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Validation and implementation of group electronic hand hygiene monitoring across twenty-four critical care units

Published online by Cambridge University Press:  25 June 2021

Jerome A. Leis Open the ORCID record for Jerome A. Leis [Opens in a new window] ,
Maryam Obaidallah ,
Victoria Williams ,
Matthew P Muller ,
Jeff E. Powis ,
Jennie Johnstone ,
Susy Hota ,
Kevin Katz ,
Michael Payne  and
Lucas Castellani
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Jerome A. Leis*
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Sunnybrook Research Institute, Toronto, Ontario, Canada
Maryam Obaidallah
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Victoria Williams
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Matthew P Muller
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada St Michael’s Hospital, Toronto, Ontario, Canada
Jeff E. Powis
Affiliation:
Michael Garron Hospital, Toronto, Ontario, Canada
Jennie Johnstone
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Sinai Health, Toronto, Ontario, Canada
Susy Hota
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada University Health Network, Toronto, Ontario, Canada
Kevin Katz
Affiliation:
North York General Hospital, Toronto, Ontario, Canada
Michael Payne
Affiliation:
London Health Science Centre, London, Ontario, Canada
Lucas Castellani
Affiliation:
The Sault Area Hospital, Sault Ste. Marie, Ontario, Canada
Mark Downing
Affiliation:
St Joseph’s Health Centre, Toronto, Ontario, Canada
Dominik Mertz
Affiliation:
Hamilton Health Sciences Centre and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Daniel R. Ricciuto
Affiliation:
Peterborough Regional Health Centre, Peterborough, Ontario, Canada Lakeridge Health, Oshawa, Ontario, Canada
Alex Kiss
Affiliation:
Sunnybrook Research Institute, Toronto, Ontario, Canada
Brian H. Cuthbertson
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
*
Author for correspondence: Jerome A. Leis, Email: [email protected]
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Abstract

Objectives:

An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units.

Design:

Multicenter, observational study (10 hospitals) followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada.

Methods:

Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS.

Results:

During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P < .0001).

Conclusions:

Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 7 , July 2022 , pp. 834 - 839
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

COVID-19 strategy update. World Health Organization website. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/strategies-and-plans. Published 2020. Accessed January 20, 2021.Google Scholar
WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. World Health Organization website. http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf. Publisehd 2019. Accessed January 20, 2021.Google Scholar
Dhar, S, Tansek, R, Toftey, EA, et al. Observer bias in hand hygiene compliance reporting. Infect Control Hosp Epidemiol 2010;31:869–870.10.1086/655441CrossRefGoogle ScholarPubMed
Eckmann, Bessert J, Behnke, M, Gastmeier, P, Ruden, H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27:931–934.10.1086/507294CrossRefGoogle Scholar
Hagel, S, Reischke, J, Kesselmeier, M, et al. Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring. Infect Control Hosp Epidemiol 2015;36:957–962.10.1017/ice.2015.93CrossRefGoogle ScholarPubMed
Kovacs-Litman, A, Wong, K, Shojania, KG, et al. Do physicians clean their hands? Insights from a covert observational study. J Hosp Med 2016;11:862–864.10.1002/jhm.2632CrossRefGoogle ScholarPubMed
Srigley, JA, Gardam, M, Fernie, G, Lightfoot, D, Lebovic, G, Muller, MP. Hand hygiene monitoring technology: a systematic review of efficacy. J Hosp Infect 2015;89:51–60.10.1016/j.jhin.2014.10.005CrossRefGoogle Scholar
Muller, MP. Improving hand hygiene in hospitals—more is better. BMJ 2015;351:h3931.10.1136/bmj.h3931CrossRefGoogle Scholar
Leis, JA, Powis, JE, McGeer, A, et al. Introduction of group electronic monitoring of hand hygiene on inpatient units: a multicenter cluster randomized quality improvement study. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa412.CrossRefGoogle Scholar
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;8:43.10.1186/s13756-019-0498-2CrossRefGoogle Scholar
Nayyar, D, Moore, C, McCreight, L, et al. Hand hygiene opportunities on Canadian acute-care inpatient units: a multicenter observational study. Infect Control Hosp Epidemiol 2018;39:1378–1380.10.1017/ice.2018.221CrossRefGoogle ScholarPubMed
Azim, S, Juergens, C, McLaws, ML. An average hand hygiene day for nurses and physicians: the burden is not equal. Am J Infect Control 2016;44:777–781.10.1016/j.ajic.2016.02.006CrossRefGoogle Scholar
Diller, T, Kelly, JW, Blackhurst, D, Steed, C, Boeker, S, McElveen, DC. Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: validation of the HOW2 benchmark study. Am J Infect Control 2014;42:602–607.10.1016/j.ajic.2014.02.020CrossRefGoogle Scholar
Kelly, JW, Blackhurst, D, McAtee, W, Steed, C. Electronic hand hygiene monitoring as a tool for reducing health care-associated methicillin-resistant Staphylococcus aureus infection. Am J Infect Control 2016;44:956–957.10.1016/j.ajic.2016.04.215CrossRefGoogle ScholarPubMed
Mitchell, R, Taylor, G, Rudnick, W, et al. Trends in healthcare-associated infections in acute-care hospitals in Canada: an analysis of repeated point-prevalence surveys. CMAJ 2019;191:E981–E988.10.1503/cmaj.190361CrossRefGoogle ScholarPubMed
Just clean your hands: education for healthcare providers. Public Health Ontario website. https://www.publichealthontario.ca/-/media/documents/b/2014/bp-hand-hygiene.pdf?la=en. Published April 2014. Accessed January 20, 2021.Google Scholar
Marshall, JC, Bosco, L, Adhikari, NK, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2017;37:270–276.10.1016/j.jcrc.2016.07.015CrossRefGoogle ScholarPubMed
Goodliffe, L, Ragan, K, Larocque, M, et al. Rate of healthcare worker–patient interaction and hand hygiene opportunities in an acute-care setting. Infect Control Hosp Epidemiol 2014;35:225–230.10.1086/675286CrossRefGoogle Scholar
Han, A, Conway, LJ, Moore, C, et al. Unit-specific rates of hand hygiene opportunities in an acute-care hospital. Infect Control Hosp Epidemiol 2017;38:411–416.10.1017/ice.2016.308CrossRefGoogle Scholar
Steed, C, Kelly, JW, Blackhurst, D, et al. Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 benchmark study. Am J Infect Control 2011;39:19–26.10.1016/j.ajic.2010.10.007CrossRefGoogle ScholarPubMed
Scheithauer, S, Haefner, H, Schwanz, T, et al. Compliance with hand hygiene on surgical, medical, and neurologic intensive care units: direct observation versus calculated disinfectant usage. Am J Infect Control 2009;37:835–841.10.1016/j.ajic.2009.06.005CrossRefGoogle ScholarPubMed