Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-24T09:23:51.263Z Has data issue: false hasContentIssue false
  • English
  • Français

Automated Measures of Hand Hygiene Compliance among Healthcare Workers Using Ultrasound: Validation and a Randomized Controlled Trial

Published online by Cambridge University Press:  02 January 2015

Dale A. Fisher ,
Theresa Seetoh ,
Helen Oh May-Lin ,
Sivakumar Viswanathan ,
Yanling Toh ,
Wong Chiang Yin ,
Loh Siw Eng ,
Tan Shire Yang ,
Steve Schiefen  and
Minkyu Je
...Show all authors
Dale A. Fisher*
Affiliation:
Department of Medicine, National University Health System, Singapore Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Theresa Seetoh
Affiliation:
Department of Medicine, National University Health System, Singapore Ministry of Health Holdings, Singapore
Helen Oh May-Lin
Affiliation:
Department of General Medicine, Changi General Hospital, Singapore
Sivakumar Viswanathan
Affiliation:
Agency for Science, Technology, and Research, Singapore
Yanling Toh
Affiliation:
Healthcare and Lifestyle Programme, Agency for Science, Technology, and Research, Singapore
Wong Chiang Yin
Affiliation:
Healthcare and Lifestyle Programme, Agency for Science, Technology, and Research, Singapore
Loh Siw Eng
Affiliation:
Department of General Medicine, Changi General Hospital, Singapore
Tan Shire Yang
Affiliation:
Department of Medicine, National University Health System, Singapore
Steve Schiefen
Affiliation:
HanGenix, North Chelmsford, Massachusetts
Minkyu Je
Affiliation:
Institute of Microelectronics, Agency for Science, Technology, and Research, Singapore
Ruey Feng Peh
Affiliation:
Healthcare and Lifestyle Programme, Agency for Science, Technology, and Research, Singapore
Fiona Wei Ling Loke
Affiliation:
Healthcare and Lifestyle Programme, Agency for Science, Technology, and Research, Singapore
Michael Dempsey
Affiliation:
Center for the Integration of Medicine and Innovative Technology, Boston, Massachusetts
*
Infectious Disease Division, Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, NUHS Tower Block, IE Kent Ridge Road, Level 10, 119228, Singapore (mdcfda@nus.edu.sg)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

The primary objective of this study was to validate a novel method of assessing hand hygiene compliance using ultrasound transmitters in patient zones and staff tagged with receivers. The secondary objective was to assess the impact of audio reminders and quantified individual feedback.

Design.

An observational comparison against manual assessment followed by assessment using an open-label randomized control method.

Setting.

Patient zones were established in 3 wards of 2 large teaching hospitals, including 88 general and 18 intensive care unit ward beds.

Participants.

Consented regular ward nursing, medical, and allied health staff.

Methods.

Concordance between 40 hours of manual observation using trained hand hygiene auditors and automated measures of opportunities and compliance. Subsequent measured interventions were reminder beeps and written individual feedback.

Results.

When compared with manual observations, ultrasound monitoring underestimated percentage compliances by a nonsignificant mean (95% confidence interval [CI]) difference of 5.2% (−20.1% to 9.8%; P = .491). After the intervention, adjusted multivariate analysis showed mean (95% CI) overall compliance in the intervention arm was 6.8% (2.5%−11.1%; P = .002) higher than in the control arm. Results stratified by compliance at entry and exit showed that the effect of intervention was stronger for compliance at exit than at entry.

Conclusions.

