Mandated Audit-and-Feedback Did Not Improve Hospital Hand Hygiene

MedicalResearch.com Interview with:
"Hand Washing" by Anthony Albright is licensed under CC BY-SA 2.0Dr. Daniel J. Livorsi, MD
Assistant Professor
INFECTIOUS DISEASE SPECIALIST
University of Iowa

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the Joint Commission’s standards is that hospitals audit and provide feedback on hand hygiene compliance among healthcare workers. Audit-and-feedback is therefore commonly practiced in US hospitals, but the effective design and delivery of this intervention is poorly defined, particularly in relation to hand hygiene improvement.

We studied how 8 hospitals had implemented audit-and-feedback for hand hygiene improvement. We found that hospitals were encountering several barriers in their implementation of audit-and-feedback. Audit data on hand hygiene compliance was challenging to collect and was frequently questioned. The feedback of audit results did not motivate positive change. 

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Placement of Hand Sanitizer Dispensers Important For Staff Compliance

Laila Cure, Ph.D. Assistant Professor Dept. of Industrial and Manufacturing Engineering Wichita State UniversityMedicalResearch.com Interview with:
Laila Cure, Ph.D.
Assistant Professor
Dept. of Industrial and Manufacturing Engineering
Wichita State University

Medical Research: What is the background for this study? What are the main findings?

Response: It is widely known that healthcare work, particularly inpatient care work, is mostly knowledge-based. Healthcare workers are constantly assessing the clinical state of their patients and making decisions that affect their workflow. This type of work is difficult to study and organize as a whole using traditional work design techniques, which are mostly designed for routine, repetitive work. Nevertheless, there are components of inpatient work that can be improved using basic workstation design principles. Hand hygiene is one of them.

Hand hygiene is still the single most important intervention to prevent infection in hospitals. Guidelines state that health care workers should clean their hands before touching a patient, before an aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings. Hand sanitizer dispensers are practical resources to support hand hygiene because they can be placed almost anywhere throughout hospital units. This study aimed at determining whether “good” placement of sanitizer dispensers correlates with compliance of staff in using the sanitizer. “Good placement” was defined in terms of usability characteristics extracted from hand hygiene literature recommendations. Of the usability characteristics included in the study, visibility and accessibility had some statistical influence on improving compliance.

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Improving Hand Hygiene Compliance With Red Flashing Lights

Dr. Gianni D'Egidio HBSc, MD, MEng Academic Division of Internal Medicine Ottawa Hospital, CanadaMedicalResearch.com Interview with:
Dr. Gianni D’Egidio HBSc, MD, MEng
Academic Division of Internal Medicine
Ottawa Hospital, Canada

Medical Research: What are the main findings of the study?

Dr. D’Egidio: Baseline hand hygiene compliance at our main entrance in our study was 12.4%.  We believe one of the main reasons for such an appalling low compliance was that individuals were distracted.  Visitors entering are often preoccupied with acquiring information to help them navigate a large and confusing environment given the multitude of signs, lights, announcements and other people.  Also, the majority of individuals entering have objects occupying their hands; keys, hand-held devices, coffee mugs, and during cold weather, gloves.  All this together contributes to poor compliance at our front entrance.

We hypothesized that a conspicuous flashing red light at 3 Hz (3 flashed per second) attached to alcohol hand dispensers located at our front entrance would attract an individual’s attention and hopefully increase compliance.  We measured hand hygiene compliance for 1-week periods from 07:30-08:30 before and after the implementation of our flashing lights.  We found that compliance increased by more than double to 25.3% (p<0.0001).
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C. Diff Contamination of Health Care Workers’ Hands

Caroline Landelle, PharmD, PhD Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, FranceMedicalResearch.com Interview with:
Caroline Landelle, PharmD, PhD
Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, France

MedicalResearch.com: What are the main findings of the study?

Dr. Landelle: The main findings point to the fact that nearly one in four healthcare workers’ hands are contaminated with Clostridium difficile spores after routine care of patients infected with the bacteria, before performing hand hygiene. This is the first study focusing upon the carriage of viable C. difficile spores on healthcare workers’ hands. C. difficile exist in 2 possible forms: vegetative and spore. Vegetative forms of C. difficile are killed when exposed to air, whereas their spores are resistant to oxygen, desiccation, and most disinfectants, and may persist in the hospital environment for long periods of time; thus, bacterial spores could be the principal form of transmission. Furthermore, contamination of exposed healthcare workers’ hands is statistically associated with direct exposure to fecal soiling and contact without the use of gloves.

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Hand Hygiene: Global WHO Strategy

Prof Didier Pittet, MD, MS Director of the Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, SwitzerlandMedicalResearch.com Interview with :
Prof Didier Pittet, MD, MS
Director of the Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland

 

MedicalResearch.com : What are the main findings of the study?

Prof. Pittet: The main finding is that the WHO hand hygiene promotion strategy is feasible and sustainable across healthcare settings worldwide. For the first time, we have evidence of its feasibility and successful effects to improve hand hygiene in a variety of different geographical and income settings, with an even greater impact in low-/middle-income countries than in high-income countries.

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