scholarly journals Quantifying the Hawthorne Effect in Hand Hygiene Compliance Through Comparing Direct Observation With Automated Hand Hygiene Monitoring

2015 ◽  
Vol 36 (8) ◽  
pp. 957-962 ◽  
Author(s):  
Stefan Hagel ◽  
Jana Reischke ◽  
Miriam Kesselmeier ◽  
Johannes Winning ◽  
Petra Gastmeier ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Direct Observation ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Prospective Observational Study ◽  
University Hospital ◽  
Hawthorne Effect ◽  
Strong Positive Correlation ◽  
Working Shift ◽  
Hygiene Compliance

OBJECTIVETo quantify the Hawthorne effect of hand hygiene performance among healthcare workers using direct observation.DESIGNProspective observational study.SETTINGIntensive care unit, university hospital.METHODSDirect observation of hand hygiene compliance over 48 audits of 2 hours each. Simultaneously, hand hygiene events (HHEs) were recorded using electronic alcohol-based handrub dispensers. Directly observed and electronically recorded HHEs during the 2 hours of direct observation were compared using Spearman correlations and Bland-Altman plots. To quantify the Hawthorne effect, we compared the number of electronically recorded HHEs during the direct observation periods with the re-scaled electronically recorded HHEs in the 6 remaining hours of the 8-hour working shift.RESULTSA total of 3,978 opportunities for hand hygiene were observed during the 96 hours of direct observation. Hand hygiene compliance was 51% (95% CI, 49%–53%). There was a strong positive correlation between directly observed compliance and electronically recorded HHEs (ρ=0.68 [95% CI, 0.49–0.81], P<.0001). In the 384 hours under surveillance, 4,180 HHEs were recorded by the electronic dispensers. Of those, 2,029 HHEs were recorded during the 96 hours in which direct observation was also performed, and 2,151 HHEs were performed in the remaining 288 hours of the same working shift that were not under direct observation. Healthcare workers performed 8 HHEs per hour when not under observation compared with 21 HHEs per hour during observation.CONCLUSIONSDirectly and electronically observed HHEs were in agreement. We observed a marked influence of the Hawthorne effect on hand hygiene performance.Infect Control Hosp Epidemiol 2015;36(8):957–962

scholarly journals Observed and Self-reported Hand Hygiene Compliances and Associated Factors among Healthcare Workers at a County Referral Hospital in Kenya

2020 ◽  
Author(s):  
Karlmax Kiprotich ◽  
Atipatsa Chiwanda Kaminga ◽  
Miriam Kessi ◽  
Wang Honghong
Keyword(s):  
Hand Hygiene ◽  
Direct Observation ◽  
Healthcare Workers ◽  
Associated Factors ◽  
Hand Hygiene Compliance ◽  
Social Influences ◽  
Professional Role ◽  
Referral Hospital ◽  
Environmental Resources ◽  
Hygiene Compliance

Abstract Background: Hand hygiene is effective in preventing and controlling healthcare-associated infections (HCAIs); however, its compliance remains low, and reasons are poorly understood, thus its research and feedback may lead to successful interventions. This study aimed to explore the observed and self-reported hand hygiene compliance and associated factors among healthcare workers (HCWs) in the medical/surgical ward of a county referral hospital. Methods: Cross-sectional study design was used in this study. Direct observation guided by 5 moments for hand hygiene concept was carried to describe compliance, and the questionnaire technique informed by Theoretical Domains Framework (TDF) was employed to investigate self-reported compliance, barriers, and facilitators of hand hygiene compliance. This study was done at a county referral hospital in Kenya. The total number of hand hygiene opportunities observed was 347 among 55 HCWs, and 132 HCWs filled the questionnaires. Results: The overall compliance based on direct observation was 23.9%, whereas self-reported compliance was 80.0%. Hand hygiene was significantly associated with indication (p < 0.001), training (p = 0.014), social influences (p = 0.002) and knowledge (p = 0.044). Barriers identified were environmental resources, social influences, beliefs about consequences, memory, attention, and decision processes. Facilitators included knowledge and social/professional role, and identity.Conclusions: Despite the high report rate of hand hygiene compliance, the observed compliance is unacceptably low. Although knowledge, and social/professional role and identity of the HCWs may primarily facilitate hand hygiene compliance, barriers associated with non-compliance such as environmental resources remain significant constraints and should be considered to ensure optimal hand hygiene compliance and quality of patient care. The results also suggest that HCWs education on hand hygiene still needs improvements, particularly on the 5 moments for hand hygiene.

