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Open Access 01-12-2017 | Research

Implementation of WHO multimodal strategy for improvement of hand hygiene: a quasi-experimental study in a Traditional Chinese Medicine hospital in Xi’an, China

Authors: Li Shen, Xiaoqing Wang, Junming An, Jialu An, Ning Zhou, Lu Sun, Hong Chen, Lin Feng, Jing Han, Xiaorong Liu

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2017

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Abstract

Background

Hand hygiene (HH) is an essential component for preventing and controlling of healthcare-associated infection (HAI), whereas compliance with HH among health care workers (HCWs) is frequently poor. This study aimed to assess compliance and correctness with HH before and after the implementation of a multimodal HH improvement strategy launched by the World Health Organization (WHO).

Methods

A quasi-experimental study design including questionnaire survey generalizing possible factors affecting HH behaviors of HCWs and direct observation method was used to evaluate the effectiveness of WHO multimodal HH strategy in a hospital of Traditional Chinese Medicine. Multimodal HH improvement strategy was drawn up according to the results of questionnaire survey. Compliance and correctness with HH among HCWs were compared before and after intervention. Also HH practices for different indications based on WHO “My Five Moments for Hand Hygiene” were recorded.

Results

In total, 553 HCWs participated in the questionnaire survey and multimodal HH improvement strategy was developed based on individual, environment and management levels. A total of 5044 observations in 23 wards were recorded in this investigation. The rate of compliance and correctness with HH improved from 66.27% and 47.75% at baseline to 80.53% and 88.35% after intervention. Doctors seemed to have better compliance with HH after intervention (84.04%) than nurses and other HCWs (81.07% and 69.42%, respectively). When stratified by indication, compliance with HH improved for all indications after intervention (P < 0.05) except for “after body fluid exposure risk” and “after touching patient surroundings”.

