A Day in the Saddle Can Take Its Toll: The Impact of Accumulated Time, Work Intensity and Work Breaks on Hand Hygiene Compliance

Author(s):  
Hengchen Dai ◽  
Katherine L. Milkman ◽  
David A. Hofmann ◽  
Bradley R. Staats
2009 ◽  
Vol 30 (3) ◽  
pp. 222-225 ◽  
Author(s):  
Erol Kohli ◽  
Judy Ptak ◽  
Randall Smith ◽  
Eileen Taylor ◽  
Elizabeth A. Talbot ◽  
...  

Objective.To determine the impact of known observers on hand hygiene performance in inpatient care units with differing baseline levels of hand hygiene compliance.Design.Observational study.Setting.Three inpatient care units, selected on the basis of past hand hygiene performance, in a hospital where hand hygiene observation and feedback are routine.Participants.Three infection control practitioners (ICPs) and a student intern observed hospital staff.Methods.Beginning in late 2005, the 3 ICPs, who were well known to the hospital staff, performed frequent, regular observations of hand hygiene in all 3 inpatient care units of the hospital, as part of routine surveillance. During the study period (January-May 2007), a student intern who was unknown to the hospital staff also performed observations of hand hygiene in the 3 inpatient care units. The rates of hand hygiene compliance observed by the 3 ICPs were compared with those observed by the student intern.Results.The 3 ICPs observed 332 opportunities for hand hygiene during 15 observation periods, and the student intern observed 355 opportunities during 19 observation periods. The overall rate of hand hygiene compliance observed by the ICPs was 65% (ie, in 215 of the 332 opportunities, the performance of proper hand hygiene by hospital staff was observed), and the overall rate of hand hygiene compliance observed by the student intern was 58% (ie, in 207 of the 355 opportunities, the performance of proper hand hygiene by hospital staff was observed) (P = .1). Both the ICPs and the student intern were able to distinguish between inpatient care units with a high rate of hand hygiene compliance (hereafter referred to as high-performing units) and those with a low rate (hereafter referred to as low-performing units). However, in the 2 high-performing units, the ICPs observed significantly higher compliance rates than did the student intern, whereas in the low-performing unit, both the ICPs and the student intern measured similarly low rates of hand hygiene compliance.Conclusions.Recognized observers are associated with higher rates of hand hygiene compliance, even in a healthcare setting where such observations have become routine. This effect (ie, the Hawthorne effect) is more pronounced in high-performing units and insignificant in low-performing units. The use of unrecognized observers may be important for verifying high performance but is probably unnecessary for documenting poor performance. Moreover, the Hawthorne effect may be a useful tool for sustaining and improving hand hygiene compliance.


Author(s):  
Aeshah N. Alqahtani ◽  
Rana H. Almaghrabi ◽  
Mohammed M. Albaadani ◽  
Khalid Almossa

The purpose of this study was to explore the impact of various training programs and guidelines on improving the healthcare quality and patient. The training programs that we have explained in this study are related to Hand Hygiene compliance, Improving clinical outcomes and reducing financial burden and Preventing healthcare associated infection, This study Applied to many health institutions and healthcare employees in the Kingdom of Saudi Arabia, It is from this analysis that improve quality of healthcare through control training program, IPC training program improve hand hygiene compliance and reduces the HAIs prevalence, improves patient outcomes and reduces healthcare costs, training of all the persons involved in primary healthcare may fill the IPC gaps.


2014 ◽  
Vol 35 (9) ◽  
pp. 1163-1168 ◽  
Author(s):  
Jun Yin ◽  
Heather Schacht Reisinger ◽  
Mark Vander Weg ◽  
Marin L. Schweizer ◽  
Andrew Jesson ◽  
...  

