Adoption of electronic hand hygiene monitoring systems in New York state hospitals and the associated impact on hospital-acquired C. difficile infection rates

Durant, Danielle J.; Willis, Loretta; Duvall, Sarah

doi:10.1016/j.ajic.2020.04.005

Cited by 13 publications

(5 citation statements)

References 25 publications

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“…This is the first study showing the cost-effectiveness of an AHHMS in comparison with manual monitoring which we conducted by shadowing techniques, since the results reported by Guest et al were based on effectiveness data of other studies ( 12 ). Although implementation of an AHHMS may entail a significant investment for healthcare providers as reported in other studies ( 17 ); our results show that the return obtained as a consequence of the reduction in infections is greater and may even result in savings.…”

Section: Discussionsupporting

confidence: 58%

Cost-effectiveness analysis of a hand hygiene monitoring system in a tertiary pediatric hospital in Mexico

Salinas-Escudero

Rosa-Zamboni²,

Carrillo-Vega³

et al. 2023

Front. Public Health

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BackgroundAn automated hand-hygiene monitoring system (AHHMS) was implemented in October 2019 at the Hospital Infantil de México Federico Gómez (HIMFG), a tertiary pediatric referral hospital, in four of the hospital wards with the highest rates of Healthcare Associated Infections (HAIs). The clinical and economic impact of this system had not yet been assessed prior to this study. This study aimed to evaluate if the AHHMS is a cost-effective alternative in reducing HAIs in the HIMFG.MethodologyA full cost-effectiveness economic assessment was carried out for the hospital. The alternatives assessed were AHHMS implementation vis-a-vis AHHMS non-implementation (historical tendency). The outcomes of interest were infection rate per 1,000 patient-days and cost savings as a result of prevented infections. Infection rate data per 1,000 patient-days (PD) were obtained from the hospital's Department of Epidemiology with respect to the AHHMS. As regards historical tendency, an infection-rate model was designed for the most recent 6-year period. Infection costs were obtained from a review of available literature on the subject, and the cost of the implemented AHHMS was provided by the hospital. The assessment period was 6 months. The incremental cost-effectiveness ratio was estimated. Costs are reported in US Dollars (2021). Univariate sensitivity and threshold analysis for different parameters was conducted.ResultsThe total estimated cost of the AHHMS alternative represented potential savings of $308,927–$546,795 US Dollars compared to non-implementation of the system (US$464,102 v. US$773,029–$1,010,898) for the period. AHHMS effectiveness was reflected in a diminished number of infections, 46–79 (−43.4–56.7%) compared to non-implementation (60 v. 106-139 infections).ConclusionThe AHHMS was found to be a cost-saving alternative for the HIMFG given its cost-effectiveness and lower cost vis-a-vis the alternate option. Accordingly, the recommendation was made of extending its use to other areas in the hospital.

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Section: Discussionsupporting

confidence: 58%

Cost-effectiveness analysis of a hand hygiene monitoring system in a tertiary pediatric hospital in Mexico

Salinas-Escudero

Rosa-Zamboni²,

Carrillo-Vega³

et al. 2023

Front. Public Health

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“…[ 18 ] Social pressure highly influences visitor’s compliance to HH rules. [ 19 ] Visitors being in the company are more likely to use AHR than being alone - a reduction of HH compliance from 44% at the main hospital’s entrance to 4.1% at the departments, and only 2.7% at patient’s room. [ 20 ] Furthermore, visitors are 5.28-times more prone to use AHR, when dispensers are located in the middle of the lobby and demonstrably labelled with landmarks and barriers.…”

Section: Discussionmentioning

confidence: 99%

“…[ 20 ] Furthermore, visitors are 5.28-times more prone to use AHR, when dispensers are located in the middle of the lobby and demonstrably labelled with landmarks and barriers. [ 19 ] The AHR use is 1.35-times more likely in the afternoon than morning, and by younger people than the elder. To increase the AHR usage, dispensers should be installed in exposed/public, not private areas.…”

Section: Discussionmentioning

confidence: 99%

Identification of human-dependent routes of pathogen’s transmission in a tertiary care hospital

