Effects of a 4-year intervention on hand hygiene compliance and incidence of healthcare associated infections: a longitudinal study

Abstract

Purpose Studies have demonstrated improvements in hand hygiene (HH) compliance through interventions, noting the negative association of HH and healthcare associated infections (HAIs), but how to sustain long-term improvement is still unknown in the Chinese population. This study sought to determine the extent of change in HH compliance after multimodal HH interventions, and to evaluate the relationship between that change and HAI incidence. Methods We conducted a longitudinal study in a general teaching hospital in China from 2017 to 2020. Trained investigators observed HH practices based on the World Health Organization's 5 moments for HH. We identified the incidence of HAIs using semi-automated constant surveillance software. We used the Cochran-Mantel-Haenszel test to assess the secular trend of HH compliance and HAIs. The Spearman correlation coefficient (r s ) was used to evaluate the relationship between the incidence of HAIs and compliance with HH. Results The study made 480,943 observations, where HH was occurring between 2017 and 2020. HH compliance increased from 68.90 to 91.76% during that period (P trend < 0.01), while the incidence of HAIs decreased from 1.10 to 0.91%. Compliance also increased for each moment type and for each healthcare worker (P trend < 0.01). Lower HH compliance was observed in before-patient contact and after contact with patient surroundings, and among interns and cleaners. We also observed a weak but statistically significant negative correlation between the monthly HH compliance and incidence of HAIs (r s = − 0.27; P = 0.037). Conclusions The multimodal HH implementation delivered sustained improvement in HH compliance, and this change was associated with a decline in the incidence of HAIs.

Decreased Hospital-Acquired Respiratory Infections among elder Inpatients in General Hospital during the COVID-19 Pandemic

“…[18] A Chinese longitudinal study from 2017 to 2020 in a provincial general teaching hospital showed that improvement in HH compliance was associated with a decline in the incidence of HAIs. In this study the compliance of hand hygiene increased form 68.9-91.76%, and the incidence of HAIs decreased from 1.1-0.91%, p < 0.01 [19] . A historical control study in China showed the adherence of hand hygiene and mask-wearing during the COVID-19 pandemic (from February 1 to June 29, 2020) increased from 66-92%.…”

Impact of direct hand hygiene observations and feedback on hand hygiene compliance among nurses and doctors in medical and surgical wards: an eight-year observational study

“…It has earlier been reported that the incidence of HAIs begins to decrease on the hospital level once monthly HHC exceeds 80% for two years [9]. In a recent four-year longitudinal Chinese study, HHC increased from 64.8% to 90.5% as a result of direct observations and immediate feedback [18]. They observed a weak but statistically significant negative correlation (r ¼ À0.27) between monthly HHC and HAI incidence.…”

“…According to a four-year study from a teaching hospital in China, direct observations and immediate feedback increased doctors' monthly HHC to levels as high as 92.2% [18]. Hence, continuous observations and feedback may dispel resistance among doctors and change their HH behaviour.…”

Evaluation of the Residual Disinfection Effects of Commonly Used Skin Disinfectants against Viruses: An Innovative Contact Transmission Control Method

“…Thorough hand hygiene is important for effective contact transmission prevention, which is one of the primary causes of the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and influenza A virus (IAV). − Previous studies have shown that SARS-CoV-2 is more stable (survives longer) on human skin surfaces than IAV, suggesting that appropriate hand hygiene practices are important for SARS-CoV-2 infection control . However, it is difficult to ensure adherence to frequent and proper hand hygiene practices even in hospitals or clinics and improving these adherence rates remains challenging. − The introduction of new infection control approaches may help achieve reliable prevention of contact transmission. For example, if the disinfection effect of disinfectants persists on the skin surface for a long time after hand hygiene practices, this residual disinfection effect (RDE) may reduce the risk of contact transmission by inactivating the virus on the skin surface without further intervention, even if hand hygiene practices are not followed immediately after accidental exposure to infectious substances.…”