Impact of a multimodal intervention program on hand hygiene compliance at Bangkok Tertiary Care Hospital
Keywords:
Hand hygiene compliance, handwashing, hospital acquired infections.Abstract
Background: Implementation of handwashing in real life healthcare settings is challenging. Immense clinical benefits from hand hygiene (HH) compliance can be gained in resource-limited settings such as Thailand. Customized multimodal strategies to promote HH are advocated by World Health Organization.
Objectives: Good HH practices are a simple and cost-effective strategy to limit pathogen transmission between patients. This study explores the effect of a multimodal hand hygiene promotion program on HH compliance amongst healthcare workers.
Methods: A prospective study was conducted at the pediatric intensive care unit and pediatric immunocompromised ward. A baseline attitudes survey was performed by asking perceived barriers and motivators to HH compliance. Interventions performed were tailored according to this and included: HH promotion videos sent to staff via mobile phone, HH signs at the bedside, distribution of portable alcohol gel bottles, HH promotion culture led by senior staff members and fob watch prizes. HH compliance was assessed by direct observation using the WHO’s 5-moments for hand hygiene (WHO5HH) – before touching patients, before clean/aseptic procedures, after body fluid exposure risk, after touching patients, and after touching patient surroundings. A minimum of 200 opportunities in total were observed at pre-intervention and three times following intervention commencement. Hospital acquitted infection rates (HAIs) were routinely monitored during the study period.
Results: In December 2015, pre-intervention, overall HH compliance rates were 51.0% (95%CI 44 - 58). Between January and June 2016, post-intervention, overall HH compliance increased to 70.0% (95% CI 67 - 74) (P < 0.001). When divided into the five moments for HH, handwashing prior to touching patients significantly improved the following intervention from 44.0% to 87.0% (P < 0.001). HH after touching patient surroundings remained low. HH compliance was highest amongst nurses (55.0% at baseline and 83.0% with intervention). HAI rates were unchanged during the study period.
Conclusions: A multimodal HH promotion campaign tailored towards the local population was effective in increasing HH compliance overall. HAI rates were unchanged following HH compliance improvement.
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References
World Health Organization Guidelines on Hand Hygiene in Healthcare: a Summary. First Global Patient Safety Challenge: Clean Care is Safer Care. World Health Organization, 2009. Available from: http://whqlibdoc.who.int/publications/2009/9789241597906 _eng.pdf
Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis 2013;13:843-51. https://doi.org/10.1016/S1473-3099(13)70163-4
Would Health Organization. A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. Geneva: WHO; 2009.
Paotong D, Trakarnchansiri J, Phongsanon K, Churncharoean P, Sitaphong S, Poldee T, et al. Compliance with handwashing in a university hospital in Thailand. Am J Infect Control 2003;31:128.
https://doi.org/10.1067/mic.2003.37
Picheansathian W, Pearson A, Suchaxaya P. The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit. Int J Nurs Pract 2008;14:315-21. https://doi.org/10.1111/j.1440-172X.2008.00699.x
Eiamsitrakoon T, Apisarnthanarak A, Nuallaong W, Khawcharoenporn T, Mundy LM. Hand hygiene behavior: translating behavioral research into infection control practice. Infect Control Hosp Epidemiol 2013;34:1137-45. https://doi.org/10.1086/673446
Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis 2001;7:234-40. https://doi.org/10.3201/eid0702.010217
Danchaivijitr S, Pichiensatian W, Apisarnthanarak A, Kachintorn K, Cherdrungsi R. Strategies to improve hand hygiene practices in two university hospitals. J Med Assoc Thai 2005;88 Suppl 10:S155-60.
The joint Commission Mission. Measuring hand hygiene adherence: overcoming the challenges. illinois; The Joint Commission; 2009.
Boyce JM, Pittet D. 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. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep 2002;51:1-45.
https://doi.org/10.1086/503164
Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31:283-94. https://doi.org/10.1086/650451
Borg MA, Benbachir M, Cookson BD, Redjeb SB, Elnasser Z, Rasslan O, et al. Self-protection as a driver for hand hygiene among healthcare workers. Infect Control Hosp Epidemiol 2009;30:578-80.
https://doi.org/10.1086/597511
World Health Organization. Prevention of hospitalacquired infections. A practical guide. 2nd ed. Geneva: WHO; 2002.
FitzGerald G, Moore G, Wilson AP. Hand hygiene after touching a patient's surroundings: the opportunities most commonly missed. J Hosp Infect 2013;84:27-31.
https://doi.org/10.1016/j.jhin.2013.01.008
Kampf G, Loffler H, Gastmeier P. Hand hygiene for the prevention of nosocomial infections. Dtsch Arztebl Int 2009;106:649-55. https://doi.org/10.3238/arztebl.2009.0649
Sickbert-Bennett EE, Di Biase LM, Schade Willis TM, Wolak ES, Weber DJ, Rutala WA. Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerg Infect Dis 2016;22:1628-30. https://doi.org/10.3201/eid2209.151440
Salemi C, Canola T, Eck EK. Hand washing and physicians: how to get them together. Infect Control Hosp Epidemiol 2002;23:32-5. https://doi.org/10.1086/501965
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