Hand Hygiene E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Hospital Medicine - Current Concepts
- Sprache: Englisch
The first comprehensive, authoritative review of one of the most fundamental and important issues in infection control and patient safety, hand hygiene. Developed and presented by the world's leading scholar-clinicians, Hand Hygiene is an essential resource for all medical professionals. * Developed and presented by the world leaders in this fundamental topic * Fully integrates World Health Organization (WHO) guidelines and policies * Offers a global perspective in tackling hand hygiene issues in developed and developing countries * Coverage of basic and highly complex clinical applications of hand hygiene practices * Includes novel and unusual aspects and issues in hand hygiene such as religious and cultural aspects and patient participation * Offers guidance at the individual, institutional, and organizational levels for national and worldwide hygiene promotion campaigns
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Seitenzahl: 762
Veröffentlichungsjahr: 2017
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Table of Contents
Cover
Title Page
Copyright
Contributors
Preface
Foreword
Chapter 1: The Burden of Healthcare-Associated Infection
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 2: Historical Perspectives
References
Chapter 3: Flora and Physiology of Normal Skin
Key Messages
Research Agenda
References
Chapter 4: Dynamics of Hand Transmission
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 5: Mathematical Models of Handborne Transmission of Nosocomial Pathogens
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 6: Methodological Issues in Hand Hygiene Science
Key Messages
Methodological challenges and Recommendations
Research Agenda
References
Chapter 7: Statistical Issues: How to Overcome the Complexity of Data Analysis in Hand Hygiene Research?
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 8: Hand Hygiene Agents
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 9: Methods to Evaluate the Antimicrobial Efficacy of Hand Hygiene Agents
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 10: Hand Hygiene Technique
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 11: Compliance with Hand Hygiene Best Practices
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 12: Barriers to Compliance
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 13: Physicians and Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 14: Surgical Hand Preparation
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research agenda
References
Chapter 15: Skin Reaction to Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 16: Alcohol-Based Handrub Safety
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 17: Rinse, Gel, Foam, Soap … Selecting an Agent
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 18: Behavior and Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Additional References
Chapter 19: Hand Hygiene Promotion Strategies
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 20: My Five Moments for Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 21: System Change
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 22: Education of Healthcare Professionals
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 23: Glove Use and Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 24: Monitoring Hand Hygiene Performance
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 25: Performance Feedback
Key Messages
What We Know – The Evidence
Research Agenda
References
Chapter 26: Marketing Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 27: Human Factors Design
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 28: Institutional Safety Climate
Key messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 29: Personal Accountability for Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do Not Know and Research Agenda
References
Chapter 30: Patient Participation and Empowerment
Key Messages
What We Know – The Evidence
What We Do not Know – The Uncertain
Research Agenda
References
Chapter 31: Religion and Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 32: Hand Hygiene Promotion from the US Perspective: Putting WHO and CDC Guidelines into Practice
Key Messages
What We Know – The Evidence
What We Do Not Know and Research Agenda
References
Chapter 33: WHO Multimodal Promotion Strategy
Key messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 34: Monitoring Your Institution (Hand Hygiene Self-Assessment Framework)
Key Messages
What We Do Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 35: National Hand Hygiene Campaigns
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 36: Hand Hygiene Campaigning: From One Hospital to the Entire Country
Key Messages
What We Know – The Evidence
What We Do Not Know and Research Agenda
References
Chapter 37: Improving Hand Hygiene through Joint Commission Accreditation and the Joint Commission Center for Transforming Healthcare
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 38: A Worldwide WHO Hand Hygiene in Healthcare Campaign
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 39: The Economic Impact of Improved Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 40: Hand Hygiene: Key Principles for the Manager
Key Messages
What We Know – The Evidence
What We Do Not Know and Research Agenda
References
Chapter 41: Effect of Hand Hygiene on Infection Rates
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 42A: Hand Hygiene in Specific Patient Populations and Situations: Critically Ill Patients
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 42B: Hand Hygiene in Specific Patient Populations and Situations: Neonates and Pediatrics
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 42C: Hand Hygiene in Long-Term Care Facilities and Home Care
Key Messages
What We Know – The Evidence
Research Agenda
References
Additional References
Chapter 42D: Hand Hygiene in Ambulatory Care
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 42E: Hand Hygiene in Hemodialysis
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 42F: Hand Hygiene in Specific Patient Populations and Situations: Anesthesiology
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 43: Hand Hygiene in Resource-Poor Settings
Key messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 44A: Role of Hand Hygiene in MRSA Control
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 44B: Role of Hand Hygiene in Clostridium difficile Control
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 44C: Role of Hand Hygiene in Respiratory Diseases Including Influenza
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 44D: Handborne Spread of Noroviruses and its Interruption
Key Messages
What We Know – The Evidence
What We Do Not Know – The Uncertain
Research Agenda
References
Chapter 45: Conducting a Literature Review on Hand Hygiene
Key Messages
What We Know – The Evidence
What We Do not Know and Research Agenda
References
Appendix
Index
End User License Agreement
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Guide
Cover
Table of Contents
Preface
Foreword
Begin Reading
List of Illustrations
Chapter 3: Flora and Physiology of Normal Skin
Figure 3.1 The anatomical layers of the skin
Chapter 4: Dynamics of Hand Transmission
Figure 4.1 Relationship between duration of patient care and bacterial contamination of hands of hospital staff who wore gloves (solid circles and dashed line) and those who did not wear gloves (open circles and solid line) in 417 observations conducted at the University Hospitals of Geneva, Geneva, Switzerland, in 1996. Lines represent the average trend in each group, obtained using nonparametric regression (LOWESS).
