PDF
ePub
Citation
Print
Abstract
Background
This study evaluated the frequency and types of hand hygiene practices among healthcare workers directed by the WHO multimodal hand hygiene improvement strategy, and investigated the effect of hand hygiene practice on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) isolation and MRSA acquisition rate and colonization pressure.
Methods
A quasi-experimental study was performed at a tertiary care university hospital with 850 beds from January to September 2012. We assessed the hospital hand hygiene program using the WHO hand hygiene self-assessment framework. The WHO multimodal strategy was used for healthcare workers with low indexes, and the subjects were reassessed.
Results
Hand hygiene compliance increased significantly from a pre-intervention rate of 58.7% to 72.6% post-intervention. MRSA and VRE isolation rates decreased from 1.69 per 1000 patient days to 1.41 and from 0.17 to 0.11, respectively. In intensive care units (ICUs), hand hygiene compliance rate rose to 77.9%, with a total score of 4.16 points out of 5 being awarded for the hand hygiene method, which was higher than that for the other care units. The pre-intervention MRSA acquisition rate in the ICU decreased from 7.47% to 4.30% post-intervention. This was associated with a decrease in the MRSA colonization pressure over the intervention period (26.2% to 16.9%).
Conclusion
The utilization of the WHO multimodal strategy for improvement of hand hygiene increased the hand hygiene compliance rate and was effective in predicting a decreased rate of cross-infection, MRSA acquisition, and colonization pressure. We conclude that the implementation of such improvement strategies is crucial to maintaining hygiene standards and reducing infection within healthcare facilities.
References
1. Jeong JS, Choe MA. The effect of hand washing improving programs on the adherence of hand washing and nosocomial infections in a surgical intensive care unit. Korean J Nosocomial Infect Control. 2004; 9:117–29.
2. Boyce JM, Pittet D. Healthcare Infection Control Practices Advisory Committee. Society for Healthcare Epidemiology of America. Association for Professionals in Infection Control. Infectious Diseases Society of America. Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol. 2002; 23(12 Suppl):S3–40.
3. Larson EL, Early E, Cloonan P, Sugrue S, Parides M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med. 2000; 26:14–22.
4. Kweon OM, Park E, Lee D, Lee JH, Ha EJ, Yong D, et al. A three-year study of the effectiveness of hand-hygiene protocol implementation at a university hospital. Korean J Nosocomial Infect Control. 2012; 17:53–60.
5. Chun HK. Individual feedback and its effects on hand washing, MRSA acquired incidence rate and MRSA colonization pressure among Intensive Care Unit nurses. Seoul; Department of Public Health, Graduate School, Catholic University of Korea. 2009.
6. Lee MH, Kang HS. A comparative study on profession-specific handwashing practices of ICU health care providers. J Korean Acad Fundam Nurs. 2007; 14:297–305.
7. Khatib M, Jamaleddine G, Abdallah A, Ibrahim Y. Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest. 1999; 116:172–5.
8. Lee JY. Epidemiology of MRSA Colonization and Effects of Infection Control Strategies in a Neurosurgical Intensive Care Unit. Seoul; Department of Public Health, Graduate School, Catholic University of Korea. 2005.
9. WHO.WHO guidelines on hand hygiene in health care. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. (Update on August. 2009.
10. Larson E, McGeer A, Quraishi ZA, Krenzischek D, Parsons BJ, Holdford J, et al. Effect of an automated sink on handwashing practices and attitudes in high-risk units. Infect Control Hosp Epidemiol. 1991; 12:422–8.
11. Dubbert PM, Dolce J, Richter W, Miller M, Chapman SW. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol. 1990; 11:191–3.
12. WHO.Hand Hygiene Self-Assessment Framework 2010. http://www.who.int/gpsc/country_work/hhsa_framework.pdf. (Update on May. 2010.
13. Stewardson AJ, Allegranzi B, Perneger TV, Attar H, Pittet D. Testing the WHO Hand Hygiene Self-Assessment Framework for usability and reliability. J Hosp Infect. 2013; 83:30–5.
14. Kilpatrick C. Save lives: clean your hands. A global call for action at the point of care. Am J Infect Control. 2009; 37:261–2.
15. World Health Organization.A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. Geneva; World Health Organization. 2009.
16. Allegranzi B, Sax H, Bengaly L, Richet H, Minta DK, Chraiti MN, et al. World Health Organization “Point G” Project Management Committee. Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol. 2010; 31:133–41.