scholarly journals NICU Healthcare Workers Hand Hygiene Compliance during 6 Months of Direct Observation

2020 ◽  
Vol 11 (1) ◽  
pp. 41
Author(s):  
Inna Fairuuza Firdaus ◽  
Dwiyanti Puspitasari ◽  
Marijam Purwanta
Keyword(s):  
Hand Hygiene ◽  
General Hospital ◽  
Direct Observation ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Patient Contact ◽  
Healthcare Associated Infection ◽  
Effective Measure ◽  
Hygiene Compliance ◽  
Healthcare Associated

Introduction: Hospitalized neonates are at risk of developing nosocomial sepsis, a systemic infection due to unhygienic healthcare, especially in Indonesia where healthcare-associated infection incidence rate is 5.9%-8.3%. Hand hygiene by healthcare workers is an effective measure to prevent it. This study aimed to understand the healthcare workers’ hand hygiene compliance towards WHO guidelines 2009 in Dr. Soetomo General Hospital NICU. Methods: This research was an observational study. The healthcare workers’ hand hygiene compliance was obtained through 6 months of direct observation, from November 2018 to April 2019, with doctors and nurses who agreed to be observed and present during the observation period as samples. The observation was recorded with WHO observation form, and processed with Microsoft Excel 2013 to obtain compliance rate. Results: Overall, the compliance of healthcare worker in NICU Dr. Soetomo General Hospital during the 6 months of study was 84%. Nurses’ compliance was higher (87%) than doctors’ (78%). Compliance to My 5 Moments of Hand Hygiene indications varied from 82% for moments before patient contact to 93% for moments after patient contact. Conclusion: In conclusion, hand hygiene compliance of healthcare workers in Dr. Soetomo General Hospital NICU varied between profession categories and each indication. To maintain and improve hand hygiene compliance, intervention in healthcare workers’ behavior is needed, so that healthcare-associated infection can be better prevented.

Quantifying limitations of direct observation as a means of assessing hand hygiene compliance among healthcare workers

2007 ◽  
Vol 55 (3) ◽  
pp. e91
Author(s):  
Chris Fuller ◽  
John McAteer ◽  
Rachel Slade ◽  
Andre Charlett ◽  
Barry Cookson ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Direct Observation ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Hygiene Compliance

Direct observation of hand hygiene compliance among healthcare workers in a teaching hospital of Rome

2017 ◽  
Vol 27 (suppl_3) ◽  
Author(s):  
V Baccolini ◽  
V D'Egidio ◽  
P de Soccio ◽  
G Migliara ◽  
C Marzuillo ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Direct Observation ◽  
Teaching Hospital ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Hygiene Compliance

scholarly journals SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
A. Landoas ◽  
F. Cazzorla ◽  
M. Gallouche ◽  
S. Larrat ◽  
B. Nemoz ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Prospective Observational Study ◽  
University Hospital ◽  
Healthcare Facilities ◽  
Hospitalised Patients ◽  
Hygiene Measures ◽  
Hygiene Compliance ◽  
A Prospective Study ◽  
Pandemic Wave

