Maximising handwashing rates in the critical care unit through yearly performance feedback (original) (raw)
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Measuring handwashing performance in health service audits and research studies
Journal of Hospital Infection, 2007
Handwashing is regarded as the most effective way of controlling healthcare-associated infection. A search of the literature identified 42 intervention studies seeking to increase compliance in which the data were collected by directly observing practice. The methods used to undertake observation were so poorly described in most studies that it is difficult to accept the findings as reliable or as valid indicators of health worker behaviour. Most studies were limited in scope, assessing the frequency of handwashing in critical care units. The ethical implications of watching health workers during close patient contact were not considered, especially when observation was covert or health workers were misinformed about the purpose of the study. Future studies should take place in a range of clinical settings to increase the generalizability of findings. Observation should be timed to capture a complete picture of 24 h activity and should include all health workers in contact with patients because all have the potential to contribute to cross-infection. Reported details of observation should include: vantage of data collectors; inter-rater reliability when more than one individual is involved; and attempts to overcome the impact of observation on usual health worker behaviour. Ideally an additional data collection method should be used to corroborate or refute the findings of observation, but no well-validated method is presently available.
2012
Introduction: Achieving a sustained improvement in hand-hygiene compliance is the WHO's first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness. Methods: Three year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%). Results: All 16 trusts (60 wards) randomised, 33 wards implemented intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all wards) accounting for confounders, temporal trends, ward type and fidelity to intervention (forms/month used).
Predictors of compliance handwashing practice among healthcare professionals
Healthcare infection, 2011
Background: Handwashing compliance among healthcare professionals is the most important recommended practice to combat hospital-associated infections. However, compliance rates with handwashing practices remain low, particularly among physicians. Objectives: The purpose of this study was to determine the application status of handwashing information given within the context of infection control measures in practice areas; and also to determine the need for inclusion of more in-depth information about handwashing and identifying the predictors for handwashing compliance in relation to knowledge, behaviour, beliefs, and attitude by healthcare professionals. Methods: This study was a cross-sectional survey. The target population was all healthcare professionals, including physicians, nurses and technicians, working in large acute-care hospitals in Amman, Jordan. However, medical and nursing students were excluded. Results: The results showed a predictive model of five predictors which were significantly related to self-reported handwashing: beliefs about outcomes, attitude, referent beliefs, control beliefs and skin assessment. These factors have a comparable power in the prediction of self-reported handwashing. Attitude, control beliefs and skin assessment had relatively higher prediction effects (B = 0.406, P < 0.001), (B = 0.296, P < 0.000), (B = 0.523, P < 0.000), respectively, compared with intention (B =-0.233, P = 0.102) and years of experience (B =-0.078, P = 0.576). Conclusion: The results of this study have important implications for improving healthcare professionals' compliance with handwashing through continuous education for those providers to reinforce and educate them about the concepts of universal precautions and guidelines of infection control.
American Journal of Infection Control, 2004
Background: Implementation of a hand hygiene promotion program in a large university hospital required that we find a suitable method to assess health care workers' (HCWs) hand hygiene practices. This study aims at comparing direct observation and selfassessment methods. Methods: Hand hygiene practices of 206 HCWs (physicians, nurses, and nurse assistants) in 25 care units were directly observed by trained auditors for 1 day. A week later, 1050 HCWs filled out a self-assessment questionnaire on their compliance with handwashing indications (participation rate was 83%). Results: Average global self-reported compliance rate (SRR) after patient care was similar to the observed rate (OBR) (74%). According to the type of care, differences between SRR and OBR were nonsignificant, except for change of infusion bag by nurses and nursing care by nurse assistants. Physicians and nurse assistants tended systematically to over evaluate their compliance, whereas nurses tended to under evaluate their compliance with hand hygiene recommendations. Conclusions: Mean compliance rates were higher than those reported in the literature but varied as a function of patient care activity and occupation of the HCW. A reinforced in-service educational program will be implemented that will target especially physicians and medical students. Self-assessment method, easy to use and inexpensive, gave encouraging results. The development of a broad-based, routine, self-assessment program is underway at Nantes University Hospital, but, before such a program can be implemented, reproducibility of these self-assessment indicators must be further confirmed.
Background. In 2005, WHO developed the campaign " Clean care is safer care " , aiming at the reduction of Healthcare Associated Infections (HCAI) through the worldwide promotion of appropriate hand hygiene practices. Adherence to these practices presently ranges from 5 to 81% (average 40%). Methods. Aim of the study was the evaluation of healthcare workers (HCWs) adherence to the application of WHO guidelines on the hand hygiene and the possible impact on HCAI reduction. First, some wards at highest HCAI risk were identified. Then, direct observational survey was conducted to evaluate the behaviour of the different HCW categories. Results. Six-hundred-twenty-eight HCWs were observed: 519 nurses (68 in training), 109 physicians (63 in training). Survey analysis highlighted that compliance with handwashing was higher in post care practices (59.6%) than before (55.1%). Some HCWs performed handwashing in both cases. Only in 30.6% of cases HCWs observed the handwashing technique suggested by the guidelines. In 70.4% they wore gloves during procedures in which it was possible to have contact with potentially infectious material, but they did not change them before caring for a new patient in 64% of cases. Conclusions. The survey confirms the international data, showing a low compliance with hand hygiene practices by the HCWs and the need to promote a correct handwashing based on respect of the international guidelines.
