Improving Hand Hygiene Compliance Through Who’s Multimodal Hand Hygiene Improvement Strategy (original) (raw)
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International Journal of Nursing, Midwife and Health Related Cases
Hand Hygiene (HH) is the leading measure for preventing the spread of pathogens and reducing health care associated infections, health care providers’ adherence to recommended practices remains suboptimal in most settings, and maintaining its standards is difficult to sustain. However, Healthcare-associated infections (HAIs) remain the most common adverse event in healthcare, resulting in a significant burden on patients, their families, and health care systems. This study examines evaluation of hand hygiene facilities and compliance of health care workers at the University of Medical Sciences Teaching Hospital, Ondo. This was a cross-sectional descriptive study that was made up of 324 participants. Multi-stage sampling technique was used for the selection of participants. Self-administered questionnaire and observational checklists were used as tools for data collection. The reliability value of the questionnaire eliciting responses on self-reported compliance to hand hygiene techn...
The Level of Compliance of Healthcare Workers in Performing Hand Hygiene: A Literature Review
Journal of Nursing Care
Compliance level of healthcare workers in performing hand hygiene is a significant aspect of patient safety goals. However, it is still not optimal and is one of the critical problems of many hospitals globally, including in Indonesia. The non-optimal consequence of hand hygiene compliance is hospital-associated infections since hands are an intermediary medium for transmitting infection. This literature aims to determine the level of compliance of health workers in performing hand hygiene and find out several matters that can be done so that the health worker's compliance can be optimal or increased. Review of articles through several electronic databases including PubMed and ProQuest, with the keywords "Compliance", "Hand Hygiene", "Health Workers", and "Hospital". Inclusion criteria include articles published between 2005 and 2019, health worker respondents, English language, full text and observation, or interview data collection techn...
Antimicrobial Resistance and Infection Control, 2017
Background: The burden of health-care associated infections in low-income countries is high. Adequate hand hygiene is considered the most effective measure to reduce the transmission of nosocomial pathogens. We aimed to assess compliance with hand hygiene and perception and knowledge about hand hygiene before and after the implementation of a multimodal hand hygiene campaign designed by the World Health Organization. Methods: The study was carried out at Asella Teaching Hospital, a university hospital and referral centre for a population of about 3.5 million in Arsi Zone, Central Ethiopia. Compliance with hand hygiene during routine patient care was measured by direct observation before and starting from six weeks after the intervention, which consisted of a four day workshop accompanied by training sessions and the provision of locally produced alcohol-based handrub and posters emphasizing the importance of hand hygiene. A second follow up was conducted three months after handing over project responsibility to the Ethiopian partners. Health-care workers' perception and knowledge about hand hygiene were assessed before and after the intervention. Results: At baseline, first, and second follow up we observed a total of 2888, 2865, and 2244 hand hygiene opportunities, respectively. Compliance with hand hygiene was 1.4% at baseline and increased to 11.7% and 13.1% in the first and second follow up, respectively (p < 0.001). The increase in compliance with hand hygiene was consistent across professional categories and all participating wards and was independently associated with the intervention (adjusted odds ratio, 9.18; 95% confidence interval 6.61-12.76; p < 0.001). After the training, locally produced alcohol-based handrub was used in 98.4% of all hand hygiene actions. The median hand hygiene knowledge score overall was 13 (interquartile range 11-15) at baseline and increased to 17 (15-18) after training (p < 0.001). Health-care workers' perception surveys revealed high appreciation of the different strategy components. Conclusion: Promotion of hand hygiene is feasible and sustainable in a resource-constrained setting using a multimodal improvement strategy. However, absolute compliance remained low. Strong and long-term commitment by hospital management and health-care workers may be needed for further improvement.
ABSTRACT Background: Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients. The objectives of this study were to assess healthcare workers compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices. Methods: The study was an observational, cross‑sectional one. Hand hygiene compliance was monitored using the hand hygiene observation tool developed by the WHO. A nonidentified observer was used for monitoring compliance with hand hygiene. The observational period was over a 60‑day period from August 2015 to October 2015. Results: One hundred and seventy‑six observations were recorded from healthcare personnel. The highest number of observationswere seen in surgery, n = 40. The following were found to be in noncompliance before patient contact – anesthetist P = 0.00 and the Intensive Care Unit P = 0.00 while compliance was seen with senior nurses (certified registered nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the removal of gloves, the following were areas of noncompliance – the emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance was seen with surgery P = 0.01. With regards to compliance after touching the patient, areas of noncompliance were the anesthetists P = 0.00, as opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P = 0.02 that were compliant. Overall, the rates of compliance to hand hygiene were low. Discussion: The findings however from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, healthcare workers in developing settings see such as ours regard such programs as being mundane. Conclusion: The observance of hand hygiene is still low in our local environment. Handwashing practices in our study show that healthcare workers pay attention to hand hygiene when it appears there is a direct observable threat to their wellbeing. Educational programs need to be developed to address the issue of poor hand hygiene. Key words: Alcohol hand rub, compliance, hand washing, healthcare associated infections, healthcare workers, infection control
Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital
Indian Journal of Critical Care Medicine, 2014
Aim: We are using multimodal technique to improve hand hygiene (HH) compliance among all health care staff for the past 1-year. This cross-sectional observational study was conducted in the surgical ICU to assess adherence to HH among nurses and allied healthcare workers, at the end of the training year. Materials and Methods: This was a cross-sectional observational study using direct observation technique. A single observer collected all HH data. During this analysis, 1500 HH opportunities were observed. HH compliance was tested for all 5 moments as per WHO guidelines. Results: Overall compliance as per WHO Guidelines was 78%. Nurses had an adherence rate of 63%; allied staff adherence was 86.5%. Compliance was 93% after patient contact versus 63% before patient contact. Nurses'compliance before aseptic procedures was lowest at 39%. 92% staff was aware of the facts viz. Diseases prevented by hand washing, ideal duration of HH, reduction of health care associated infections, etc. Conclusion: After 1-year of aggressive multimodal intervention in improving HH compliance, we have an overall compliance of 78%. It implies that sustained performance and compliance to HH can be ensured by ongoing training. Direct observation remains a widely used, easily reproducible method for monitoring compliance.