Conclusion

Implementing the WHO multimodal HH strategy can significantly improve HH compliance and correctness among HCWs.
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Literature
1.
go back to reference Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–41.CrossRefPubMed Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–41.CrossRefPubMed
2.
go back to reference Ren N, Wen X, Wu A. Nationwide cross-sectional survey on healthcare-associated infection in 2014. Chinese Journal of Infection Control. 2016;15:83–7. Ren N, Wen X, Wu A. Nationwide cross-sectional survey on healthcare-associated infection in 2014. Chinese Journal of Infection Control. 2016;15:83–7.
3.
go back to reference Graves N, Weinhold D, Tong E, Birrell F, Doidge S, Ramritu P, et al. Effect of healthcare-acquired infection on length of hospital stay and cost. Infect Control Hosp Epidemiol. 2007;28:280–92.CrossRefPubMed Graves N, Weinhold D, Tong E, Birrell F, Doidge S, Ramritu P, et al. Effect of healthcare-acquired infection on length of hospital stay and cost. Infect Control Hosp Epidemiol. 2007;28:280–92.CrossRefPubMed
4.
go back to reference Jia H, Hou T, Li W, Ma Q, Liu W, Yang Y, et al. Economic loss due to healthcare-associated infection in 68 general hospitals in China. Chinese Journal of Infection Control. 2016;15:637–41. Jia H, Hou T, Li W, Ma Q, Liu W, Yang Y, et al. Economic loss due to healthcare-associated infection in 68 general hospitals in China. Chinese Journal of Infection Control. 2016;15:637–41.
5.
go back to reference Allegranzi B, Pittet D. Preventing infections acquired during health-care delivery. Lancet. 2008;372:1719–20.CrossRefPubMed Allegranzi B, Pittet D. Preventing infections acquired during health-care delivery. Lancet. 2008;372:1719–20.CrossRefPubMed
6.
go back to reference Chen P, Liu D. Epidemiological characteristics and preventive strategies of nosocomial infection outbreak incidents in China in recent 30 years. Chinese Journal of Infection Control. 2010;9:387–92,99. Chen P, Liu D. Epidemiological characteristics and preventive strategies of nosocomial infection outbreak incidents in China in recent 30 years. Chinese Journal of Infection Control. 2010;9:387–92,99.
7.
go back to reference Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73:305–15.CrossRefPubMed Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73:305–15.CrossRefPubMed
8.
go back to reference Dancer SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect. 2009;73:378–85.CrossRefPubMed Dancer SJ. The role of environmental cleaning in the control of hospital-acquired infection. J Hosp Infect. 2009;73:378–85.CrossRefPubMed
9.
go back to reference Weber DJ, Anderson D, Rutala WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis. 2013;26:338–44.CrossRefPubMed Weber DJ, Anderson D, Rutala WA. The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis. 2013;26:338–44.CrossRefPubMed
11.
go back to reference Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis. 2013;13:843–51.CrossRefPubMed Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis. 2013;13:843–51.CrossRefPubMed
12.
go back to reference Arntz PR, Hopman J, Nillesen M, Yalcin E, Bleeker-Rovers CP, Voss A, et al. Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department. Am J Infect Control. 2016;44:1203–7.CrossRefPubMed Arntz PR, Hopman J, Nillesen M, Yalcin E, Bleeker-Rovers CP, Voss A, et al. Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department. Am J Infect Control. 2016;44:1203–7.CrossRefPubMed
13.
go back to reference Farhoudi F, Sanaei Dashti A, Hoshangi Davani M, Ghalebi N, Sajadi G, Taghizadeh R. Impact of WHO hand hygiene improvement program implementation: a quasi-experimental trial. Biomed Res Int. 2016;2016:7026169.CrossRefPubMedPubMedCentral Farhoudi F, Sanaei Dashti A, Hoshangi Davani M, Ghalebi N, Sajadi G, Taghizadeh R. Impact of WHO hand hygiene improvement program implementation: a quasi-experimental trial. Biomed Res Int. 2016;2016:7026169.CrossRefPubMedPubMedCentral
14.
