Hand hygiene compliance in intensive care units: An observational study.

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Abstract

Health care-associated infections along with antibiotic resistance are a leading risk for patient safety in intensive care units. Hygienic hand disinfection is still regarded as the most effective, simplest, and most cost-effective measure to reduce health care-associated infections. To improve hand hygiene compliance and to prevent health care-associated infections, interventions of the "German Clean Hands Campaign" were implemented in a university hospital.

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Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study

Alessandro Cassini, Diamantis Plachouras, Tim Eckmanns … (2016)

Background Estimating the burden of healthcare-associated infections (HAIs) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. Based on the methodology of the Burden of Communicable Diseases in Europe (BCoDE) project and 2011–2012 data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals, we estimated the burden of six common HAIs. Methods and Findings The included HAIs were healthcare-associated pneumonia (HAP), healthcare-associated urinary tract infection (HA UTI), surgical site infection (SSI), healthcare-associated Clostridium difficile infection (HA CDI), healthcare-associated neonatal sepsis, and healthcare-associated primary bloodstream infection (HA primary BSI). The burden of these HAIs was measured in disability-adjusted life years (DALYs). Evidence relating to the disease progression pathway of each type of HAI was collected through systematic literature reviews, in order to estimate the risks attributable to HAIs. For each of the six HAIs, gender and age group prevalence from the ECDC PPS was converted into incidence rates by applying the Rhame and Sudderth formula. We adjusted for reduced life expectancy within the hospital population using three severity groups based on McCabe score data from the ECDC PPS. We estimated that 2,609,911 new cases of HAI occur every year in the European Union and European Economic Area (EU/EEA). The cumulative burden of the six HAIs was estimated at 501 DALYs per 100,000 general population each year in EU/EEA. HAP and HA primary BSI were associated with the highest burden and represented more than 60% of the total burden, with 169 and 145 DALYs per 100,000 total population, respectively. HA UTI, SSI, HA CDI, and HA primary BSI ranked as the third to sixth syndromes in terms of burden of disease. HAP and HA primary BSI were associated with the highest burden because of their high severity. The cumulative burden of the six HAIs was higher than the total burden of all other 32 communicable diseases included in the BCoDE 2009–2013 study. The main limitations of the study are the variability in the parameter estimates, in particular the disease models’ case fatalities, and the use of the Rhame and Sudderth formula for estimating incident number of cases from prevalence data. Conclusions We estimated the EU/EEA burden of HAIs in DALYs in 2011–2012 using a transparent and evidence-based approach that allows for combining estimates of morbidity and of mortality in order to compare with other diseases and to inform a comprehensive ranking suitable for prioritization. Our results highlight the high burden of HAIs and the need for increased efforts for their prevention and control. Furthermore, our model should allow for estimations of the potential benefit of preventive measures on the burden of HAIs in the EU/EEA.

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Systematic review of studies on compliance with hand hygiene guidelines in hospital care.

Vicki Erasmus, D Behrendt, Sacha van Hijum … (2010)

To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care. A systematic review of studies published before January 1, 2009, on observed or self-reported compliance rates. Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed. We included 96 empirical studies, the majority (n = 65) in intensive care units. In general, the study methods were not very robust and often ill reported. We found an overall median compliance rate of 40%. Unadjusted compliance rates were lower in intensive care units (30%-40%) than in other settings (50%-60%), lower among physicians (32%) than among nurses (48%), and before (21%) rather than after (47%) patient contact. The majority of the time, the situations that were associated with a lower compliance rate were those with a high activity level and/or those in which a physician was involved. The majority of the time, the situations that were associated with a higher compliance rate were those having to do with dirty tasks, the introduction of alcohol-based hand rub or gel, performance feedback, and accessibility of materials. A minority of studies (n = 12) have investigated the behavioral determinants of hand hygiene, of which only 7 report the use of a theoretical framework with inconclusive results. Noncompliance with hand hygiene guidelines is a universal problem, which calls for standardized measures for research and monitoring. Theoretical models from the behavioral sciences should be used internationally and should be adapted to better explain the complexities of hand hygiene.

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Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus.

Walter Zingg, Alison Holmes, Markus Dettenkofer … (2015)

Despite control efforts, the burden of health-care-associated infections in Europe is high and leads to around 37,000 deaths each year. We did a systematic review to identify crucial elements for the organisation of effective infection-prevention programmes in hospitals and key components for implementation of monitoring. 92 studies published from 1996 to 2012 were assessed and ten key components identified: organisation of infection control at the hospital level; bed occupancy, staffing, workload, and employment of pool or agency nurses; availability of and ease of access to materials and equipment and optimum ergonomics; appropriate use of guidelines; education and training; auditing; surveillance and feedback; multimodal and multidisciplinary prevention programmes that include behavioural change; engagement of champions; and positive organisational culture. These components comprise manageable and widely applicable ways to reduce health-care-associated infections and improve patients' safety.

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Author and article information

Journal

Journal ID (iso-abbrev): Int J Nurs Pract

Title: International journal of nursing practice

Publisher: Wiley

ISSN (Electronic): 1440-172X

ISSN (Print): 1322-7114

Publication date (Electronic): Apr 2020

Volume: 26

Issue: 2

Affiliations

[1 ] Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.

[2 ] Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

[3 ] Research Unit for Safety in Health, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.

[4 ] Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.

[5 ] Department of Surgery, University Hospital Graz, Graz, Austria.

[6 ] University Hospital Graz, Graz, Austria.

Article

DOI: 10.1111/ijn.12789

PubMed ID: 31670442

SO-VID: 893c2f35-0010-44ab-80bf-9f39f1715bdb

History

Keywords: compliance,culture,hand disinfection,hand hygiene,intensive care,nursing

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Keywords: compliance, culture, hand disinfection, hand hygiene, intensive care, nursing

Hand hygiene compliance in intensive care units: An observational study.

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Most cited references 33

Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study

Systematic review of studies on compliance with hand hygiene guidelines in hospital care.

Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus.

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