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Use of a verbal electronic audio reminder with a patient hand hygiene bundle to increase independent patient hand hygiene practices of older adults in an acute care setting

Published:March 01, 2018DOI:https://doi.org/10.1016/j.ajic.2018.01.005

      Highlights

      • Hospitalized patients demonstrate poor hand hygiene practice and face practice barriers.
      • Very few studies support independent patient hand hygiene practice.
      • The addition of a verbal electronic audio reminder to an education bundle is proposed.
      • Independent patient hand hygiene can be improved with the use of a verbal reminder.

      Background

      We hypothesized that the addition of a novel verbal electronic audio reminder to an educational patient hand hygiene bundle would increase performance of self-managed patient hand hygiene.

      Methods

      We conducted a 2-group comparative effectiveness study randomly assigning participants to patient hand hygiene bundle 1 (n = 41), which included a video, a handout, and a personalized verbal electronic audio reminder (EAR) that prompted hand cleansing at 3 meal times, or patient hand hygiene bundle 2 (n = 34), which included the identical video and handout, but not the EAR. The primary outcome was alcohol-based hand sanitizer use based on weighing bottles of hand sanitizer.

      Results

      Participants that received the EAR averaged significantly more use of hand sanitizer product over the 3 days of the study (mean ± SD, 29.97 ± 17.13 g) than participants with no EAR (mean ± SD, 10.88 ± 9.27 g; t73 = 5.822; P ≤ .001).

      Conclusions

      The addition of a novel verbal EAR to a patient hand hygiene bundle resulted in a significant increase in patient hand hygiene performance. Our results suggest that simple audio technology can be used to improve patient self-management of hand hygiene. Future research is needed to determine if the technology can be used to promote other healthy behaviors, reduce infections, and improve patient-centered care without increasing the workload of health care workers.