Our automated measure of hand hygiene compliance is valid when compared with the traditional gold standard of manual observations. As an interventional tool, ultrasound-based automated hand hygiene audits have significant benefit that can be built upon with enhancements and find increasing acceptance with time.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 9 , September 2013 , pp. 919 - 928
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.World Alliance for Patient Safety; World Health Organization (WHO). The Global Patient Safety Challenge 2005-2006: Clean Care is Safer Care. Geneva: WHO, 2005.Google Scholar
2.Hawkey, PM. The growing burden of antimicrobial resistance. J Antimicrob Chermother 2008;62(suppl 1):i1–i9.CrossRefGoogle ScholarPubMed
3.World Health Organization (WHO). WHO Guidelines on Hand Hygiene in Healthcare: First Global Patient Safety Challenge, Clean Care is Safer Care. Geneva: WHO, 2009.Google Scholar
4.Mushtaq, M, Walsh, TR. Hand hygiene does work. Lancet Infect Dis 2012;12:828–829.CrossRefGoogle ScholarPubMed
5.Grol, R, Grimshaw, J. From evidence to best practice: effective implementation of charge in patients' care. Lancet 2003;362: 1225–1230.Google Scholar
6.Erasmus, V, Daha, TJ, Brug, H, Richardus, JH, Behrendt, MD, Vos, MC, van Beeck, ERSystematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect ControlHosp Epidemiol 2010;31:283–294.CrossRefGoogle ScholarPubMed
7.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Morb Mortal Wkly Rep 2002;51(RR-16):1–48.Google ScholarPubMed
8.Boyce, JM. Hand hygiene compliance monitoring: current perspectives from the USA. J Hosp Infect 2008;70(suppl 1):2–7.CrossRefGoogle ScholarPubMed
9.Swoboda, SM, Earsing, K, Strauss, K, Lane, S, Lipsett, PA. Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit. Crit Care Med 2004;32:358–363.CrossRefGoogle Scholar
10.Cheng, VC, Tai, JWM, Ho, SKY, Chan, JFW, Kwan, NH, Pak, L, Kwok, YY. Introduction of an electronic monitoring system for monitoring compliance with moments 1 and 4 of the WHO “my 5 moments for hand hygiene” methodology. BMC Infect Dis 2011;11:1–13.CrossRefGoogle ScholarPubMed
11.Sahud, AG, Bhanot, N, Radhakrishnan, A, Bajwa, R, Manyam, H, Post, JC. An electronic hand hygiene surveillance device: a pilot study exploring surrogate markers for hand hygiene compliance. Infect Control Hosp Epidemiol 2010;31:634–639.Google Scholar
12.Swoboda, SM, Earsing, K, Strauss, K, Lane, S, Lipsett, PA. Isolation status and voice prompts improve hand hygiene. Am J Infect Control 2007;32:358–363.Google Scholar
13.Venkatesh, AK, Lankford, MG, Rooney, DM, Blachford, T, Watts, CM, Noskin, GA. Use of electronic alerts to enhance hand hygiene compliance and decrease transmission of vancomycin-resistant enterococcus in a hematology unit. Am J Infect Control 2008;36:199–205.Google Scholar
14.Pittet, D, Simon, A, Hugonnet, S, Pessoa-Silva, CL, Sauvan, V, Perneger, TV. Hand hygiene among physicians: performance, beliefs and perceptions. Ann Intern Med 2004;141:18.Google Scholar
15.Pittet, D. Improving adherence to hand hygiene practice: a mul-tidisciplinary approach. Emerg Infect Dis 2001;7:234–240.CrossRefGoogle Scholar
16.Pittet, D, Hugonnet, S, Harbarth, S, Mourouga, P, Sauvan, V, Tou-veneau, S, Perneger, TV. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene infection control programme. lancer 2000;356:1307–1312.Google Scholar
17.Huis, A, Schoonhoven, L, Grol, R, Borm, G, Adang, E, Hulscher, M, van Achterberg, T. Helping hands: a cluster randomised trial to evaluate the effectiveness of two different strategies for promoting hand hygiene in hospital nurses. Implement Sci 2011; 6(101):1–9.CrossRefGoogle Scholar
18.Kohli, E, Ptak, J, Smith, R, Taylor, E, Talbot, EA, Kirkland, KB. Variability in the Hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units. Infect Control Hosp Epidemiol 2009;30:222–225.Google Scholar