Abstract Background In healthcare facilities, nosocomial transmissions of respiratory viruses are a major issue. SARS-CoV-2 is not exempt from nosocomial transmission. Our goals were to describe COVID-19 nosocomial cases during the first pandemic wave among patients in a French university hospital and compliance with hygiene measures. Methods We conducted a prospective observational study in Grenoble Alpes University Hospital from 01/03/2020 to 11/05/2020. We included all hospitalised patients with a documented SARS-CoV-2 diagnosis. Nosocomial case was defined by a delay of 5 days between hospitalisation and first symptoms. Hygiene measures were evaluated between 11/05/2020 and 22/05/2020. Lockdown measures were effective in France on 17/03/2020 and ended on 11/05/2020. Systematic wearing of mask was mandatory for all healthcare workers (HCW) and visits were prohibited in our institution from 13/03/2021 and for the duration of the lockdown period. Results Among 259 patients included, 14 (5.4%) were considered as nosocomial COVID-19. Median time before symptom onset was 25 days (interquartile range: 12–42). Eleven patients (79%) had risk factors for severe COVID-19. Five died (36%) including 4 deaths attributable to COVID-19. Two clusters were identified. The first cluster had 5 cases including 3 nosocomial acquisitions and no tested HCWs were positive. The second cluster had 3 cases including 2 nosocomial cases and 4 HCWs were positive. Surgical mask wearing and hand hygiene compliance were adequate for 95% and 61% of HCWs, respectively. Conclusions The number of nosocomial COVID-19 cases in our hospital was low. Compliance regarding mask wearing, hand hygiene and lockdown measures drastically reduced transmission of the virus. Monitoring of nosocomial COVID-19 cases during the first wave enabled us to determine to what extent the hygiene measures taken were effective and patients protected. Trial registration Study ethics approval was obtained retrospectively on 30 September 2020 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891).

scholarly journals Hand hygiene and the sequence of patient care

2021 ◽  
pp. 1-6
Author(s):  
Nai-Chung Chang ◽  
Michael Jones ◽  
Heather Schacht Reisinger ◽  
Marin L. Schweizer ◽  
Elizabeth Chrischilles ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hand Hygiene ◽  
Patient Care ◽  
Intensive Care Units ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Resistant Bacteria ◽  
Surgical Intensive Care ◽  
Hygiene Compliance ◽  
Hand Hygiene Opportunity

Abstract Objective: To determine whether the order in which healthcare workers perform patient care tasks affects hand hygiene compliance. Design: For this retrospective analysis of data collected during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, we linked consecutive tasks healthcare workers performed into care sequences and identified task transitions: 2 consecutive task sequences and the intervening hand hygiene opportunity. We compared hand hygiene compliance rates and used multiple logistic regression to determine the adjusted odds for healthcare workers (HCWs) transitioning in a direction that increased or decreased the risk to patients if healthcare workers did not perform hand hygiene before the task and for HCWs contaminating their hands. Setting: The study was conducted in 17 adult surgical, medical, and medical-surgical intensive care units. Participants: HCWs in the STAR*ICU study units. Results: HCWs moved from cleaner to dirtier tasks during 5,303 transitions (34.7%) and from dirtier to cleaner tasks during 10,000 transitions (65.4%). Physicians (odds ratio [OR]: 1.50; P < .0001) and other HCWs (OR, 2.15; P < .0001) were more likely than nurses to move from dirtier to cleaner tasks. Glove use was associated with moving from dirtier to cleaner tasks (OR, 1.22; P < .0001). Hand hygiene compliance was lower when HCWs transitioned from dirtier to cleaner tasks than when they transitioned in the opposite direction (adjusted OR, 0.93; P < .0001). Conclusions: HCWs did not organize patient care tasks in a manner that decreased risk to patients, and they were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks than the reverse. These practices could increase the risk of transmission or infection.

scholarly journals Access to Alcohol-Based Hand Rub Is Associated With Improved Hand Hygiene in an Ebola-Threatened District of Western Uganda

2020 ◽  
Vol 41 (S1) ◽  
pp. s457-s457
Author(s):  
Mohammed Lamorde ◽  
Matthew Lozier ◽  
Maureen Kesande ◽  
Patricia Akers ◽  
Olive Tumuhairwe ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Wide Distribution ◽  
Patient Contact ◽  
Improve Hand Hygiene ◽  
Before And After ◽  
Hygiene Compliance ◽  
Handwashing With Soap