      Graphical abstract

      Key Words

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      References

        • Stone P.W.
        Economic burden of healthcare-associated infections: an American perspective.
        Expert Rev Pharmacoecon Outcomes Res. 2009; 9: 417-422
        • Cao J.
        • Min L.
        • Lansing B.
        • Foxman B.
        • Mody L.
        Multidrug-resistant organisms on patients' hands: a missed opportunity.
        JAMA Intern Med. 2016; 176: 705-706
        • Istenes N.
        • Bingham J.
        • Hazelett S.
        • Fleming E.
        • Kirk J.
        Patients' potential role in the transmission of health care-associated infections: prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene.
        Am J Infect Control. 2013; 41: 793-798
        • Mody L.
        • Krein S.L.
        • Saint S.
        • Min L.C.
        • Montoya A.
        • Lansing B.
        • et al.
        A targeted infection prevention intervention in nursing home residents with indwelling devices.
        JAMA Intern Med. 2015; 175: 714-723
        • Larson E.L.
        • Cronquist A.B.
        • Whittier S.
        • Lai L.
        • Lyle C.T.
        • Della Latta P.
        Differences in skin flora between inpatients and chronically ill outpatients.
        Heart Lung. 2000; 29: 298-305
        • Sunkesula V.
        • Kundrapu S.
        • Macinga D.R.
        • Donskey C.J.
        Efficacy of alcohol gel for removal of methicillin-resistant Staphylococcus aureus from hands of colonized patients.
        Infect Control Hosp Epidemiol. 2015; 36: 229-231
        • Schorey J.S.
        • Cheng Y.
        • Singh P.P.
        • Smith V.L.
        Exosomes and other extracellular vesicles in host–pathogen interactions.
        EMBO Rep. 2015; 16: 24-43
        • Koganti S.
        • Alhmidi H.
        • Tomas M.E.
        • Cadnum J.L.
        • Jencson A.
        • Donskey C.J.
        Evaluation of hospital floors as a potential source of pathogen dissemination using a nonpathogenic virus as a surrogate marker.
        Infect Control Hosp Epidemiol. 2016; 37: 1374-1377
        • Linnane B.
        • Collins L.
        • Bussmann N.
        • O'Connell N.H.
        • Dunne C.
        Medical devices for cystic fibrosis care may be portable reservoirs of potential pathogens.
        J Hosp Infect. 2017; 96: 397-398
        • Percival S.L.
        • Suleman L.
        • Vuotto C.
        • Donelli G.
        Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control.
        J Med Microbiol. 2015; 64: 323-334
        • Sunkesula V.C.K.
        • Kundrapu S.
        • Knighton S.
        • Cadnum J.L.
        • Donskey C.J.
        A randomized trial to determine the impact of an educational patient hand-hygiene intervention on contamination of hospitalized patient's hands with healthcare-associated pathogens.
        Infect Control Hosp Epidemiol. 2017; 38: 595-597
        • Barker A.
        • Sethi A.
        • Shulkin E.
        • Caniza R.
        • Zerbel S.
        • Safdar N.
        Patients' hand hygiene at home predicts their hand hygiene practices in the hospital.
        Infect Control Hosp Epidemiol. 2014; 35: 585-588
        • Srigley J.A.
        • Furness C.D.
        • Gardam M.
        Measurement of patient hand hygiene in multiorgan transplant units using a novel technology: an observational study.
        Infect Control Hosp Epidemiol. 2014; 35: 1336-1341
        • Savage J.
        • Fuller C.
        • Besser S.
        • Stone S.
        Use of alcohol hand rub (AHR) at ward entrances and use of soap and AHR by patients and visitors: a study in 27 wards in nine acute NHS trusts.
        J Infect Prev. 2011; 12: 54-58
        • Sunkesula V.C.
        • Knighton S.
        • Zabarsky T.F.
        • Kundrapu S.
        • Higgins P.A.
        • Donskey C.J.
        Four moments for patient hand hygiene: a patient-centered, provider-facilitated model to improve patient hand hygiene.
        Infect Control Hosp Epidemiol. 2015; 36: 986-989
        • Cheng V.C.C.
        • Tai J.W.
        • Li W.S.
        • Chau P.H.
        • So S.Y.
        • Wong L.M.
        • et al.
        Implementation of directly observed patient hand hygiene for hospitalized patients by hand hygiene ambassadors in Hong Kong.
        Am J Infect Control. 2016; 44: 621-624
        • O'Donnell M.
        • Harris T.
        • Horn T.
        • Midamba B.
        • Primes V.
        • Sullivan N.
        • et al.
        Sustained increase in resident meal time hand hygiene through an interdisciplinary intervention engaging long-term care facility residents and staff.
        Am J Infect Control. 2015; 43: 162-164
        • Ardizzone L.L.
        • Smolowitz J.
        • Kline N.
        • Thom B.
        • Larson E.L.
        Patient hand hygiene practices in surgical patients.
        Am J Infect Control. 2013; 41: 487-491
        • Lawrence M.
        Patient hand hygiene—a clinical inquiry.
        Nurs Times. 1983; 79: 24-25
        • Landers T.
        • Abusalem S.
        • Coty M.-B.
        • Bingham J.
        Patient-centered hand hygiene: the next step in infection prevention.
        Am J Infect Control. 2012; 40: S11-S17
        • Gudnadottir U.
        • Fritz J.
        • Zerbel S.
        • Bernardo A.
        • Sethi A.K.
        • Safdar N.
        Reducing health care-associated infections: patients want to be engaged and learn about infection prevention.
        Am J Infect Control. 2013; 41: 955-958
        • Ottum A.
        • Sethi A.K.
        • Jacobs E.
        • Zerbel S.
        • Gaines M.E.
        • Safdar N.
        Engaging patients in the prevention of health care-associated infections: a survey of patients' awareness, knowledge, and perceptions regarding the risks and consequences of infection with methicillin-resistant Staphylococcus aureus and Clostridium difficile.
        Am J Infect Control. 2013; 41: 322-326
        • Whelan M.E.
        • Morgan P.S.
        • Sherar L.B.
        • Orme M.W.
        • Esliger D.W.
        Can functional magnetic resonance imaging studies help with the optimization of health messaging for lifestyle behavior change? A systematic review.
        Prev Med. 2017; 99: 185-196
        • Knighton S.C.
        • McDowell C.
        • Rai H.
        • Higgins P.
        • Burant C.
        • Donskey C.J.
        Feasibility: an important but neglected issue in patient hand hygiene.
        Am J Infect Control. 2017; 45: 626-629
        • Rai H.
        • Knighton S.
        • Zabarsky T.F.
        • Donskey C.J.
        Comparison of ethanol hand sanitizer versus moist towelette packets for mealtime patient hand hygiene.
        Am J Infect Control. 2017; 45: 1033-1034
        • Tanner J.
        • Mistry N.
        Hand hygiene: product preference and compliance.
        Nurs Times. 2011; 107: 16-19
        • Gagné D.
        • Bédard G.
        • Maziade P.J.
        Systematic patients' hand disinfection: impact on meticillin-resistant Staphylococcus aureus infection rates in a community hospital.
        J Hosp Infect. 2010; 75: 269-272
        • Ajzen I.
        The theory of planned behavior.
        Organ Behav Hum Decis Process. 1991; 50: 179-211
        • Janz N.K.
        • Becker M.H.
        The health belief model: a decade later.
        Health Educ Q. 1984; 11: 1-47
        • Backman C.
        • Zoutman D.E.
        • Marck P.B.
        An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections.
        Am J Infect Control. 2008; 36: 333-348
        • Boyce J.M.
        • Pittet D.
        • Healthcare Infection Control Practices Advisory Committee & HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force
        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. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America.
        MMWR Recomm Rep. 2002; 51 (quiz CE1-4): 1-45
        • McGuckin M.
        • Govednik J.
        Patient empowerment and hand hygiene, 1997-2012.
        J Hosp Infect. 2013; 84: 191-199
        • Sax H.
        • Allegranzi B.
        • Chraïti M.N.
        • Boyce J.
        • Larson E.
        • Pittet D.
        The World Health Organization hand hygiene observation method.
        Am J Infect Control. 2009; 37: 827-834
        • Borson S.
        • Scanlan J.
        • Brush M.
        • Vitaliano P.
        • Dokmak A.
        The Mini-Cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly.
        Int J Geriatr Psychiatry. 2000; 15: 1021-1027
        • Faul F.
        • Erdfelder E.
        • Lang A.-G.
        • Buchner A.
        G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Mijnarends D.M.
        • Meijers J.M.
        • Halfens R.J.
        • ter Borg S.
        • Luiking Y.C.
        • Verlaan S.
        • et al.
        Validity and reliability of tools to measure muscle mass, strength, and physical performance in community-dwelling older people: a systematic review.
        J Am Med Dir Assoc. 2013; 14: 170-178
        • Matheson L.N.
        • Melhorn J.M.
        • Mayer T.G.
        • Theodore B.R.
        • Gatchel R.J.
        Reliability of a visual analog version of the QuickDASH.
        J Bone Joint Surg Am. 2006; 88: 1782-1787
        • Bell C.
        • Whiting J.
        Patient education in the hospital setting.
        Dimens Health Serv. 1981; 58: 26-28
        • Tuong W.
        • Larsen E.R.
        • Armstrong A.W.
        Videos to influence: a systematic review of effectiveness of video-based education in modifying health behaviors.
        J Behav Med. 2014; 37: 218-233
        • Larson E.
        Monitoring hand hygiene: meaningless, harmful, or helpful?.
        Am J Infect Control. 2013; 41: S42-S45