scholarly journals Hand Hygiene in Acute Care Hospitals—Evaluation of 12 Years National Hand Hygiene Campaign in Germany

2020 ◽  
Vol 41 (S1) ◽  
pp. s242-s243
Author(s):  
Tobias Kramer ◽  
Karin Bunte ◽  
Janine Walter ◽  
Christin Schroeder ◽  
Michael Behnke ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Acute Care ◽  
Direct Observation ◽  
Surveillance System ◽  
Intervention Strategy ◽  
Acute Care Hospitals ◽  
Annual Data ◽  
Healthcare Settings ◽  
German Healthcare System ◽  
Hand Hygiene Campaign

Background: Hand hygiene is one of the most effective measures to prevent healthcare-associated infections and transmission of multidrug-resistant organisms in healthcare settings. The WHO proposes a multimodal intervention strategy to improve hand hygiene in healthcare settings. In 2008, a voluntary national campaign for hand hygiene was implemented in the German healthcare system. The objective of this study was to evaluate participation, practices, and performance of hand hygiene in German acute-care hospitals. Methods: In 2008 a national hand hygiene campaign began in Germany. Based on voluntary participation, the campaign’s goal was to implement the WHO 5 Moments model, to establish a national surveillance system for compliance to hand hygiene, to improve availability of alcohol-based hand-rub (ABHR) dispensers at points of care, and to implement interdisciplinary executive boards at each hospital to ensure sustainable implementation. Annual data on ABHR consumption and patient days (PD) were collected within the national surveillance system (HAND-KISS) on the individual ward level and were validated. Direct observation of compliance was performed according the recommendations of the WHO. Results: Overall, 1,047 of 1,942 acute-care hospitals in Germany participated in the national hand hygiene campaign in 2018, covering 81,571,917 patient days. Moreover, 9,360 regular wards (RWs), 338 intermediate care units (IMCs) and 1,342 intensive care units (ICUs) provided data on ABHR consumption. Between 2007 and 2018 in the ICU, ABHR consumption increased continuously from 70 mL/PD (IQR, 52–98) to 129 mL/PD (IQR, 102–162). In intermediate care units, ABHR consumption increased from 40 mL/PD (IQR, 15–54) to 67 mL/PD (IQR, 46–95), and on regular wards, ABHR consumption increased from 14 mL/PD (IQR, 10–21) to 29 mL/PD (IQR, 22–39). These increases were especially pronounced in wards that continuously provided annual data for ABHR consumption over the past 12 years. In 2014, electronic documentation for direct observation of compliance to hand hygiene was established. From 2014 until 2018, 1,598,209 opportunities were observed on 1,907 wards of 422 hospitals. The median directly observed compliance in 2018 was 76% (IQR, 66%–84%). Median compliance to the 5 Moments was 71% (IQR, 57%–82%) before touching a patient, 68% (IQR, 51%–85%) before clean or aseptic procedures, 83% (IQR, 72%–92%) after body fluid exposure or risk, 84% (IQR, 75%–90%) after touching a patient, and 74% (IQR, 61%–84%) after touching patient surroundings. Conclusions: The WHO multimodal intervention strategy has been successfully established in German acute-care hospitals. A surveillance system for ABHR consumption and direct observation of compliance to hand hygiene are widely used by hospitals in Germany. Hand hygiene practices have significantly improved in the German healthcare system.Funding: NoneDisclosures: None

scholarly journals 422. Sustainability of Improvements to Hand Hygiene Performance Throughout the COVID-19 Pandemic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S311-S312
Author(s):  
Victoria R Williams ◽  
Matthew Muller ◽  
Jeff Powis ◽  
Daniel R Ricciuto ◽  
Dominik Mertz ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Hand Hygiene ◽  
Acute Care ◽  
Electronic Monitoring ◽  
Acute Care Hospitals ◽  
Transmission Risk ◽  
Teaching Hospitals ◽  
Infection Prevention And Control ◽  
Healthcare Settings ◽  
Case Count