Source
: Pittet 1999. Reproduced with permission from The American Medical Association.
Chapter 5: Mathematical Models of Handborne Transmission of Nosocomial Pathogens
Figure 5.1 Results derived from a model combining vector-borne transmission of a nosocomial pathogen (assumed to be entirely mediated by the hands of healthcare workers), with transmission in the community reservoir. Results are shown for both a pathogen adapted to the hospital setting but assumed to transmit poorly in the community (left), and for a pathogen that transmits well in the community, but poorly in hospitals (right). The plots show how the equilibrium level of carriage prevalence (the percentage of hospital patients colonized or infected with the pathogen at any one time in the long term) changes in response to an intervention to improve hand hygiene compliance as a function of baseline (pre-intervention) compliance. See Table 5.1 for model assumptions.
Figure 5.2
Chapter 7: Statistical Issues: How to Overcome the Complexity of Data Analysis in Hand Hygiene Research?
Figure 7.1 Three levels of parameters (from the most to the least influential) impacting healthcare workers' behavior towards hand hygiene.
Figure 7.2 Illustration of the complexity in the data from a large observational study assessing the effectiveness of the WHO Multimodal Strategy in different pilot sites and countries.
6
1
Chapter 10: Hand Hygiene Technique
Figure 10.1 Hand hygiene technique with an alcohol-based formulation.
Source: WHO Guidelines on Hand Hygiene in Health Care
, 2009 (Reproduced with permission from World Health Organization).
Figure 10.2 Hand hygiene technique with soap and water.
Source: WHO Guidelines on Hand Hygiene in Health Care,
2009 (Reproduced with permission from World Health Organization).
Chapter 11: Compliance with Hand Hygiene Best Practices
Figure 11.1 Relation between level of hand hygiene compliance and opportunities per hour of patient care.
*
Figure 11.1 Relationship between opportunities for hand hygiene and compliance across hospital wards, University of Geneva Hospitals, 1994. Average compliance is indicated for handwashing and handrubbing. The size of the symbol is proportional to the number of opportunities observed in the different wards.
Source
: Pittet 2001. Reproduced with permission from Elsevier.
Figure 11.2 Self-reported vs. observed hand hygiene baseline compliance among healthcare workers in pilot sites testing the WHO Hand Hygiene Multimodal Improvement Strategy. KAMC/KSMC refer to hospitals in the Kingdom of Saudi Arabia.
Chapter 14: Surgical Hand Preparation
Figure 14.1 Surgical hand preparation with an alcohol-based handrub. The first two steps of the surgical handrub ensure complete moistening of the forearms, starting from the elbow (see 1 to 10), then the forearms, and followed by a handrub for 1.5–3 minutes.
Chapter 18: Behavior and Hand Hygiene
Figure 18.1 The Hook (modified)
Chapter 20: My Five Moments for Hand Hygiene
Figure 20.1 Unified visuals for “My Five Moments for Hand Hygiene”.
Figure 20.2 Translations and local adaptations of the “My Five Moments for Hand Hygiene” visual.
Source
: Reproduced with permission from the World Health Organization.
See plate section for color representation of this figure.
Chapter 21: System Change
Figure 21.1 Different types of ABHR dispensers.
See plate section for color representation of this figure.
Chapter 23: Glove Use and Hand Hygiene
Figure 23.1 How to don and remove nonsterile gloves.
Source
: Reproduced with permission from World Health Organization. “WHO Glove Use Information Leaflet”, available from www.who.int/gpsc/5may/tools/training-education/en/.
