Continued direct observation and feedback of hand hygiene adherence can result in long-term improvement

doi:10.1016/j.ajic.2016.07.011

American Journal of Infection Control

Volume 44, Issue 11, 1 November 2016, Pages e211-e214

https://doi.org/10.1016/j.ajic.2016.07.011 Get rights and content

Highlights

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The overall hand hygiene compliance rate increased and was sustained through the completion of the study.
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Direct observation and feedback methods are effective strategies that resulted in a long-lasting improvement in hand hygiene compliance.
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Focusing on the procedures with high baseline noncompliance rates can be an effective way to improve overall compliance.

Background

Hospital-wide multifaceted approaches can improve hand hygiene compliance in health care workers. However, the true effects of monitoring and feedback interventions are not clear.

Methods

Hand hygiene compliance was evaluated by applying direct observation techniques over 5 years (2005-2009) in a tertiary care general hospital in Japan. The observed results were periodically reported as feedback to the health care workers.

Results

The overall hand hygiene compliance rate increased from 50.8% in 2005 to 61.0% in 2006 (P = .004) and was sustained at approximately 60% through the completion of the study. The compliance rate for the indication before entering the room increased from 2005 to 2009 (P = .005). The compliance rates for 4 before patient contact indications increased from 2005 to 2009 (P = .002). The combined compliance rate for the 6 indications with the lowest compliance rates in 2005 increased from 2005 to 2009 (P = .001).

Conclusions

Direct observation and feedback methods are effective strategies that resulted in a long-lasting improvement in hand hygiene compliance that was sustained over 5 years through the completion of the study. Focusing on the procedures with high baseline noncompliance rates can be an effective way to improve the overall compliance.

Section snippets

Study setting

We conducted this observation trial at Kochi Medical School Hospital, Japan, which is a 605-bed tertiary care general hospital with 13 wards. The study was conducted from January 2005-December 2009.

Study variables

Five observers were present on the ward between 10 AM and 10:30 AM once a week, where they monitored the hand hygiene practice of the HCWs using the direct observation technique. The observers consisted of an infection control practitioner, a pharmacist, a medical doctor, a medical student, and a

Number of recorded hand hygiene opportunities

The observations were performed between 10 AM and 10:30 AM, during which period most types of daily patient care activities were performed; most of the observed HCWs were female nurses aged between 20 and 40 years. Over the 5-year study period, we observed 12 different types of indications for hand hygiene (4 before procedures and 8 after procedures) and recorded a total of 5,644 separate hand hygiene opportunities (Table 1). The most frequently observed indication was before entering the room,

Discussion

We evaluated the effect of direct observation and feedback on hand hygiene compliance improvement in a tertiary care general hospital in Japan. The overall hand hygiene compliance rate increased from 50.8% in 2005 to 61.0% in 2006 (P = .004) and remained around 60% until the completion of the study. The average compliance rate in 2009 was statistically significantly higher than that in 2005 (P = .03).

We succeeded in maintaining high rates of hand hygiene compliance for 5 years through a

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Cited by (12)