International journal of community medicine and public health/International journall of community medicine and public health, 2024
Background: Hand hygiene (HH) is the simplest, but most effective infection prevention and control measure. This study was aimed to determine HH compliance among health care workers (HCWs) in a cancer hospital and the impact of targeted and phased training over changes in HH compliance and determination of Hawthorne effect among HCWs. Methods: Prospective observational study conducted in two phases by HH trained auditor (Overt observer) and ICN (Covert observer) performing 30 minutes HH audit at ICU, haemato-lymphoid (HL) ward and paediatric ward to observe the pattern of HH compliance among HCW for HH moments and its impact over Hawthorne effect for HH compliance. Results: Highest compliance for HH was observed at HL ward (59.34%) in first phase and at ICU (70.08%) in second phase. Gradual and significant improvement in HH compliance was observed for ICU (52.24% to 70.08%), HL ward (59.34% to 68.48%) and paediatric ward (43.42% to 53.46%). Profession specific Hawthorne effect was observed for nurses with higher compliance in covert observation in first phase and for doctors with higher compliance in overt observation in second phase of the study. Conclusions: Regular targeted HH audit with motivational training is the better influential tool for improving HH compliance. Regular audits also improve efficiency of auditor for effective HH compliance supervision. Decentralization and availability of workstation specific HH auditor is the most of effective cost saving approach for achieving significant progressive improvement in HH adherence.
The Relationship Between Characteristics of Health Workers on Handwashing Behavior
JMMR (Jurnal Medicoetivolegal dan Manajemen Rumahsakit), 2020
Based on data from PPI Hospital X in Surabaya there are still nosocomial infections. If the incidence of this infection continues to recur, then the hospital's image will be bad and can cause hospital bed occupational rates to decrease. The purpose of this study was to determine the relationship between the characteristics of health workers (level of knowledge, level of education, age, and length of work) with the level of compliance of health workers doing hand washing at the "X" Hospital in Surabaya. This research is a descriptive correlation study. The sample in this study was 150 health workers working at X Hospital Surabaya, using proportional random sampling stratification technique. Data were collected using a questionnaire instrument. Data analysis using Pearson correlation test. The results revealed a significant relationship between the level of knowledge about handwashing (p = 0.001), an education level (p = 0.004), age (p = 0,000) and years of service (p = 0,000) to the level of compliance of health workers doing hand washing at the "X" Hospital in Surabaya. Surabaya "X" Hospital health workers have a level of compliance with handwashing with a maximum compliance category >75% (76%). Berdasarkan data dari PPI Rumah Sakit X di Surabaya masih terdapat kejadian infeksi nosokomial. Jika kejadian infeksi ini terus berulang, maka citra rumah sakit akan buruk dan bisa mengakibatkan Bed Occupational Rate rumah sakit menurun. Tujuan penelitian ini untuk mengetahui hubungan karakteristik tenaga kesehatan (tingkat pengetahuan, tingkat pendidikan, umur dan lama bekerja) dengan tingkat kepatuhan tenaga kesehatan melakukan cuci tangan di Rumah Sakit "X" Surabaya. Penelitian ini merupakan penelitian deskriptif korelasi. Sampel dalam penelitian ini adalah tenaga kesehatan yang bekerja di Rumah Sakit X Surabaya sebanyak 150 orang, dengan menggunakan teknik stratifikasi proporsional random sampling. Data dikumpulkan dengan menggunakan instrumen kuesioner. Analisis data menggunakan uji pearson correlation. Hasil penelitian menyatakan adanya hubungan yang signifikan antara tingkat pengetahuan mengenai cuci tangan (p=0,001), tingkat pendidikan (p=0,004), usia (p=0,000) dan masa kerja (p=0,000) terhadap tingkat kepatuhan tenaga kesehatan melakukan cuci tangan) di Rumah Sakit "X" Suarabaya. Tenaga kesehatan Rumah Sakit "X" Surabaya mempunyai tingkat kepatuhan melakukan cuci tangan dengan kategori kepatuhan maksimal >75% (76%).
Effectiveness of a training programme to improve hand hygiene compliance in primary healthcare
BMC Public Health, 2009
Background: Hand hygiene is the most effective measure for preventing infections related to healthcare, and its impact on the reduction of these infections is estimated at 50%. Non-compliance has been highlighted in several studies in hospitals, although none have been carried out in primary healthcare. Main objective: To evaluated the effect of a "Hand Hygiene for the reduction of healthcareassociated infections" training program for primary healthcare workers, measured by variation from correct hand hygiene compliance, according to regulatory and specific criteria, 6 months after the baseline, in the intervention group (group receiving a training program) and in the control group (a usual clinical practice). Secondary objectives:-To describe knowledges, attitudes and behaviors as regards hand hygiene among the professionals, and their possible association with "professional burnout", stratifying the results by type of group (intervention and usual clinical practice).-To estimate the logistic regression model that best explains hand hygiene compliance. Methods/Design: Experimental study of parallel groups, with a control group, and random assignment by Health Center. Area of study.-Health centers in northeastern Madrid (Spain). Sample studied.-Healthcare workers (physicians, odontostomatologists, pediatricians, nurses, dental hygienists, midwife and nursing auxiliaries).