Chapter 24: Monitoring Hand Hygiene Performance
Figure 24.1 Hand hygiene performance calculation legend: The timeline (t) shows graphically three hand hygiene opportunities (Opp#1 to Opp#3) and four hand hygiene actions (HH#1 to HH#4), of which two are within hand hygiene opportunities (HH#1 and HH#4) and two are not (HH#2 and HH#3). The included formula to calculate allows determination of a 66.6% hand hygiene performance for the given example.
Chapter 25: Performance Feedback
Figure 25.1 In the absence of a direct and observable outcome of hand hygiene, performance feedback provides an important positive feedback loop between healthcare workers and their hand hygiene behavior.
Chapter 26: Marketing Hand Hygiene
Figure 26.1 Traditional versus marketing-informed approaches.
Chapter 27: Human Factors Design
Figure 27.1 The many opportunities for human factors and ergonomics design to promote hand hygiene (HH). The opportunities for supporting healthcare worker (HCW) hand hygiene performance through human factors engineering can be applied at three levels: PE, physical ergonomics; CE, cognitive ergonomics; and ME, macroergonomics. ABHR, alcohol-based handrub.
See plate section for color representation of this figure.
Chapter 33: WHO Multimodal Promotion Strategy
Figure 33.1 Implementation strategy and toolkit for the translation into practice of the
WHO Guidelines on Hand Hygiene in Health Care
.
Source:
Reproduced with permission from the World Health Organization.
See plate section for color representation of this figure.
Figure 33.2 WHO Multimodal Hand Hygiene Improvement Strategy Implementation Model.
Source:
Reproduced with permission from the World Health Organization.
See plate section for color representation of this figure.
Chapter 36: Hand Hygiene Campaigning: From One Hospital to the Entire Country
Figure 36.1 Australian NHHI participation, private and public, (2014) 828 sites.
Chapter 37: Improving Hand Hygiene through Joint Commission Accreditation and the Joint Commission Center for Transforming Healthcare
Figure 37.1 Overall hand hygiene compliance: US and international hospitals participating in Center for Transforming Healthcare Hand Hygiene initiatives
1
,
2
(data as of September 2013).
1
2
Chapter 38: A Worldwide WHO Hand Hygiene in Healthcare Campaign
Figure 38.1 Categoriesassociated with how campaign registered healthcare facilities hear about
SAVE LIVES: Clean Your Hands
– 2010.
See plate section for color representation of this figure
.
Figure 38.2 Summary of tool download activity for 2009 and 2010 and key events that may have influenced these.
See plate section for color representation of this figure
.
Chapter 39: The Economic Impact of Improved Hand Hygiene
Figure 39.1 A framework for decision making; the
y
-axis shows costs and the
x
-axis shows health benefits in life years gained.
Figure 39.2 Diminishing returns for hand hygiene programs (all data are hypothetical). HAI, health-care associated infections.
Chapter 42A: Hand Hygiene in Specific Patient Populations and Situations: Critically Ill Patients
Figure 42A.1 Association between workload and compliance with handwashing and alcohol-based handrubbing.
Chapter 42B: Hand Hygiene in Specific Patient Populations and Situations: Neonates and Pediatrics
Figure 42B.1 The introduction of pathogens to childcare is complex due to the close link of children's hospitals with families, day care centers and schools, where microorganisms circulate easily.
Chapter 42D: Hand Hygiene in Ambulatory Care
Figure 42D.1 Hand hygiene indications in the context of a vaccination campaign. Hand Hygiene in Outpatient and Home-Based Care and Long-Term Care Facilities: A Guide to the Application of the WHO Multimodal Hand Hygiene Improvement Strategy and the “My Five Moments for Hand Hygiene” Approach. WHO, 2012.
Source
: Reproduced with permission from the World Health Organization. Additional Figure illustrating other care situations in outpatient settings are available in the guidance document cited above.
See plate section for color representation of this figure
.
Figure 42D.2 Hand hygiene indications during a pediatric consultation. Hand Hygiene in Outpatient and Home-Based Care and Long-Term Care Facilities: A Guide to the Application of the WHO Multimodal Hand Hygiene Improvement Strategy and the “My Five Moments for Hand Hygiene” Approach. WHO, 2012.
Source
: Reproduced with permission from the World Health Organization. Additional Figure illustrating other care situations in outpatient settings are available in the guidance document cited above.
See plate section for color representation of this figure
.
Chapter 42E: Hand Hygiene in Hemodialysis
Figure 42E.1 Hand hygiene indications in the context of haemodialysis. WHO Hand Hygiene in Outpatient and Home-Based Care and Long-Term Care Facilities: a Guide to the Application of the WHO Multimodal Hand Hygiene Improvement Strategy and the My Five Moments for Hand Hygiene Approach 2012.
