Interventions to improve hand hygiene compliance in patient care

Gould, Dinah; Chudleigh, Jane; Moralejo, Donna; Drey, Nicholas

doi:10.1002/14651858.cd005186.pub2

Cited by 44 publications

(21 citation statements)

References 54 publications

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“…We included eight reviews on interventions to promote safety culture in health facility with a median AMSTAR score of 5.5; four reviews focused on administration of preventive influenza vaccination to healthcare workers and its effectiveness and uptake [44-47], one on hand hygiene promotion [48], one on the impact of interventions to reduce medication related errors [49] while two of the reviews reported the impacts of multi-component safety culture strategies and organizational interventions [50,51]. None of the reviews reported MNH specific outcomes while meta-analysis was conducted in two of the reviews.…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacist-led interventions aimed to reduce drug-related morbidity, hospitalization or death from medication overuse or misuse in healthcare facility have shown significant impact on reducing hospital admissions (RR: 0.64, 95% CI: 0.43, 0.96) although the evidence is weak and does not report impact on preventable drug related morbidity [49]. Various safety culture strategies and interventions to improve hand hygiene compliance reported insufficient evidence to draw any firm conclusion [48] with some evidence of improved perceptions and potentially reduced patient harm [50,51]. …”

Section: Resultsmentioning

confidence: 99%

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Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings

et al. 2014

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Most of the maternal and newborn deaths occur at birth or within 24 hours of birth. Therefore, essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric care facilities. Facilities provide complex interventions including advice on referrals, post discharge care, long-term management of chronic conditions along with staff training, managerial and administrative support to other facilities. This paper reviews the effectiveness of facility level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined facility level interventions and included 32 systematic reviews.Findings suggest that additional social support during pregnancy and labour significantly decreased the risk of antenatal hospital admission, intrapartum analgesia, dissatisfaction, labour duration, cesarean delivery and instrumental vaginal birth. However, it did not have any impact on pregnancy outcomes. Continued midwifery care from early pregnancy to postpartum period was associated with reduced medical procedures during labour and shorter length of stay. Facility based stress training and management interventions to maintain well performing and motivated workforce, significantly reduced job stress and improved job satisfaction while the interventions tailored to address identified barriers to change improved the desired practice. We found limited and inconclusive evidence for the impacts of physical environment, exit interviews and organizational culture modifications.At the facility level, specialized midwifery teams and social support during pregnancy and labour have demonstrated conclusive benefits in improving maternal newborn health outcomes. However, the generalizability of these findings is limited to high income countries. Future programs in resource limited settings should utilize these findings to implement relevant interventions tailored to their needs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings

et al. 2014

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“…The WHO recommends undertaking hand hygiene when entering the patient environment. However as staff compliance with hand hygiene is routinely less than 100% [11], introduction of microbes into bed spaces is still a risk. Accordingly, optimising ward design to limit the risk of contamination, is still of value.…”

Section: Discussionmentioning

confidence: 99%

Hospital Door Handle Design and Their Contamination with Bacteria: A Real Life Observational Study. Are We Pulling against Closed Doors?

Wojgani

Kehsa²,

Cloutman-Green³

et al. 2012

PLoS ONE

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ObjectiveTo determine whether microbial contamination of door handles in two busy intensive care units and one high dependency unit was related to their design, location, and usage.DesignObservational study of the number of viable bacteria on existing door handles of different design at defined entry/exit points with simultaneous data collection of who used these doors and how often.SettingTwo busy specialised intensive care units and one high dependency unit in a tertiary referral NHS neurological hospital.Main outcome measuresSurface bacterial density on door handles with reference to design, location, and intensity of use.ResultsWe found a significant correlation between the frequency of movements through a door and the degree to which it was contaminated (p = <0.01). We further found that the door's location, design and mode of use all influenced contamination. When compared to push plate designs, pull handles revealed on average a five fold higher level of contamination; lever handles, however, displayed the highest levels of bacterial contamination when adjusted for frequency of use. We also observed differences in contamination levels at doors between clinical areas, particularly between the operating theatres and one of the ICUs.ConclusionsDoor handles in busy, “real life” high acuity clinical environments were variably contaminated with bacteria, and the number of bacteria found related to design, location, mode and frequency of operation. Largely ignored issues of handle and environmental design can support or undermine strategies designed to limit avoidable pathogen transmission, especially in locations designed to define “thresholds” and impose physical barriers to pathogen transmission between clinical areas. Developing a multidisciplinary approach beyond traditional boundaries for purposes of infection control may release hitherto unappreciated options and beneficial outcomes for the control of at least some hospital acquired infections.

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“…Healthcare worker (HCW) hand hygiene is considered to be one of the most important interventions for the prevention of HAIs and AROs [4,5]. However HCW hand hygiene is typically poor, with a median compliance of 40% [6], and few interventions have been demonstrated to result in significant and sustained improvement [4,5,7]. Currently, ‘multimodal’ hand hygiene programs are recommended, including education, improved access to alcohol-based hand sanitizer, workplace reminders, and regular and sustained audit and feedback of hand hygiene compliance [4,5,8].…”

Section: Introductionmentioning

confidence: 99%

Hand hygiene monitoring technology: protocol for a systematic review

et al. 2013

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BackgroundHealthcare worker hand hygiene is thought to be one of the most important strategies to prevent healthcare-associated infections, but compliance is generally poor. Hand hygiene improvement interventions must include audits of compliance (almost always with feedback), which are most often done by direct observation - a method that is expensive, subjective, and prone to bias. New technologies, including electronic and video hand hygiene monitoring systems, have the potential to provide continuous and objective monitoring of hand hygiene, regular feedback, and for some systems, real-time reminders. We propose a systematic review of the evidence supporting the effectiveness of these systems. The primary objective is to determine whether hand hygiene monitoring systems yield sustainable improvements in hand hygiene compliance when compared to usual care.Methods/DesignMEDLINE, EMBASE, CINAHL, and other relevant databases will be searched for randomized control studies and quasi-experimental studies evaluating a video or electronic hand hygiene monitoring system. A standard data collection form will be used to abstract relevant information from included studies. Bias will be assessed using the Cochrane Effective Practice and Organization of Care Group Risk of Bias Assessment Tool. Studies will be reviewed independently by two reviewers, with disputes resolved by a third reviewer. The primary outcome is directly observed hand hygiene compliance. Secondary outcomes include healthcare-associated infection incidence and improvements in hand hygiene compliance as measured by alternative metrics. Results will be qualitatively summarized with comparisons made between study quality, the measured outcome, and study-specific factors that may be expected to affect outcome (for example, study duration, frequency of feedback, use of real-time reminders). Meta-analysis will be performed if there is more than one study of similar systems with comparable outcome definitions.DiscussionElectronic and video monitoring systems have the potential to improve hand hygiene compliance and prevent healthcare-associated infection, but are expensive, difficult to install and maintain, and may not be accepted by all healthcare workers. This review will assess the current evidence of effectiveness of these systems before their widespread adoption.Study registrationPROSPERO registration number: CRD42013004519

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Interventions to improve hand hygiene compliance in patient care

Abstract: This is the published version of the paper. This version of the publication may differ from the final published version. Permanent repository link: https://openaccess.city.ac.uk/id/eprint/20266/ Link to published version: http://dx.

Cited by 44 publications

References 54 publications

Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings

Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings

Hospital Door Handle Design and Their Contamination with Bacteria: A Real Life Observational Study. Are We Pulling against Closed Doors?

Hand hygiene monitoring technology: protocol for a systematic review

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