Using a Qualitative Study to Understand the Failure of a Strategy Implemented for Improving Hand Hygiene Adherence in 4 Intensive Care Units

Eveillard, Matthieu; Bruna, Tiphaine; Kouatchet, Achille; Dubé, Laurent; Poiroux, Laurent; Dabin, Evelyne; Hitoto, Hikombo; Mercat, Alain; Joly-Guillou, Marie-Laure; Desfontaines, Hélène

doi:10.1086/669875

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…In our study HCW were most compliant with HH before and after patient contact and after potential body fluid exposure. This is consistent with studies that have found that HCWs perform HH most often when they perceive it will protect themselves or their patients, 15,33-36 …”

Section: Discussionsupporting

confidence: 92%

“…13-15 Clinical practice as seen in our study suggests that strict adherence to the WHO ‘My 5 Moments’ of HH may be infeasible in the setting of active resuscitation. Creating a set of guidelines that focuses on glove use for HH before and after patient care, after contact with body fluids and before certain clean procedures may be more effective in promoting HH compliance.…”

Section: Discussionmentioning

confidence: 85%

“…This is consistent with studies that have found that HCWs perform HH most often when they perceive it will protect themselves or their patients. 15, 33-36 More research is needed to understand if certain moments are more important to HCWs than others and whether certain moments may pose a greater risk for transmission.…”

Section: Discussionmentioning

confidence: 99%

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Hand Hygiene Compliance in the Setting of Trauma Resuscitation

Haac

Rock

Harris

et al. 2017

Injury

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Background Healthcare-associated infections are a significant health burden, and hand hygiene (HH) is an essential prevention strategy. World Health Organization (WHO) 2009 guidelines recommend washing hands during five moments of patient care; 1) before touching a patient; 2) before a clean procedure; 3) after body fluid exposure; and 4) after touching a patient or 5) patient surroundings. HH opportunities at these 5 moments are frequent and compliance is low (22-60%). Infection risk is particularly high in trauma patients, and HH compliance during active trauma resuscitation has yet to be evaluated. Study Design Using video surveillance, all healthcare worker (HCW)-patient interactions for 30 patients were retrospectively reviewed for HH compliance according to WHO guidelines and glove use during initial resuscitation at a level-1 trauma center. Results 342 HCW-patient interactions and 1034 HH opportunities were observed. HH compliance with the WHO moments was 7% (71/1034) overall; 3% (10/375) before patient contact, 0% (0/178) before a clean procedure, 11% (2/19) after body fluid contact, 15% (57/376) after patient contact and 2% (2/86) after contact with the environment. Glove use was more common, particularly before (69%) and after (47%) patient contact and after body fluid contact (58%). No HH was observed before clean procedures, but HCW donned new gloves 75% of the time before bedside procedures. If donning/removing gloves was included with HH as compliant, compliance was 57% overall. Conclusion HH opportunities are frequent and compliance with WHO HH guidelines may be infeasible, requiring significant amounts of time that may be better spent with the patient during the golden hour of trauma resuscitation. In an era where more scrutiny is being applied to patient safety, particularly the prevention of inpatient infections, more research is needed to identify alternative strategies (e.g. glove use, prioritizing moments) that may more effectively promote compliance in this setting.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 85%

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Hand Hygiene Compliance in the Setting of Trauma Resuscitation

Haac

Rock

Harris

et al. 2017

Injury

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“…The reports represented two brief research reports submitted as letters to the editor (Eveillard et al, 2013; Jang et al, 2010a); one published conference abstract (Jones et al, 2015); one published conference paper (Patterson et al, 2014); one report of a research study embedded in a published technical report (Zimmerman et al, 2013). The remaining 31 sources were published empirical research studies.…”

Section: Resultsmentioning

confidence: 99%

Hand hygiene among healthcare workers: A qualitative meta summary using the GRADE-CERQual process

Chatfield

DeBois

Nolan

et al. 2016

Journal of Infection Prevention

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“…In Europe, adherence to hand hygiene and contact precautions stems more from a concern for self‐protection than patient safety (Erasmus et al., ; Eveillard et al., ; Seibert et al., ). Some professionals do not adhere to hand washing because they do not think a strong link exists between hand hygiene and HAI (Erasmus et al., ).…”

Section: Introductionmentioning

confidence: 99%