Figure 42E.2 Hand hygiene opportunities in the context of haemodialysis. WHO hand hygiene in outpatient and home-based care and long-term care facilities: a guide to the application of the WHO Multimodal Hand Hygiene Improvement Strategy and the My Five Moments for Hand Hygiene approach 2012.
Source
: Reproduced with permission from the World Health Organization.
Chapter 42F: Hand Hygiene in Specific Patient Populations and Situations: Anesthesiology
Figure 42F.1 Hand hygiene algorithm (adapted from 3rd edition of the ASA's Recommendations for Infection Control for the Practice of Anesthesiology.
Chapter 43: Hand Hygiene in Resource-Poor Settings
Figure 43.1 Tippy Taps are designed for simple, economical, and effective hand washing stations in countries with resource-poor settings with a lack of access to a piped water supply.
Figure 43.2 Examples of using various types of hand washing facilities in LMI countries where there is a lack of access to a piped water supply.
Chapter 44A: Role of Hand Hygiene in MRSA Control
Figure 44A.1 Standard Approaches to the Control of Endemic Methicillin-Resistant
Staphylococcus aureus
.
Figure 44A.2 Difference in the improvement of alcohol-based hand rub (ABHR) use and the change in MRSA rates in nine epidemiological studies.
Chapter 44B: Role of Hand Hygiene in Clostridium difficile Control
Figure 44B.1 Hand imprint culture of
Clostridium difficile
on sterile gloves after contact with a
C. difficile
–associated diarrhea-affected patient's groin.
Source
: Reprinted from Bobulsky G et al., with permission from C.J. Donskey.
2
See plate section for color representation of this figure.
Figure 44B.2 Percentage of positive gloved hand imprint cultures (a) and the mean (± standard error) number of colony-forming units (CFUs) acquired (b) after contact with commonly examined skin sites of 30 patients with
Clostridium difficile
infection (CDI) and commonly touched environmental surfaces in the CDI rooms.
Chapter 44C: Role of Hand Hygiene in Respiratory Diseases Including Influenza
Figure 44C.1 The role of frequent hand hygiene to interrupt or reduce the spread of respiratory viruses; meta-analysis.
8
Source
: Reproduced with permission from the World Health Organization.
Figure 44C.2 The efficacy of hand hygiene interventions with or without face masks to reduce the risk of laboratory-confirmed influenza in community settings; meta-analysis.
Source
: Reproduced with permission from the World Health Organization.
Chapter 44D: Handborne Spread of Noroviruses and its Interruption
Figure 44D.1 The pivotal role of hands in the spread of human noroviruses.
Chapter 45: Conducting a Literature Review on Hand Hygiene
Figure 45.1 Number of publications on hand hygiene by year and main landmark publications. (Search conducted on August 23, 2015)
List of Tables
Chapter 1: The Burden of Healthcare-Associated Infection
Table 1.1 Cumulative Incidence Density of HAI and Device-Associated Infections in Adult ICU Patients in High-, and Low/Middle-Income Countries
Chapter 4: Dynamics of Hand Transmission
Table 4.1 The Five Sequential Steps for Cross-Transmission of Microbial Pathogens
Table 4.2 Relationship Between the Time Spent in Various Patient Care Activities and Bacterial Contamination of the Hands of Gloveless Hospital Staff (Multiple Linear Regression Model)
Chapter 5: Mathematical Models of Handborne Transmission of Nosocomial Pathogens
Table 5.1 Model Parameter Values Used in Figures 5.1 and 5.2. These parameter values were chosen to illustrate model dynamics, and do not represent estimates from data. The models split the community population into two groups to account for the observation that recently hospitalized patients have an initially high rate of hospitalization that diminishes over time
9
Chapter 7: Statistical Issues: How to Overcome the Complexity of Data Analysis in Hand Hygiene Research?
