Impact of an Interventional Program on Improving Compliance of Hand Hygiene and Reducing Hospital-Acquired Infection in the Critical Care Unit (original) (raw)
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Hand hygiene compliance in intensive care units: An observational study
International Journal of Nursing Practice, 2020
Aim: Health care-associated infections along with antibiotic resistance are a leading risk for patient safety in intensive care units. Hygienic hand disinfection is still regarded as the most effective, simplest, and most cost-effective measure to reduce health care-associated infections. To improve hand hygiene compliance and to prevent health care-associated infections, interventions of the "German Clean Hands Campaign" were implemented in a university hospital. Methods: Observational single-center study using direct observation and feedback. Hand hygiene performance was assessed in 12 intensive care units between 2013 and 2017. Linear mixed model regression analyses were used to estimate the compliance trend over time. Results: In total, 10 315 "my five moments for hand hygiene" were observed. The mean hand hygiene compliance rates increased from 75.1% to 88.6% during the study period, yielding an estimated increase of about 4.5% per year. However, there are differences in compliance between occupational groups (physicians: between 61.2% and 77.1%; nurses: between 80.2% and 90.9%; others: between 61.3% and 82.4%). Conclusions: After implementation of the "German Clean Hands Campaign" interventions, an overall significant improvement of hand hygiene was detected. Compliance measurements helped to raise awareness among health care professional groups.
Antimicrobial Resistance and Infection Control, 2013
Background: To determine hand hygiene compliance before and after an intervention campaign in critical care units, this study was carried out in the Intensive care unit (ICU), Neonatal intensive care unit (NICU), Burns unit (BU) and the Kidney unit of the King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia. The observation using the WHO hand hygiene protocol took place in four phases with phase I, between April 24-May 06 2010 and phase II from May 29-June 09 2010. An educational intervention took place between the Phases I and II. Follow-up Phases III and IV were from 01-15 October 2010 and 15-30 March 2011 respectively. Findings: 1,975 hand hygiene opportunities comprising of 409 in Phase I, 406 in Phase II, 620 in Phase III and 540 Phase IV were observed. Compliance rate was 67% pre-intervention, 81% in phase II, declining to 59% and 65% in phases III and IV. Increased compliance in the ICU from 39% in Phase I to 81% in Phase IV (p < 0.05) was sustained throughout the study. Highest compliance rates were recorded among nurses in all phases. The improved compliance for physicians observed in the post-intervention phase was lost in follow-up phases. Missed opportunities for hand hygiene were before patient contact, after touching patient's surrounding and before aseptic techniques. Teamwork and leadership were identified as enhancing factors for compliance. Conclusion: The WHO hand hygiene strategy combined with health education, continuous evaluation and team approach resulted in increased compliance but this was not sustained in certain critical care areas.
Journal of Infection and Public Health, 2013
Hand washing is widely accepted as the cornerstone of infection control in the intensive care unit (ICU). Nosocomial infections are frequently viewed as indicating poor compliance with hand washing guidelines. To determine the hand hygiene (HH) compliance rate among healthcare workers (HCWs) and its effect on the nosocomial infection rates in the ICU of our hospital, we conducted an interventional study. The study spanned a period of 7 months (February 2011-August 2011) and consisted of education about HH indications and techniques, workplace reminder posters, focused group sessions, and feedback on the HH compliance and infection rates. The WHO HH observation protocol was used both before and after a hospital-wide HH campaign directed at all staff members, particularly those in the ICU. Compliance was measured by direct observation of the HCWs, using observation record forms in a patient-directed manner, with no more than two patients observed simultaneously. The overall HH compliance rate was calculated by dividing the number of HH actions by the total number of HH opportunities. The nosocomial infection rates for the pre-and post-interventional periods were also compared to establish the effect of the intervention on rate of infections acquired within the unit. The overall rate of HH compliance by all the HCWs increased from 42.9% preintervention to 61.4% post-intervention, P < 0.001. Individually, the compliance was highest among the nurses, 49.9 vs. 82.5%, respectively (P < 0.001) and lowest among the doctors, 38.6 vs. 43.2%, respectively (P = 0.24). The effect of the increase in the HH compliance rate on the nosocomial infection rate was remarkable. There were significant reductions in the following: the rate of overall health care-associated M.F. Salama et al.
Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units
Journal of Preventive Medicine and Hygiene, 2017
Summary Introduction. Healthcare associated infections (HAIs) are a cause of high morbidity, disability and reduced quality of life, as well as mortality and rising costs for health systems. Preventing the HAI risk by planning and implementing effective preventive strategies is important to safeguard patient health. Methods. The study aimed to evaluate the presence of procedures and protocols for infection control, to assess the adhesion to the different aspects of hand hygiene (HH) and hand washing technique by healthcare workers in six ICUs. A perspective observational study was conducted in six ICUs. In each ICU, the adherence by health care workers to both hand hygiene practices and standard precautions was assessed, as well as the presence of procedures and written protocols. Results. The findings showed that in all the involved ICUs, 73 of 142 required protocols and procedures were available. Specifically, 59 of 79 were available for general measure of risk control, 12 of 15 f...