Background: Ebola virus disease (EVD) is highly transmissible and has a high mortality rate. During outbreaks, EVD can spread across international borders. Inadequate hand hygiene places healthcare workers (HCWs) at increased risk for healthcare-associated infections, including EVD. In high-income countries, alcohol-based hand rub (ABHR) can improve hand hygiene compliance among HCWs in healthcare facilities (HCF). We evaluated local production and district-wide distribution of a WHO-recommended ABHR formulation and associations between ABHR availability in HCF and HCW hand hygiene compliance. Methods: The evaluation included 30 HCF in Kabarole District, located in Western Uganda near the border with the Democratic Republic of the Congo, where an EVD outbreak has been ongoing since August 2018. We recorded baseline hand hygiene practices before and after patient contact among 46 healthcare workers across 20 HCFs in August 2018. Subsequently, in late 2018, WHO/UNICEF distributed commercially produced ABHR to all 30 HCFs in Kabarole as part of Ebola preparedness efforts. In February 2019, our crossover evaluation distributed 20 L locally produced ABHR to each of 15 HCFs. From June 24–July 5, 2019, we performed follow-up observations of hand hygiene practices among 68 HCWs across all 30 HCFs. We defined hand hygiene as handwashing with soap or using ABHR. We conducted focus groups with healthcare workers at baseline and follow-up. Results: We observed hand hygiene compliance before and after 203 and 308 patient contacts at baseline and follow-up, respectively. From baseline to follow-up, hand hygiene compliance before patient contact increased for ABHR use (0% to 17%) and handwashing with soap (0% to 5%), for a total increase from 0% to 22% (P < .0001). Similarly, hand hygiene after patient contact increased from baseline to follow-up for ABHR use (from 3% to 55%), and handwashing with soap decreased (from 12% to 7%), yielding a net increase in hand hygiene compliance after patient contact from 15% to 62% (P < .0001). Focus groups found that HCWs prefer ABHR to handwashing because it is faster and more convenient. Conclusions: In an HCF in Kabarole District, the introduction of ABHR appeared to improve hand hygiene compliance. However, the confirmation of 3 EVD cases in Uganda 120 km from Kabarole District 2 weeks before our follow-up hand hygiene observations may have influenced healthcare worker behavior and hand hygiene compliance. Local production and district-wide distribution of ABHR is feasible and may contribute to improved hand hygiene compliance among healthcare workers.Funding: NoneDisclosures: Mohammed Lamorde, Contracted Research - Janssen Pharmaceutica, ViiV, Mylan

scholarly journals Hand hygiene compliance in the intensive care unit of the Onderstepoort Veterinary Academic Hospital.

2019 ◽  
Author(s):  
Dikeledi Carol Sebola ◽  
Charlie Boucher ◽  
Caroline Maslo ◽  
Daniel Nenene Qekwana
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Infection Prevention And Control ◽  
Patient Contact ◽  
Academic Hospital ◽  
Hand Wash ◽  
Hygiene Compliance

Abstract Hand hygiene compliance remains the cornerstone of infection prevention and control (IPC) in healthcare facilities. However, there is a paucity of information on the level of IPC in veterinary health care facilities in South Africa. Therefore, this study evaluated hand hygiene compliance of healthcare workers and visitors in the intensive care unit (ICU) at the Onderstepoort Veterinary Academic Hospital (OVAH). Method: A cross-sectional study was conducted among healthcare workers (HCWs) and visitors in the ICU using the infection control assessment tool (ICAT) as stipulated by the South African National Department of Health. Direct observations using the “five hand hygiene moments” criteria as set out by the World helath Organisation were also recorded. The level of compliance and a 95% confidence interval were calculated for all variables. Results: Individual bottles of alcohol-based hand-rub solution and hand-wash basins with running water, soap dispensers, and paper towels were easily accessible and available at all times in the ICU. In total, 296 observations consisting of 734 hand hygiene opportunities were recorded. Hand hygiene compliance was also evaluated during invasive (51.4%) and non-invasive (48.6%) procedures. The overall hand hygiene compliance was 24.3% (178/734). In between patients, most HCWs did not sanitize stethoscopes, leashes, and cellular phones used. Additionally, the majority of HCWs wore jewellery below the elbows. The most common method of hand hygiene was hand-rub (58.4%), followed by hand-wash (41.6%). Nurses had a higher (44%) level of compliance compared to students (22%) and clinicians (15%). Compliance was also higher after body fluid exposure (42%) compared to after patient contact (32%), before patient contact (19%), after contact with patient surroundings (16%), and before an aseptic procedure (15%). Conclusion: Hand hygiene compliance in this study was low, raising concerns of potential transmission of hospital-acquired infections and zoonoses in the ICU. Therefore, it is essential that educational programs be developed to address the low level of hand hygiene in this study.

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