Abstract Background Hand hygiene (HH) is a standard infection prevention and control precaution to be applied in healthcare settings to prevent transmission of COVID-19. Many healthcare institutions observed significant improvements in HH performance during wave one of the COVID-19 pandemic but the sustainability of this change is unknown. Our aim was to evaluate long-term HH performance throughout subsequent waves of the pandemic across acute care hospitals in Ontario, Canada. Methods HH adherence was measured using a previously validated group electronic monitoring system which was installed on all alcohol handrub and sink soap dispensers inside and outside each patient room across 56 inpatient units (35 wards and 21 critical care units) spanning 13 acute care hospitals (6 university and 7 community teaching hospitals) from 1 November 2019 to 31 May 2021. Daily HH adherence was compared with daily COVID-19 case count across Ontario. During this period, weekly performance continued to be reported to units but unit-based quality improvement discussions were inconsistent due to the COVID-19 response. Results Figure 1 depicts daily aggregate HH adherence plotted against the new daily COVID-19 case count across Ontario. An elevation in HH adherence was seen prior to the start of the first wave, rising almost to 80% and then remained above 70% for the peak of wave one. During waves two and three, peak COVID-19 case counts were associated with a maximum HH adherence of 51%, only marginally above the pre-pandemic baseline. After the end of wave one (from 1 July 2020 to 31 May 2021) the median HH performance was only 49% (interquartile range 47%-50%). Figure 1. Hand hygiene adherence across 13 acute care hospitals in comparison to overall new daily COVID-19 cases in Ontario Conclusion Initial improvements in HH adherence preceding the start of the COVID-19 pandemic were not sustained, possibly due to increasing comfort and reduced anxiety associated with providing care to COVID-19 patients leading to a perception of reduced COVID-19 transmission risk. These findings highlight the need for HH monitoring to be tied to longitudinal unit-led quality improvement in order to achieve durable changes in practice. Disclosures Susy S. Hota, MSc MD FRCPC, Finch Therapeutics (Research Grant or Support) Susy S. Hota, MSc MD FRCPC, Finch Therapeutics (Individual(s) Involved: Self): Grant/Research Support

scholarly journals Clostridium DifficileInfection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention

2017 ◽  
Vol 38 (4) ◽  
pp. 476-482 ◽  
Author(s):  
Irene K. Louh ◽  
William G. Greendyke ◽  
Emilia A. Hermann ◽  
Karina W. Davidson ◽  
Louise Falzon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hand Hygiene ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Grey Literature ◽  
Quality Criteria ◽  
Acute Care Hospitals ◽  
Cochrane Library ◽  
Chlorhexidine Bathing ◽  
The Impact

OBJECTIVEPrevention ofClostridium difficileinfection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009.DESIGNWe searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015.SETTINGWe included studies performed in acute-care hospitals.PATIENTS OR PARTICIPANTSWe included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates.INTERVENTIONSWe used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible.RESULTSOf 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates.CONCLUSIONSDaily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates.Infect Control Hosp Epidemiol2017;38:476–482

Sharps Injuries among Employees of Acute Care Hospitals in Massachusetts, 2002–2007

2011 ◽  
Vol 32 (6) ◽  
pp. 538-544 ◽  
Author(s):  
Angela K. Laramie ◽  
Vivian C. Pun ◽  
Shona C. Fang ◽  
David Kriebel ◽  
Letitia Davis
Keyword(s):  
Acute Care ◽  
Surveillance System ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Acute Care Hospitals ◽  
Injury Surveillance System ◽  
Hospital Size ◽  
Sharps Injury ◽  
The Impact ◽  
Sharps Injuries

Objective.Sharps with engineered sharps injury protections (SESIPs) have been found to reduce risk of sharps injuries (Sis). We examined trends in SI rates among employees of acute care hospitals in Massachusetts, including the impact of SESIPs on SI trends during 2002-2007.Design.Prospective surveillance.Setting.Seventy-six acute care hospitals licensed by the Massachusetts Department of Public Health.Participants.Employees of acute care hospitals who reported Sis to their employers.Methods.Data on Sis in acute care hospitals collected by the Massachusetts Sharps Injury Surveillance System were used to examine trends in SI rates over time by occupation, hospital size, and device. Negative binomial regression was used to assess trends.Results.During 2002-2007, 16,158 Sis among employees of 76 acute care hospitals were reported to the surveillance system. The annual SI rate decreased by 22%, with an annual decline of 4.7% (P< .001). Rates declined significantly among nurses (—7.2% per year;P< .001) but not among physicians (—0.9% per year;P= .553). SI rates associated with winged steel needles and hypodermic needles and syringes also declined significantly as the proportion of injuries involving devices with sharps injury prevention features increased during the same time period.Conclusion.SI rates involving devices for which SESIPs are widely available and appear to be increasingly used have declined. The continued use of devices lacking SI protections for which SESIPs are available needs to be addressed. The extent to which injuries involving SESIPs are due to flaws in design or lack of experience and training must be examined.