Table 7.1 Parameters Associated with Successful Hand Hygiene Promotion
Table 7.2 Hand Hygiene: Distribution of Factors Associated with Noncompliance
Chapter 8: Hand Hygiene Agents
Table 8.1 Examples of Ingredients Commonly Used in the Formulation of Hand Hygiene Preparations
Chapter 9: Methods to Evaluate the Antimicrobial Efficacy of Hand Hygiene Agents
Table 9.1 Basic Experimental Design of Current Methods to Test the Efficacy of Hand Hygiene and Surgical Hand Preparation Formulations
*
Chapter 11: Compliance with Hand Hygiene Best Practices
Table 11.1 Compliance with the Five Moments for Hand Hygiene Recommended by WHO (Measured Up to 2010)
Chapter 13: Physicians and Hand Hygiene
Table 13.1 Main Determinants of Physicians' Hand Hygiene Behavior and Possible Specific Elements for Effective Targeted Improvement
Chapter 15: Skin Reaction to Hand Hygiene
Table 15.1 Methods to Minimize Skin Irritation Associated with Hand Hygiene
Chapter 19: Hand Hygiene Promotion Strategies
Table 19.1 Strategies for Hand Hygiene Promotion in Healthcare
*
Chapter 20: My Five Moments for Hand Hygiene
Table 20.1 Design Requirements for a High-Usability Hand Hygiene Indication Concept
Table 20.2 Five Moments Indications
Chapter 21: System Change
Table 21.1 Criteria for the Selection of Alcohol-Based Handrubs (ABHRs)
Chapter 24: Monitoring Hand Hygiene Performance
Table 24.1 Observation Systems and their Advantages and Disadvantages
Chapter 25: Performance Feedback
Table 25.1 Key Parameters and Considerations in Hand Hygiene Performance Feedback
Chapter 26: Marketing Hand Hygiene
Table 26.1 Cornerstones of Marketing
Chapter 27: Human Factors Design
Table 27.1 Human Factors Engineering Core Principles
Table 27.2 Human Factors Engineering Evaluation and Design Techniques
Chapter 28: Institutional Safety Climate
Table 28.1 Some Factors Encouraging Staff Commitment to Institutional Safety
Table 28.2 Some Barriers to Patient and User Involvement in Safety Initiatives
Chapter 30: Patient Participation and Empowerment
Table 30.1 Checklist for Developing a Patient Participation Program
Chapter 31: Religion and Hand Hygiene
Table 31.1 Specific Indications for Hand Hygiene According to the Most Widely Represented Religions Worldwide
Table 31.2 Alcohol Prohibition in Some Religions
Chapter 32: Hand Hygiene Promotion from the US Perspective: Putting WHO and CDC Guidelines into Practice
Table 32.1 Summary of Recommended Indications for Routine (i.e., Excluding Surgical Hand Preparation) Hand Hygiene from the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) Guidelines
Chapter 33: WHO Multimodal Promotion Strategy
Table 33.1 Components of the WHO Hand Hygiene Multimodal Improvement Strategy and Associated Implementation Tools
Table 33.2 Step-Wise Approach for the Implementation of the WHO Hand Hygiene Multimodal Improvement Strategy
Chapter 34: Monitoring Your Institution (Hand Hygiene Self-Assessment Framework)
Table 34.1 Levels of Hand Hygiene Implementation Progress Defined by the WHO Hand Hygiene Self-Assessment Framework (HHSAF)
Chapter 35: National Hand Hygiene Campaigns
Table 35.1 WHO Recommendations for National Governments
Table 35.2 Results from a WHO Survey on Hand Hygiene Promotion Campaigns Worldwide (2009).
3
Table 35.3 A Summary of the Critical Success Factors Emerging from WHO
CleanHandsNet
Discussions
Chapter 37: Improving Hand Hygiene through Joint Commission Accreditation and the Joint Commission Center for Transforming Healthcare
Table 37.1 Main Causes of Failure to Clean Hands and Potential Solutions Identified by Hospitals Participating in the Center for Transforming Healthcare Hand Hygiene Initiative
Chapter 38: A Worldwide WHO Hand Hygiene in Healthcare Campaign
Table 38.1 The Research Agenda – What is Missing to Ensure a Successful Global Campaign?
