Role of Hand Hygiene Ambassador and Implementation of Directly Observed Hand Hygiene Among Residents in Residential Care Homes for the Elderly in Hong Kong

Abstract

OBJECTIVEMultidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.METHODSFrom July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum β-lactamse (ESBL)-producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.RESULTSThe overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).CONCLUSIONSThe direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.Infect Control Hosp Epidemiol 2018;39:571-577.

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Air dispersal of meticillin-resistant Staphylococcus aureus in residential care homes for the elderly: implications for transmission during the COVID-19 pandemic

“…Unnecessary prescription of proton pump inhibitors and fluoroquinolones, which are risk factors for MRSA colonization as shown in our multivariate analysis, should be avoided. Practice of directly observed hand hygiene in resident before meal and medication rounds, 40 enforcement of environmental cleaning and disinfection, as well as implementation of universal MRSA decolonization should be incorporated into the bundle of control. 41,42 There are several limitations in this study.…”

Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

“…McConeghy's 2017 study [76] was assessed at unclear risk for random sequence generation and allocation concealment, high risk for blinding of personnel and participants, outcome assessment and selective reporting; Temime's 2018 study [77] was at high risk for random sequence generation, unclear risk from allocation concealment, high risk from blinding of participants and personnel, performance assessment and incomplete data; and Yeung's 2011 study [78] was at unclear risk from random sequence generation, allocation concealment and selective reporting and high risk from blinding of participants and personnel and outcome assessment. There is only one c-RCT of hand hygiene for patients and staff which assessed bacterial contamination and there was a significant decrease in bacterial colonisation [79]. A 2020 systematic review of hand washing, distancing and mask wearing to prevent the transmission of SARS-CoV-2 identified 172 observational studies in 16 countries but no RCTs, and a meta-analysis of 44 non-randomised studies identified substantial protection by distancing more than one metre, hand washing, mask wearing and eye protection [80] (Table 9).…”