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Impact of an automated hand hygiene monitoring system combined with a performance improvement intervention on hospital-acquired infections

Published online by Cambridge University Press:  28 May 2020

Bryan C. Knepper Open the ORCID record for Bryan C. Knepper [Opens in a new window] ,
Amber M. Miller  and
Heather L. Young
Bryan C. Knepper*
Affiliation:
Department of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado
Amber M. Miller
Affiliation:
Department of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado University of Colorado Health, Aurora, Colorado
Heather L. Young
Affiliation:
Department of Patient Safety and Quality, Denver Health Medical Center, Denver, Colorado Department of Medicine and Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Denver, Colorado
*
Author for correspondence: Bryan Knepper, E-mail: [email protected]
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Abstract

Objective:

Hand hygiene adherence has been associated with reductions in nosocomial infection. We assessed the effect of improvements in electronically measured hand hygiene adherence on the incidence of hospital-acquired infections.

Methods:

This quasi-experimental study was conducted in a 555-bed urban safety-net level I trauma center. The preintervention period was January 2015 through June 2016. Baseline electronic hand hygiene data collection took place from April through June 2016. The intervention period was July 2016 through December 2017. An electronic hand hygiene system was installed in 4 locations in our hospital. Performance improvement strategies were implemented that included education, troubleshooting, data dissemination, and feedback. Adherence rates were tracked over time. Rates of hospital-acquired infections were evaluated in the intervention units and in control units selected for comparison. The intervention period was subdivided into the initial and subsequent 9-month periods and were compared to the baseline period.

Results:

Electronically measured hand hygiene rates improved significantly from baseline to intervention, from 47% 77% adherence. Rates >70% continued to be measured 18 months after the intervention. Interrupted time series analysis indicated a significant effect of hand hygiene on healthcare facility-onset Clostridioides difficile infection rates during the first 9 months of the intervention. This trend continued during the final 9 months of the intervention but was nonsignificant. No effects were observed for other hospital-acquired infection rates.

Conclusions:

Implementation of electronic hand hygiene monitoring and performance improvement interventions resulted in reductions in hospital-onset Clostridioides difficile infection rates.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 8 , August 2020 , pp. 931 - 937
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