go back to reference Pfafflin F, Tufa TB, Getachew M, Nigussie T, Schonfeld A, Haussinger D, et al. Implementation of the WHO multimodal Hand Hygiene Improvement Strategy in a University Hospital in Central Ethiopia. Antimicrob Resist Infect Control. 2017;6:3.CrossRefPubMedPubMedCentral Pfafflin F, Tufa TB, Getachew M, Nigussie T, Schonfeld A, Haussinger D, et al. Implementation of the WHO multimodal Hand Hygiene Improvement Strategy in a University Hospital in Central Ethiopia. Antimicrob Resist Infect Control. 2017;6:3.CrossRefPubMedPubMedCentral
17.
go back to reference Visscher MO, Randall WR. Hand hygiene compliance and irritant dermatitis: a juxtaposition of healthcare issues. Int J Cosmet Sci. 2012;34:402–15.CrossRefPubMed Visscher MO, Randall WR. Hand hygiene compliance and irritant dermatitis: a juxtaposition of healthcare issues. Int J Cosmet Sci. 2012;34:402–15.CrossRefPubMed
18.
go back to reference Boyce JM, Kelliher S, Vallande N. Skin irritation and dryness associated with two hand-hygiene regimens: soap-and-water hand washing versus hand antisepsis with an alcoholic hand gel. Infect Control Hosp Epidemiol. 2000;21:442–8.CrossRefPubMed Boyce JM, Kelliher S, Vallande N. Skin irritation and dryness associated with two hand-hygiene regimens: soap-and-water hand washing versus hand antisepsis with an alcoholic hand gel. Infect Control Hosp Epidemiol. 2000;21:442–8.CrossRefPubMed
19.
go back to reference Larson E, Girard R, Pessoa-Silva CL, Boyce J, Donaldson L, Pittet D. Skin reactions related to hand hygiene and selection of hand hygiene products. Am J Infect Control. 2006;34:627–35.CrossRefPubMed Larson E, Girard R, Pessoa-Silva CL, Boyce J, Donaldson L, Pittet D. Skin reactions related to hand hygiene and selection of hand hygiene products. Am J Infect Control. 2006;34:627–35.CrossRefPubMed
20.
go back to reference Bissett L. Skin care: an essential component of hand hygiene and infection control. Br J Nurs. 2007;16:976–81.CrossRefPubMed Bissett L. Skin care: an essential component of hand hygiene and infection control. Br J Nurs. 2007;16:976–81.CrossRefPubMed
21.
go back to reference Walsh B, Blakemore PH, Drabu YJ. The effect of handcream on the antibacterial activity of chlorhexidine gluconate. J Hosp Infect. 1987;9:30–3.CrossRefPubMed Walsh B, Blakemore PH, Drabu YJ. The effect of handcream on the antibacterial activity of chlorhexidine gluconate. J Hosp Infect. 1987;9:30–3.CrossRefPubMed
22.
go back to reference Benson L, LeBlanc D, Bush L, White J. The effects of surfactant systems and moisturizing products on the residual activity of a chlorhexidine gluconate handwash using a pigskin substrate. Infect Control Hosp Epidemiol. 1990;11:67–70.CrossRefPubMed Benson L, LeBlanc D, Bush L, White J. The effects of surfactant systems and moisturizing products on the residual activity of a chlorhexidine gluconate handwash using a pigskin substrate. Infect Control Hosp Epidemiol. 1990;11:67–70.CrossRefPubMed
23.
24.
go back to reference Harnoss JC, Brune L, Ansorg J, Heidecke CD, Assadian O, Kramer A. Practice of skin protection and skin care among German surgeons and influence on the efficacy of surgical hand disinfection and surgical glove perforation. BMC Infect Dis. 2014;14:315.CrossRefPubMedPubMedCentral Harnoss JC, Brune L, Ansorg J, Heidecke CD, Assadian O, Kramer A. Practice of skin protection and skin care among German surgeons and influence on the efficacy of surgical hand disinfection and surgical glove perforation. BMC Infect Dis. 2014;14:315.CrossRefPubMedPubMedCentral
25.
go back to reference Kampf G, Loffler H. Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review. Ind Health. 2007;45:645–52.CrossRefPubMed Kampf G, Loffler H. Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review. Ind Health. 2007;45:645–52.CrossRefPubMed
27.
go back to reference Ghorbani A, Sadeghi L, Shahrokhi A, Mohammadpour A, Addo M, Khodadadi E. Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran. Am J Infect Control. 2016;44:e279–e81.CrossRefPubMed Ghorbani A, Sadeghi L, Shahrokhi A, Mohammadpour A, Addo M, Khodadadi E. Hand hygiene compliance before and after wearing gloves among intensive care unit nurses in Iran. Am J Infect Control. 2016;44:e279–e81.CrossRefPubMed