Has Improved Hand Hygiene Compliance Reduced the Risk of Hospital-Acquired Infections among Hospitalized Patients in Ontario? Analysis of Publicly Reported Patient Safety Data from 2008 to 2011

2013 ◽  
Vol 34 (6) ◽  
pp. 605-610 ◽  
Author(s):  
Giulio DiDiodato
Keyword(s):  
Patient Safety ◽  
Hand Hygiene ◽  
Acute Care ◽  
Poisson Regression ◽  
Hand Hygiene Compliance ◽  
Acute Care Hospitals ◽  
Ordinary Least Squares ◽  
Hospital Acquired Infections ◽  
Hygiene Compliance ◽  
Hospital Acquired

Design.Prospective, observational, ecological, time series, cross-sectional study examining the association between hand hygiene compliance (HHC) rates and the incidence of hospital-acquired infections.Setting.Acute care hospitals (N = 166) located in the province of Ontario, Canada.Methods.All data were extracted from the Ontario patient safety indicator database (http://www.hqontario.ca/public-reporting/patient-safety). Complete data were available for 166 acute care hospitals from October 1, 2008, to December 31, 2011. The rates of Clostridium difficile infection (CDI) are reported monthly, methicillin-resistant Staphylococcus aureus (MRSA) bacteremia quarterly, and HHC rates yearly. Trends and associations for each indicator were evaluated by ordinary least squares regression (HHC), zero-inflated Poisson regression (MRSA bacteremia), or Poisson regression (CDI). Dependent variables included in the regression analyses were extracted from the same database and included year, healthcare region, and type of hospital (teaching or small or large community).Results.Compared to those in 2008, reported HHC rates improved every year both before and after environment/patient contact (range, 10.6%–25.3%). Compared to those in 2008, there was no corresponding change in the rates of MRSA bacteremia; however, the rates of CDI decreased in 2009 but were not statistically significantly decreased from baseline in either 2010 or 2011. No consistent association was demonstrated between changes in the rates of HHC and these two healthcare-associated infections (HAIs).Conclusions.Despite significant improvements in reported rates of HHC among healthcare personnel in Ontario's hospitals, we could not demonstrate a positive ecological impact on rates of these two HAIs.

Sustained improvement in hospital cleaning associated with a novel education and culture change program for environmental services workers

2019 ◽  
Vol 40 (9) ◽  
pp. 1024-1029 ◽  
Author(s):  
Elena K. Martin ◽  
Elizabeth L. Salsgiver ◽  
Daniel A. Bernstein ◽  
Matthew S. Simon ◽  
William G. Greendyke ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Acute Care ◽  
Culture Change ◽  
Acute Care Hospitals ◽  
Role Playing ◽  
Environmental Services ◽  
Audience Response ◽  
Post Intervention ◽  
Before And After ◽  
Quasi Experimental

AbstractObjective:To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.Design:Prospective, quasi-experimental, before-and-after intervention study.Setting:The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.Participants:Frontline environmental services workers.Intervention:A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.Results:On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.Conclusion:A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.

Adherence to hand hygiene and risk factors for poor adherence in 13 Ontario acute care hospitals

2011 ◽  
Vol 39 (8) ◽  
pp. 693-696 ◽  
Author(s):  
Dominik Mertz ◽  
Jennie Johnstone ◽  
Paul Krueger ◽  
Kevin Brazil ◽  
Stephen D. Walter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hand Hygiene ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Poor Adherence

Hand hygiene opportunities on Canadian acute-care inpatient units: A multicenter observational study

2018 ◽  
Vol 39 (11) ◽  
pp. 1378-1380 ◽  
Author(s):  
Dhruv Nayyar ◽  
Christine Moore ◽  
Liz McCreight ◽  
Chiana Garvida ◽  
Emily Xu ◽  
...  
Keyword(s):  
Observational Study ◽  
Hand Hygiene ◽  
Acute Care ◽  
Direct Observation ◽  
Monitoring Systems ◽  
Multicenter Observational Study ◽  
Surgical Units ◽  
To Receive ◽  
Inpatient Units ◽  
Multivariable Adjustment

AbstractIn this multicenter observational study, medical and surgical inpatient rooms were randomized to receive 1 hour of continuous direct observation to determine hand hygiene opportunities (HHOs). After multivariable adjustment, HHOs were similar across inpatient units and hospitals. This estimate could serve to calibrate electronic hand hygiene monitoring systems for Canadian medical and surgical units.

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