Acta Medica Philippina
Background. While hand hygiene is recognized as the cornerstone for reducing risk for nosocomial infections, compliance in our institution remains low. Previously identified barriers include poor access to hand hygiene products, lack of reminders, and poor knowledge on indications. Methods. At the medical wards and ICU of a tertiary hospital, a group of medical students, residents, and nurses was exposed to interventions addressing the identified barriers. Alcohol handrub was provided at each bedside, visual reminders were placed at critical locations, and commonly missed opportunities were reinforced at the start of the study. Hand hygiene compliance was covertly evaluated after two weeks and compared against that of an unexposed group. Results. 664 and 727 hand hygiene opportunities were observed in the unexposed and exposed groups, respectively. Compliance was higher in the exposed group (32.60% vs. 16.26%, p <0.05), which by subset analysis was consistent for the different he...
International Journal of Infection Control, 2018
Hand hygiene (HH) is comprehensively recognized to be the single most significant measure to prevent cross-transmission of microorganisms between patients. This study aimed to measure the HH compliance rates baseline, identify the barriers for HH non-compliance and to assess the impact of multidisciplinary intervention. An interventional study conducted from March 2017 to July 2017 in two surgical paediatric intensive care units (PICU) in two tertiary care hospitals. Root Cause Analysis (RCA) was used for identification of the barriers that affect HH compliance followed by intervention included HH training and education, video presentations in the hospital internal circuit, visual cues, using a code word for gentle verbal reminding and HH champions for follow up. Direct observation of HH was done before and after the intervention applying the WHO HH observation method. HH compliance rate was calculated by dividing the number of HH actions by the total number of opportunities. Chi-sq...
Indian Journal of Critical Care Medicine, 2011
Context: The role of hand hygiene in preventing health care associated infections (HCAIs) has been clearly established. However, compliance rates remain poor among health care personnel. Aims: a) To investigate the health care workers' hand hygiene compliance rates in the intensive care unit (ICU), b) to assess reasons for non-compliance and c) to study the efficacy of a multimodal intervention strategy at improving compliance. Settings: A mixed medical-surgical ICU of a tertiary level hospital. Design: A beforeafter prospective, observational, intervention study. Materials and Methods: All health care personnel who came in contact with patients in the ICU were observed for their hand hygiene compliance before and after a multimodal intervention strategy (education, posters, verbal reminders and easy availability of products). A self-report questionnaire was also circulated to assess perceptions regarding compliance. Statistical analysis was done using χ2 test or Fisher exact test (Epi info software). Results: Hand hygiene compliance among medical personnel working in the ICU was 26% and the most common reason cited for non-compliance was lack of time (37%). The overall compliance improved significantly following the intervention to 57.36% (P<0.000). All health care worker groups showed significant improvements: staff nurses (21.48-61.59%, P<0.0000), nursing students (9.86-33.33%, P<0.0000), resident trainees (21.62-60.71%, P<0.0000), visiting consultants (22-57.14%, P=0.0001), physiotherapists (70-75.95%, P=0.413) and paramedical staff (10.71-55.45%, P< 0.0000). Conclusions: Hand hygiene compliance among health care workers in the ICU is poor; however, intervention strategies, such as the one used, can be useful in improving the compliance rates significantly.
Biometrics & Biostatistics International Journal, 2016
Healthcare-acquired infection is a serious problem, and patients in intensive care units are the most vulnerable group. Hand hygiene is known to be the most effective way to prevent the infection, but healthcare professionals' compliance is not good enough. The best way to improve hand hygiene compliance among healthcare workers in a unit would through programs well-tailored for each unit based on a thorough evaluation of the unit and the designing of the necessary interventions, but the scarcity of resources often hampers such an approach. In order to minimize the required resources and develop a realistic program, this study tried to utilize already proven infection control interventions. By repackaging them using the theory of planned behavior as the framework, we developed a four-week program called HI-TPB whose program components were either introduced in academic journals or well-known hand hygiene guidelines or, more importantly, were previously tried and showed positive results in the hospital of this study. HI-TPB was implemented with nurses in two intensive care units for adults and newborns. The hand hygiene compliance of nurses rose from 70.5% to 92.3% and 74.4% to 91.1%, respectively. This study suggests that, for certain problems, using existing interventions could suffice to reach the goal of improvement, as long as there is already a sufficient amount of information available.
American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2015
Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not signifi...