Interventions to Improve Hand Hygiene Compliance in the ICU: A Systematic Review
Lydon, S et al
Critical Care Medicine: November 2017 - Volume 45 - Issue 11 - p e1165–e1172
Objectives: To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described.
Data Sources: Systematic searches were conducted in November 2016 using five electronic databases: Medline, CINAHL, PsycInfo, Embase, and Web of Science. Additionally, the reference lists of included studies and existing review papers were screened.
Study Selection: English language, peer-reviewed studies that evaluated an intervention to improve hand hygiene in an adult ICU setting, and reported hand hygiene compliance rates collected via observation, were included.
Data Extraction: Data were extracted on the setting, participant characteristics, experimental design, hand hygiene measurement, intervention characteristics, and outcomes. Interventional components were categorized using the Behavior Change Wheel. Methodological quality was examined using the Downs and Black Checklist.
Data Synthesis: Thirty-eight studies were included. The methodological quality of studies was poor, with studies scoring a mean of 8.6 of 24 (SD= 2.7). Over 90% of studies implemented a bundled intervention. The most frequently employed interventional strategies were education (78.9%), enablement (71.1%), training (68.4%), environmental restructuring (65.8%), and persuasion (65.8%). Intervention outcomes were variable, with a mean relative percentage change of 94.7% (SD= 195.7; range, 4.3–1155.4%) from pre to post intervention.
Conclusions: This review demonstrates that best practice for improving hand hygiene in ICUs remains unestablished. Future research employing rigorous experimental designs, careful statistical analysis, and clearly described interventions is important.
Showing posts with label hand hygiene. Show all posts
Showing posts with label hand hygiene. Show all posts
Sunday, 26 November 2017
Wednesday, 2 August 2017
Key factors for hand hygiene promotion in intensive care units
Key factors for hand hygiene promotion in intensive care units
De Wandel D et al
Critical Care Medicine: Article in Press
Hand hygiene remains a cornerstone in the fight against healthcare-associated infections and multidrug resistance (Blot, 2008). Hand hygiene behaviour is deep-rooted and difficult to change. According to a recently published Intensive & Critical Care Nursing article by Battistella et al. (2017), professional hand hygiene behaviour in intensive care settings is influenced by habits of social handwashing in everyday life. Therefore, they plead for the creation of specific professional hand hygiene habits (washing hands should become ‘a routine inside a habit’).
De Wandel D et al
Critical Care Medicine: Article in Press
Hand hygiene remains a cornerstone in the fight against healthcare-associated infections and multidrug resistance (Blot, 2008). Hand hygiene behaviour is deep-rooted and difficult to change. According to a recently published Intensive & Critical Care Nursing article by Battistella et al. (2017), professional hand hygiene behaviour in intensive care settings is influenced by habits of social handwashing in everyday life. Therefore, they plead for the creation of specific professional hand hygiene habits (washing hands should become ‘a routine inside a habit’).
Thursday, 17 November 2016
Developing professional habits of hand hygiene in intensive care settings: An action-research intervention
Developing professional habits of hand hygiene in intensive care settings: An action-research intervention
Battistella G, Bazzo S.
Critical Care Nursing - Article in Press
To explore perceptions and unconscious psychological processes underlying handwashing behaviours of intensive care nurses, to implement organisational innovations for improving hand hygiene in clinical practice.
Battistella G, Bazzo S.
Critical Care Nursing - Article in Press
To explore perceptions and unconscious psychological processes underlying handwashing behaviours of intensive care nurses, to implement organisational innovations for improving hand hygiene in clinical practice.
Thursday, 3 September 2015
Physician report cards and rankings yield long-lasting hand hygiene compliance exceeding 90 %
Physician report cards and rankings yield long-lasting hand hygiene compliance exceeding 90 %
Critical Care 2015, 19:292 doi:10.1186/s13054-015-1008-4
Reich J, et al
Hand hygiene is an effective, low-cost intervention that prevents the spread of multidrug-resistant bacteria. Despite mandatory education and reminders, compliance by physicians in our hospital remained stubbornly low. Our objective was to study whether surveillance by our unit coordinator (secretary) paired with regular feedback to chiefs of service would increase physician hand hygiene compliance in the ICU.
Method: The ICU unit coordinator was trained to observe and measure hand hygiene compliance. Data were collected on hand hygiene compliance at room entry and exit for 9 months. Percentage compliance for each medical and surgical subspecialty was reported to chiefs of service at the end of each month. Comparative rankings by service were widely distributed throughout the physician organization and the medical center.
Results: The hand hygiene compliance rate among physicians increased from 65.1 % to 91.6 % during the study period..................
Critical Care 2015, 19:292 doi:10.1186/s13054-015-1008-4
Reich J, et al
Hand hygiene is an effective, low-cost intervention that prevents the spread of multidrug-resistant bacteria. Despite mandatory education and reminders, compliance by physicians in our hospital remained stubbornly low. Our objective was to study whether surveillance by our unit coordinator (secretary) paired with regular feedback to chiefs of service would increase physician hand hygiene compliance in the ICU.