ObjectiveHand hygiene surveillance programs that rely on direct observations of healthcare worker activity may be limited by the Hawthorne effect. In addition, comparing compliance rates from period to period requires adequately sized samples of observations. We aimed to statistically determine whether the Hawthorne effect is stable over an observation period and statistically derive sample sizes of observations necessary to compare compliance rates.DesignProspective multicenter cohort study.SettingFive intensive care units and 6 medical/surgical wards in 3 geographically distinct acute care hospitals.MethodsTrained observers monitored hand hygiene compliance during routine care in fixed 1-hour periods, using a standardized collection tool. We estimated the impact of the Hawthorne effect using empirical fluctuation processes and F tests for structural change. Standard sample-size calculation methods were used to estimate how many hand hygiene opportunities are required to accurately measure hand hygiene across various levels of baseline and target compliance.ResultsExit hand hygiene compliance increased after 14 minutes of observation (from 56.2% to 60.5%; P < .001) and increased further after 50 minutes (from 60.5% to 66.0%; P < .001). Entry compliance increased after 38 minutes (from 40.4% to 43.4%; P = .005). Between 79 and 723 opportunities are required during each period, depending on baseline compliance rates (range, 35%–90%) and targeted improvement (5% or 10%).ConclusionsLimiting direct observation periods to approximately 15 minutes to minimize the Hawthorne effect and determining required number of hand hygiene opportunities observed per period on the basis of statistical power calculations would be expected to improve the validity of hand hygiene surveillance programs.Infect Control Hosp Epidemiol 2014;35(9):1163-1168


2011 ◽  
Vol 5 (S6) ◽  
Author(s):  
P Rodriguez-Perez ◽  
CC Mireia ◽  
RR Cristina ◽  
PM Rosa ◽  
JM Ana Belén ◽  
...  

2013 ◽  
Vol 34 (9) ◽  
pp. 919-928 ◽  
Author(s):  
Dale A. Fisher ◽  
Theresa Seetoh ◽  
Helen Oh May-Lin ◽  
Sivakumar Viswanathan ◽  
Yanling Toh ◽  
...  

Objective.The primary objective of this study was to validate a novel method of assessing hand hygiene compliance using ultrasound transmitters in patient zones and staff tagged with receivers. The secondary objective was to assess the impact of audio reminders and quantified individual feedback.Design.An observational comparison against manual assessment followed by assessment using an open-label randomized control method.Setting.Patient zones were established in 3 wards of 2 large teaching hospitals, including 88 general and 18 intensive care unit ward beds.Participants.Consented regular ward nursing, medical, and allied health staff.Methods.Concordance between 40 hours of manual observation using trained hand hygiene auditors and automated measures of opportunities and compliance. Subsequent measured interventions were reminder beeps and written individual feedback.Results.When compared with manual observations, ultrasound monitoring underestimated percentage compliances by a nonsignificant mean (95% confidence interval [CI]) difference of 5.2% (−20.1% to 9.8%; P = .491). After the intervention, adjusted multivariate analysis showed mean (95% CI) overall compliance in the intervention arm was 6.8% (2.5%−11.1%; P = .002) higher than in the control arm. Results stratified by compliance at entry and exit showed that the effect of intervention was stronger for compliance at exit than at entry.Conclusions.Our automated measure of hand hygiene compliance is valid when compared with the traditional gold standard of manual observations. As an interventional tool, ultrasound-based automated hand hygiene audits have significant benefit that can be built upon with enhancements and find increasing acceptance with time.


2012 ◽  
Vol 16 ◽  
pp. e379-e380
Author(s):  
S.F. Mahmood ◽  
S. Musani ◽  
H. Amin ◽  
R. Khowaja ◽  
S. Jindani ◽  
...  