Chapter 39: The Economic Impact of Improved Hand Hygiene
Table 39.1 The Value for Money of Three Programs Competing for Healthcare Funds
*
Table 39.2 Diminishing Marginal Returns and Improving Patient Safety
Chapter 40: Hand Hygiene: Key Principles for the Manager
Table 40.1 Factors that Affect Hand Hygiene Compliance with Associated Examples
Chapter 41: Effect of Hand Hygiene on Infection Rates
Table 41.1 Published Studies Assessing the Effect of Hand Hygiene Compliance Improvement on Healthcare-Associated Infections (Selected Studies)
*
Chapter 42A: Hand Hygiene in Specific Patient Populations and Situations: Critically Ill Patients
Table 42A.1 Association Between Hand Hygiene Improvement and Healthcare-Associated Infection Rates in Intensive Care Units (Excluding Pediatric and Neonatal Intensive Care Units): 1975–2013
Chapter 42C: Hand Hygiene in Long-Term Care Facilities and Home Care
Table 42C.1 Hand Hygiene Compliance and Healthcare-associated Infections Rates in LTCFs; Selected Studies
Chapter 42F: Hand Hygiene in Specific Patient Populations and Situations: Anesthesiology
Table 42F.1 Indications for Hand Hygiene (Adapted from ASA/ASA Committees/Recommendations for Infection Control for the Practice of Anesthesiology)
Table 42F.2 Potentially Contaminated Environmental Surfaces and Elements Considered as Possible Sources of Cross-Transmission in the Operating Room
Chapter 43: Hand Hygiene in Resource-Poor Settings
Table 43.1 Advantages and Potential Barriers to the Local Production of Alcohol-Based HandRubs
Chapter 44D: Handborne Spread of Noroviruses and its Interruption
Table 44D.1 Basics of Human Noroviruses and the Diseases They Cause
Table 44D.2 Factors to Consider in Selecting and Using Alcohol-Based Handrubs against HuNoVs
Chapter 45: Conducting a Literature Review on Hand Hygiene
Table 45.1 Summary of Hand Hygiene Literature Commonly Used Terms, PubMed® Search Strategy, and Number of Publications
Table 45.2 Selected Landmark Publications on Hand Hygiene
Hospital Medicine: Current Concepts
Scott A. Flanders and Sanjay Saint, Series Editors
Hospitalist's Guide to the Care of the Older Patient 1e
Brent C. Williams, Preeti N. Malani, David H. Wesorick, Editors, 2013
Inpatient Anticoagulation
Margaret C. Fang, Editor, 2011
Hospital Images: A Clinical Atlas
Paul B. Aronowitz, Editor, 2012
Becoming a Consummate Clinician: What Every Student, House Officer, and Hospital Practitioner Needs to Know
Ary L. Goldberger and Zachary D. Goldberger, Editors, 2012
Perioperative Medicine: Medical Consultation and Co-Management
Amir K. Jaffer and Paul J. Grant, Editors, 2012
Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine
James C. Pile, Thomas E. Baudendistel, and Brian J. Harte, Editors, 2013
Inpatient Cardiovascular Medicine
Brahmajee K. Nallamothu and Timir S. Baman, Editors 2013
Hospital-Based Palliative Medicine: A Practical, Evidence-Based Approach
Steven Pantilat, Wendy Anderson, Matthew Gonzales and Eric Widera, Editors, 2015
Hand Hygiene
A Handbook for Medical Professionals
Edited by
Didier Pittet
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
John M. Boyce
Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, and Yale University School of Medicine, New Haven, CT, USA
Benedetta Allegranzi
Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, and Faculty of Medicine, University of Geneva, Geneva, Switzerland
Series Editors
Scott A. Flanders, MD, MHM
Sanjay Saint, MD, MPH, FRCP
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Library of Congress Cataloging-in-Publication Data
Names: Pittet, Didier, 1957- editor. | Boyce, John M., editor. | Allegranzi, Benedetta, editor.
Title: Hand hygiene : a handbook for medical professionals / edited by Didier Pittet, John M. Boyce, Benedetta Allegranzi.
Other titles: Hand hygiene (Pittet) | Hospital medicine, current concepts.
Description: Chichester, West Sussex, UK ; Hoboken, NJ : John Wiley & Sons, Ltd., 2016. | Series: Hospital medicine : current concepts | Includes bibliographical references and index.
Identifiers: LCCN 2016016293 (print) | LCCN 2016017182 (ebook) | ISBN 9781118846865 (pbk.) | ISBN 9781118846803 (pdf) | ISBN 9781118846858 (epub)
Subjects: | MESH: Hand Hygiene
Classification: LCC RA776.95 (print) | LCC RA776.95 (ebook) | NLM WA 110 | DDC 613-dc23
LC record available at https://lccn.loc.gov/2016016293
A catalogue record for this book is available from the British Library.
