Inclusion of Real-Time Hand Hygiene Observation and Feedback in a Multimodal Hand Hygiene Improvement Strategy in Low-Resource Settings

Lenglet, Annick; Deursen, Babette van; Viana, Rebeca V. R.; Abubakar, Nura; Hoare, Sarah; Murtala, Adebowala; Okanlawon, Mulikat; Osatogbe, Jacob; Emeh, Vera; Gray, Nell; Keller, Sara; Masters, Pete; Roolvink, Duco; Davies, Jane; Hickox, Kaci; Fotso, Adolphe; Bil, Karla; Nwankwo, Chijioke; Ahmad, Badariah; Caluwaerts, An; Lessard, Isabelle; Dimeglio, Sandrine; Malou, Nada; Kanapathipillai, Rupa; McRae, Melissa; Wong, Sidney; Hopman, Joost

doi:10.1001/jamanetworkopen.2019.9118

Cited by 11 publications

(9 citation statements)

References 29 publications

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“…Our pre-intervention findings were concordant with those of a systematic review, which found that baseline HH compliance is high in HICs at 64.5% but much lower in LICS (9-32%) (15,21). The magnitude of improvement with an education-based HH program was near that of a study done at Swiss multisite regional hospital, where compliance increased from 61.4% to 83.4% after 18 months of the program (16).…”

Section: Discussionsupporting

confidence: 87%

“…Pre-intervention. The aim was to target a large sample size of around 900 observations in pre-and post-interventions based on a literature review of similar studies(15)(16)(17). We collected pre-intervention data on HH adherence from July 18 to August 9, 2019 by using the WHO 'My 5 Moments of Hand Hygiene': before patient contact, before aseptic technique, after body fluid risks, after patient contact, and after contact with patient surroundings(18,19).…”

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confidence: 99%

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Improving hand hygiene measures in low-resourced intensive care units: experience at the Kigali University Teaching Hospital in Rwanda

Mvukiyehe¹,

Tuyishime²,

Ndindwanimana³

et al. 2021

IJIC

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Background: Proper hand hygiene (HH) practices have been shown to reduce healthcare-acquired infections. Several potential challenges in low-income countries might limit the feasibility of effective HH, including preexisting knowledge gaps and staffing. Aim: We sought to evaluate the feasibility of the implementation of effective HH practice at a teaching hospital in Rwanda. Methods: We conducted a prospective quality improvement project in the intensive care unit (ICU) at the Kigali University Teaching Hospital. We collected data before and after an intervention focused on HH adherence as defined by the World Health Organization ‘5 Moments for Hand Hygiene’ and assuring availability of HH supplies. Pre-intervention data were collected throughout July 2019, and HH measures were implemented in August 2019. Post-implementation data were collected following a 3-month wash-in. Results: In total, 902 HH observations were performed to assess pre-intervention adherence and 903 observations post-intervention adherence. Overall, HH adherence increased from 25% (222 of 902 moments) before intervention to 75% (677 of 903 moments) after intervention (P < 0.001). Improvement was seen among all health professionals (nurses: 19–74%, residents: 23–74%, consultants: 29–76%). Conclusions: Effective HH measures are feasible in an ICU in a low-income country. Ensuring availability of supplies and training appears key to effective HH practices.

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

Improving hand hygiene measures in low-resourced intensive care units: experience at the Kigali University Teaching Hospital in Rwanda

Mvukiyehe¹,

Tuyishime²,

Ndindwanimana³

et al. 2021

IJIC

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“…[33, 50,81,83,119,162,168,173,211]. An additional 18 studies reported mixed-methods evaluations which included interviews, focus groups, or analysis of chart notes [27,29,56,57,61,68,116,127,147,161,[177][178][179]187,192,194,204,212]; only 6 reported results of qualitative assessments of end-user perceptions of dashboards without a quantitative evaluation[28, 48,52,163,167,203](Table 5). When dashboards had an administrative purpose, evaluations more often were conducted using dashboard/EHR data (n=25/54, 46.3%) 25 [30,37,44,71,72,74,91,98,106,107,110,117,124,[131][132][133]…”

Section: Discussionmentioning

confidence: 99%

Scoping review of dashboards in health care: why, how, and for whom they have been developed, implemented, and evaluated (Preprint)

