Evaluation of staff compliance with ‘influencing’ tactics in relation to infection control policy implementation

Eradication of methicillin resistant Staphylococcus aureus by “ring fencing” of elective orthopaedic beds

“…3 We acknowledge that the reduction in infection rate was achieved by several factors: ring fencing, simple infection control measures, and reducing the number of agency staff to a minimum. However, the model as a whole shows important and significant results.…”

Nurses' hands as vectors of hospital‐acquired infection: a review

“…On a more posihve note, good role models may mcrease hand hygiene compbance (Larson 1983) and there is evidence that the mtroduction of mfechon control baison nurses -dmical nurses who have had additional trairung m mfechon control -may enhance awareness of nsks and influence prevenhon strategies (Chmg & Seto 1990) CONCLUSION This review has demonstrated that mcreasmg rates of HAJ are due chiefly to spread by the contact route and that disseminahon must occur to a considerable extent on nurses' hands Hand hygiene, the most important means of preventmg HAI, is often poorly performed, somehmes through lack of knowledge and also because even when nurses have the requisite knowledge of appbed microbiology, mohvation is poor Poor facilities and equipment, bemg too busy and lack of encouragement from suitable rok models may be influential, but their contnbution is presently unknown More time should be spent documentmg preasely what nurses know zhouk HM and how they perform all aspects D GouM of hand hygiene before posihve attempts are made to provide them with informahon they presoitiy lack and encouragement to perfonn more efiechvely…”

“…The need to reduce HAl has been recognized durmg the development of quality assurance programmes m view of the dear relevance to pahent safety and tangible economic retum coupled with the relahvely measurable nature of mfechon rates (Shaw 1986) However, CadwaUader (1989, chsappomted after the implementahon of a new mfechon conhol policy, conduded that the experhse of microbiologists and infechon conhol nurses wdl be of limited benefit m the absense of commitment fi-om nurses who must implement their suggeshons Lack of motivation and accountabihty for HAl on an mdividual basis may be contnbutory fadors (Nursing Times News 1991) A queshonnaire study by Larson & KiUien (1982) sought to identify fadors which mfluenced staff to wash or not wash hands Inchviduals were aware of the need to reduce HAl but were deterred through the possibility of developmg sore, dry skm The authors judged that future compliance might be secured by closer examination of deterrent factors A study in the Far East ldenhfied tachcs employed by mfechon conhol nurses to secure comphance and asked chnical nurses to idenhfy which approaches they found most helpful (Seto et al 1990) Speaalist and ward nurses found trust based on professional resped mutuaUy more benefiaal than coeraon or threats from senior staff In the UK, mfedion conhol nurses do not occupy hne managenal posihons m the nursmg hierarchy and it is chfficult to imagme coeraon havmg much impact m hospitals m our scKaety Lack of resources may be an issue related to motivation Observmg that nurses tended to wash hands more often at a sink posihoned near the nurses' stahon, BroughaU et al (1984) proposed that more sinks placed nearer to the pahent care areas might mcrease comphance A study by Kaplan & McGuckhn (1986) found supporting evidence, but Preston et al (1981), documenhng handwashmg and infechon rates before and after the upgrachng of an ITU, chd not Evot when facihties are good staff may not wash hands because they have developed sore, cby skm, itself undesirable as this uKreases b»ienal aAotazakion (Ojajarvi 1981) Nurses are weU aware of th»e nsks (see Larson & Killien 1982) A queshonnaire study by Newsom et al (1988) estabbshed that choice of hand scrub preparahon depended mainly on skm tolerance This problem is not insurmountable as manufacturers are now paymg mcreased attenhon to product acceptabibty Recent tnals have demonstrated that cleansing with disposable alcoholic wipes mcorporatmg emollients Qones et al 1986, Butz et al 1990, antimicrobial gel (Newman & Seitz 1990) or an emulsion to replace soap and water (Kolan et al 1989) can reduce crackmg, drymg and erythema while effectively removmg transient bactena Related to availabibty and acceptability of resources is the issue of bemg too busy to use them Throughout the bterature, there are numerous suggeshons that at very busy times hand hygiene is more likely to break down (Lowbury et al 1970…”

Hand Hygiene

“…58,831 This offers a distinct advantage because studies have shown that guidelines are in themselves an effective means of influencing behaviour regarding infection control. 832 However, the wide dissemination of guidelines alone is insufficient to change clinical practice. 728 It is important to realize that HCWs' compliance can be extremely low when guidelines are simply circulated down the hospital hierarchy: research indicates that the compliance rate can be as low as 20%.…”