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Cluster Randomized Trial to Evaluate the Effect of a Multimodal Hand Hygiene Improvement Strategy in Primary Care

Published online by Cambridge University Press:  02 January 2015

Carmen Martín-Madrazo ,
Sonia Soto-Díaz ,
Asuncion Cañada-Dorado ,
Miguel Angel Salinero-Fort ,
Manuela Medina-Fernández ,
Enrique Carrillo de Santa Pau ,
Paloma Gómez-Campelo  and
Juan Carlos Abánades-Herranz
Carmen Martín-Madrazo*
Affiliation:
Centro de Salud Monóvar, Gerencia de Atención Primaria de Madrid, Spain
Sonia Soto-Díaz
Affiliation:
Unidad de Apoyo Técnico a la Investigación, Gerencia de Atención Primaria de Madrid, Spain
Asuncion Cañada-Dorado
Affiliation:
Dirección Técnica de Procesos y Calidad, Gerencia Atención Primaria de Madrid, Spain
Miguel Angel Salinero-Fort
Affiliation:
Fundación Investigación Biomedica, Hospital Carlos III Madrid, Spain
Manuela Medina-Fernández
Affiliation:
Centro de Salud Miraflores, Gerencia de Atención Primaria de Madrid, Spain
Enrique Carrillo de Santa Pau
Affiliation:
Unidad de Apoyo a la Investigación, Gerencia de Atención Primaria de Madrid, Spain
Paloma Gómez-Campelo
Affiliation:
Unidad de Epidemiología Clínica, Hospital Carlos III Madrid, Spain
Juan Carlos Abánades-Herranz
Affiliation:
Unidad de Docencia e Investigación, Gerencia de Atención Primaria de Madrid, Spain
*
Centra de Salud Monóvar, Gerencia de Atencion Primaria de Madrid, Spain (cmartinm.gapm04@salud.madrid.org)
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Abstract

Objective.

To evaluate the effectiveness of a multimodal intervention in primary care health professionals for improved compliance with hand hygiene practice, based on the World Health Organization's 5 Moments for Health Hygiene.

Design.

Cluster randomized trial, parallel 2-group study (intervention and control).

Setting.

Primary healthcare centers in Madrid, Spain.

Participants.

Eleven healthcare centers with 198 healthcare workers (general practitioners, nurses, pediatricians, auxiliary nurses, midwives, odontostomatologists, and dental hygienists).

Methods.

The multimodal hand hygiene improvement strategy consisted of training of healthcare workers by teaching sessions, implementation of hydroalcoholic solutions, and installation of reminder posters. The hand hygiene compliance level was evaluated by observation during regular care activities in the office visit setting, at the baseline moment, and 6 months after the intervention, all by a single external observer.

Results.

The overall baseline compliance level was 8.1% (95% confidence interval [CI], 6.2-10.1), and the healthcare workers of the intervention group increased their hand hygiene compliance level by 21.6% (95% CI, 13.83-28.48) compared with the control group.

Conclusions.