28.
go back to reference O'Donoghue M, Ng SH, Suen LK, Boost M. A quasi-experimental study to determine the effects of a multifaceted educational intervention on hand hygiene compliance in a radiography unit. Antimicrob Resist Infect Control. 2016;5:36.CrossRefPubMedPubMedCentral O'Donoghue M, Ng SH, Suen LK, Boost M. A quasi-experimental study to determine the effects of a multifaceted educational intervention on hand hygiene compliance in a radiography unit. Antimicrob Resist Infect Control. 2016;5:36.CrossRefPubMedPubMedCentral
29.
go back to reference McBryde ES, Bradley LC, Whitby M, McElwain DL. An investigation of contact transmission of methicillin-resistant Staphylococcus Aureus. J Hosp Infect. 2004;58:104–8.CrossRefPubMed McBryde ES, Bradley LC, Whitby M, McElwain DL. An investigation of contact transmission of methicillin-resistant Staphylococcus Aureus. J Hosp Infect. 2004;58:104–8.CrossRefPubMed
30.
go back to reference Snyder GM, Thom KA, Furuno JP, Perencevich EN, Roghmann MC, Strauss SM, et al. Detection of methicillin-resistant Staphylococcus Aureus and vancomycin-resistant enterococci on the gowns and gloves of healthcare workers. Infect Control Hosp Epidemiol. 2008;29:583–9.CrossRefPubMedPubMedCentral Snyder GM, Thom KA, Furuno JP, Perencevich EN, Roghmann MC, Strauss SM, et al. Detection of methicillin-resistant Staphylococcus Aureus and vancomycin-resistant enterococci on the gowns and gloves of healthcare workers. Infect Control Hosp Epidemiol. 2008;29:583–9.CrossRefPubMedPubMedCentral
31.
go back to reference Lee A, Chalfine A, Daikos GL, Garilli S, Jovanovic B, Lemmen S, et al. Hand hygiene practices and adherence determinants in surgical wards across Europe and Israel: a multicenter observational study. Am J Infect Control. 2011;39:517–20.CrossRefPubMed Lee A, Chalfine A, Daikos GL, Garilli S, Jovanovic B, Lemmen S, et al. Hand hygiene practices and adherence determinants in surgical wards across Europe and Israel: a multicenter observational study. Am J Infect Control. 2011;39:517–20.CrossRefPubMed
32.
go back to reference Patel B, Engelbrecht H, McDonald H, Morris V, Smythe W. A multifaceted hospital-wide intervention increases hand hygiene compliance. S Afr Med J. 2016;106:32–5.PubMed Patel B, Engelbrecht H, McDonald H, Morris V, Smythe W. A multifaceted hospital-wide intervention increases hand hygiene compliance. S Afr Med J. 2016;106:32–5.PubMed
33.
go back to reference FitzGerald G, Moore G, Wilson AP. Hand hygiene after touching a patient's surroundings: the opportunities most commonly missed. J Hosp Infect. 2013;84:27–31.CrossRefPubMed FitzGerald G, Moore G, Wilson AP. Hand hygiene after touching a patient's surroundings: the opportunities most commonly missed. J Hosp Infect. 2013;84:27–31.CrossRefPubMed
34.
go back to reference Donskey CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control. 2013;41:S12–9.CrossRefPubMed Donskey CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control. 2013;41:S12–9.CrossRefPubMed
35.
go back to reference Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium Difficile, and Acinetobacter species. Am J Infect Control. 2010;38:S25–33.CrossRefPubMed Weber DJ, Rutala WA, Miller MB, Huslage K, Sickbert-Bennett E. Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium Difficile, and Acinetobacter species. Am J Infect Control. 2010;38:S25–33.CrossRefPubMed
36.
go back to reference Ramphal L, Suzuki S, McCracken IM, Addai A. Improving hospital staff compliance with environmental cleaning behavior. Proc (Bayl Univ Med Cent). 2014;27:88–91. Ramphal L, Suzuki S, McCracken IM, Addai A. Improving hospital staff compliance with environmental cleaning behavior. Proc (Bayl Univ Med Cent). 2014;27:88–91.
37.
