Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback

doi:10.1016/j.ajic.2016.01.040

American Journal of Infection Control

Volume 44, Issue 8, 1 August 2016, Pages 868-872

https://doi.org/10.1016/j.ajic.2016.01.040 Get rights and content

Background

The importance of hand hygiene in the prevention of health care–associated infection is well known. Experience with hand hygiene compliance (HHC) evaluation in hemodialysis units is scarce.

Methods

This study was a 3-phase, prospective longitudinal intervention study during a 5-month period in a 13-bed hemodialysis unit at a university hospital in Northern Mexico. The unit performs an average of 1,150 hemodialysis procedures per month. Compliance was evaluated by a direct observer and a video assisted observer. Feedback was given to health care workers in the form of educational sessions and confidential reports and video analysis of compliance and noncompliance.

Results

A total of 5,402 hand hygiene opportunities were registered; 5,201 during 7,820 minutes of video footage and 201 by direct observation during 1,180 minutes. Lower compliance during the baseline evaluation was observed by video monitoring compared with direct observation (P <0.05). Discrepancy between both methods was 29.2% (0.4%-59.8%); the average improvement in compliance during the study was 30.6% (range, 7.3%-75.5%). Global and Individual results for each subject revealed a statistically significant Improvement in the majority. Noncompliance according to WHO's 5 Moments for HH was greater for moment 5 (30.1%). We estimated that a health care worker in a hemodialysis unit could take 22-44.3% of working hours for proper hand hygiene compliance.

Conclusions

Video-assisted monitoring of hand hygiene is an excellent method for the evaluation of HHC in a hemodialysis unit; enhanced HHC can be achieved through a feedback program to the hemodialysis staff that includes video examples and confidential reports.

Section snippets

Study design

We designed a 3-phase prospective longitudinal intervention study during a 4-month period (February 5-May 22, 2015).

Setting

The study was conducted in the HU of the Hospital Universitario “Dr. José Eleuterio González” in Monterrey, Mexico, a 13-bed unit that performs an average of 1,150 hemodialysis procedures per month. There is an average of 4 nurses per shift, with a supervisor to nurse ratio of 3:1. There are also 4 attending nephrologists and 6-7 fellows.

Compliance monitoring

Two observers participated in the study.

Results

During the 3 study phases, a total of 5,402 HHOs were registered. For VAO, 782 ten-minute video monitoring sessions were performed; during these sessions, 7,820 minutes of video footage were taken, for a total of 5,201 HHOs identified. The DO registered 118 direct observations, 10 minutes each, representing 1,180 observation minutes in which 201 HHOs were found.

The HH compliance percentages under direct observation were reported as follows: 57%, 65%, and 73% for the preintervention and first

Discussion

Although HH importance for preventing and controlling HAI is widely known, HHC remains a complex issue because of multiple factors, such as HH personal materials and disposition and location of sinks,11, 12 insufficient time for adequate HH, insufficient knowledge regarding the WHO's My 5 Moments for HH, skepticism about HH impact,⁴ and acknowledgment of personal risk, such as treating those patients under contact isolation.¹³

Although the most used method for evaluating HHC is trained

Conclusions

Video-assisted monitoring of HH is a useful method for the evaluation of HHC in an HU. Enhanced HHC can be achieved by a feedback program to the hemodialysis staff that includes video examples and confidential reports.

