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      Impact of a multicomponent hand hygiene intervention strategy in reducing infection rates at a university hospital in Saudi Arabia

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          Abstract

          Background and aims

          Few studies have reported the correlation between hand hygiene (HH) practices and infection rates in Saudi Arabia. This work was aimed to study the effect of a multicomponent HH intervention strategy in improving HH compliance and reducing infection rates at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia between January 2014 and December 2016.

          Methods

          A yearlong multicomponent HH intervention, which included various strategies recommended by the World Health Organization, was introduced. HH compliance among staff and infection rates observed in the inpatient wards were assessed and compared at pre- and post-interventional phases.

          Results

          There was a significant increase in mean HH compliance from 50.17% to 71.75% after the intervention ( P < 0.05). Hospital-acquired infection (HAI) and catheter-associated urinary tract infection (CAUTI) rates decreased from 3.37 to 2.59 and from 3.73 to 1.75, respectively ( P < 0.05). HH compliance was found to be negatively correlated with HAI ( r = −0.278) and CAUTI ( r = −0.523) rates.

          Conclusions

          Results show that multicomponent intervention is effective in improving HH compliance, and that an increase in HH compliance among hospital staff decreases infection rates. Further studies on cost-effectiveness of such a model could augment to these findings.

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          Most cited references 38

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          The World Health Organization hand hygiene observation method.

          Monitoring hand hygiene adherence and providing performance feedback to health care workers is a critical component of multimodal hand hygiene promotion programs, but important variations exist in the way adherence is measured. Within the framework of the World Health Organization's (WHO) First Global Patient Safety Challenge known as "Clean Care is Safer Care," an evidence-based, user-centered concept, "My five moments for hand hygiene," has been developed for measuring, teaching, and reporting hand hygiene adherence. This concept is an integral part of the WHO's hand hygiene improvement strategy conceived to translate the WHO Guidelines on Hand Hygiene in Health Care into practice. It has been tested in numerous health care facilities worldwide to ensure its applicability and adaptability to all settings irrespective of the resources available. Here we describe the WHO hand hygiene observation method in detail-the concept, the profile and the task of the observers, their training and validation, the data collection form, the scope, the selection of the observed staff, and the observation sessions-with the objective of making it accessible for universal use. Sample size estimates, survey analysis and report, and major bias and confounding factors associated with observation are discussed.
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            Nosocomial infections and their control strategies

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              Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention.

               John W Stamm (1991)
              Catheter-associated urinary tract infections (UTIc) remain the most common nosocomial infection. Although usually benign, UTIc cause bacteremia in 2-4% of patients and have been associated with a case fatality rate three times as high as nonbacteriuric patients. Risk factors for UTIc identified in multivariate analyses include increasing duration of use, female sex, absence of systemic antibiotics, and disconnection of the catheter-collecting tube junction. Recent studies suggest that most episodes of low colony count bacteriuria (10(2)-10(4) cfu/ml) rapidly progress to high (greater than or equal to 10(5)/ml) colony counts within 24-48 hours. In persons with long-term catheterization, bacteriuria inevitably develops and the infecting strains change frequently. In this setting, Proteus and Morganella species produce catheter encrustations and persistent bacteriuria. Routes of bacterial entry have been well defined and differ by gender, with the periurethral route predominating in women and the intraluminal route in men. Growth of bacteria in biofilms on the inner surface of catheters promotes encrustation and may protect bacteria from antimicrobial agents. Bacterial virulence factors have not been well characterized in UTIc, but fimbrial adhesins have been associated with bacterial persistence in the catheterized urinary tract, and urease production has been associated with stone formation and catheter encrustation. Recent efforts to prevent UTIc have focused mainly on preventing bacterial entry to the urinary tract or eradicating bacteriuria after its onset and have been largely unsuccessful. Systemic antimicrobials, sealed tubing and catheter junctions, silver ion-coated catheters, and antiseptics in the collecting bag have all been efficacious in one or more controlled trials. Failure to stratify patients by major risk factors, especially gender, antimicrobial exposure, and catheter duration, makes interpretation of many trials difficult. Further research in the areas of innovative catheter system design, bacterial-host epithelial cell interaction, and targeted antimicrobial prophylaxis seem the most likely approaches to controlling UTIc in the future.
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                Author and article information

                Journal
                imas
                IMAS
                Interventional Medicine and Applied Science
                Interventional Medicine and Applied Science
                Akadémiai Kiadó (Budapest )
                2061-1617
                2061-5094
                09 September 2017
                September 2017
                : 9
                : 3
                : 137-143
                Affiliations
                [ 1 ] Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University (Formerly University of Dammam) , Al-Khobar, Kingdom of Saudi Arabia
                Author notes
                [* ]Corresponding address: Ahmed Al Kuwaiti; Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University (Formerly University of Dammam), P.O. Box 40065, Al-Khobar 31952, Kingdom of Saudi Arabia; Phone: +966 13 3332500; Fax: +966 13 3330380; Mobile: +966 505843183; E-mail: qaa@ 123456uod.edu.sa
                Article
                10.1556/1646.9.2017.24
                5700699
                © 2017 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited.

                Page count
                Figures: 0, Tables: 4, Equations: 0, References: 38, Pages: 7
                Funding
                Funding sources: No financial support was received for this study.
                Categories
                ORIGINAL PAPER

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