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Barriers and Facilitators to Improving Hospital Cleanliness in a Brazilian Hospital
- Amanda Luiz Pires Maciel, Marcia Maria Baraldi, Icaro Boszczowski, Janaina Alves Bezerra, Filipe Piastrelli, Eduardo Fernandes Camacho, Cristiane Schmitt
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s138-s139
- Print publication:
- October 2020
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- Article
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Background: Antimicrobial resistance is a global public health threat. Integrated actions are necessary to reduce multidrug-resistant organisms (MDROs) in healthcare settings, including antimicrobial stewardship, infection prevention measures, and optimal environmental hygiene. We developed a project to improve hospital hygiene that involves 3 phases: (1) diagnostic, compounded by assessment of cleanliness and identification of barriers and facilitators for environment cleanliness improvement; (2) intervention, based on review of structure and processes followed by a training program focused on major weaknesses identified; and (3) evaluation, impact of the intervention assessment. Objectives: We performed group interviews to identify barriers and facilitators for improving environment cleanliness. Methods: The project was performed by the infection control team and the housekeeping manager in a 350-bed, private hospital located in the city of São Paulo (Brazil). Two group interviews were conducted, one involving supervisors and the other involving housekeeping cleaners. All professionals were invited to participate. A semistructured questionnaire was used to guide the discussion, which was compounded by the following topics: working process, availability of human and material resources, training on institutional norms and routines, perception regarding work conditions, and quality of cleanliness. Results: In total, 33 professionals attended the interviews: 12 were supervisors and 21 were housekeeping cleaners. The main facilitator identified was a good perception by the housekeeping team regarding the project. We identified several sets of barriers: (1) human resources, such as supervisor executing the cleaning, inadequate sizing of human resources in shifts, reduced scale on Sunday and holiday shifts, and lack of professional replacement for sick leave and vacation; (2) supplies and equipment, such as torn bed linen, insufficient mops, centralized and inadequate dilution of sanitizers causing delays and impacting quality of hygiene; (3) education, such as lack of training program perceived by supervisors (management) and housekeeping cleaners (basic procedures for cleaning) and knowledge regarding who cleans what; (4) motivation and relationships, such as supervisor perceptions that housekeeping cleaners are unmotivated, and this causes absenteeism. The team feels that they are disregarded by doctors, and they have relationship problems with nursing and hospital engineering staff. Also, they are afraid of being physically assaulted by coworkers. Finally, professionals reported the perception that the hospital is not clean enough and that this is related to the short time goals imposed on the staff. Conclusions: The main barriers identified were related to education strategies and management of human and material resources. The results will support the intervention phase.
Funding: None
Disclosures: None
Staphylococcus spp Resistance to Chlorhexidine: Is There Any Impact Related to the Routine Use for Hand Hygiene?
- Icaro Boszczowski, William Kazumassa Minami, Marcia Baraldi, Ana Paula Marchi, nia Alves dos Santos, o Paulo cristiane schmitt, Amanda Luiz Pires Maciel, Maria Eduarda Rufino Zani, cia Muniz Souza, Nicole Soares de Souza, Silvia Figueiredo Costa
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s390-s391
- Print publication:
- October 2020
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- Article
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- You have access Access
- Export citation
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Background: Although guidelines recommend the use of chlorhexidine gluconate (CHG) for hand hygiene (HH), the impact of its routine use on antimicrobial resistance is not clear. Objective: To analyze the impact on the CHG susceptibility among isolates obtained from hands of HCW during its routine use for HH. Methods: We conducted a crossover study at 4 medical-surgical wards of a tertiary-care hospital in São Paulo, Brazil. In 2 units (intervention group), we established routine use of CHG for HH. For the other 2 units (control group), regular soap was provided. The availability of alcohol formulation for HH was not changed during the study. Every 4 months we swapped the units, ie, those using CHG changed for regular soap and vice versa. At baseline, we cultured the hands of HCWs. Only nursing staff hands were investigated. For hand culturing, HCWs placed their hands inside a sterile bag containing a solution of phosphate-buffered saline, Tween 80, and sodium thiosulfate. After the solution incubated overnight, it was inoculated onto brain-heart infusion. Next, it was plated on McConkey and Mannitol agar. MALDI-TOF was used for identification. Agar dilution was performed for Staphylococcus spp. We selected all Staphylococcus spp with MIC ≥ 8 and performed inhibition of efflux pump test. For isolates that showed a decrease of 2 dilutions, we searched the gene qacA/B by polymerase chain reaction. Results: We obtained 262 samples from HCW hands yielding 428 isolates. The most frequent genera were Staphylococcus spp (58%), Acinetobacter spp (8%), Enterobacter spp (8%), Stenotrophomonas spp (5%), Klebsiella spp (4%), Pseudomonas spp (3%), and others (14%). Staphylococcus spp were less frequent in the intervention compared to control group (43% vs 61%; OR, 0.48; 95% CI, 0.29–0.69; P = .005). Among all Staphylococcus spp, the proportion of chlorhexidine resistance (RCHG; MIC ≥ 8) was 12%. All resistant isolates recovered susceptibility after inoculation with pump-efflux inhibitor. For pump-inhibited isolates, 53% had the gene qacA/B amplified by PCR. We did not investigate RCHG among gram-negative isolates. There was a nonsignificant increase in Staphylococcus spp RCHG in the intervention group (4% to 6%; P = .90). Healthcare-acquired infection rates did not change significantly during the intervention. The consumption of CHG increased from 7.3 to 13.9 mL per patient day. Conclusions: We did not detect a significant difference in RCHG during the routine use of CHG for HH, although we observed increasing resistance. Further investigation is needed to clarify other reasons for increasing MIC to CHG.
Funding: None
Disclosures: None