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Cover design: Wiley
Cover images: (Top) © monkeybusinessimages/Gettyimages; (Middle) © CNRI/Science Photo Library/Corbis; (Bottom) © Antagain/Gettyimages
Contributors
Benedetta Allegranzi, Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, and Faculty of Medicine, University of Geneva, Geneva, Switzerland
Jaffar A. Al-Tawfiq, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia
Hanan H. Balkhy, Infection Prevention and Control Department, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Fernando Bellissimo-Rodrigues, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Anne Marie Benedicto, The Joint Commission, Oakbrook Terrace, USA
Pascal Bonnabry, University of Geneva Hospitals and Faculty of Medicine, and Univeristy of Lausanne, Geneva and Lausanne, Switzerland
John M. Boyce, Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, and Yale University School of Medicine, New Haven, USA
Barbara I. Braun, The Joint Commission, Oakbrook Terrace, USA
Enrique Castro-Sánchez, National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
Mark R. Chassin, The Joint Commission, Oakbrook Terrace, USA
Marie-Noëlle Chraïti, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland
Lauren Clack, Division of Infectious Diseases and Infection Control, University Hospitals of Zurich, Zürich, Switzerland
Ben S. Cooper, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand and Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
Benjamin J. Cowling, Department of Pathology, Hong Kong Baptist Hospital, Kowloon Tong, Hong Kong SAR, China
Nizam Damani, Infection Prevention and Control, Southern Health and Social Care Trust, Portadown, and Queen's University, Belfast, UK
Katherine Ellingson, Oregon Health Authority, Public Health Division, Healthcare-Associated Infections Program, Portland, USA
Angèle Gayet-Ageron, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Nicholas Graves, School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
M. Lindsay Grayson, Infectious Diseases Department, Austin Hospital and University of Melbourne, Melbourne, Australia
Stephan Harbarth, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Alison Holmes, National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
Gürkan Kaya, Dermatology and Venereology Service, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Claire Kilpatrick, Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
Caroline Landelle, Infection Control Unit, Centre Hospitalier Universitaire Grenoble Alpes, and University Grenoble Alpes/CNRS, THEMAS TIM-C UMR 5525, Grenoble, France
Elaine Larson, Columbia University School of Nursing, New York, USA
Yves Longtin, Infection Control and Prevention Unit, Jewish General Hospital, and McGill University, Montreal, Canada
Nantasit Luangasanatip, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, and School of Public Health, Queensland University of Technology, Brisbane, Australia
Jean-Christophe Lucet, Infection Control Unit, Bichat-Claude Bernard Hospital, Paris, France
Maryanne McGuckin, Patient-Centered Outcomes Research Institute, Washington, USA
Mary-Louise McLaws, Healthcare Infection and Infectious Diseases Control, University of New South Wales, Sydney, Australia
Shaheen Mehtar, Unit for Infection Prevention and Control, Division of Community Health, Stellenbosch University, Cape Town, South Africa
Ziad A. Memish, Former Deputy Health Minister, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
Maria Luisa Moro, Health and Social Agency Emilia-Romagna Region, Bologna, Italy
Eleanor Murray, Saïd Business School, University of Oxford, Oxford, UK
Sepideh Bagheri Nejad, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
Eli Perencevich, Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, USA
Daniela Pires, Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Didier Pittet, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Peter Pronovost, Armstrong Institute for Patient Safety and Quality, Johns Hopkins, and Patient Safety and Quality, The Johns Hopkins University School of Medicine, Baltimore, USA
Manfred L. Rotter, Institute of Hygiene and Applied Immunology, Medical University of Vienna, Vienna, Austria
Philip L. Russo, Hand Hygiene Australia, Melbourne, Australia
Matthew Samore, Department of Epidemiology, University of Utah School of Medicine, Salt Lake City, USA
Syed A. Sattar, Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
Hugo Sax, Division of Infectious Diseases and Infection Control, University Hospital of Zurich, Zürich, Switzerland
Wing-Hong Seto, World Health Organization Collaborating Centre for Infectious Disease, Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong SAR, China
Susan E. Sheridan, World Alliance for Patient Safety, World Health Organization, Geneva, Switzerland
Joseph Solomkin, University of Cincinnati College of Medicine, Cincinnati, USA
François Stéphan, Réanimation Adulte, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
Andrew J. Stewardson, Infectious Diseases Department, Austin Health and Hand Hygiene Australia, Melbourne, Australia and Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Julie Storr, Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
Miranda Suchomel, Institute of Hygiene and Applied Immunology, Medical University of Vienna, Vienna, Austria
Andreas Voss, Radboud University Medical Centre and Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
Robert M. Wachter, Department of Medicine, University of California, and University of California San Francisco Medical Center, San Francisco, USA
Andreas F. Widmer, Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
Walter Zingg, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Preface
Do we need another medical textbook?
Does a textbook of hand hygiene exist?
Does hand hygiene deserve a textbook?
These are some of the questions I asked myself when I was invited to consider such a project. I write “project,” when, in fact, I mean “journey.” Editing Hand Hygiene was a journey; in the same way, hand hygiene promotion is a journey. But what a fantastic journey it is!
Together with my dear friends and colleagues John M. Boyce and Benedetta Allegranzi, we have had the unique privilege to ask the world's pre-eminent scholars and clinicians on hand hygiene, infection control, and patient safety to contribute to the first comprehensive, single-source overview of best practices in hand hygiene. Hand Hygiene fully integrates the World Health Organization (WHO) guidelines and policies, and offers a global perspective in tackling challenges in both developed and developing countries. A total of fifty-five chapters includes coverage of basic and highly complex clinical applications of hand hygiene practices, and considers novel and unusual issues in hand hygiene, such as religious and cultural aspects, social marketing, campaigning, and patient participation. It also provides guidance on the best approaches to achieve behavioral change in healthcare workers that can also be applied in fields other than hand hygiene.
