Library

Evidence-based Interventions

1. Princeton Baptist APIC abstract poster
2. Using nGage to Transform Healthcare

General Information on Hand Hygiene and Healthcare-Associated Infections

1. CDC Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011
2. Online “Wikipedia” collaboration site for “hand washing”
3. Online “Wikipedia” collaboration site for “health care associated infections”
4. World Health Organization — Save Lives Clean Your Hands Campaign May 5th, 2009 – Healthcare Facilities World Wide Encourage to Register Support
5. National Patient Safety Agency — UK — Clean Your Hands Campaign
6. Electronic Hand Hygiene Surveillance and Feedback Monitoring Compels Compliance Through Behavior Change

Federal and Local Government Information

1. HHS Action Plan To Prevent Healthcare Associated Infections — Jan. 2009 (PDF by Section)
2. HHS Action Plan to Prevent Healthcare Associated Infections — Jan. 2009 (PDF Complete Document)
3. State legislatures weigh in on healthcare-associated infection March 2007

Favorite Blogs

1. Not Running a Hospital
2. Quality and bond Ratings
   Excerpt: “Recently, Moody’s issued a report entitled “Clinical Quality Initiatives Have Positive Long-Term Impact on Not-for-Profit Hospital Bond Ratings”. Here is a publicly available excerpt.

Healthcare-Associated Infection — Economic Models

1. Financial Impact of Nosocomial Infection Markers
2. Dispelling the Myths: The True Costs of Healthcare-Associated Infections
3. 2005, 2006, 2007, 2009 Pennsylvania — Hospital Acquired Infection Reports

Published Studies

1. How to Guide – Improving Hand Hygiene — A Guide for Improving Practices among Health Care Workers (~2005)
   This guide was prepared in collaboration with the Centers for Disease Control and Prevention (CDC), the Association for Professionals in Infection Control and Epidemiology (APIC), and the Society of Healthcare Epidemiology of America (SHEA), and has been endorsed by APIC and SHEA. Valuable input also was provided by the World Health Organization’s World Alliance for Patient Safety through the Global Patient Safety Challenge.
2. Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach (2001)
   Hand hygiene prevents cross-infection in hospitals, but health-care workers’ adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol-based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene
3. Hand hygiene in the intensive care unit: prospective observations of clinical practice. (2008)
   INTRODUCTION: Adherence to hand hygiene recommendations in the intensive care unit (ICU) is variable and moderate, at best. OBJECTIVES: To measure adherence to hand hygiene recommendations among ICU clinicians in a prospective observational study in 6 multidisciplinary ICUs among 4 hospitals. PATIENTS AND METHODS: We observed 115 clinicians (64 nurses, 21 respiratory therapists, 18 residents and 12 physicians) during 1 patient encounter, each. Clinicians were unaware that they were under observation. We documented use of gloves, soap, and alcohol solution before and after patient encounters for purposes of physical examination or patient care. RESULTS: The rate of adherence to current recommendations was 251 (95% CI 13.7-28.2). All 23 clinicians adhering to recommendations used gloves followed by washing with soap or alcohol solution. 57.4% (95% CI 48.3-66.0) of clinicians used some form of hand hygiene without fully adhering to recommendations, whereas 42.6% did not appear to attend to hand hygiene at all during observation. By univariate analysis, with nurses as the reference group, we found trends suggesting lowest adherence rates among residents (odds ratio [OR] 0.32, 95% CI 0.11-0.96) and intensivists (OR 0.46, 95% CI, 0.13-1.60), and highest adherence among respiratory therapists (OR 2.05, 95% CI 0.67-6.30). We also observed a center effect (p = 0.04). However, multivariate analysis showed no relationship of hand hygiene to clinician group (p = 0.06) nor ICU (p = 0.05). CONCLUSIONS: Multidisciplinary, multimethod approaches to improving hand hygiene are likely necessary to improve the modest adherence to hand hygiene that we observed.
4. Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit (2004)
   OBJECTIVE: To evaluate the effects of a hand hygiene program on compliance with hand hygiene and the rate of nosocomial infections in a neonatal intensive care unit (NICU). DESIGN: Open trial. SETTING: A level-III NICU in a teaching hospital. PARTICIPANTS: Nurses, physicians, and other healthcare workers in the NICU. INTERVENTIONS: A multimodal campaign for hand hygiene promotion was conducted beginning in September 1998. This program consisted of formal lectures, written instructions and posted reminders regarding hand hygiene and proper handwashing techniques, covert observation, financial incentives, and regular group feedback on compliance. Surveillance of handwashing compliance and nosocomial infections before and during the program was analyzed. RESULTS: Overall compliance with hand hygiene improved from 43% at baseline to 80% during the promotion program. The rate of nosocomial infections decreased from 15.13 to 10.69 per 1,000 patient-days (P = .003) with improved handwashing compliance. In particular, respiratory tract infections decreased from 3.35 to 1.06 per 1,000 patient-days during the handwashing campaign (P = .002). Furthermore, the correlation between nosocomial infection of the respiratory tract and handwashing compliance also reached statistical significance (r = -0.385; P = .014). CONCLUSIONS: Improved compliance with handwashing was associated with a significant decrease in overall rates of nosocomial infection and respiratory infections in particular. Washing hands is a simple, economical, and effective method for preventing nosocomial infections in the NICU.
5. Handwashing: a simple, economical and effective method for preventing nosocomial infections in intensive care units (2006)
   As most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered to be the single most important intervention to prevent nosocomial infections. However, studies have shown that handwashing practices are poor, especially among medical personnel. This review gives an overview of handwashing in health care and in the community, including some aspects that have attracted little attention, such as hand drying and cultural issues determining hand hygiene behavior. Hand hygiene is the most effective measure for interrupting the transmission of micro-organisms which cause infection, both in the community and in the healthcare setting. Using hand hygiene as a sole measure to reduce infection is unlikely to be successful when other factors in infection control, such as environmental hygiene, crowding, staffing levels and education, are inadequate. Hand hygiene must be part of an integrated approach to infection control. Compliance with hand hygiene recommendations is poor worldwide. While the techniques involved in hand hygiene are simple, the complex interdependence of factors that determine hand hygiene behavior makes the study of hand hygiene complex. It is now recognized that improving compliance with hand hygiene recommendations depends on altering human behavior. Input from behavioral and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social needs.