Jurnal Indonesia Sosial Teknologi
The Hospital Infection Prevention and Control Program (HIPCP) is an effort to reduce the risk of Healthcare-Associated Infections (HAIs), including hand hygiene compliance. WHO issued the Multimodal Hand Hygiene Improvement Strategy as one of the strategies to tackle low hand hygiene compliance. Dr. M. Goenawan Partowidigdo Pulmonary Hospital (RSPG) has implemented hand hygiene regulations referring to the current policies, but it has not met the target over the last three years. This study aims to analyze the implementation of the regulation of hand hygiene compliance at RSPG according to the WHO Multimodal Hand Hygiene Improvement Strategy, using an analytical descriptive qualitative approach with a case study method. The analysis uses the combination of the theory of George Edward III, Weaver, and the WHO Multimodal Hand Hygiene Improvement Strategy. WHO Multimodal Hand Hygiene Improvement Strategy assessment was conducted by scoring the Hand Hygiene Self-Assessment Framework (H...
Implementation of Who Hand Hygiene Improvement Strategy in Trnava University Hospital, Slovakia
Scientific Journal of Polonia University
Hand hygiene is considered to be the most simple, effective and economic measure to prevent the spread of healthcare-associated infections and antimicrobial resistance. Based on the study, application of the World Health Organization’s Multimodal Hand Hygiene Improvement Strategy can improve hand hygiene compliance in hospital settings and reduce these infections. Trnava University Hospital was included to World Health Organization (WHO) launched a worldwide campaign focused on hand hygiene in 2013, when infection control specialist has started working on daily basis. Our objective was to evaluate the impact of implementing the Multimodal Hand Hygiene Strategy according to WHO. We assessed alcohol-based hand rub consumption during the period 2013 and 2018 and hand hygiene compliance in 2018 as a baseline. During observed period alcohol-based hand rub consumptions significantly increased from 15.7 L/1000 patient days to 24.3 L/1000 patient days (p<0.05). Overall compliance as per ...
Assessing Hand Hygiene Compliance in Healthcare Workers to Reduce Infectious Disease
Hand hygiene is the first line of defense against the prevalence of infectious diseases in healthcare settings. Therefore, healthcare costs can be reduced. However, having rare incidents of healthcare-associated infections (HAI) does not always mean that hand hygiene compliance is high and at its desired level. This research study aims to develop multi-statistical measurements to assess hand hygiene compliance of the medical and nursing groups at the inpatient wards, 5B, 6B and ICU at the Providence Veterans Affairs Medical Center (PVAMC). The PVAMC was trying to identify whether the few cases or rare incidents of HAI that have been reported in the past few years was caused by or linked to poor hand hygiene practices. Healthcare worker (HCWs) subgroups of nurses and hospitalist doctors were asked to self report their patient contact over one complete week. The URI research team and 25 other secret observers were asked to directly observe the medical and nursing groups' hand hygiene behavior over two complete months including all working shifts: night, day and evening. These two months were overlapped with the one complete week of selfreporting patient contact. The results indicated that the monthly hand hygiene compliance mean estimation was not as expected by the PVAMC. The monthly hand hygiene compliance mean estimation was around 50%. The results also indicated that as bed days of care (BDOC) increased, hand hygiene compliance decreased. In contrast, the results did not indicate any strong correlation between hand hygiene compliance and HAIs. However, the possibility that the PVAMC has been adopting other infection prevention methods that are associated with the rare HAI incident (for example zero MRSA for the past five years) cannot be eliminated or ignored. Hand hygiene compliance was higher after touching a patient than before, even though both are recommended in the World Health Organization's 5 moments of hand hygiene. Risk factors for poor adherence to recommended hand-hygiene practices were observed and found to be statistically significant, including being a male patient, working in a step-down unit (5B) and working on weekdays and working in night shift. In addition, an attempt was made to indirectly estimate hand hygiene compliance over a 10 month period by measuring how many times Purell and Soap cartridges were replaced at inpatient wards. Similarly, an attempt was made to indirectly estimate personal protective equipment (PPE) compliance over a three year period using PPE inventory data. In the indirect methods, patient contact data was used to average how many times a patient was seen by the medical and nursing groups. This estimation was used to indirectly estimate the hand hygiene compliance. The indirect hand hygiene compliance via measuring product use (Purell and Soap) was very low compared to the hand hygiene compliance estimated via the direct hand hygiene observation method when the same two months were compared in all inpatient wards. The actual Purell and Soap