Helminski,

Sussman,

Pfeiffer

et al. 2024

Preprint

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BACKGROUND While dashboards are frequently used by health systems to monitor and improve performance, little is known about their characteristics and the processes used to incorporate them into practice. OBJECTIVE This scoping review aimed to explore published literature on health care dashboards to summarize why, how, and for whom they have been developed, implemented, and evaluated. METHODS MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched from inception through July 2020. Studies were included if they described the development or evaluation of a health care dashboard with publication since 2015. Clinical setting, purpose (categorized as clinical, administrative, or both), and end-user were extracted for all studies. Data on dashboard development, design characteristics, implementation strategies, and evaluation were extracted only for studies published from 2018-2020. RESULTS Data was extracted for 199 dashboards described in 193 publications. The most common settings in which dashboards were used were inpatient (n=81/199, 40.7%) and outpatient clinics (n=68/199, 34.2%). Most dashboards had ≥2 stated purposes (n=142/199, 71.4%); of these, 97/199 (48.7%) were administrative, 68/199 (34.2%) were clinical, and 31/199 (15.6%) met both criteria. Most dashboards included front-line clinical staff as end-users (n=154/199, 77.4%). In the 118 dashboards published from 2018-2020, half involved end-users in the design process (n=59/118, 50.0%); fewer described formative usability testing (n=26/118, 22.0%) or use of any theory or framework to guide development, implementation, or evaluation (n=24/118, 20.3%). Dashboards tended to be web-based (n=41/118, 34.7%) or embedded directly into the electronic health record (n=17/118, 14.4%). Common implementation strategies used alongside dashboards included education (n=60/118, 50.8%), audit and feedback (n=59/118, 50.0%), and advisory boards (n=54/118, 45.8%). Evaluations of dashboards (n=84/118, 71.2%) were mostly quantitative (n=60/118, 50.8%), or mixed methods, combining dashboard or health record data with qualitative findings (n=18/118, 15.2%). CONCLUSIONS Dashboards in health care have been used in diverse settings, for multiple purposes and varied end users. The complexity of many dashboards – serving many purposes and end users at once – and the frequent expectation that clinicians will use them underscores the importance of systematic design and evaluation to ensure they are having the intended outcomes. Future work is needed to identify best practices for the development, implementation, and evaluation of health care dashboards. INTERNATIONAL REGISTERED REPORT RR2-10.2196/34894

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“…The studies in the final reviewed papers, fifteen, involved dashboards implemented in various continents North America, Europe, Africa, Asia etc. Most of the studies were conducted in the USA [2,15,20,23,24,31,35], one in Canada [28], one in Indonesia [17],…”

Section: Study Demographicsmentioning

confidence: 99%

“…one in Mali [38], one in Netherlands [14], one in Nigeria [23], one in South Africa [9] and one in Uganda [22]. One paper reviewed involved multi-countries studies: England, Scotland, Wales, Ireland, and Northern Ireland [3]…”

Section: Study Demographicsmentioning

confidence: 99%

Program evaluation dashboard design and development for Missouri telehealth network show-me echo program

Arinze¹

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Background: The Show-Me ECHO Program is a state funded telehealth project, established in 2014, that connects interdisciplinary teams of experts with rural and isolated primary care providers (PCPs) and other professionals using videoconferencing and interactive case-based learning in an effort to develop advanced skills, best practices and ultimately improve patient care access, quality, and efficiency. Since inception, the Show-Me ECHO program has experienced rapid growth and expansion to over 40 ECHO topics, impacting all 114 Missouri Counties and over 2,300 health/community organizations. The exponential growth experienced by the ECHO model highlights a crucial need for adept program evaluation, reporting tools and resources which will facilitate the process of systematically examining the implementation, quality, impact, and value of the program. Objective: The objective of this project is to design and build data dashboards that support a macro-evaluation and management of Missouri Telehealth Network's Show-Me ECHO program and contributes to program improvement activities. Methods: A stakeholder identification and needs analysis was completed to ensure comprehensive measurement of program performance metrics. Show-Me ECHO program administrative data, clinic information, attendance records for participants and facilitators, case presentation metrics, didactic presentations, and more were extracted from MTN data repositories for the 2014-2021 period and analyzed for dashboard development. Data cleaning and preprocessing was conducted in a combination of Excel, Python and Tableau. The dashboards and other data visualization metrics were created in Tableau. Results: Data extraction generated a total of 70,910 observations across three reports ('Clinic Data', 'Didactic Presentation Data' and 'Patient Presentation Data'). Three preliminary dashboards -- "Show-Me ECHO Project Reach and Attendance" "Show-Me ECHO Project Overview" and "ECHO Clinic Performance Report" were established to provide Missouri Telehealth Network (MTN) teams and stakeholders detailed insight into growth and performance of the Show-Me ECHO project and support development and management of action plans. Conclusions: The constructed MTN Dashboards support organization efforts to establish a single unified approach to monitor program progress, identify and prioritize efforts and resource allocation, identify specific Missouri counties that may benefit from interventions and ECHO clinic expansions, and provide appropriate performance metrics that can be shared with both decision makers and relevant stakeholders. Future considerations for dashboard expansion include incorporating PCP self-efficacy and knowledge surveys and Claims data analysis to enable further tracking of Provider and Patient outcomes. A feasibility assessment of the implementation of dashboards at other superhubs for benchmarking and program outcome comparison studies should also be considered.

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Inclusion of Real-Time Hand Hygiene Observation and Feedback in a Multimodal Hand Hygiene Improvement Strategy in Low-Resource Settings

Abstract: This quality improvement study uses a novel data collection and visualization tool to audit hand hygiene adherence before and after training among health care workers in low-resource settings at 2 hospitals in Nigeria.

Cited by 11 publications

References 29 publications

Improving hand hygiene measures in low-resourced intensive care units: experience at the Kigali University Teaching Hospital in Rwanda

Improving hand hygiene measures in low-resourced intensive care units: experience at the Kigali University Teaching Hospital in Rwanda

Scoping review of dashboards in health care: why, how, and for whom they have been developed, implemented, and evaluated (Preprint)

Program evaluation dashboard design and development for Missouri telehealth network show-me echo program

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