Highlights
- •Overall hand hygiene compliance before the intervention was low (44.1%) which was in line with other studies performed in intensive care units.
- •After our video camera hand hygiene surveillance, scenario based interactive education and feedback intervention, the overall hand hygiene and glove showed and insignificant improvement.
- •The before patient contact hand hygiene compliance rate increased significantly.
- •The improvements in hand hygiene behavior were not sustained in the long term (6 months after the intervention) follow period. This shows the importance of continuous and frequent feedback and educations to sustain a high hand hygiene and glove use compliance.
Abstract
Objective
The purpose of this study is to determine whether use of the video camera surveillance
system for hand hygiene (HH) monitoring, video-based education and feedback can improve
the HH compliance in a neonatal intensive care unit (NICU).
Methods
This is an interventional before-after trial conducted in a level-III NICU between
July 2019-June 2020. The HH compliance was measured using the randomly selected video-camera
footages in the baseline, intervention, and maintenance periods. After the baseline,
an intervention consisting of feedback, and education with video scenarios was implemented.
The primary outcome was the HH compliance change. The compliance rates were tested
as an interrupted time series (ITS) with a segmented regression model adjusted for
autocorrelation for each study periods.
Results
We identified a total of 8335 HH indications. There was an increase in the total compliance
rate of 9.0% (95% CI(-2%-20%)) at the time of intervention with increase in rate after
intervention of 0.26% (95% CI(-0.31%-0.84%)) per day. The hand hygiene compliance
before-patient contact significantly increase 19.8% (95% CI(4.8%-34.8%). Incorrect
gloves use improved insignificantly with the intervention -3.4% (95% CI(-13.4%-6.7%)).
Conclusion
In this study HH monitoring using video-camera footage combined with an intervention
includes feedback, and education improved HH compliance. However, these improvements
were not sustained in the long term. Frequent feedback and education may be required
to sustain high compliance.
Graphical Abstract
Graphical Abstract
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References
- Hand hygiene-related clinical trials reported since 2010: a systematic review.Journal of Hospital Infection. 2016; 92: 309-320
World Health Organization. The Burden of Health Care-Associated Infection Worldwide. A Summary; 2010. https://apps.who.int/iris/bitstream/handle/10665/80135/9789241501507_eng.pdf. 2017.
- A 6-year prospective surveillance of healthcare-associated infections in a neonatal intensive care unit from southern part of Turkey.Journal of paediatrics and child health. 2010; 46: 337-342
- The first six years of surveillance in pediatric and neonatal intensive care units in Turkey.Antimicrobial Resistance and Infection Control. 2015; 4: 34
- The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point-prevalence study.Pediatrics & Neonatology. 2021; 62: 208-217
- Strategies to prevent healthcare-associated infections through hand hygiene.Infection Control and Hospital Epidemiology. 2014; 35: S155-S178
- Evidence-based model for hand transmission during patient care and the role of improved practices.The Lancet Infectious Diseases. 2006; 6: 641-652
- Systematic review of studies on compliance with hand hygiene guidelines in hospital care.Infection Control and Hospital Epidemiology. 2010; 31: 283
- Hand hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review.Journal of Hospital Infection. 2021; 111: 6
- Hand hygiene compliance rates: fact or fiction?.American journal of infection control. 2018; 46: 876-880
- Hand hygiene technical reference manual: to be used by health-care workers, trainers and observers of hand hygiene practices.World Health Organization, 2009 ([Internet]2009 [cited 2019 Oct 24]. Available from:)
- Hand hygiene knowledge, perception and practice of healthcare workers in a Turkish university hospital intensive care unit.The Journal of Infection in Developing Countries. 2019; 13: 744-747
- Compliance of healthcare workers with hand hygiene practices in neonatal and pediatric intensive care units: overt observation.Interdisciplinary perspectives on infectious diseases. 2014; (2014)
- Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit.International Journal of Nursing Practice. 2015; 21: 486-492
- Hand hygiene compliance rates after an educational intervention in a neonatal intensive care unit.Infection Control and Hospital Epidemiology. 2007; 28: 1096-1098
- High rate of hand contamination and low rate of hand washing before infant contact in a neonatal intensive care unit.The Pediatric Infectious Disease Journal. 1996; 15: 908-910
- Video surveillance audit of hand-washing practices in a neonatal intensive care unit.Indian Pediatrics. 2015; 52: 409-411
- Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis.European Journal of Clinical Microbiology & Infectious Diseases. 2015; 34: 887-897
- Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback.American Journal of Infection Control. 2016; 44: 868-872
- Challenges encountered and lessons learned during a trial of an electronic hand hygiene monitoring system.American Journal of Infection Control. 2019; 47: 1443-1448
- Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission?.Journal of Hospital Infection. 2004; 57: 162-169
- Safe removal of gloves from contact precautions: The role of hand hygiene.American Journal of Infection Control. 2018; 46: 764-767
- Monitoring the hand hygiene compliance of health care workers in a general intensive care unit: use of continuous closed circle television versus overt observation.American Journal of Infection Control. 2017; 45: 849-854
- Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare.Clinical Infectious Diseases. 2011; 54: 1-7
- Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring.Infection Control and Hospital Epidemiology. 2015; 36: 957-962
- Impact of observation and analysis methodology when reporting hand hygiene data.Journal of Hospital Infection. 2011; 4: 358-359
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