go back to reference Kurashige EJ, Oie S, Furukawa H. Contamination of environmental surfaces by methicillin-resistant Staphylococcus Aureus (MRSA) in rooms of inpatients with MRSA-positive body sites. Braz J Microbiol. 2016;47:703–5.CrossRefPubMedPubMedCentral Kurashige EJ, Oie S, Furukawa H. Contamination of environmental surfaces by methicillin-resistant Staphylococcus Aureus (MRSA) in rooms of inpatients with MRSA-positive body sites. Braz J Microbiol. 2016;47:703–5.CrossRefPubMedPubMedCentral
38.
go back to reference Ji G, Yin H, Chen Y. Prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among obstetrics and gynaecology workers in rural China. J Hosp Infect. 2005;59:235–41.CrossRefPubMed Ji G, Yin H, Chen Y. Prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among obstetrics and gynaecology workers in rural China. J Hosp Infect. 2005;59:235–41.CrossRefPubMed
39.
go back to reference Li LY, Zhao YC, Jia JX, Zhao XL, Jia HX. Investigation on compliance of hand hygiene of healthcare workers. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2008;30:546–9.PubMed Li LY, Zhao YC, Jia JX, Zhao XL, Jia HX. Investigation on compliance of hand hygiene of healthcare workers. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2008;30:546–9.PubMed
40.
go back to reference Chau JP, Thompson DR, Twinn S, Lee DT, Pang SW. An evaluation of hospital hand hygiene practice and glove use in Hong Kong. J Clin Nurs. 2011;20:1319–28.CrossRefPubMed Chau JP, Thompson DR, Twinn S, Lee DT, Pang SW. An evaluation of hospital hand hygiene practice and glove use in Hong Kong. J Clin Nurs. 2011;20:1319–28.CrossRefPubMed
41.
go back to reference Su D, Hu B, Rosenthal VD, Li R, Hao C, Pan W, et al. Impact of the international nosocomial infection control consortium (INICC) multidimensional hand hygiene approach in five intensive care units in three cities of China. Public Health. 2015;129:979–88.CrossRefPubMed Su D, Hu B, Rosenthal VD, Li R, Hao C, Pan W, et al. Impact of the international nosocomial infection control consortium (INICC) multidimensional hand hygiene approach in five intensive care units in three cities of China. Public Health. 2015;129:979–88.CrossRefPubMed
42.
go back to reference Mu X, Xu Y, Yang T, Zhang J, Wang C, Liu W, et al. Improving hand hygiene compliance among healthcare workers: an intervention study in a Hospital in Guizhou Province. China Braz J Infect Dis. 2016;20:413–8.CrossRefPubMed Mu X, Xu Y, Yang T, Zhang J, Wang C, Liu W, et al. Improving hand hygiene compliance among healthcare workers: an intervention study in a Hospital in Guizhou Province. China Braz J Infect Dis. 2016;20:413–8.CrossRefPubMed
43.
go back to reference Chen P, Yuan T, Sun Q, Jiang L, Jiang H, Zhu Z, et al. Role of quality control circle in sustained improvement of hand hygiene compliance: an observational study in a stomatology hospital in Shandong. China Antimicrob Resist Infect Control. 2016;5:54.CrossRefPubMed Chen P, Yuan T, Sun Q, Jiang L, Jiang H, Zhu Z, et al. Role of quality control circle in sustained improvement of hand hygiene compliance: an observational study in a stomatology hospital in Shandong. China Antimicrob Resist Infect Control. 2016;5:54.CrossRefPubMed
44.
go back to reference Cheng VC, Tai JW, Li WS, Chau PH, So SY, Wong LM, et al. Implementation of directly observed patient hand hygiene for hospitalized patients by hand hygiene ambassadors in Hong Kong. Am J Infect Control. 2016;44:621–4.CrossRefPubMed Cheng VC, Tai JW, Li WS, Chau PH, So SY, Wong LM, et al. Implementation of directly observed patient hand hygiene for hospitalized patients by hand hygiene ambassadors in Hong Kong. Am J Infect Control. 2016;44:621–4.CrossRefPubMed
Metadata
Title
Implementation of WHO multimodal strategy for improvement of hand hygiene: a quasi-experimental study in a Traditional Chinese Medicine hospital in Xi’an, China
Authors
Li Shen
Xiaoqing Wang
Junming An
Jialu An
Ning Zhou
Lu Sun
Hong Chen
Lin Feng
Jing Han
Xiaorong Liu
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2017
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-017-0254-4

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