Method: The ICU unit coordinator was trained to observe and measure hand hygiene compliance. Data were collected on hand hygiene compliance at room entry and exit for 9 months. Percentage compliance for each medical and surgical subspecialty was reported to chiefs of service at the end of each month. Comparative rankings by service were widely distributed throughout the physician organization and the medical center.
Results: The hand hygiene compliance rate among physicians increased from 65.1 % to 91.6 % during the study period..................
Tuesday, 28 April 2009
Hand hygiene adherence is influenced by the behavior of role models.
Pediatr Crit Care Med. 2009 Mar 25. [Epub ahead of print] LinkOut
Hand hygiene adherence is influenced by the behavior of role models.
Schneider J, Moromisato D, Zemetra B, Rizzi-Wagner L, Rivero N, Mason W, Imperial-Perez F, Ross L.
From the Department of Anesthesiology Critical Care Medicine (JS, DM, BZ, LR-W, NR, FI-P); Division of Infectious Diseases (WM, LR); Department of Pediatric Critical Care Medicine (JS), Childrens Hospital Los Angeles, Los Angeles, CA.
OBJECTIVE:: Proper hand hygiene (HH) reduces nosocomial infections. Therefore, factors that influence HH behavior of healthcare workers are of great interest. We hypothesized that strict HH adherence by supervisor role models would improve the HH behavior of junior staff.
DESIGN:: Prospective observational study.
SETTING:: Pediatric and cardiac intensive care units of a tertiary care children's hospital. SUBJECTS:: Two critical care fellows and four nurse orientees.
INTERVENTIONS:: First, we observed and recorded HH adherence of the fellows and nurse orientees and their respective supervising attending physician or nurse preceptor during daily patient care. Subsequently, we paired the same fellows and nurse orientees with a different supervisor who maintained strict HH adherence, and again noted HH adherence. We used measures of HH opportunities and HH adherence consistent with guidelines set by the Centers for Disease Control and Association for Professionals in Infection Control and Epidemiology.
MEASUREMENTS AND MAIN RESULTS:: HH adherence by fellows and nurse orientees at baseline was 22% of 200 HH opportunities, and improved to 56% of 234 opportunities as a result of role modeling-an average increase of 34% points (95% confidence interval, 18.7-51; p < 0.01 by linear regression), representing a HH adherence rate greater than 1.5 times that of the baseline. The control senior practitioners' HH adherence rate was 20% of 180 opportunities compared with the study senior practitioners' HH adherence of 94% of 187 opportunities-an average difference of 72%points higher compared with the control senior practitioners (95% confidence interval, 56-88.3; p < 0.01 by linear regression).
CONCLUSIONS:: HH adherence of junior practitioners improved under the supervision of adherent role models. These results suggest that HH behavior of senior practitioners plays a crucial influence on other staff. Senior healthcare practitioners should consider the important role they may play in reinforcing or weakening a culture of patient safety and proper HH.
PMID: 19325501 [PubMed - as supplied by publisher]
Hand hygiene adherence is influenced by the behavior of role models.
Schneider J, Moromisato D, Zemetra B, Rizzi-Wagner L, Rivero N, Mason W, Imperial-Perez F, Ross L.
From the Department of Anesthesiology Critical Care Medicine (JS, DM, BZ, LR-W, NR, FI-P); Division of Infectious Diseases (WM, LR); Department of Pediatric Critical Care Medicine (JS), Childrens Hospital Los Angeles, Los Angeles, CA.
OBJECTIVE:: Proper hand hygiene (HH) reduces nosocomial infections. Therefore, factors that influence HH behavior of healthcare workers are of great interest. We hypothesized that strict HH adherence by supervisor role models would improve the HH behavior of junior staff.
DESIGN:: Prospective observational study.
SETTING:: Pediatric and cardiac intensive care units of a tertiary care children's hospital. SUBJECTS:: Two critical care fellows and four nurse orientees.
INTERVENTIONS:: First, we observed and recorded HH adherence of the fellows and nurse orientees and their respective supervising attending physician or nurse preceptor during daily patient care. Subsequently, we paired the same fellows and nurse orientees with a different supervisor who maintained strict HH adherence, and again noted HH adherence. We used measures of HH opportunities and HH adherence consistent with guidelines set by the Centers for Disease Control and Association for Professionals in Infection Control and Epidemiology.
MEASUREMENTS AND MAIN RESULTS:: HH adherence by fellows and nurse orientees at baseline was 22% of 200 HH opportunities, and improved to 56% of 234 opportunities as a result of role modeling-an average increase of 34% points (95% confidence interval, 18.7-51; p < 0.01 by linear regression), representing a HH adherence rate greater than 1.5 times that of the baseline. The control senior practitioners' HH adherence rate was 20% of 180 opportunities compared with the study senior practitioners' HH adherence of 94% of 187 opportunities-an average difference of 72%points higher compared with the control senior practitioners (95% confidence interval, 56-88.3; p < 0.01 by linear regression).
CONCLUSIONS:: HH adherence of junior practitioners improved under the supervision of adherent role models. These results suggest that HH behavior of senior practitioners plays a crucial influence on other staff. Senior healthcare practitioners should consider the important role they may play in reinforcing or weakening a culture of patient safety and proper HH.
PMID: 19325501 [PubMed - as supplied by publisher]
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