2021 ◽  
pp. 175717742110127
Author(s):  
Tony Y Eng ◽  
Nina L Eng ◽  
Carol A Jenkins ◽  
Patti G Grota

Background: Hand hygiene is paramount in preventing the spread of healthcare-associated infections especially during disease epidemics. Compliance rates with hand hygiene policies remain below 50% internationally and may be lower in the outpatient care setting. This study assessed the impact of the patient empowerment model on hand hygiene compliance among healthcare providers. Methods: From October 2016 to May 2017, patients from a large ambulatory oncology centre were prospectively enrolled. Patients were instructed to observe healthcare providers for hand hygiene compliance and to remind healthcare providers where it was not observed during at least three consecutive encounters. Healthcare provider reactions to this intervention were rated by patients. Patients’ hand hygiene knowledge and beliefs were objectively elicited pre and post-study. Results: Thirty patients with a median age of 52 years (range 5–91) completed the study for a total of 190 healthcare provider encounters. When initial hand hygiene was not observed, patients offered a reminder in 71 (37.4%) encounters, did not offer a reminder in 73 (38.4%) encounters and forgot to offer a reminder in 24 (14.2%) encounters. Patients perceived positive or neutral reactions in 76.8% of encounters and negative or surprised reactions in 23.2% of encounters. Healthcare provider compliance improved from 11.6% to 48.9% with intervention. Patient hand hygiene knowledge improved by 16% following the study. Conclusions: Patient-empowered hand hygiene may be a useful adjunct for improving hand hygiene compliance among healthcare providers and improving patient hand hygiene knowledge, although it may confer an emotional burden on patients.


2020 ◽  
Author(s):  
Komal Shah ◽  
Priya Kotwani ◽  
Somen Saha

Abstract Background: HAIs impart a huge clinical and economic burden in India. Healthcare worker’s compliance to hand hygiene protocol can play an important role in preventing the transmission of cross-infection and thus reducing the HAIs. Over last few years, there has been a wide use of ultraviolate (UV) based fluorescent markers for assessing quality of hand hygiene. This Health Technology Assessment (HTA) study will be conducted with the aim to identify low cost, easy and feasible strategy having potential to get integrated in the current health system to deal with issue of HAI in ICU settings. Methods: The study will be conducted in three phases. The impact of innovation on hand hygiene compliance will be assessed quantitatively by undertaking meta-analysis of secondary literature on UV based imaging tool in improving hand hygiene compliance in ICUs. Following this, the feasibility of using this innovation in developing country like India will be assessed. Decision Analytic modelling will be conducted for cost-effectiveness analysis using health systems perspective. Cost per ICU stay (day) and QALY gained will be calculated and ICER will be reported to comment on the cost-effectiveness of the innovation. Discussion: The HTA study will provide a comprehensive overview of the effectiveness of UV light based imaging device in reduction of HAIs. The results of this HTA study will generate evidence for the decision makers for its incorporation in public healthcare system of India. Systematic review registration: The protocol has been registered in Prospero (Prospero Id: CRD42018108960)


2020 ◽  
Author(s):  
Komal Shah ◽  
Priya Kotwani ◽  
Somen Saha

Abstract Background: HAIs impart a huge clinical and economic burden in India. Healthcare worker’s compliance to hand hygiene protocol can play an important role in preventing the transmission of cross-infection and thus reducing the HAIs. Over last few years, there has been a wide use of ultraviolate (UV) based fluorescent markers for assessing quality of hand hygiene. This Health Technology Assessment (HTA) study will be conducted with the aim to identify low cost, easy and feasible strategy having potential to get integrated in the current health system to deal with issue of HAI in ICU settings.Methods: The study will be conducted in three phases. The impact of innovation on hand hygiene compliance will be assessed quantitatively by undertaking meta-analysis of secondary literature on UV based imaging tool in improving hand hygiene compliance in ICUs. Following this, the feasibility of using this innovation in developing country like India will be assessed. Decision Analytic modelling will be conducted for cost-effectiveness analysis using health systems perspective. Cost per ICU stay (day) and QALY gained will be calculated and ICER will be reported to comment on the cost-effectiveness of the innovation.Discussion: The HTA study will provide a comprehensive overview of the effectiveness of UV light based imaging device in reduction of HAIs. The results of this HTA study will generate evidence for the decision makers for its incorporation in public healthcare system of India.Systematic review registration: The protocol has been registered in Prospero (Prospero Id: CRD42018108960)


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