17. Lee WK. Semmelweis's Work: Hand-washing lowered maternal death rate dramatically. Korean J Nosocomial Infect Control. 2005; 10:43–7.
18. Kim NC, Choi KO. Effects on Nurses’ Hand Washing Behavior and Reduction of Respiratory Isolation Rate of MRSA of the Hand Washing Education. J Korean Acad Adult Nurs. 2002; 14:26–33.
19. Coello R, Jiménez J, García M, Arroyo P, Minguez D, Fernandez C, et al. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis. 1994; 13:74–81.
20. Park ES, Park MR, Kim JE, Choi JS, Jin HY, Song YG, et al. Multicenter ICU surveillance study for nosocomial infection in Korea. Korean J Nosocomial Infect Control. 2003; 8:23–33.
21. Lee MH, Kang HS. A Comparative Study on Profession-specific Handwashing Practices of ICU Health Care Providers. J Korean Acad Fundam Nurs. 2007; 14:297–305.
22. Larson EL. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control. 1995; 23:251–69.
23. Merrer J, Santoli F, Appéré de Vecchi C, Tran B, De Jonghe B, Outin H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol. 2000; 21:718–23.
24. Eveillard M, Lancien E, Hidri N, Barnaud G, Gaba S, Benlolo JA, et al. Estimation of methicillin-resistant Staphylococcus aureus transmission by considering colonization pressure at the time of hospital admission. J Hosp Infect. 2005; 60:27–31.
Fig. 1.
Trends of MRSA and VRE isolaton rates. MRSA isolaton rates, No. of MRSA isolation /1,000 patient’s days; VRE isolaton rates, No. of VRE isolation /1,000 patient’s days.
Table 1.
Compliance rate of hand hygiene
Table 2.
Comparison of healthcare-workers total score in hand hygiene method
Table 3.
Hand hygiene self-assessment framework 2010: system change
Table 4.
Hand hygiene self-assessment framework 2010: training and education
| Question | Range of score | Pre-intervention period | Intervention period |
|---|---|---|---|
| 2.1 Regarding training of health-care workers in your facility: | |||
| 2.1a. How frequently do health-care workers receive training regarding hand hygiene7 in your facility? | 20 | 5 | 20 |
| ▶ At least once (score; 5) | |||
| ▶ Mandatory training for all professional categories at commencement of employment, then ongoing regular training (at least annually) (score; 20) | |||
| 2.1b. Is a process in place to confirm that all health-care workers complete this training? | 20 (yes) | 0 | 20 |
| 2.2 Are the following WHO documents (available at www.who.int/gpsc/5may/tools), or similar local adaptations, easily available to all health-care workers? | |||
| 2.2a The WHO ‘Guidelines on Hand Hygiene in Health-care: A Summary’ | 5 (yes) | 5 | 5 |
| 2.2b The WHO ‘Hand Hygiene Technical Reference Manual’ | 5 (yes) | 5 | 5 |
| 2.2c The WHO ‘Hand Hygiene: Why, How and when’ Brochure | 5 (yes) | 5 | 5 |
| 2.2d The WHO ‘Glove Use Information’ Leaflet | 5 (yes) | 0 | 0 |
| 2.3 Is a professional with adequate skills to serve as trainer for hand hygiene educational programmes active within the health-care facility? | 15 (yes) | 15 | 15 |
| 2.4. Is a system in place for training and validation of hand hygiene compliance observers? | 15 (yes) | 15 | 15 |
| 2.5. Is there is a dedicated budget that allows for hand hygiene training? | 10 (yes) | 0 | 0 |
| Training and Education subtotal | 100 | 50 | 85 |
Table 5.
Hand hygiene self-assessment framework 2010: evaluation and feedback
Table 6.
Hand hygiene self-assessment framework 2010: reminders in the workplace
Table 7.
Hand hygiene self-assessment framework 2010: institutional safety climate for hand hygiene
Table 8.
Level of hand hygiene promotion and practice before and after the intervention activities
*Pä0.05. †Intermediate: an appropriate hand hygiene promotion strategy is in place and hand hygiene practices have improved. It is now crucial to develop long-term plans to ensure that improvement is sustained and progresses. ‡Advanced: hand hygiene promotion and optimal hand hygiene practices have been sustained and/or improved, helping to embed a culture of safety in the health-care setting.
XML Download