A multi-centre study of the effects of direct observation of hand hygiene practices on alcohol-based handrub consumption
2022, Infection Prevention in Practice
Citation Excerpt :
The WHO recommendations have been adopted in guidelines used in many countries and are now recognized as the global standard [11–13]. Several studies have shown that the WHO evaluation methods are effective [14–18]. However, they have been conducted in one or few facilities, thereby limiting the generalizability of the results.
The World Health Organization recommends monitoring alcohol-based handrub (ABHR) consumption and direct observation of hand hygiene practices to ensure compliance. In Japan monitoring of ABHR consumption is widely performed. However, direct observation is not common, particularly in small facilities and non-acute-care facilities. Hence, the current study aimed to evaluate the longitudinal effects of direct observation of hand hygiene practices and monitoring of ABHR consumption with provision of feedback to healthcare personnel on ABHR consumption and hand hygiene compliance.
We conducted a 4-year prospective intervention study. Monitoring of ABHR consumption and direct observation of hand hygiene practices with monthly feedback to healthcare personnel was implemented in 17 facilities. These consisted of 11 acute-care facilities of varying sizes and six non-acute-care facilities. A generalized linear mixed model analysis was performed to assess factors associated with ABHR consumption.
All facilities implemented ABHR consumption monitoring within one month of starting the study. However, the mean time required to implement direct observation of hand hygiene practices was 24.7 (±19.1) months. The ABHR consumption increased significantly (P<0.0001) in all medical facilities after implementing the direct observation. Multivariable regression analysis showed the hospital ward type, duration of ABHR consumption monitoring, and duration of direct observation of hand hygiene practices were independently associated with ABHR consumption.
Direct observation of hand hygiene practices with feedback should be implemented more widely in combination with ABHR consumption monitoring to help increase hand hygiene compliance.
Improvement of hand hygiene adherence among staff in long-term care facilities for elderly in Japan
2021, Journal of Infection and Chemotherapy
Citation Excerpt :
Thus, improving adherence with hand hygiene for these five situations is very important for infection control. Therefore, many medical facilities are making efforts to estimate [4–7] and promote [8–17] the hand hygiene adherence in these situations. These efforts are essential for infection control because monitoring hand hygiene adherence and promoting hand hygiene can reduce healthcare-associated infections [18].
Hand hygiene is crucial for infection control in long-term care facilities for elderly (LTCFEs), because it can be easily implemented in the low-resource settings of LTCFEs. This study investigated the actual status of hand hygiene adherence in LTCFEs, identified the factors inhibiting its appropriate implementation, and evaluated the effectiveness of a hand hygiene promotion program.
In this before-and-after study, participants were staff members (n = 142) at two LTCFEs in Gunma Prefecture, Japan. We modified the World Health Organization's “five moments for hand hygiene” and assessed participants' hand hygiene adherence rates in four situations: (1) Before touching around a resident's mucous membrane area; (2) Before medical practice or clean/aseptic procedures; (3) After body fluid exposure/risk or after touching around a resident's mucous membrane area; and (4) After touching a resident's contaminated environments. The study was divided into four phases. In Phase 1, participants self-assessed their hand hygiene adherence using a questionnaire. In Phase 2, we objectively assessed participants' pre-intervention adherence rates. In Phase 3, an intervention comprising various hand hygiene promotion measures, such as education and hands-on training on hand hygiene practices and timings, was implemented. In Phase 4, participants' post-intervention adherence rates were objectively measured.
Although most participants reported high hand hygiene adherence rate in the self-assessment (93.1%), the pre-intervention evaluation revealed otherwise (16.8%). Participants’ post-intervention adherence rates increased for all four situations (77.3%).
The intervention program helped increase participants’ hand hygiene adherence rates, indicating its effectiveness. Similar interventions in other LTCFEs may also improve adherence rates.
Compliance to empirical contact precautions for multidrug-resistant microorganisms
2020, American Journal of Infection Control
Citation Excerpt :
Compliance to hand hygiene before and after contact with the patient was 79.4% and 90.53%, respectively. Previous studies comparing compliance during these 2 times reported values ranging from 27.3%-53.4% before contact and from 60%-66.4% after contact.6-8 The compliance to CP in patients who were later determined to be colonized was only 43.1%.
Health care–associated infections impact patient morbidity and mortality, and institutions adopt evidence-based measures to prevent and control such infections. In this study, professionals were observed during patient care under empirical contact precautions. A total of 243 observations were performed in which 39.5% complied with all measures. The positivity rate of surveillance cultures was 38.36%, and adherence to the measures in patients with colonization was 43.1%.
Patient motivational dialogue: A novel approach to improve hand hygiene through patient empowerment in ambulatory care
2020, American Journal of Infection Control
A novel patient empowerment strategy called Patient Motivational Dialogue purposed to improve hand hygiene compliance is described. Two barriers to sustainability of patients asking health care providers (HCP) to clean their hands were noted in this study: (1) the HCP responding negatively to the patient asking, and (2) the patient misunderstanding that wearing gloves does not replace hand hygiene. Both barriers may be addressed through education of HCP and of consumer.
SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update
2023, Infection Control and Hospital Epidemiology
Leveraging Advanced Computer Vision and Machine Learning for Real-Time Assessment of Hand Hygiene Compliance in Healthcare Settings
2023, SSRN

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: Funding/support: Supported in part by Japan Society for the Promotion of Science (JSPS) KAKENHI (grant no. 15K08846).

: Conflicts of interest: None to report.

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Major ArticleContinued direct observation and feedback of hand hygiene adherence can result in long-term improvement

Highlights

Background

Methods

Results

Conclusions

Section snippets

Study setting

Study variables

Number of recorded hand hygiene opportunities

Discussion

Am J Infect Control

Am J Infect Control

Am J Infect Control

Am J Infect Control

Am J Infect Control

Lancet Infect Dis

Lancet

Am J Infect Control

Am J Infect Control

Major Article
Continued direct observation and feedback of hand hygiene adherence can result in long-term improvement