et al. 2022

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Objectives The purpose of the study was to validate the risk of patients' exposure to pathogenic flora carried on hands of students, visitors, and patients themselves, analyzing its density and genera and to compare them with the microflora of healthcare workers (HCWs). Patients and methods Between May and June 2018, five groups of participants were included. Each group consisted of eight individuals. Palmar skin imprints were obtained from dominant hands of doctors, nurses, students, visitors, and patients in orthopedics ward. Imprints were incubated at 37°C under aerobic conditions, and colony-forming units (CFU) on each plate were counted after 24, 48, and 72 h. Microorganisms were identified. Results Hands of doctors were colonized more often by Gram - positive non-spore-forming rods bacteria than hands of nurses (p<0.05). A higher number of Staphylococcus epidermidis CFUs was observed on doctors’ than on nurses’ hands (p<0.05), whereas Staphylococcus hominis was isolated from doctor’s and patients’ imprints, but was not from nurses’ and students’ imprints (p<0.05). Micrococcus luteus colonized patients’ hands more often than students’ (p<0.05), visitors’ hands than doctors’ (p<0.05), students’ than nurses’ (p<0.05), visitors’ than nurses’ (p<0.05) and patients’ hands (p<0.05). Staphylococcus aureus (S. aureus) was isolated only from one doctor and one nurse (203 and 10 CFUs/25 cm 2 ). Imprints taken from the hands of patients, students and visitors were S. aureus-free . No methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci, nor expanded spectrum betalactamase-positive or carbapenemase-positive rods were isolated. The number of Gram-negative rods was the highest on visitors' hands, significantly differing from the number on patient’s, doctor’s, nurse’s, and student’s hands. Spore-forming rods from genus of Bacillus were isolated from representatives of all tested groups. Bacillus cereus occurred more commonly on visitors’ hands than doctors’ hands (p<0.05). Conclusion Patients, students, and visitors may play the causal role in the spread of pathogenic bacteria, particularly spore-forming rods. Our study results confirm the effectiveness of educational activities, that is the hospital's hand hygiene program among HCWs, patients, and visitors. Hand hygiene procedures should be reviewed to put much more effort into reducing the impact of all studied groups on the transmission of infectious diseases.

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“…To our knowledge, there are currently 29 commercially available AHHMS, 75% of which are manufactured by companies based in the USA [15]. Over the last 10 years, uptake of these systems has remained stable, yet low, at around 4% [22,23]. A small survey of Directors of Infection Prevention and Control (DIPCs) in the UK found that these systems were perceived to be expensive and not guaranteed to produce a return on investment [15].…”

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confidence: 99%

Automated Hand Hygiene Monitoring Systems: Current Issues, Developments and Perceived Benefits

2021

Microbiol Immunol Pathol

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Healthcare-Associated Infections (HCAIs) are among the leading causes of death in the United States affecting about one in every 20 hospitalised patients [1]. Furthermore, at least 50% of these infections are preventable [2]. Healthcare Workers (HCWs) practicing good Hand Hygiene (HH) is fundamental to preventing HCAI transmission, as HH compliance and HCAI rates are closely linked [3]. Though this association is well established, maintaining high levels of HH compliance is a perennial problem in all healthcare settings. When independently audited, HH compliance has been shown to be in the region of 50% at best [4]. Compliance is particularly poor when staff are busy and experiencing burnout [5] which has been mirrored in a recent report that found hospital transmission of COVID-19 accounted for 20-25% of cases [6]. Stressed and overworked HCWs perform less HH, thereby inadvertently increasing the risk of COVID-19 transmission and other HCAIs. Simply blaming HCWs is not the answer. Though maintaining adequate patient to staff ratios is essential, providing staff with unbiased and opportunistic feedback on their HH practice is also key to mitigating HCAI risk.Accurately monitoring HH compliance is an important quality improvement and patient safety control strategy. Good HH compliance should be rewarded and celebrated. Equally, areas for improvement must be identified and educational resources allocated accordingly. The World Health Organisation (WHO) currently recommends that the gold standard for monitoring HH is by direct observation (DO) of HCWs using trained, independent auditors. In its technical manual, the WHO provides detailed guidance on the audit process stressing the value of immediate personalised feedback to HCWs [7]. Whilst DO is widely accessible and requires minimal financial investment, it is labour intensive and yet only produces small quantities of data [8]. A plethora of evidence demonstrates that the quality of DO data is impeded by the Hawthorne effect as well as observer and selection bias [9]. It has been estimated that the full hand hygiene audit cycle, including data input and feedback, can cost £28,800 per year in staff time using DO [10]. This could be considered a high price to pay for low quality data that ultimately gives Infection Prevention and Control (IPC) teams an unclear picture of the HCAI risk in their organisation. Whilst these issues are widely acknowledged in the IPC community, HCWs are also cognisant of the problems with DO. A survey conducted in 2020 found that 58% of 1,120 staff Commentary

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Adoption of electronic hand hygiene monitoring systems in New York state hospitals and the associated impact on hospital-acquired C. difficile infection rates

Cited by 13 publications

References 25 publications

Cost-effectiveness analysis of a hand hygiene monitoring system in a tertiary pediatric hospital in Mexico

Cost-effectiveness analysis of a hand hygiene monitoring system in a tertiary pediatric hospital in Mexico

Identification of human-dependent routes of pathogen’s transmission in a tertiary care hospital

Automated Hand Hygiene Monitoring Systems: Current Issues, Developments and Perceived Benefits

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