approaches. A matched-cohort study was performed among Veterans Affairs (VA) patients screened for MRSA colonization between the years 2007 and 2009 and followed to evaluate outcomes until 2010. Cox proportional-hazard models were used to evaluate the association between MRSA colonization and long-term outcomes, such as infection-related readmission and crude mortality. A total of 404 veterans were included, 206 of whom were MRSA carriers and 198 of whom were noncarriers. There were no culture-proven MRSA infections on readmission among the noncarriers, but 13% of MRSA carriers were readmitted with culture-proven MRSA infections on readmission (P < 0.01). MRSA carriers were significantly more likely to be readmitted, to be readmitted more than once due to proven or probable MRSA infections, and to be readmitted within 90 days of discharge than noncarriers (P < 0.05). Infection-related readmission (adjusted hazard ratio [HR] = 4.07; 95% confidence interval [CI], 2.16 to 7.67) and mortality (adjusted HR = 2.71; 95% CI, 1.87 to 3.91) were significantly higher among MRSA carriers than among noncarriers after statistically adjusting for potential confounders. Among a cohort of VA patients, MRSA carriers are at high risk of infection-related readmission, MRSA infection, and mortality compared to noncarriers. Noncarriers are at very low risk of subsequent MRSA infection. Future studies should address whether interventions such as nasal or skin decolonization could result in improved outcomes for MRSA carriers.     

Assessment of two hand hygiene regimens for intensive care unit personnel

OBJECTIVE: To compare skin condition and skin microbiology among intensive care unit personnel using one of two randomly assigned hand hygiene regimens: a 2% chlorhexidine gluconate (CHG)-containing traditional antiseptic wash and a waterless handrub containing 61% ethanol with emollients (ALC). DESIGN: Prospective, randomized clinical trial. SETTING: Two critical care units (medical and surgical) in a large, metropolitan academic health center in Manhattan. SUBJECTS: Fifty staff members (physicians, nurses, housekeepers, respiratory therapists) working full time in the intensive care unit. INTERVENTIONS: One of two hand hygiene regimens randomly assigned for four consecutive weeks. MEASUREMENTS AND MAIN RESULTS: The two outcomes were skin condition (measured by two tools: Hand Skin Assessment form and Visual Skin Scaling form) and skin microbiology. Samples were obtained at baseline, on day 1, and at the end of wks 2 and 4. Participants in the ALC group had significant improvements in the Hand Skin Assessment scores at wk 4 (p = 0.04) and in Visual Skin Scaling scores at wks 3 (p = 0.01) and 4 (p = 0.0005). There were no significant differences in numbers of colony-forming units between participants in the CHG or ALC group at any time period. The ALC regimen required significantly less time than the CHG regimen (mean: 12.7 secs and 21.1 secs, respectively; p = 0.000) and resulted in a 50% reduction in material costs. CONCLUSIONS: Changes in hand hygiene practices in acute care settings from the traditional antiseptic wash to use of plain, mild soap and an alcohol-based product should be considered. Further research is needed to examine the association between use of antiseptic products for hand hygiene of staff and reductions in nosocomial infection rates among patients.