Poor hand decontamination and healthcare-acquired infections

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How does poor hand decontamination from nurses in a hospital setting contribute to healthcare-associated infection?

P: Healthcare associated infections
I: Hand hygiene
O: Reducing HCAIs in a hospital setting

Search carried out by: Jason Curtis

Selected papers

Gould DJ, Moralejo D, Drey N, Chudleigh JH Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews 2010.
Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This review assesses the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection.
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Title: Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial.
Citation: International journal of nursing studies, Apr 2013, vol. 50, no. 4, p. 464-474, 1873-491X (April 2013)
Author(s): Huis, Anita, Schoonhoven, Lisette, Grol, Richard, Donders, Rogier, Hulscher, Marlies, van Achterberg, Theo
Abstract: Improving hand hygiene compliance is still a major challenge for most hospitals. Innovative approaches are needed. We tested whether an innovative, theory based, team and leaders-directed strategy would be more effective in increasing hand hygiene compliance rates in nurses than a literature based state-of-the-art strategy. A cluster randomised controlled trial called HELPING HANDS was conducted in 67 nursing wards of three hospitals in the Netherlands. All affiliated nurses of the nursing wards. Wards were randomly assigned to either the team and leaders-directed strategy (30 wards) or the state-of-the-art strategy (37 wards). The control arm received a state-of-the-art strategy including education, reminders, feedback and targeting adequate products and facilities. The experimental group received all elements of the state-of-the-art strategy supplemented with interventions based on social influence and leadership, comprising specific team and leaders-directed activities. Strategies were delivered during a period of six months. We monitored nurses’ HH compliance during routine patient care before and directly after strategy delivery, as well as six months later. Secondary outcomes were compliance with each type of hand hygiene opportunity, the presence of jewellery and whether the nurses wore long-sleeved clothes. The effects were evaluated on an intention-to-treat basis by comparing the post-strategy hand hygiene compliance rates with the baseline rates. Multilevel analysis was applied to compensate for the clustered nature of the data using mixed linear modelling techniques. During the study, we observed 10,785 opportunities for appropriate hand hygiene in 2733 nurses. The compliance in the state-of-the-art group increased from 23% to 42% in the short term and to 46% in the long run. The hand hygiene compliance in the team and leaders-directed group improved from 20% to 53% in the short term and remained 53% in the long run. The difference between both strategies showed an Odds Ratio of 1.64 (95% CI 1.33-2.02) in favour of the team and leaders-directed strategy. Our results support the added value of social influence and enhanced leadership in hand hygiene improvement strategies. The methodology of the latter also seems promising for improving team performance with other patient safety issues. ClinicalTrials.gov [NCT00548015]. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Title: The short-term and long-term effectiveness of a multidisciplinary hand hygiene improvement program.
Citation: American journal of infection control, Oct 2012, vol. 40, no. 8, p. 732-736, 1527-3296 (October 2012)
Author(s): Tromp, Mirjam, Huis, Anita, de Guchteneire, Inge, van der Meer, Jos, van Achterberg, Theo, Hulscher, Marlies, Bleeker-Rovers, Chantal
Abstract: Although hand hygiene (HH) compliance has been an important issue for years, the compliance rate is still a problem in health care today. This was an observational, prospective, before-and-after study. We measured HH knowledge and HH compliance before (baseline), directly after (poststrategy), and 6 months after the performance of HH team strategies (follow-up). The study was composed of employed nurses and physicians working in the department of internal medicine of a university hospital. We performed a multifaceted improvement program including HH education, feedback, reminders, social influence activities including the use of role models, and improvement of HH facilities. Ninety-two nurses and physicians were included. Compared with baseline, there was a significant improvement in the overall mean HH knowledge score at poststrategy (from 7.4 to 8.4) and follow-up (from 7.4 to 8.3). The overall HH compliance was 27% at baseline, 83% at poststrategy, and 75% at follow-up. At baseline, the compliance rate was 17% in nurses and 43% in physicians and significantly improved to 63% in nurses and 91% in physicians at follow-up. Our multifaceted HH improvement program resulted in a sustained improvement of HH knowledge and compliance in nurses as well as physicians. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
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Title: Hand-washing behaviour and nurses’ knowledge after a training programme.
Citation: International journal of nursing practice, Oct 2011, vol. 17, no. 5, p. 464-469, 1440-172X (October 2011)
Author(s): Erkan, Tulay, Findik, Ummu Yildiz, Tokuc, Burcu
Abstract: The aim of this study was to evaluate the nurses’ hand-washing behaviour and knowledge before and after a training programme. This prospective study involved 200 nurses who participated in hand-washing training at a university hospital in Turkey. The data were collected using a personal information form and pre- and post-test surveys that had been developed by the researchers. During the study, the nurses received 40 min of training on hand washing and a handbook prepared by the researchers. The hand-washing behaviour and knowledge of the nurses were assessed before training and 1 month after the training. To analyse the data, descriptive statistics, a t-test and a Mc Nemar chi-squared test were used. Following the training, there was a significant increase in the frequency of hand washing by the nurses (t = -2.202, P = 0.029), together with an increase in the time allowed for hand washing (P = 0.024, P < 0.05), knowledge of hand-washing practices (t = -16.081, P < 0.05) and quality (t = -10.874, P < 0.05). Planned training programmes for hand washing should be implemented to improve the behaviour and knowledge of nurses. © 2011 Blackwell Publishing Asia Pty Ltd.
Full Text: Available from EBSCOhost in International Journal of Nursing Practice


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