Best, M, Neuhauser, D.Ignaz Semmelweis and the birth of infection control. Qual Saf Health Care 2004;13:233–234.CrossRefGoogle ScholarPubMed
My five moments for hand hygiene. World Health Organization website. https://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/. Accessed May 5, 2020.Google Scholar
Guideline for hand hygiene in healthcare settings. Morbid Mortal Wkly Rep 2002;51(RR-16):1–48.Google Scholar
Pittet, D, Hugonnet, S, Harbarth, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
Pittet, D, Allegranzi, B, Sax, H, et al.Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;641–652.CrossRefGoogle ScholarPubMed
Grayson, ML, Stewardson, AJ, Russo, PL, et al.Effects of the Australian National Hand Hygiene Initiative after 8 years on infection control practices, health-care worker education, and clinical outcomes: a longitudinal study. Lancet Infect Dis 2018;18:1269–1277.CrossRefGoogle ScholarPubMed
Rubin, ZA, Martin, EM, Allyn, P.Primary prevention of Clostridium difficile-associated diarrhea: current controversies and future tools. Curr Infect Dis Rep 2018;20:32.CrossRefGoogle ScholarPubMed
Ragusa, R, Giorgianni, G, Lupo, L, et al.Healthcare-associated Clostridium difficile infection: role of correct hand hygiene in cross-infection control. J Prev Med Hyg 2018;59:E145–E152.Google ScholarPubMed
Haas, JP, Larson, EL.Measurement of compliance with hand hygiene. J Hosp Infect 2007;66:6–14.CrossRefGoogle ScholarPubMed
Kwok, YLA, Juergens, CP, McLaws, ML.Automated hand hygiene auditing with and without an intervention. Am J Infect Control 2016;44:1475–1480.CrossRefGoogle ScholarPubMed
Pittet, D.Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000;21:381–386.CrossRefGoogle ScholarPubMed
Walker, JL, Sistrunk, WW, Higginbotham, MA, et al.Hospital hand hygiene compliance improves with increased monitoring and immediate feedback. Am J Infect Control 2014;42:1074–1078.CrossRefGoogle ScholarPubMed
Chen, LF, Carriker, C, Staheli, R, et al.Observing and improving hand hygiene compliance: implementation and refinement of an electronic-assisted direct-observer hand hygiene audit program. Infect Control Hosp Epidemiol 2013;34:207–210.CrossRefGoogle ScholarPubMed
Stewardson, A, Pittet, D.Quicker, easier, and cheaper? The promise of automated hand hygiene monitoring. Infect Control Hosp Epidemiol 2011;32:1029–1031.CrossRefGoogle ScholarPubMed
Ellingson, K, Polgreen, PM, Schneider, A, et al.Healthcare personnel perceptions of hand hygiene monitoring technology. Infect Control Hosp Epidemiol 2011;32:1091–1096.CrossRefGoogle ScholarPubMed
Polgreen, PM, Hlady, CS, Severson, MA, Segre, AM, Herman, T.Method for automated monitoring of hand hygiene adherence without radio-frequency identification. Infect Control Hosp Epidemiol 2010;31:1294–1297.CrossRefGoogle ScholarPubMed
Boyce, JM, Cooper, T, Yin, J, Li, FY, Arbogast, JW.Challenges encountered and lessons learned during a trial of an electronic hand hygiene monitoring system. Am J Infect Control 2019;47:1443–1448.CrossRefGoogle ScholarPubMed
Filho, MA, Marra, AR, Magnus, TP, et al.Comparison of human and electronic observation for the measurement of compliance with hand hygiene. Am J Infect Control 2014;42:1188–1192.CrossRefGoogle ScholarPubMed
Pineles, LL, Morgan, DJ, Limper, HM, et al.Accuracy of a radiofrequency identification (RFID) badge system to monitor hand hygiene behavior during routine clinical activities. Am J Infect Control 2014;42:144–147.CrossRefGoogle ScholarPubMed
Fisher, DA, Seetoh, T, Oh May-Lin, H, et al.Automated measures of hand hygiene compliance among healthcare workers using ultrasound: validation and a randomized controlled trial. Infect Control Hosp Epidemiol 2013;34:919–928.CrossRefGoogle Scholar
Boudjema, S, Dufour, JC, Aladro, AS, Desquerres, I, Brouqui, P.MediHandTrace: a tool for measuring and understanding hand hygiene adherence. Clin Microbiol Infect 2014;20:22–28.CrossRefGoogle ScholarPubMed
Levin, PD, Razon, R, Schwartz, C, et al.Obstacles to the successful introduction of an electronic hand hygiene monitoring system, a cohort observational study. Antimicrob Resist Infect Control 2019;8:43.CrossRefGoogle ScholarPubMed
Doll, ME, Masroor, N, Cooper, Ket al.A comparison of the accuracy of two electronic hand hygiene monitoring systems. Infect Control Hosp Epidemiol 2019;40:1194–1197.CrossRefGoogle ScholarPubMed
Boyce, JM.Current issues in hand hygiene. Am J Infect Control 2019;47S:A46–A52.CrossRefGoogle ScholarPubMed
Conway, LJ, Riley, L, Saiman, L, Cohen, B, Alper, P, Larson, EL.Implementation and impact of an automated group monitoring and feedback system to promote hand hygiene among health care personnel. Jt Comm J Qual Patient Saf 2014;40:408–417.Google ScholarPubMed
Boyce, JM, Laughman, JA, Ader, MH, Wagner, PT, Parker, AE, Arbogast, JW.Impact of an automated hand hygiene monitoring system and additional promotional activities on hand hygiene performance rates and healthcare-associated infections. Infect Control Hosp Epidemiol 2019;40:741–747.CrossRefGoogle ScholarPubMed
Demirel, A.Improvement of hand hygiene compliance in a private hospital using the Plan-Do-Check-Act (PDCA) method. Pak J Med Sci 2019;35:721–725.CrossRefGoogle Scholar
Van Diijk, MD, Mulder, SA, Erasmus, V, et al.A multimodal regional intervention strategy framed as friendly competition to improve hand hygiene compliance. Infect Control Hosp Epidemiol 2019;40:187–193.CrossRefGoogle Scholar
Staines, A, Amherdt, I, Lecureux, E, et al.Hand hygiene improvement and sustainability: assessing a breakthrough collaborative in western Switzerland. Infect Control Hosp Epidemiol 2017;38:1420–1427.CrossRefGoogle ScholarPubMed
Luangasanatip, N, Hongsuwan, M, Limmathurosakul, D.Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. BMJ 2015;351:h3728.CrossRefGoogle ScholarPubMed
CDC/NHSN surveillance definitions for specific types of infections. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/17pscnosinfdef_current.pdf. Published January 2020. Accessed May 5, 2020.Google Scholar
McCalla, S, Reilly, M, Thomas, R, et al.An automated hand hygiene compliance system is associated with decreased rates of health care-associated infections. Am J Infect Control 2018;46:1381–1386.CrossRefGoogle ScholarPubMed
Swoboda, SM, Earsing, K, Strauss, K.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
Venkatesh, AK, Lankford, AG, 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.CrossRefGoogle Scholar
Erasmus, V, Daha, TJ, Brug, H, et al.Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31:283–294.CrossRefGoogle ScholarPubMed
Edmisten, C, Hall, C, Kernizan, L, et al.Implementing an electronic hand hygiene monitoring system: lessons learned from community hospitals. Am J Inf Control 2017;45:860–865.CrossRefGoogle ScholarPubMed
McCalla, S, Reilly, M, Thomas, R, McSpedon-Rai, D, McMahon, LA, Palumbo, M.An automated hand hygiene compliance system is associated with decreased rates of healthcare-associated infections. Am J Inf Control 2018;46:1381–6.CrossRefGoogle Scholar
Qasmi, SA, Shah, SMM, Wakil, HYI, Pirzada, S.Guiding hand hygiene interventions among future healthcare workers: implications of knowledge, attitudes, and social influences. Am J Infect Control 2018;46:1026–1031.CrossRefGoogle ScholarPubMed
Pittet, D.Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis 2001;7:234–240.CrossRefGoogle ScholarPubMed
Sakihama, T, Kayauchi, N, Kamiya, T, et al.Assessing sustainability of hand hygiene adherence 5 years after a contest-based intervention in 3 Japanese hospitals. Am J Infect Control 2020;48:77–81.CrossRefGoogle ScholarPubMed