Diurnal variation in hand hygiene compliance in a tertiary level multidisciplinary intensive care unit

Sahay, Sandeep; Panja, Sauren; Ray, Sumit; Rao, Brijendra Kumar

doi:10.1016/j.ajic.2010.03.013

Cited by 36 publications

(21 citation statements)

References 20 publications

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“…This could reflect serious flaws in their phlebotomy education and should be addressed with great attention. The association of various occupations with adherence to guideline practices was shown to differ significantly in a study of hand hygiene [35]. However, in a study of guideline adherence in cardiopulmonary resuscitation, no such association was found [36].…”

Section: Discussionmentioning

confidence: 94%

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Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE)

Šimundić¹,

Church²,

Cornes³

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Section: Discussionmentioning

confidence: 94%

“…The median number of audits per country was 33 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). The total number of audits was 336.…”

Section: Resultsmentioning

confidence: 99%

Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE)

Šimundić¹,

Church²,

Cornes³

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…As liberation from mechanical ventilation is an important quality measure in ICUs, we demonstrate a close process-outcome relationship between nighttime sedation and patient outcomes that may be modifiable (44, 45). Future efforts to improve protocol adherence may be focused towards nighttime ICU staff, who may be less compliant with certain ICU quality measures (46). Nighttime staff may have reduced opportunity for formal training in ICU assessments for delirium or sedation requirements (47), disrupting the link between patient needs and drug delivery.…”

Section: Discussionmentioning

confidence: 99%

Diurnal sedative changes during intensive care

Seymour

Pandharipande

Koestner

et al. 2012

Critical Care Medicine

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Objective To determine whether benzodiazepine and propofol doses are increased at night and whether daytime and nighttime sedative doses are associated with delirium, coma, and delayed liberation from mechanical ventilation. Design Single-center, prospective cohort study nested within the Awakening and Breathing Controlled randomized trial Setting Saint Thomas Hospital in Nashville, TN from 2004–2006 Patients Adult patients receiving mechanical ventilation for greater than 12 hours with continuous recording of hourly sedation dosing Interventions We measured hourly doses of benzodiazepine and propofol exposure during the daytime (7am–11pm) and nighttime (11pm–7am) for five days. We quantified nighttime dose increases by subtracting the average hourly daytime dose on the preceding day from subsequent average hourly nighttime dose. We used multivariable logistic regression to determine if daytime and nighttime dose increases were independently associated with delirium, coma, and delayed liberation from mechanical ventilation. Measurements and main results Among 140 patients, the median APACHE II score was 27 [IQR: 22, 33]. Among those receiving the sedatives, benzodiazepine and propofol doses were increased at night on 40% and 41% of patient-days, respectively. Of 485 patient-days, delirium was present on 160 (33%) and coma on 206 (42%). In adjusted models, greater daytime benzodiazepine dose was independently associated with failed SBT and extubation, and subsequent delirium (p<0.02 for all). Nighttime increase in benzodiazepine dose was associated with failed SBT (p<0.01) and delirium (p=0.05). Daytime propofol dose was marginally associated with subsequent delirium (p=0.06). Conclusions Nearly half of mechanically ventilated ICU patients received greater doses of sedation at night, a practice associated with failed SBTs, coma, and delirium. Over the first five days in our study, patients spent 75% of their time in coma or delirium, outcomes that may be reduced by efforts to decrease sedative exposure during both daytime and nighttime hours in the ICU.

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“…These results are comparable to other studies. (610) So high workload and opportunities for HH related to a high risk for cross-transmission were associated with reduced adherence.…”

Section: Discussionmentioning

confidence: 99%

Hand hygiene compliance in the intensive care units of a tertiary care hospital

Sk¹,

Sharma²,

Puri³

et al. 2011

Indian J Community Med

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Context:Hand hygiene (HH) is the most important measure to prevent hospital-acquired infections but the compliance is still low.Aims:To assess the compliance, identify factors influencing compliance and to study the knowledge, attitude and perceptions associated with HH among health care workers (HCW).Settings and Design:Cross-sectional study conducted in 42 bedded Medical (Pulmonary, Medicine and Stroke) intensive care units (ICU) of a tertiary care hospital.Materials and Methods:HCWs (doctors and nurses) were observed during routine patient care by observers posted in each ICU and their HH compliance was noted. Thereafter, questionnaire regarding knowledge, perception and attitudes toward HH was filled by each HCW.Statistical Analysis:Percentages and χ2 test.Results:The overall compliance was 43.2% (394/911 opportunities). It was 68.9% (31/45) in the intensivists, 56.3% (18/32) in attending physicians, 40.0% (28/70) in the postgraduate residents and 41.3% (301/728) in the nurses. Compliance was inversely related to activity index. Compliance for high, medium and low risk of cross-transmission was 38.8% (67/170), 43.8% (175/401) and 44.7% (152/340), respectively.Conclusions:Compliance of the study group is affected by the activity index (number of opportunities they come across per hour) and professional status. The HCWs listed less knowledge, lack of motivation, increased workload as some of the factors influencing HH.

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Diurnal variation in hand hygiene compliance in a tertiary level multidisciplinary intensive care unit

Cited by 36 publications

References 20 publications

Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE)

Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE)

Diurnal sedative changes during intensive care

Hand hygiene compliance in the intensive care units of a tertiary care hospital

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