Highlights
- •Implementation of multimodal infection control strategies was assessed in Greece.
- •Systematic situation analysis of hand hygiene practices in 17 acute-care hospitals.
- •Greek hospitals are, on average, at an intermediate level in hand hygiene practice.
- •Training, feedback and safety climate for hand hygiene require improvements.
- •Infection control nurse staffing levels significantly affect implementation progress.
Background
In this first attempt to suggest achievable standards for improvement in hospital
infection prevention and control (IPC) in Greece, we assessed main IPC structure and
process indicators emphasizing hand hygiene.
Methods
Acute-care hospitals across the country participated in a cross-sectional survey by
completing the World Health Organization Hand Hygiene Self-assessment Framework (HHSAF)
and by providing hospital-level IPC indicators.
Results
Seventeen hospitals completed the survey, comprising 14% of the country's public hospitals.
Median IPC staffing levels were 0.8 nurses and 0.5 doctors per 250 beds. Few hospitals
implemented full multimodal IPC programs. The HHSAF indicated that appropriate hand
hygiene practices and promotion strategies were in place in most hospitals, but the
mean HHSAF score of 289 was lower compared with studies in Italy (mean, 332; P = .040) and the United States (mean, 373; P < .001). Presence of 1 additional IPC nurse was independently associated with increases
of 53% in the HHSAF median score for training-education (P = .035) and by 38% in the lower 30th percentile HHSAF score for safety climate (P = .049).
Conclusions
Surveyed hospitals are, on average, at an intermediate level in hand hygiene practice
but require improvements on training-education, evaluation-feedback, and safety climate.
Ensuring adequate IPC nurse staffing levels and systematically implementing multimodal
IPC programs may lead to substantial improvements.
Key Words
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References
- Role of hand hygiene in healthcare-associated infection prevention.J Hosp Infect. 2009; 73: 305-315
- Evidence of hand hygiene to reduce transmission and infections by multi- drug resistant organisms in health-care settings.(Geneva)2017
- World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations.Infect Control Hosp Epidemiol. 2009; 30: 611-622
- Systematic review of studies on compliance with hand hygiene guidelines in hospital care.Infect Control Hosp Epidemiol. 2010; 31: 283-294
- Guide to implementation: a guide to the implementation of the WHO Multimodal Hand Hygiene Improvement Strategy.(Available from:)
- Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study.Lancet Infect Dis. 2013; 13: 843-851
- Determinants of success and sustainability of the WHO multimodal hand hygiene promotion campaign, Italy, 2007-2008 and 2014.Euro Surveill. 2017; 22: 30546
- Prevalence, incidence burden, and clinical impact of healthcare-associated infections and antimicrobial resistance: a national prevalent cohort study in acute care hospitals in Greece.Infect Drug Resist. 2017; 10: 317-328
- Hand hygiene self-assessment framework 2010.(Available from:)http://www.who.int/entity/gpsc/country_work/hhsa_framework_October_2010.pdfDate: 2010Date accessed: August 1, 2018
- Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Protocol Version 5.3.(Stockholm: ECDC; Available from:)https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/PPS-HAI-antimicrobial-use-EU-acute-care-hospitals-V5-3.pdfDate: 2016Date accessed: August 1, 2018
- Testing the WHO Hand Hygiene Self-Assessment Framework for usability and reliability.J Hosp Infect. 2013; 83: 30-35
- The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals.Am J Epidemiol. 1985; 121 (Available from:): 182-205http://www.ncbi.nlm.nih.gov/pubmed/4014115Date accessed: November 7, 2017
- World Health Organization framework: multimodal hand hygiene strategy in Piedmont (Italy) health care facilities.J Patient Saf. 2017; (Jan 10. [Epub ahead of print])
- Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities.Am J Infect Control. 2014; 42: 224-230
- Summary Report:Hand Hygiene Self-Assessment Framework Survey 2015/2016.(A Report from the WHO Infection Prevention and Control Global Unit; Available from:)
- The role of the champion in infection prevention: results from a multisite qualitative study.Qual Saf Health Care. 2009; 18: 434-440
- Improving healthcare worker hand hygiene adherence before patient contact: a before-and-after five-unit multimodal intervention in Tuscany.Qual Saf Health Care. 2009; 18: 429-433
- Involving the patient to ask about hospital hand hygiene: a National Patient Safety Agency feasibility study.J Hosp Infect. 2011; 77: 299-303
- Patient empowerment and multimodal hand hygiene promotion: a win-win strategy.Am J Med Qual. 2011; 26: 10-17
- Audit and feedback: effects on professional practice and health care outcomes. Jamtvedt G.Cochrane Database Syst Rev. 2006; (CD000259)
- Effects of peer monitoring and peer feedback on hand hygiene in surgical intensive care unit and step-down units.J Nurs Care Qual. 2011; 26: 49-53
- Measurement and feedback of infection control process measures in the intensive care unit: Impact on compliance.Am J Infect Control. 2006; 34: 537-539
- Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in European Acute Care Hospitals.(Stockholm: ECDC; Available from:)https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdfDate: 2013Date accessed: August 30, 2018
- Epidemiology of Clostridium difficile infection.J Pharm Pract. 2013; 26: 464-475
- Point-prevalence survey of healthcare facility-onset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study.PLoS ONE. 2017; 12 (e0182799)
Article Info
Publication History
Published online: May 17, 2018
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