This study has demonstrated that hand hygiene compliance in primary healthcare workers can be improved with a multimodal hand hygiene improvement strategy.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 7 , July 2012 , pp. 681 - 688
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1. Pittet, D, Donaldson, L. Clean care is safer care: a worldwide priority. Lancet 2005;366:1246–1247.CrossRefGoogle Scholar
2. Klevens, RM, Edwards, JR, Richards, CL, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160–166.CrossRefGoogle ScholarPubMed
3. European Centre for Disease Prevention and Control (ECDC). Healthcare-Associated Infections. Stockholm: ECDC, 2010. http://ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/Pages/index.aspx. Accessed January 15, 2010.Google Scholar
4. Sociedad Española de Medicina Preventiva Salud Pública e Higiene (SEMPSPH). Estudio de Prevalencia de las Infecciones Nosocomiales 2010: Informe Global de España. http://www.sempsph.com/sempsph/attachments/327_Informe%20EPINE-2010%20ESPA%C3%91A.pdf. SEMPSPH, 2010. Accessed January 15, 2010.Google Scholar
5. Informe Sobre Infección Hospitalaria: Subdirección General de Prestaciones y Evaluación de Tecnologías Sanitarias. Dirección General de Aseguramiento y Planificación Sanitaria. Ministerio de Sanidad y Consumo. Madrid. Med Clin (Bare) 1994;102:20–24.Google Scholar
6. Jarvis, WR. Handwashing: the Semmelweis lesson forgotten? Lancet 1994;344:1311–1312.Google Scholar
7. Larson, EI. A causal link between handwashing and risk of infection? examination of the evidence. Infect Control Hosp Epidemiol 1988;9:28–36.CrossRefGoogle ScholarPubMed
8. Malone, N, Larson, E. Factors associated with a significant reduction in hospital-wide infection rates. Am J Infect Control 1996;24:180–185.CrossRefGoogle ScholarPubMed
9. Pittet, D, Mourouga, P, Perneger, TV. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.Google Scholar
10. Hugonnet, S, Pittet, D. Hand hygiene—beliefs or science? Clin Microbiol Infect 2000;6:350–356.CrossRefGoogle ScholarPubMed
11. Pittet, D, Boyce, JM. Hand hygiene and patient care: pursuing the Semmelweis legacy. Lancet Infect Dis 2001;1(suppl 1):9–20.CrossRefGoogle Scholar
12. Luby, SP, Agboatwalla, M, Feikin, DR, et al. Effect of handwashing on child health: a randomised controlled trial. Lancet 2005;366: 225–233.Google Scholar
13. Pittet, D, Allegranzi, B, Sax, H, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641–652.CrossRefGoogle ScholarPubMed
14. Larson, El. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.CrossRefGoogle ScholarPubMed
15. World Health Organization (WHO). WHO Guidelines on Hand Hygiene in Health Care (Advance Draft). Geneva: WHO, 2006. http://www.who.int/patientsafety/challenge/en/. Accessed January 15, 2010.Google Scholar
16. Larson, El, Kretzer, EK. Compliance with handwashing and barrier precautions. J Hosp Infect 1995;30(suppl):88–106.Google Scholar
17. Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130: 126–130.Google Scholar
18. Thompson, BL, Dwyer, DM, Ussery, XT, Denman, S, Vacek, P, Schwartz, B. Handwashing and glove use in a long-term care facility. Infect Control Hosp Epidemiol 1997;18:97–103.CrossRefGoogle ScholarPubMed
19. Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999; 130: 126–130.Google Scholar
20. Erasmus, V, Daha, TJ, Brug, H, Richardus, JH, Behrendt, MD, Vos, MC, van Beeck, EE Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010;31:283–294.Google Scholar
21. Teare, EL, Cookson, B, French, GL, et al. UK handwashing initiative. J Hosp Infect 1999;43:1–3.Google Scholar
22. Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Morb Mortal Wkly Rep 2002;51:1–45.Google Scholar
23. World Health Organization (WHO). Alianza Mundial para la Seguridad del Paciente: Reto Mundial en Pro de la Seguridad del Paciente 2005-2006. Geneva: WHO, 2005. http://www.who.int/gpsc/background/en/index.html. Accessed January 15, 2010.Google Scholar
24. World Health Organization (WHO). A Guide to the Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy. Geneva: WHO, 2009. http://whqlibdoc.who.int/hq/2009/WHO_IER_PSP_2009.02_eng.pdf. Accessed January 15, 2010.Google Scholar
25. National Institute for Health and Clinical Excellence (NICE). Infection Control: Prevention of Healthcare-Associated Infections in Primary and Community Care. London: NICE, 2010. http://www.nice.org.uk/guidance/index.jspfaction = download&o = 29119. Accessed January 15, 2010.Google Scholar
