APSIC Abstracts on Hand Hygiene

The following abstracts on the topic of hand hygiene are from the meeting of the eighth International Congress of the Asia Pacific Society of Infection Control (APSIC), held in Bangkok, Thailand, Feb. 12-15, 2017.

Reference: Antimicrobial Resistance & Infection Control. Abstracts from the 8th International Congress of the Asia Pacific Society of Infection Control (APSIC) Volume 6, Supplement 2. February 2017.

H1: Promoting effective hand hygiene practices through implementing standard guidelines at the healthcare facilities in Bangladesh

Lutfe Ara, Syed Mohammad Niaz Mowla, Shaikh Mahmud Kamal Vashkar

Background
Contaminated hands are the foremost source of spreading infections in healthcare facilities. Wellness and safety of patients and healthcare workers (HCWs) can be achieved by promoting best practices in infection control through education and advocacy. We aimed to develop effective hand hygiene (HH) practices among HCWs by improving their knowledge, attitude and practices through implementing standard HH guidelines.

Materials and methods
A year-long project was conducted at two hospitals of Bangladesh. This included a baseline survey, intervention by implementing standard HH guidelines through classroom and hands-on training, and a post intervention survey. Pretest-posttest was conducted with preformed questionnaire and observation checklist during pre and post intervention surveys. Total of 600 physicians and nurses were trained on standard HH practices.

Results
At the Institute of Child and Mother Health, rate of HH compliance before patient contact improved from 4% to45.32%(p?<?0.0001) among physicians and 2.07% to 60% (p?<?0.0001) among nurses. After patient contact, it increased from 4.8% to 50.36% (p?<?0.0001) among physicians and 5.93% to 59.51% (p?<?0.0001) among nurses. At General Hospital, Sirajgonj, rate of compliance before patient contact increased from 2.25% to 49.18% (p?<?0.0001) among physicians and 3.10% to 53.57% (p?<?0.0001) among nurses. After patient contact, it increased from 2.25% to 58.20% (p?<?0.0001) among physicians and 5.31% to 60.71% (p?<?0.0001) among nurses.

Conclusions
The project outcomes signify that implementing standard HH guidelines improves the knowledge, attitude and practices of the HCWs. The results emphasize the necessity of continuous education and advocacy in improving HH compliance to promote excellence in infection prevention and control.

H2: The effective hand hygiene promotional measures in hospital: listen to your staff

Wai Fong Chan

Background
The World Health Organization multi-modal intervention to increase hand hygiene compliance was adopted in a rehabilitation hospital since 2008. However, the effectiveness of the individual measure was unknown. This study was conducted for evaluating the effectiveness of hand hygiene promotion activities used in the hospital.

Materials and methods
A cross-sectional survey was applied in 2012. A 16-item self-administered questionnaire was adopted to collect the opinion on the effectiveness of measures previously used on hand hygiene promotion. Nurses and healthcare assistants working in the inpatient settings of hospital were invited to participate in the survey. Seven-point Likert-type scale from “extremely ineffective” to “extremely effective” was used for ratingindividual items. Rasch measurement was employed for data analysis by Winsteps version 3.92.1.

Results
One hundred and seventy-nine questionnaires were returned contributing 97.2% of the response rate. The categories in the rating scale were collapsed into 4-point scale before further analysis. Thirty-one misfitting persons and three misfitting items were removed after examination in quantitative and qualitative manners. No differential item functioning was found between subgroups. The final scale was considered as unidimensional with reliabilities ranged at 0.95-0.96 and 0.91-0.92for persons and items respectively. “Placing the alcohol-based handrub” was identified as the most effective measure on hand hygiene promotion and “Set up an annual target of hand hygiene compliance” was considered as the least effective.

Conclusions
The survey identified and located the effective measures on hand hygiene promotion. For a more efficient approach, the hospital may prioritize the most effective items in hand hygiene promotion.

H3: Effective hand hygiene with individual hand microbial profiles through validating scores of bioluminescene assay with actual microbial load

Mabel Yin ChunYau, Karen Kam LingChong, Tze OnLi, Rajwinder Kaur

Background
Adenosine-Triphosphate (ATP) bioluminescence assay has been popularly adopted in clinical and catering industry due to its ease of use and immediate results. ATP bioluminescence assay picks up cellular discharged ATP, which can also be found on cellular debris or organic components that are not microbial in nature.Its measurement on animate objects can be misleading. This study was developed for the catering crew of a private hospital as a Hand Hygiene (HH) practice monitoring. Microbial viable count was used as a validating reference for the ATP Relative Light Units (RLUs) as a control measure of HH effectiveness. A set of basal microbial values was developed for each staff member. This provided a convenient but reliable protocol for ATP luminometry users.

Materials and methods
Swab sampling was collected from crews’ hand for bacterial culture. Selective media and serological tests were used for pathogen screenings, which included Staphylococcus aureus, coliform and salmonella. Standard curves to demonstrate the correlation between the viable microbial counts and the corresponding RLUs of the ATP measurements were developed.

Results
The study showed the actual viable microbial density of individuals after handwashing did not correlate positively with RLUs. Each individual had his/her own confidence regarding to the limitation of RLUs. However, the HH compliance could be reflected by the viable microbial counts.Individual skin condition played a role in this association.

Conclusions
The measurement instilled a positive effect on the crew. Hand hygiene compliance can be reflected with the bench marking standard technique. Hand hygiene compliance was increased and microbial load was significantly reduced.

H4: I pledge on hand hygiene: hand hygiene campaign in Caritas Medical Centre (CMC)

Ng Po Yan

Background
Hand hygiene is the single and most effective way to prevent the spread of microorganisms in hospital. When health care workers (HCWs) have own sense and aware of the importance of hand hygiene, it yields twice the result with half the effort in infection control. The study aimed to promulgate hand hygiene is the responsibility of every HCW and maintain hand hygiene as the standard of care in the daily work of HCWs

Materials and methods
On the International Hand Hygiene Day 5th May, a hand hygiene campaign was held in CMC. HCWs were invited to take photo and pledged on hand hygiene compliance. Hand hygiene technique was also taught personally by infection control nurses and return demonstration was needed during the activity. An instant photo was taken when they pledged. These photos were shown on a board during the hand hygiene promotion activity and returned to each colleague as a souvenir afterward.

Results
Hospital managers, frontline doctors and nurses, allied health professionals and supporting staff, total over 100 colleagues in CMC were pledged on hand hygiene on that day. This pledge motivated other colleagues to compile in hand hygiene. The hand hygiene compliance rate in CMC maintained over 90%.

Conclusions
Motivate health care workers to perform hand hygiene by a soft commitment is another way to promote and raise their awareness of hand hygiene.

H5: Hand hygiene: dreams come true “clean care is safer care”

Gloria Chor Shan Chiu, Christina WY Cheung, Patricia TY Ching, Radley HC Ching, Conita HS Lam, CH Kan, Shirley SY Lee, CP Chen, Regina FY Chan, Annie FY Leung, Isadora LC Wong, S S Lam1, Queenie WL Chan

Background
More than hundreds of millions of worldwide people are suffered from infection regardless of acquiring in the Community or Healthcare setting. Most of the infections especially the Healthcare associated Infections (HCAIs) are preventable through adherence to patient care practices. Hand hygiene (HH) is the most effective and easier way to prevent and control the infections in which also being the major component in WHO the First Global Patient Safety Challenge.

Materials and methods
To introduce the “WHO hand hygiene save life campaign” and enhance the awareness of public and healthcare workers for the importance of hand hygiene. Hong Kong Infection Control Nurse Association (HKICNA) has joined actively in the community events such as “World Health Day Carnival” since 2008. In these few years, there were over a thousand public to participate in HH and infection control related educational game booths and talks.

Results
Further to extend the engagement of public and healthcare workers, a poster design competition for promotion of Hand Hygiene was organized in 2012; the winning poster was used as “Talking Wall” in community and healthcare settings and the background of HKICNA’s souvenirs. In 2014, a creative reminder- hand-held electric fan with visual lit up “Hand Hygiene" was distributed. In addition, another innovative idea – two HH Dances were designed to continuously promote the HH; they stress that HH practice should start from children to adulthood, from healthcare worker to all in the community. Both of them were used as a tool for promoting in hospitals and schools and assessable in YouTube which was gained thousands of 'Likes'

Conclusions
HKICNA is working hard on introducing hand hygiene concept for infections prevention and control in healthcare settings and community. The concept of "Clean Hand Save Lives" will continue be emphasized.

H6: Unforgettable 7 steps & 5 moments” – critique on staff’s technique and accuracy

Cecilia Chan, Rajwinder Kaur

Background
Hand hygiene (HH) is recognized as the most effective measure to prevent the spread of micro-organisms through hand contact during patient care. Besides yearly mandatory infection control training through On-line Learning Management System, Matilda International Hospital (MIH) also provides relentless training to staff emphasizing the importance of proper hand hygiene and embracing WHO 5 moments. In June 2016, educational booth game – “Unforgettable 5 moments and 7 steps” was held to assess knowledge and techniques of both clinical and non-clinical. This study aimed to evaluate the techniques of staff’s hand hygiene practice, compliance to rubbing time and accuracy in reiterating the 5 moments.

Materials and methods
Observational methods were used to evaluate HH technique and rubbing time. Staff were required to accurately call to remembrance the 5 moments through direct questioning and demonstrate 7 steps of hand hygiene technique with at least 20 seconds of rubbing time. Immediate feedbacks were supplemented.

Results
The overall accuracy of all assessed criteria’s was 90.53%. Majority of HH steps achieved greater than 90% compliance rate except “Between finger” and “Back of finger”. “Before clean aseptic procedure” demonstrated to be the most difficult to recall.

Conclusions
The audit allowed for gaps and in-depth understanding of staff HH practices to be more accurately identified with subsequent staff training strategies to be drawn and implemented.

H7: Knowledge and self-reported hand hygiene compliance among nurses in Shiraz, Iran, 2016

Seyed Sadeq Seyed Nematian, Charles John Palenik, Mehrdad Askarian

Background
Alcohol-based hand rubs (ABHRs) are the preferred methods for performing routine hand hygiene (HH) in healthcare facilities. However, soap-and-water hand washing is still popular. This study measured the HH knowledge and self-reported practices of Shiraz Nemazee Hospital nurses.

Materials and methods
This study employed two questionnaires. A six-question survey covered HH knowledge, (19 possible points), while HH practices were monitored in a second survey containing four multi-part self-reporting inquiries (37 possible points) in 2016. Surveys were voluntarily completed at work. Responses were analyzed anonymously.

Results
342 nurses completed the questionnaire.54.4%had formal HH training in the past year.55.6%reported using ABHRs for more than a year. 53.8% preferred traditional soap-and-water hand washing. Eleven nurses never used ABHRs. Nursing experience varied - 15.1% (>ten years), 10.8% (5-10 years), 35.2% (2-5 years) and 28.9% (<2 years). Knowledge scores ranged from 11-15 (high score was17). Self-reported HH compliance scores ranged from 24-31 (high score of 37). A positive, but weak correlation existed between knowledge and self-reported practice scores (r =0.28, p <0.001). No correlation existed between years of experience and knowledge (p =0.85, r?=?0.011) or self –reported practice scores (p?=?0.86, r?=?0.01). Also, no correlation was found between age and self-reported practices (p =0.4, r?=?- 0.048) and/or knowledge scores (p =0.85, r?=?-0.011).

Conclusions
HH training needs to be increased for all nurses. Stressing benefits of ABHR use could improve HH compliance and effectiveness.

H8: Observing hand hygiene compliance among hospital nurses in southern Iran, 2016

Seyed Sadeq Seyed Nematian, Charles John Palenik,Nahid Hatam, Mehrdad Askarian

Background
Hand hygiene (HH) is the most effective way to prevent healthcare-associated infections. Unfortunately, HH compliance worldwide is suboptimal. In this study, we measured HH compliance among Shiraz Nemazee Hospital nurses.

Materials and methods
A WHO method for direct observation of HH was used. We observed staff members (nurses, paramedics and auxiliaries) HH practices. A single trained observer made all determinations. Nurses were not informed of being observed. The study was conducted in 29 hospitals wards involving four major services (intensive care, internal medicine, surgery and pediatrics) during January through June 2016.

Results
1097 observations were made. The overall HH compliance rate was 39.23% with greatest compliance (44.12%) occurring in intensive care wards, while internal disease ward shad the lowest (26.88%) rates. HH compliance in surgical and pediatrics wards was 39.15% and 38.30%.HH compliance between intensive care and internal disease wards was significantly (p?<?0.001) different. However, no significant differences were noted between intensive care and surgical wards (p?=?0.16) and intensive care and pediatric wards (p?=?0.24). Also, there was no statistically significance difference between professional nursing categories (p?=?0.66). Alcohol- based hand rubs were used during 81% of HH events. Soap-and-water hand washing was used the remainder of times.

Conclusions
Type of nursing position was not a reliable predictor of higher HH compliance. HH policies in intensive care wards appear more effective than those of other wards. Alcohol-based hand rubs proved to be the preferred HH methods.

H9: Scenario-based simulation healthcare education for hand hygiene

Itaru Nakamura, Hiroaki Fujita, Ayaka Tsukimori,Takehito Kobayashi, Akihiro Sato, Shinji Fukushima, Tetsuya Matsumoto

Background
Simulation healthcare education is widely used in medical education and has great potential. However, scenario-based simulation healthcare education for preventing nosocomial infections has not been described. This study aimed to determine the effectiveness of scenario-based simulation education to improve hand hygiene.

Materials and methods
A single-centre, prospective, cohort study was conducted at Tokyo Medical University Hospital (1015 beds), an acute-care teaching hospital, from January 2011 to December 2014. Each infection-control training course (ICTC) was held every month and lasted 2 hours. Trainees put on and removed personal protective equipment under scenarios of standard precaution (two scenarios) and contact precaution with Methicillin-resistant Staphylococcus aureus (one scenario), while considering timing of hand hygiene. We determined the correlations between the participation rate in the simulation education and use of alcohol-based hand disinfection and reduction of catheter-related blood stream infection (CRBSI).

Results
There were 1077 trainees. The total participation rate for hospital staff was 76% by the end of the study. The overall correlation between use of alcohol-based hand disinfection in the hospital and the course participation rate was significant (correlation coefficient, 0.97). An inverse correlation (-0.94) was observed for the relation between the ICTC participation rate and the incidence of CRBSI. With participation in the ICTC, CRBSIs due to Staphylococcus spp. and Enterobacteriaceae were significantly lower than those due to Candida spp.

Conclusions
Our ICTC had a positive effect on hand hygiene and reducing CRBSI. This study is the first effective scenario-based simulation healthcare education to hand hygiene and control of nosocomial infection.

H10: Increasing hand hygiene compliance through an evidenced-based strategy

Jose Paulo Flor, Nicolo Andrei Añonuevo, Marko Bautista, Justine Vergara, V James De Roxas, Marion Kwek

Background
The purpose of this study is to increase and sustain hand hygiene compliance through evidence-based approach and to relate compliance with the trend of healthcare associated infections in the hospital.

Materials and methods
The study was conducted over a 1 year period from September 2015 to August 2016. The methods used in monitoring hand hygiene compliance are “Direct Observation” which includes self-reporting and by the use of secret shoppers. Another is “Electronic Monitoring” through the use of Radio Frequency Identification Device. Surveillance of healthcare associated infection (HAI) is conducted in the General Nursing Units, Telemetry and Intensive Care Units. Interventions to increase hand hygiene compliance were implemented such as Training of nurse LINC representatives in monitoring hand hygiene compliance, use of social media (Facebook) in promoting hand hygiene, recognition of individuals and department with high compliance.

Results
After the implementation of interventions, result showed an increase in the hand hygiene compliance from below 50%, during the start of the period monitored, to above 80% during the succeeding months. Comparison of hand hygiene compliance versus healthcare associated infection rates was shown through a graph, this information was cascaded to the different departments during unit meetings. Correlation showed a contrasting trend between Hand hygiene compliance and healthcare associated infection rates.

Conclusions
It was therefore concluded that an increase in the compliance to hand hygiene can decrease the healthcare associated infections among patients. In addition, feedback methods and other evidenced-based interventions can increase hand hygiene compliance.

H11: Implementing multiple interventions through the use of an electronic monitoring system in increasing the hand hygiene compliance in medical surgical ICU

Jose Paulo Flor, Marko Bautista, Justine Vergara, V James De Roxas, Nicolo AndreiAñonuevo, Marion Kwek

Background
There is no single solution in addressing poor compliance to hand hygiene. The purpose of this study is to increase the compliance of hand hygiene in the Medical Surgical Intensive Care Unit (MSICU) by the use of multiple interventions and the aid of an electronic monitoring system. The Infection Prevention and Control Unit (IPCU) would also like to correlate the trend of hand hygiene rate with healthcare associated infections in the MSICU.

Materials and methods
The data collected is generated by an automated system through the use of radio frequency badges worn by the healthcare worker and sensors attached to the hand rubs and soap dispensers. Badges provide real time feedback by means of an alarm system. A quasi-experimental design was used to test the effectiveness of the interventions implemented. The utilization of visual boards in providing feedback, converting the door entrance into a giant hand hygiene poster, use of social media, and reward system were included in the interventions.

Results
Total number of opportunities captured is 121,252. Post intervention data showed an increase in the compliance from below 50% to above 80%.

Conclusions
It was therefore concluded that the multiple strategic approach, through the use of electronic monitoring, helped in increasing compliance of healthcare workers to hand hygiene. Moreover, when hand hygiene trend was compared to the healthcare associated infection, a contrasting trend was evident.

H12: Hand hygiene compliance audits – is there a role for the ‘link doctor’?

Yeng May Ho, Jia Qi Kum, Bee Fong Poh, Kalisvar Marimuthu, Brenda Ang

Background
Auditing of Hand Hygiene compliance is usually done by the Infection Control (IC) team. Because it is time consuming and resource intensive, hospitals often rely on ‘link nurses’ to do audits. There are questions as to how these results would correspond to that done by other observers who do not belong to the same unit. As part of a hospital-wide Hand Hygiene program, an initiative to involve young doctors in Hand Hygiene activities was mooted and residents nominated by heads of departments to be hand hygiene auditors.

Materials and methods
These residents (‘link doctors’) were first trained by the Infection Control nurses, following WHO Five Moments, and underwent inter-rater reliability testing. They were tasked with doing audits on Hand Hygiene compliance for their own departments, at times of their choosing. The study period was from February to Sep 2015. The results of their audits were submitted to the Infection Control Unit, and compared with the results done by the IC unit.

Results
While the overall compliance rate when audits were done by the ‘link doctors’ was 76%, it was 46% when done by IC team. The only ‘moment’ where there was no difference in compliance rates between them was ‘after patient contact’.

Conclusions
There was significant difference in hand hygiene compliance rates when audits were done by ‘link doctors’. While there might be concerns about the validity of their results, such exercises could lead to improved understanding, ownership of, and participation in activities to improve hand hygiene.

H13: A workshop for training hand hygiene observers and evaluating learning outcomes

Tzu-Yin Liu, Sin-Man Chu, Hui-Zhu Chen, Tun-chieh Chen

Background
To achieve good compliance and correct hand hygiene for healthcare workers in clinical setting, we conducted quality audit by non-fixed observers to prevent the Hawthorne effect.This study aimed to train hand hygiene observers who can educate hand hygiene audit ability and reinforce the concepts of good compliance of correct hand hygiene

Materials and methods
The process included 1.Set up the standard of hand hygiene audit; 2. Hold the lecture for the perception of the importance of hand hygiene; 3. Correct hand hygiene hands-on practice: using fluorescent cream on hands and washing hands with water and soap and then checked hands under fluorescent lamp; 4. Teaching hand hygiene audit in real clinical settings; 5. Hand hygiene Q &A, sharing and discussion.

Results
The workshop trained 23 nurses as hand hygiene observers and all passed the assessment. The average learning outcome evaluation is 86.3%. The average satisfactory rate of the workshop is 98.3% via the 5 domains of the value of learning, applicability, enhancing professional knowledge, the appropriate application of educational materials, the achievement of learning expectation. All trained hand hygiene observers can apply the concepts in clinical settings.

Conclusions
The workshop composed with hands-on practice, teaching in real clinical settings and sharing-discussion instead of one-way lecturing. This multimodal educational program integrated with lecturing, idea sharing, experiments and teach-reply methods to enhance learning outcomes and reinforce the hand hygiene perception. Through the educational program, we transferred the hand hygiene knowledge to modify healthcare workers’ perception and then their quality improvement attitude to cooperate the patient safety strategies in the whole institute.

H14: Evaluation direct observation methods to measure compliance with hand hygiene rates in regional hospital

Yichun Chen

Background
Compliance with hand hygiene is the most important concept in preventing infection to patients in health care settings. The World Health Organization (WHO) guidelines on hand hygiene in health care indicate that the direct observation methods to measure compliance with hand hygiene are the gold standard, also the most reliable methods of measurement.The study aimed to explore the compliance with hand hygiene rates in regional hospital.

Materials and methods
Direct observation methods were performed to measure compliance with hand hygiene in physicians, nurses, nurse practitioners and nurse assistants from January 1, 2016 to September 30, 2016 of a regional hospital in Taiwan.

Results
Compliance with hand hygiene rates 87.37% (83/95), physicians 80% (8/10), nurses 92.5% (62/67), nurse practitioners 76.9% (10/13) and nurse assistants 80% (4/5).

Conclusions
Compliance with hand hygiene rates were higher than reported in the literature (CDC). Another problem with direct observation was the Hawthorne effect produced by the observation. When a medical practitioner discovered that he or she was observed, he or she would be conscious of his or her own observation and deliberately changed his or her behavior to increase the frequency of hand hygiene. In the pursuit of the desired positive results, and affect the hand hygiene compliance measurement results. Recommendation to regular change auditor or monitoring type, ex: video recorder, but given these measurement limitations, more valid, practical, and less costly methods are needed.

H15: The efficiency of patients and visitors’ education for promoting handwashing and respiratory hygiene compliance in a local community hospital

Ya-Ching Tsao

Background
Handwashing and respiratory hygiene are fundamental in infection control management. They seem a global language in health settings. A majority studies investigate the relationship between hand hygiene and infectious diseases transmission among healthcare staffs. The aim of this survey was to discover the efficiency of hand hygiene and cough manners education model among patients and visitors.

Materials and methods
This study measured by questionnaires with hand hygiene and cough manner observation compliance tools. Duration of data collection was from July, 2015 to August, 2016. 428 patients and visitors of a local community hospital in North Taiwan were submitted their questionnaire.

Results
83.41% participants were over 61 years old (age group: 57.24% 61-64 years old, 26.17%over 65 years old). The finding from cough manner observation revealed that only 33.04% participants allowed cough manners while they have sneezing, coughing or flu symptoms. This had significant difference to the same question of questionnaire (82.24%). The difference also appeared in hand hygiene observation, 59.65% observers performed hand washing in their hand hygiene opportunities which was considerably lower than the questionnaire result (98.83%). These findings investigate the attitudes toward hand washing and respiratory hygiene compliance among patients and visitors. Thus, a patients and visitors’ education model was applied for promoting hand hygiene and cough manners actions.

Conclusions
As the evaluation of education model, the percentage of observers allowed hand washing actions (86.09%) and cough manners (68.87%) after the education were increased. Therefore, the patients and visitors’ education model is efficient in promoting hand washing and respiratory hygiene compliance.

H16: The effectiveness of alcohol-based hand rub bottle holder: an assessment with hand hygiene compliance rate and a satisfaction of emergency department personnel.

Sumawadee Skuntaniyom, Kumthorn Malathum, Pirawadee Tipluy

Background
Hand hygiene (HH) is a known effective measure for the prevention of healthcare-associated infections and spread of antimicrobial resistant organisms. Unfortunately a compliance rate with healthcare workers in emergency department is very low because of rushed working environment. The objective of this study focused on the interventions at the point of care (POC) to improve the compliance, or “system change” according to the WHO hand hygiene strategies, which key aspect was the provision of alcohol based hand rub on a new design bottle holder that optimized the acceptance and usage.

Materials and methods
The first phase was the baseline period set on 3 months baseline (January to March 2015) observation of HH compliance and continue the second phase using the bottle holder (April to June 2015). An anonymous, self-administered questionnaire, had distributed to 126 emergency healthcare workers (HCWs) to assess their behaviors and attitudes toward hand hygiene compliance and their satisfaction.

Results
Overall, 86.5% (109 of 126)of HCWs (36 nurses, 19 physicians) satisfied with the device and 87.3% believed they could improve HH compliance.Overall compliance significantly increased from 19.7% to 59% (P-valve?=?.045), 0 to 27.3% before patient contact, 11.5% to 57.7% after patient contact, 27.3% to 60.0% before clean/aseptic procedures, 48.1% to 64.0% after body fluid exposure/risk, and 17.1% to 61.9% after touching patient surroundings.

Conclusions
The device successfully provide easy access to the bottle holder, which is critical for its success in improving HH compliance in one of the busiest area in the hospital.

H17: Electronic hand hygiene auditing tool in a Thai tertiary care hospital

Sangwan Paengta, Ratchanee wongsaen, Sutthiphun thanomphan, Samettanet Tariyo

Background
Hand hygiene compliance among hospitalized personnel is a one of safety indicator. In the past, our hospital had used the paper-based system for auditing hand hygiene compliance. The majority of the data entry, collection and analysis were performed manually which was complicated and time-consuming.We aimed to create an electronic Hand Hygiene Auditing Tool to measure hand hygiene compliance.

Materials and methods
The study was conducted in a tertiary-care hospital in Thailand. A development process using five steps of the Program Development Life cycle(PDLC). 1) Requirement gathering and analysis 2.)Design on Google Docs access methods transition.3.)Program testing. 4.) Implementation on mobile phones. 5.) Maintain the program/system. All steps were conducted in a month (April 2016). The Electronic Hand Hygiene Auditing Tool is the result of this study.

Results
Both methods of data collection were compared. The results demonstrated that the duration of the processes decreased from 5 months to 1 month. Questionnaires return rate increased from 86% to 100%.The assessors’ satisfaction rate was 80%.

Conclusions
The Electronic Hand Hygiene Auditing Tool was qualified by reducing the number of hours. Rapid assessment and real time reporting provided valuable information to Infection Control and Prevention team.

H18: Effects of using hand hygiene program to knowledge and infection prevention and control practices for multi-drug resistant organisms (MDROs) among nursing personnel and patients with care-givers in Surgical and Orthopedic Department in Nakornping hospital

Buachan Thongchuea, Pattama Khamfu, Sutthiphan Thanomphan

Background

Hand hygiene is the efficiency and low cost policy to prevent hospital-associated infections (HAIs) with multi-drug resistant organisms (MDROs). The quasi- experimental research aimed to evaluate the effect of the Hand Hygiene Program (HHP) on knowledge and practices in prevention of MDROs. Participants are 27 ICWNS, 140 RNs, 75 nurse aides, and 218 patients and their caregivers.

Material and methods
The study design was before-and after design, conducted during 1 February 2016 to 31 August 2016 in Surgical department and Orthopedics department. Participants were examined by questionnaire regarding knowledge about hand hygiene to assess their knowledge.A structured observation form was used to evaluate hand hygiene practice.The questionnaire in which the content validity was examined by 5 panel experts and the validity index was 0.8.The reliability observer was 1. Data were analyzed by Student’s t-test and descriptive statistics as appropriate.

Results
The study revealed that participants’ knowledge in hand hygiene increased from 75.7% to 89.0% in ICWNs, from 64.5% to 80.4% in nursing personnel, and from 62.3% to 79.4% in patients and care givers for significant ( p <0.001). Hand washing rates increased from 43.0% to 51.1% in moment 1, and from 66.5% to 92.7% in moment 5.

Conclusions
The collaboration of the ICWN network in Surgical and Orthopedics department contribute to the successful in increasing hand hygiene knowledge and behavior motivation. Nevertheless HAIs with MDROs was increased in this study. Other measures such as isolation precautions may be needed.

H19: Impact of a multimodal intervention programme on hand hygiene compliance at the paediatric intensive care unit and immunocompromised ward of King Chulalongkorn Memorial hospital, Bangkok, Thailand

Wipaporn Natalie Songtaweesin, Suvaporn Anugulruengkit, Rujipat Samransamruajkit, Darintr Sosothikul, Ornanong Tansrijitdee, Anry Nakphunsung, Patchareeyawan Srimuan, Jirachaya Sophonphan, ThanyaweePuthanakit1

Background
Good hand hygiene (HH) practices are a simple and cost-effective strategy to limit pathogen transmission between patients. This study explores the effect of a multimodal hand hygiene promotion program on HH compliance amongst healthcare workers.

Materials and methods
A prospective study was conducted at the pediatric intensive care unit (PICU) and pediatric immunocompromised ward at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Interventions performed were: HH promotion videos sent to staff via mobile phone, hand hygiene signs at the bedside, distribution of portable alcohol gel bottles, and HH promotion culture led by senior staff members. All interventions were tailored according to pre-intervention opinion surveys with staff. HH compliance was assessed by direct observation using the WHO 5-moments for hand hygiene (WHO5HH) – before touching patients, before clean/aseptic procedures, after body fluid exposure risk, after touching patients, and after touching patient surroundings. 200 opportunities in total were observed monthly.

Results
In December 2015, pre-intervention, overall HH compliance rates were 50%. Between January and June 2016, post-intervention, overall HH compliance increased to 72%. When divided into the five moments for hand hygiene, hand washing prior to touching patients significantly improved following intervention from 43.8% to 85.1% (p?<?0.001) on the immunocompromised ward and from 44.4% to 88.9% (p?<?0.001) on the PICU. Hand hygiene after touching patient surroundings remained low. HH compliance was highest amongst nurses.

Conclusions
A multimodal HH promotion campaign tailored towards the local population was effective in increasing HH compliance overall. However, HH after touching patient surroundings remained low post campaign.

H20: Implementation of multimodal hand hygiene improvement strategies in government hospitals

Kunyanut Payuk, Wilawan Picheansathian, Nongkran Viseskul

Background
The World Health Organization (WHO) has developed multimodal hand hygiene improvement strategies to support hospitals to improve hand hygiene and thus reduce hospital-acquired infection. The aim of the study was to study the implementation of these multimodal strategies, obstacles, and supports to promote hand hygiene in government hospitals including university hospitals, regional hospitals, and general hospitals.

Materials and methods
The samples were 59 infection control nurses who implement multimodal hand hygiene improvement strategies. The data collection instrument was the Hand Hygiene Self-Assessment Framework questionnaire developed by the WHO. The questionnaire also asked about obstacles and support.

Results
Most of the samples (61.02%) implemented multimodal hand hygiene improvement strategies at an intermediate level, followed by basic and advanced levels (22.03% and 16.95%, respectively). Fifty percent of the university hospitals had an advanced level. Most of the regional hospitals and the general hospitals (57.14% and 67.57% respectively) had an intermediate level. The highest score for implementation was the system change for hand hygiene (median score, 90.00), followed by reminders in the workplace, training and education, evaluation and feedback, and institutional safety climate for hand hygiene (median score, 72.50, 60.00, 60.00 and 50.00, respectively). All samples encountered obstacles and needed support when implementing hand hygiene improvement programs. Personnel were the first obstacle, followed by management, facilitative equipment, and budget, respectively. The greatest need was for environmental and equipment support, followed by support from staff and management support.

Conclusions
The government hospitals should improve implementation of multimodal hand hygiene strategies by addressing obstacles and providing support in order to promote hand hygiene and reduce hospital-acquired infection.

H21: Can alcohol based hand formulations be used in the entire hospital as an antiseptic and preoperative hand disinfection?

Elizabeth DeNardo, Rachel Leslie, Todd Cartner, Luciana Barbosa, Heinz-Peter Werner, Florian H.H Brill, Julia Yaeko Kawagoe

Background
In health are settings alcohol based hand antiseptics can be used with two different purposes: 1- as a hand rub (ABHR) used by health care workers to reduce the load of transient microorganism from their hands during patient care; 2-as a preoperative hand disinfection (ABSS) used by the surgical staff to eliminate transient microorganisms, reduce resident microorganisms from the hands, and maintain microorganism levels below baseline for the duration of surgery. A product must meet established regulatory standard criteria to be used in the entire hospital. This study aimed to evaluate the antimicrobial efficacy, skin compatibility, and end user acceptance of two new alcohol based formulations.

Material and methods
Two novel ABHR gel and foam 70% ethanol were tested by ASTM E1174 and European Norm (EN) 1500 for the in vivo hygienic hand rub, and by EN12791 for surgical hand disinfection. Skin irritation was evaluated according to the 21-Day Cumulative Irritation procedure and skin hydration measured by corneometer device. End user acceptance was conducted during trial periods through surveys.

Results
Both formulations met all the in vivo efficacy tests to be considered as ABHR and ABSS with sustained effect of 3 hours. No potential skin irritation was demonstrated and end user showed preference over other products.

Conclusions
Well-formulated ABHR gel and foam containing just 70% ethanol meets global efficacy norms for ABHR and ABSS, are mild to the skin, and accepted by end users. Both formulations are recommended to the entire hospital following specific protocols of usage for ABHR and ABSS as described by the World Health Organization.

H22: Not all alcohol-based hand rubs are equal: formulation is a critical component for the antimicrobial efficacy and is more important than alcohol concentration alone

Elizabeth De Nardo, Sarah Edmonds-Wilson, David Macinga, Patricia Mays-Suko, Collette Duley

Background
Many alcohol based handrub (ABHR) formulations with different alcohol concentrations and delivery formats are available in the market, making difficult the selection of those products. In this study we compared the in vivo antimicrobial efficacy of commercial available ABHR and the World Health Organization (WHO) recommended formulation used as benchmarks and determine the key factors that influence the antimicrobial efficacy.

Materials and methods
Two novel ABHR formulations (70% ethanol gel and foam) were evaluated according to global standards protocols: American Society for Testing and Materials ASTM E1174 (Health Care Personnel Hand wash [(HCPHW)] and European Norm (EN) 1500. Additionally, using E1174, the efficacy of these formulations was compared against seven commercially available ABHRs and WHO recommended formulations containing alcohol from 60% to 90% at a more realistic 2-mL volume application.

Results
The novel ABHR formulations met efficacy requirements for both HCPHW and EN 1500 when tested at volumes typically used in these methods. Moreover, these formulations met HCPHW requirements when tested at 2-mL. In contrast, the commercial ABHRs and World Health Organization formulations failed to meet HCPHW using a 2-mL application. Importantly, product efficacy did not correlate with alcohol concentration and format.

Conclusions
ABHR are complex formulations, combining alcohol with various ingredients that can influence the overall antimicrobial efficacy. Formulation as a whole and is more important than alcohol concentration alone for efficacy. Product format has the same efficacy. When selecting ABHR, ask for the in vivo efficacy results based on standard protocols and the volume of the product used to meet the criteria for HCPHW tests.

H23: Effectiveness of education, observation and feedback to hand hygiene compliance in healthcare workers

Phan Thi Hang, Tran Thi Thuy Hang, Tran Thi My Hanh, Christopher Gordon

Background
Hand hygiene compliance of healthcare workers (HCWs) is very important. This research aimed to determine the improvement of knowledge and hand hygiene compliance following an educational program and observation, feedback strategy at some important departments of Hung Vuong hospital, a tertiary obstetric and gynecological hospital in Vietnam. We aimed to determine the hand hygiene compliance rate and the mean knowledge score before –after the interventions.

Materials and methods
Intervention started from September 2014 to May 2015, included three periods: (1) pre-intervention to determine hand hygiene compliance rate and knowledge score, (2) holding training classes, auditing and feed backing monthly, (3) post-intervention to re-determine compliance rate and knowledge score. To assess HCWs knowledge and compliance, we used WHO Hand Hygiene Knowledge Questionnaire for Health-Care Workers and Observation Form.

Results
Two hundred and six participants were included. The total of hand hygiene opportunities is 3151. All participants significantly improved knowledge scores from baseline to 2 months post educational intervention with mean difference (SD): 1.5 (2.5); p?<?0.001).Hand hygiene compliance increased significantly from baseline across all sites (43.6% [95%CI: 41.1-46.1] to 63% [95%CI: 60.6-65.3]; p?<?0.0001). The compliance rate of categories and “Five hand hygiene moments” compliance rate also had improvement.

Conclusions
Training and observation with feedback on hand hygiene has improved hand hygiene knowledge and compliance rate of HCWs.

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