scholarly journals Preventing the Transmission of Multidrug-Resistant Organisms: Modeling the Relative Importance of Hand Hygiene and Environmental Cleaning Interventions

2014 ◽  
Vol 35 (9) ◽  
pp. 1156-1162 ◽  
Author(s):  
Sean L. Barnes ◽  
Daniel J. Morgan ◽  
Anthony D. Harris ◽  
Phillip C. Carling ◽  
Kerri A. Thom
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Environmental Cleaning ◽  
Control Programs ◽  
Hospital Units ◽  
Hygiene Compliance ◽  
Using Data ◽  
Intensive Care Unit Nurses

ObjectiveHand hygiene and environmental cleaning are essential infection prevention strategies, but the relative impact of each is unknown. This information is important in assessing resource allocation.MethodsWe developed an agent-based model of patient-to-patient transmission—via the hands of transiently colonized healthcare workers and incompletely terminally cleaned rooms—in a 20-patient intensive care unit. Nurses and physicians were modeled and had distinct hand hygiene compliance levels on entry and exit to patient rooms. We simulated the transmission of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci for 1 year using data from the literature and observed data to inform model input parameters.ResultsWe simulated 175 parameter-based scenarios and compared the effects of hand hygiene and environmental cleaning on rates of multidrug-resistant organism acquisition. For all organisms, increases in hand hygiene compliance outperformed equal increases in thoroughness of terminal cleaning. From baseline, a 2∶1 improvement in terminal cleaning compared with hand hygiene was required to match an equal reduction in acquisition rates (eg, a 20% improvement in terminal cleaning was required to match the reduction in acquisition due to a 10% improvement in hand hygiene compliance).ConclusionsHand hygiene should remain a priority for infection control programs, but environmental cleaning can have significant benefit for hospitals or individual hospital units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness.Infect Control Hosp Epidemiol 2014;35(9):1156-1162

Trial of Universal Gloving with Emollient-Impregnated Gloves to Promote Skin Health and Prevent the Transmission of Multidrug-Resistant Organisms in a Surgical Intensive Care Unit

2010 ◽  
Vol 31 (05) ◽  
pp. 491-497 ◽  
Author(s):  
Gonzalo Bearman ◽  
Adriana E. Rosato ◽  
Therese M. Duane ◽  
Kara Elam ◽  
Kakotan Sanogo ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Phase 1 ◽  
Multidrug Resistant ◽  
Surgical Intensive Care Unit ◽  
Phase 2 ◽  
Surgical Intensive Care ◽  
Contact Precautions ◽  
Hygiene Compliance ◽  
Device Associated Infection

Objective.To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health.Design.Prospective before-after trial.Setting.An 18-bed surgical intensive care unit.Methods.During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistantEnterococcus(VRE) and methicillin-resistantStaphylococcus aureus(MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection andClostridium difficileinfection (CDI) were determined.Results.The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P= .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters;P= .001; after patient care, 63% vs 51% of encounters;P< .001). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P= .10), 8.9 and 7.8 for urinary tract infection (P= .10), and 1.0 and 1.1 for ventilator-associated pneumonia (P= .09). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P= .53). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 (P= .17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 (P= .16). Hand skin health improved during phase 2.Conclusions.Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.

Hand Hygiene, Cohorting, or Antibiotic Restriction to Control Outbreaks of Multidrug-Resistant Enterobacteriaceae

2015 ◽  
Vol 37 (3) ◽  
pp. 272-280 ◽  
Author(s):  
Camille Pelat ◽  
Lidia Kardaś-Słoma ◽  
Gabriel Birgand ◽  
Etienne Ruppé ◽  
Michaël Schwarzinger ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Multidrug Resistant ◽  
Transmission Model ◽  
Patient Contact ◽  
Hand Hygiene Improvement ◽  
Single Carrier ◽  
Before And After ◽  
Hygiene Compliance ◽  
Using Data ◽  
Improvement Intervention

BACKGROUNDThe best strategy for controlling extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) transmission in intensive care units (ICUs) remains elusive.OBJECTIVEWe developed a stochastic transmission model to quantify the effectiveness of interventions aimed at reducing the spread of ESBL-PE in an ICU.METHODSWe modeled the evolution of an outbreak caused by the admission of a single carrier in a 10-bed ICU free of ESBL-PE. Using data obtained from recent muticenter studies, we studied 26 strategies combining different levels of the following 3 interventions: (1) increasing healthcare worker compliance with hand hygiene before and after contact with a patient; (2) cohorting; (3) reducing antibiotic prevalence at admission with or without reducing antibiotherapy duration.RESULTSImproving hand hygiene compliance from 55% before patient contact and 60% after patient contact to 80% before and 80% after patient contact reduced the nosocomial incidence rate of ESBL-PE colonization by 91% at 90 days. Adding cohorting to hand hygiene improvement intervention decreased the proportion of ESBL-PE acquisitions by an additional 7%. Antibiotic restriction had the lowest impact on the epidemic. When combined with other interventions, it only marginally improved effectiveness, despite strong hypotheses regarding antibiotic impact on transmission.CONCLUSIONOur results suggest that hand hygiene is the most effective intervention to control ESBL-PE transmission in an ICU.Infect. Control Hosp. Epidemiol. 2016;37(3):272–280

scholarly journals Hand hygiene compliance among caregivers of inpatients with multidrug-resistant organism infection in China: a cross-sectional study

2020 ◽  
Author(s):  
Wenyan Chang ◽  
Xiaobing Chen ◽  
Wenying He ◽  
Taoyu Lin
Keyword(s):  
Hand Hygiene ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Resistant Organism ◽  
Cross Sectional ◽  
The Public ◽  
Direct Observations ◽  
Medical Institutions ◽  
Hygiene Compliance ◽  
Elderly Caregivers

Abstract Background Caregivers are an important provider of daily living care for multidrug-resistant organism (MDRO) inpatients in China, they are at risk for contracting and spreading MDRO from frequent interactions with patients. Improving the hand hygiene (HH) compliance of caregivers has important significance in reducing the incidence of infection. However, we have little information about HH compliance among caregivers of MDRO inpatients in most medical institutions. Therefore, we decide to examine HH compliance among caregivers of MDRO inpatients in China. Methods Using direct observations, we investigated HH compliance among caregivers of MDRO inpatients between March and August 2019 in a large university-affiliated hospital in China. Using the WHO’s Hand Hygiene Observation Tool, we surveyed a total of 440 HH opportunities. Results Out of the total participants, 16.2% were elderly. Overall HH compliance was 46.8%. The most frequent moment for HH was “after a touching patient” (69.2%) and the lowest compliance was “before clean/aseptic procedures” (25.6%). Compliance during “visiting” was highest (66.7%), with hands being less frequently washed during “resting” (29.0%). Conclusions Overall compliance with HH when caring for MDRO inpatients is less than optimal. Elderly caregivers should be valued by society and the public. These results may be used to identify issues and interventions to address HH practices and achieve a reduction in MDRO infections.

Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran

2016 ◽  
Vol 44 (11) ◽  
pp. e279-e281 ◽  
Author(s):  
Azam Ghorbani ◽  
Leila Sadeghi ◽  
Akram Shahrokhi ◽  
Asghar Mohammadpour ◽  
Mary Addo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Before And After ◽  
Hygiene Compliance ◽  
Intensive Care Unit Nurses
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