26. Allegranzi, B. Hand Hygiene in Primary Care: A Collaborative Project between WHO Patient Safety, Spain Ministry of Health, and Geneva WCC on Patient Safety. http://www.seguridaddelpaciente.es/recursos/documentos/VI_Conferencia/03allegranzi.pdf. Accessed January 15, 2010.Google Scholar
27. Smith, S. A review of hand-washing techniques in primary care and community settings. J Clin Nurs 2009;18:786–790.Google Scholar
28. Gould, DJ, Moralejo, D, Drey, N, Chudleigh, JH. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2010;8:CD005186. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD005186/frame.html. Accessed January 15, 2010.Google Scholar
29. Sánchez, J, Fuster, M, García, C, et al. Evaluación de un programa de actualización de las recomendaciones sobre la higiene de manos. An Sist Sanit Navar 2007;30:343–352.Google Scholar
30. Gould, D, Chamberlain, A. The use of a ward-based educational teaching package to enhance nurses' compliance with infection control procedures. J Clin Nurs 1997;6:55–67.Google Scholar
31. Martin-Madrazo, C, Cañada-Dorado, A, Salinero-Fort, MA, et al. Effectiveness of a training programme to improve hand hygiene compliance in primary healthcare. BMC Public Health 2009;9: 469.CrossRefGoogle ScholarPubMed
32. World Health Organization (WHO). WHO Guidelines on HH in Health Care (Advanced Draft): A Summary. http://www.who.int/entity/patientsafety/events/05/HH_en.pdf. Geneva: WHO, 2010. Accessed January 15, 2010.Google Scholar
33. Rosenthal, V, Guzman, S, Safdar, N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Inf Control 2006;34: 392–397.Google Scholar
34. Zerr, DM, Allpress, AL, Heath, J, Bornemann, R, Bennett, E. Decreasing hospital-associated rotavirus infection: a multidisciplinary hand hygiene campaign in a children's hospital. Pediatr Infect Dis J 2005;24:397–403.CrossRefGoogle ScholarPubMed
35. Grayson, ML, Jarvie, LJ, Martin, R, et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust 2008;188:633–640.CrossRefGoogle ScholarPubMed
36. Erasmus, V, Kuperus, MN, Richardus, JH, Vos, MC, Oenema, A, van Beek, EE Improving hand hygiene of nurses using action planning: pilot study in the intensive care unit and surgical ward. J Hosp Infect 2010;76:161–164,Google Scholar
37. Hugo, S. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37:827–834.Google Scholar
38. Fuller, C, Besser, S, Cookson, BD, et al. Assessment of blinding of hand hygiene observers in randomized controlled trials of hand hygiene interventions. Am J Infect Control 2010;38:332–334.Google Scholar
39. Braun, BI, Kusek, L, Larson, E. Measuring adherence to hand hygiene guidelines: a field survey for examples of effective practices. Am J Infect Control 2009;37:282–288.Google Scholar
40. Stout, A, Ritchie, K, Macpherson, K. Clinical effectiveness of alcohol-based products in increasing hand hygiene compliance and reducing infection rates: a systematic review. J Hosp Infect 2007;66:308–312.CrossRefGoogle ScholarPubMed
41. DeLeo, FR, Otto, M, Kreiswirth, BN, Chambers, HE Community-associated meticillin-resistant Staphylococcus aureus . Lancet 2010;375:1557–1568.Google Scholar
42. Henderson, DK. Managing methicillin-resistant staphylococci: a paradigm for preventing nosocomial transmission of resistant organisms. Am J Infect Control 2006;34(suppl 1):S46–S54.Google Scholar
43. McConnell, J. Lancet conference on healthcare-associated infections. Lancet Infect Dis 2009;9:78.CrossRefGoogle ScholarPubMed
44. Ramos, D, Marrero, P. Un mes en una consulta de AP. Semergen 2004;30(suppl 1):70–115.Google Scholar
45. Pan, A, Mondello, P, Posfay-Barbe, K, et al. Hand hygiene and glove use behavior in an Italian hospital. Infect Control Hosp Epidemiol 2007;28:1099–1102.Google Scholar
46. Harbarth, S, Pittet, D, Grady, L, et al. Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis 2002;21:489–495.Google Scholar
47. Fuentes-Ferrer, ME, Peláez-Ros, B, Andrade-Lobato, R, del Prado-González, N, Cano-Escudero, S, Fereres-Castiel, J. Efectividad de una intervención para la mejora del cumplimiento en la higiene de manos en un hospital de tercer nivel. Rev Cald Asist 2012;27:3–10.CrossRefGoogle Scholar
48. Sánchez-Payá, J, Galicia-García, MD, Gracia-Rodríguez, RM, et al. Grado de cumplimiento y determinantes de las recomendaciones sobre la higiene de manos. Enferm Infecc Microbiol Clin 2007;25:369–375.Google Scholar
49. Maury, E, Alzieu, M, Baudei, JL, et al. Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. Am J Respir Crit Care Med 2000;162:324–327.Google Scholar
50. Sobrequés, J, Cebrià, J, Segura, J, Rodríguez, C, García, M, Juncosa, S. La satisfacción laboral y el desgaste profesional de los médicos de atención primaria. Aten Primaría 2003;31:227–233.CrossRefGoogle Scholar