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Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study
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The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU).
This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period.
We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%).
In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.
Individual hand hygiene improvements and effects on healthcare-associated infections: a long-term follow-up study using an electronic hand hygiene monitoring system
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Obtaining detailed insights into people's unique hand hygiene behaviour could play an important role in developing the most effective long-term hand hygiene compliance (HHC) interventions.
To investigate the effect of two feedback interventions provided by an electronic hand hygiene monitoring system (EHHMS) on sustained HHC improvement, individual responsiveness, and prevention of hospital-acquired bloodstream infections (HABSIs) and urinary tract infections (HAUTIs).
The study included two 2-year cohorts (exposed and unexposed to EHHMS) observed over 4 years in an internal medicine department with 142 caregivers and 39 doctors. Healthcare workers (HCWs) were stratified into four groups based on their baseline performance to assess predicted responsiveness to the interventions.
All HCWs increased their HHC independently from their performance at baseline, except for a few in the low-performance groups with constantly low HHC. The two low-performance groups at baseline were most responsive to group feedback (weekly change in HHC of 4.4% and 3.1%) compared with individual feedback (weekly change in HHC of 1.0% and 2.2%). The number of cases of HABSI reduced significantly during the intervention period (P=0.01), with the greatest effect on Staphylococcus aureus. No significant change in HAUTIs was observed.
The EHHMS interventions sustained the HHC improvements successfully and reduced the number of cases of HABSI. Nearly all HCWs responded to the interventions. The two low-performance groups at baseline never reached the same HHC levels as those in the high-performance groups, indicating the potential for further improvement and the need for intensified individualized interventions.
KDIGO 2022 Clinical Practice Guideline FOR the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease
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Implementing an electronic hand hygiene system improved compliance in the intensive care unit
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Citation Excerpt :
The targeted interventions should be more precise to design programs and incentives for individuals to achieve the best results. Other well-known factors associated with the levels of HH compliance are staff profession, workload, and location of sanitizers,17-19 which could be analyzed and used for designing precision interventions. This study measured not only HH quantity but also HH quality.
Hand hygiene (HH) compliance is low and difficult to improve among health care workers. We aim to validate an electronic HH system and assess the impact of this system on HH compliance and quality changes over time at both group and individual levels.
An automated electronic HH system was installed in a 10-bed surgical intensive care unit.
The full HH compliance rate increased significantly from 8.4% in week 1 to 20.5% in week 16 with week 10 being the highest (27.4%). The partial compliance rate maintained relative consistency between 13.2% and 20.0%. The combined compliance rate (full compliance rate + partial compliance rate) increased from 23.5% in week 1 to 34.6% in week 16 with week 10 being the highest (41.4%).
We found significant variations among providers in terms of HH opportunities per shift, full compliance, partial compliance and combined compliance rates. The average duration of hand rubbing over time in partial compliance occurrences did not change significantly over time.
A sensor-based platform with automated HH compliance and quality monitoring, real time feedback and comprehensive individual level analysis, improved providers’ HH compliance in an intensive care unit. There were significant variations among individual providers.
Neuroendovascular Training Using Multisource Video-Recording System in a Hybrid Operating Room
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Increasing restrictions over trainees' working hours and the recent coronavirus disease 2019 pandemic warrant new educational methods of surgical skills. We assessed a novel video-recording system for neuroendovascular skill education, developed with the installation of a hybrid operating room (OR) at our institution.
A single-plane angiography unit with a large flat display (FlexVision XL; Philips Medical Systems) was installed in our OR. All media sources in the OR, including live fluoroscopy and ceiling-mounted camcorders, were connected to a video switcher. This video switcher laid up to 8 video images into one big image, which was transferred to the large display and the professional-use Blu-ray recorder. The recording was performed continuously during the procedure. This recording system was evaluated retrospectively with a questionnaire administered to the 5 trainees.
Using this system, 68 interventional procedures were recorded. Among the potential merits, the trainees assigned the greatest value to the simultaneous recording of the operator's hand motions and the fluoroscopy images. Among the potential limitations of the system, the prolonged time and the increased volume of the video data bothered the trainees the most. The recorded video looked like a live demonstration.
Our “selfie” video recording system was useful for skill training of neuroendovascular interventions.
The Hawthorne effect on adherence to hand hygiene in patient care
2020, Journal of Hospital Infection
Numerous studies demonstrate that the Hawthorne effect (behaviour change caused by awareness of being observed) increases health workers' hand hygiene adherence but it is not clear whether they are methodologically robust, what the magnitude of the effect is, how long it persists or whether it is the same across clinical settings. The objective of this review was to determine the rigour of the methods used to assess the Hawthorne effect on hand hygiene, effect size estimation, variations between clinical settings and persistence. To this end, a systematic literature review with meta-analysis was conducted. Nine studies met the criteria for the review. Methodological quality was variable. The Hawthorne effect ranged from −6.9% to 65.3%. It was 4.2% in one study conducted in intensive care and 16.4% in transplant units. It was most marked when data were collected across an entire hospital and in a group of general hospitals. Differences between wards in the same hospital were apparent. In the two studies where duration was estimated, the Hawthorne effect appeared transient. Despite methodological shortcomings, the review indicates clear evidence of a Hawthorne effect on general wards. There is evidence that it may vary between clinical speciality and across departments. The review identifies a need for standardized methodologies to measure the Hawthorne effect to overcome the dilemma of reporting the potentially inflated rates of adherence obtained through overt audit. Occasional covert audit could give a better estimation of true hand hygiene adherence but its acceptability and feasibility to health workers need to be explored.

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Major ArticleEnhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback

Background

Methods

Results

Conclusions

Section snippets

Study design

Setting

Compliance monitoring

Results

Discussion

Conclusions

Am J Infect Control

Clin Microbiol Infect

Clin Microbiol Infect

J Hosp Infect

Am J Infect Control

Int J Infect Dis

Am J Infect Control

Major Article
Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback