Abstract
Objective. Hand hygiene (HH) is the single most important and effective measure to reduce the risk of healthcare-related infections. However, low compliance with HH indications among healthcare professionals is often low. The objective of this study was to evaluate the implementation of a multimodal strategy to promote HH among healthcare professionals.
Methods. We used the “Application guide of the multimodal strategy of the World Health Organization for the improvement of hand hygiene”, which consists of: changes to the system, education and training, evaluation and feedback, workplace reminders, organizational safety climate and monitoring of compliance with HH. The strategy was designed as an intervention study to promote HH in the Maternal and Child Insular University Hospital Complex in the period 2012-2020.
Results. Overall compliance with the HH indications at the end of the study period was 59.2%. The use of alcoholic-based products increased with respect to previous years (p <0.05), reaching 70 liters/1000 hospital admissions in the final year. Healthcare professionals perceived training and accessibility to an alcohol-based preparation at each point of care as the most effective measures for promoting good HH practice.
Conclusions. The implementation of a multimodal intervention significantly improved compliance with handwashing and the use of alcohol-based products among healthcare professionals. Despite having previous training on hand hygiene, HH knowledge among professionals remains incomplete. Prior training followed by time worked are the most important determinants of knowledge and perceptions about hand hygiene.
References
World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009.
Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73(4):305-15. doi: 10.1016/j.jhin.2009.04.019.
Merino-Plaza MJ, Rodrigo-Bartual V, Boza-Cervilla M, García-Llopis A, Gomez-Pajares F, Carrera-Hueso FJ, Fikri-Benbrahim N. ¿Cómo incrementar la adhesión del personal sanitario al protocolo de higiene de manos?. Rev Esp Salud Pública. 2018; 92: e201810072.
Kingston L, O’Connell NH, Dunne CP. Hand hygiene-related clinical trials reported since 2010: a systematic review. J Hosp Infect. 2016;92(4):309-320. doi: 10.1016/j.jhin.2015.11.012.
Händehygiene in Einrichtungen des Gesundheitswesens : Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016;59(9):1189-220. doi: 10.1007/s00103-016-2416-6.
Molina-Cabrillana J, Dorta-Hung ME, Otero Sanz L, Henández Vera JR, Martín-Rodríguez MM, García de Carlos P. Influencia del material promocional sobre higiene de manos en la cultura de seguridad de un hospital de tercer nivel. Rev Calid Asist. 2016;31 Suppl 1:55-61. doi: 10.1016/j.cali.2016.01.002
Stewardson AJ, Sax H, Gayet-Ageron A, Touveneau S, Longtin Y, Zingg W, Pittet D. Enhanced performance feedback and patient participation to improve hand hygiene compliance of health-care workers in the setting of established multimodal promotion: a single-centre, cluster randomised controlled trial. Lancet Infect Dis. 2016;16(12):1345-1355. doi: 10.1016/S1473-3099(16)30256-0.
Sax H, Allegranzi B, Chraïti MN, Boyce J, Larson E, Pittet D. The World Health Organization hand hygiene observation method. Am J Infect Control. 2009;37(10):827-34. doi: 10.1016/j.ajic.2009.07.003.
Pittet D, Allegranzi B, Storr J. The WHO Clean Care is Safer Care programme: field-testing to enhance sustainability and spread of hand hygiene improvements. J Infect Public Health. 2008;1(1):4-10. doi: 10.1016/j.jiph.2008.08.006.
Ben Fredj S, Ben Cheikh A, Bhiri S, Ghali H, Khefacha S, Dhidah L, Merzougui L, Ben Rejeb M, Said Latiri H. Multimodal intervention program to improve hand hygiene compliance: effectiveness and challenges. J Egypt Public Health Assoc. 2020;95(1):11. doi: 10.1186/s42506-020-00039-w.
Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. U.S.A.: Centers for Disease Control and Prevention; 2002.Report No.: MMWR 2002;51(RR-16). Disponible en: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm
Molina-Cabrillana J, Alvarez-León EE, Quori A, García-de Carlos P, López-Carrió I, Bolaños-Rivero M, Hernández-Vera JR, Ojeda-García I, Córdoba-Tasi E, Ramírez-Rodríguez A, Henríquez-Ojeda A. Impacto de la mejora de la higiene de las manos sobre las infecciones hospitalarias. Rev Calid Asist. 2010;25(4):215-22. doi: 10.1016/j.cali.2010.02.002.
Wold Health Organization. A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. Geneva: WHO; 2009 [citado 21 Nov 2020]. Disponible en: http://www.who.int/gpsc/5may/Guide_to_Implementation.pdf.
Multimodal intervention to increase hand hygiene compliance. Description of safe clinical practice (SPC) and implementation process for Work Package 5. PaSQ Project [consultado 21 Nov 2020]. Disponible en: http://www.pasq.eu/Wiki/SCP/WorkPackage5ToolBoxes/HandHygiene.aspx
Organización Mundial de la Salud. Cuestionario de percepción sobre la higiene de las manos destinado a los profesionales sanitarios. 2010 [citado 4 Nov 2020]. Disponible en: https://www.mscbs.gob.es/organizacion/sns/planCalidadSNS/docs/cuestionario_percepcion_prof_oms.pdf
Organización Mundial de la Salud. Cuestionario acerca de los conocimientos sobre la higiene de las manos destinado a los profesionales sanitarios. 2010 [citado 4 Nov 2020]. Disponible en: https://www.mscbs.gob.es/organizacion/sns/planCalidadSNS/docs/cuestionario_conocimientos_prof_oms.pdf
Organización Mundial de la Salud. Cuestionario de percepción sobre la higiene de las manos destinado directivos. 2010 [citado 4 Nov 2020]. Disponible en https://www.mscbs.gob.es/organizacion/sns/planCalidadSNS/docs/cuestionario_percepcion_directivos_oms.pdf
World Health Organization. Hand Hygiene Self-Assessment Framework. 2010 [citado 8 Nov 2020]. Disponible en: http://www.who.int/gpsc/country_work/hhsa_framework/en/index.html
Restrepo AV, Valderrama MP, Correa AL, Mazo LM, González NE, Jaimes F. Implementación de la estrategia “Atención Limpia es Atención Segura” en un hospital de tercer nivel en Medellín, Colombia. Rev chil infectol. 2014:31(3):280-6.
Fariñas-Alvarez C, Portal-María T, Flor-Morales V, Aja-Herrero A, Fabo-Navarro M, Lanza-Marín S, et al. Estrategia multimodal para la mejora de la adherencia a la higiene de manos en un hospital universitario. Rev Calid Asist. 2017;32(1):50-56.
Sobrequés J, Espuñes J, Bañeres J. Estrategia para mejorar la práctica de higiene de manos en Catalunya. Med Clin (Barc). 2014;143(Supl 1):36-42.
Trejo-González R, Yacaman-Handal RE, Hernández-González LA, Soto-López ME, Gabriela-Koretzky S. Higiene de manos 90/90: programa de mejora continua para la adherencia a la higiene de manos. An Med (Mex). 2019;64(3):190-195.
Batista J, Silva DP, Nazário SS, Cruz EDA. Multimodal strategy for hand hygiene in field hospitals of COVID-19. Rev Bras Enferm. 2020;73(Suppl 6):e20200487.
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 Calid Asist. 2012;27(1):3-10.
Muto CA, Sistrom MG, Farr BM. Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control. 2000;28(3):273-6.
Dorsey ST, Cydulka RK, Emerman CL. Is handwashing teachable?: failure to improve handwashing behavior in an urban emergency department. Acad Emerg Med Off J Soc Acad Emerg Med. 1996;3(4):360-5.
Pan A, Domenighini F, Signorini L, Assini R, Catenazzi P, Lorenzotti S, et al. Adherence to hand hygiene in an Italian long-term care facility. Am J Infect Control. 2008;36(7):495-7.
Albright J, White B, Pedersen D, Carlson P, Yost L, Littau C. Use patterns and frequency of hand hygiene in healthcare facilities: Analysis of electronic surveillance data. Am J Infect Control. 2018;46:1104-9.
Rodríguez-Villar D, Del-Moral-Luque JA, San-Román-Montero J, Gil-de-Miguel Á, Rodríguez-Caravaca G, Durán-Poveda M. Adherencia a la higiene de manos con soluciones hidroalcohólicas en estudiantes de medicina. Estudio descriptivo transversal. Rev Esp Quimioter. 2019;32(3):232-7.
Arredondo-Provecho AB, Horcajo-Díaz E, Cerrillo-González I, Morato-Cerro VM, Pérez-Ortiz M, Rodríguez-Caravaca G. Evolución de la adherencia a la higiene de manos en un hospital de la Comunidad de Madrid. Rev Esp Salud Pública. 2020;94(1):e202007075.
Sánchez-Payá J, Galicia-García MD, Gracia-Rodríguez RM, García-González C, Fuster-Pérez M, López-Fresneña N, et al. Grado de cumplimiento y determinantes de las recomendaciones sobre la higiene de manos. Enferm Infecc Microbiol Clin. 2007;25(6):369-75.
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