replacement was not equal to or close to the targeted replacement at any of the inpatient wards. The research study did not find any correlation between BDOC and hand hygiene compliance under such a method. The source of error on the indirect PPE compliance method forced the compliance to go beyond 100% in several months. The research study did not find any correlation between BDOC and PPE compliance. Such methods need more validation, but is an interesting first step for a new proposed method. iv ACKNOWLEDGMENTS In the name of Allah the Most Gracious the Most Merciful, and Peace and Blessings be upon the most honorable prophets and messengers Muhammad and his family and companions. Praise and thanks be to Allah first and foremost, and praise be to Allah for his kindness and thankfulness for his kindness and gratitude. Without his conciliation I was not able to achieve and complete what was accomplished. I would like to sincerely thank my academic advisor, Prof. Valerie Maier-Speredelozzi for her full support and guidance throughout my Ph.D journey. And I would like to express my gratitude to my dissertation committee, Prof. Jay Wang and Prof. Gavino Puggioni for their academic consultation. I have learned a lot from them and their classes and courses. On top of that, I would like to express my thankfulness to the University of Rhode Island (URI) for accepting me as one of its students. I am so proud to have my Ph.D degree awarded from URI. I would like to thank Prof. Carol Thornber for being the chair of the doctoral comprehensive examination. I also would like to thank Prof. Liliana Gonzalez for being the chair of the oral examination in defense of the doctoral dissertation. Special thanks and gratitude to the Providence Veterans Affairs Medical Center (PVAMC) for allowing me to conduct my Ph.D research at their facility. Thanks as big as the size of the sky to Mr. Robert Harris for his mentoring and full support as my supervisor at the PVAMC. His friendship is an achievement that goes along with my Ph.D achievement. Truly his friendship is accolade on my chest. Special thanks to Dr. Bonnie Charland, the head of the Quality Management, and Dr. Melissa Gaitanis, the Chief of Infectious Disease and Control. I cannot and do not know how to thank v Brigida Cedeno, the Infection Preventionist at the PVAMC, for her full support and assistance through out my Ph.D research. Without her support, my project at the PVAMC would literally have failed without any doubt. I would like to thank Mr. Edward Robertson for his support and motivation during the two month of experiment. I would like to thank everyone at the PVAMC who have participated in my study, supported me, mentored me and guided me throughout the four years of my research. I express my regret and apologies for anyone I have not been able to thank personally or mention here in my dissertation. But for sure you all are in my heart and good memories. I will not forget the PVAMC, the floors and my office there. I have already missed all of that. As Allah says in the holy Quran, Chapter 14 entitled "The Night Journey" verse 24: "And lower to them the wing of humility out of mercy and say, "My Lord, have mercy upon them as they brought me up [when I was] small." All my thanks and gratitude goes to my parents, Mr. Salem Alhasani and Mrs. Wedad Tayeb, indeed without them I am not who I am. The same goes to my uncle, Mr. Abdulmuti Alhasani, and my aunt, Mrs. Salma Alhasani, my parents in law and my lovely wife's parents for their full support and prayers day and night for the whole seven years that my family and I have been away from home. Earning my Ph.D degree is just a simple gift that goes back to my biological parents and my parents in law. With true feelings, I cannot and do not know how to thank my wife, Mrs. Mona Alhasani, but I can say thanks sweetheart for being in my heart and in my life. I do not want to forget thanking my two little knights, Faris and Feras for cheering me up days and nights when I come back from my office at URI. Once I see their smiley faces I ix
A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps”
BMC Infectious Diseases, 2013
Background: Hand hygiene compliance is generally assessed by observation of adherence to the "WHO five moments" using numbers of opportunities as the denominator. The quality of the activity is usually not monitored since there is no established methodology for the routine assessment of hand hygiene technique. The aim of this study was to objectively assess hand rub coverage of staff using a novel imaging technology and to look for patterns and trends in missed areas after the use of WHO's 6 Step technique. Methods: A hand hygiene education and assessment program targeted 5200 clinical staff over 7 days at the National University Hospital, Singapore. Participants in small groups were guided by professional trainers through 5 educational stations, which included technique-training and UV light assessment supported by digital photography of hands. Objective criteria for satisfactory hand hygiene quality were defined a priori. The database of images created during the assessment program was analyzed subsequently. Patterns of poor hand hygiene quality were identified and linked to staff demographic.