We asked authors to be concise, to review the evidence as well as what is unknown, and to highlight unique research perspectives in their own field. Each chapter reads easily and contains major issues summarized as bullet points, key figures, and tables. These are also available for download by accessing the e-version of Hand Hygiene, together with all of the instruments referenced in the book. My co-editors and I are extremely pleased by the work and commitment of the authors in this team effort, and take this opportunity to warmly thank them all.
Excellence is an attitude and excellence in hand hygiene, a journey.
May Hand Hygiene drive excellence in hand hygiene practices, research, and attitudes for many years to come, and contribute to save many more millions of lives every year worldwide.
Professor Didier Pittet, MD, MS, CBE Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Foreword
Hand hygiene in healthcare settings seems like a pretty simple act. One places an antiseptic agent on the hands, rubs the hands together to reduce the transient microorganisms, dries the hands or lets them dry, and thereby reduces the risk of transmission of pathogens to patients and to the healthcare worker. In Hand Hygiene, Drs Pittet, Boyce, and Allegranzi, and their esteemed colleagues, show us how complicated – yet essential – hand hygiene really is.
The book encompasses all the important aspects of hand hygiene. Each chapter has a simple-to-read format: key messages; what we know – the scientific evidence; what we don't know; and the research that needs to be done to fill these gaps. The authors begin by providing a summary of the current status of data on healthcare-associated infections (HAIs) in both developed and resource-limited countries. These data show the enormous impact that HAIs have throughout the world, including morbidity, mortality, and cost. This chapter also illustrates how even now – over thirty-five years since the Centers for Disease Control and Prevention's (CDC) Study of the Efficacy of Nosocomial Infection Control (SENIC) programs documented the preventive impact of HAI surveillance and prevention intervention programs – many countries still do not have adequate surveillance systems in place to even answer what their HAI rates are, much less evaluate the impact of prevention interventions.
Next, the authors describe the history of hand hygiene from the time of Semmelweis, discuss the flora and physiology of skin, describe the dynamics of pathogen transmission from the skin, and culminate in three chapters on mathematical models of hand-borne pathogen transmission, methodological issues in hand hygiene science, and statistical issues in hand hygiene research. These last three chapters highlight the many gaps in our knowledge about hand hygiene, illustrate the weaknesses in many if not most of our current studies, and point out that conducting the studies that are necessary may be more difficult than Semmelweis's challenge of convincing clinicians that hand hygiene should be done at all. Essential issues include antiseptic agent volume, method of application, duration of application, agent formulation, and when these are all optimized, and what percentage of HAIs are prevented by best practices. These methodological chapters are particularly important, as they illustrate that if our Guidelines are supposed to depend solely upon well-designed randomized controlled trials (RCTs) of hand hygiene – rather than on the entire body of epidemiologic data – such RCTs do not and probably never will exist, and hand hygiene will be relegated to an unresolved issue. These methodological issues also should be kept in mind as one reads the rest of this book (or other published literature) in which many studies are referenced that suffer from these methodological design flaws.
The next three chapters discuss the various available hand hygiene agents, the methods for evaluating their efficacy and the hand hygiene technique. These chapters are incredibly important and discuss issues often not known or understood in the infection control/patient safety community. Data show that formulation of alcohol-based hand hygiene agents matters. The chapter on evaluating efficacy illustrates the differences between North American and European standards – that is American Society for Testing Methods (ASTM) vs. Comité Européen de Normalisation (CEN or EN) standard methods. Everyone in infection control should understand the different methods used, what these tests do and do not tell us about efficacy, how in vivo testing does or does not relate to clinical practice, and the importance of demanding that all manufacturers provide such data to us when we are comparing products. Formulation matters, and such testing can document this.
This leads to several chapters on compliance with hand hygiene best practices, barriers to compliance, and a discussion of physicians and the almost universal finding that they are the worst compliers with hand hygiene recommendations of all healthcare workers. We must ask ourselves exactly what compliance with hand hygiene best practices is. Is it as mentioned at the beginning of this foreward simply applying some agent (formulation and amount irrelevant) and rubbing our hands together (duration and method irrelevant)? Or does compliance with hand hygiene best practices mean using a formulation documented to be effective, using the correct volume of that specific product documented in the ASTM or EN standard testing (realizing that volume will differ by product and for gels, foams vs. rubs), applying the product in a specific manner (such as recommended by the World Health Organization [WHO]), for the correct duration, at each of the WHO five moments? With current visual observation of hand hygiene “compliance,” how many healthcare workers pay any attention to the volume of agent used, the method of application, the duration of application, and so on. All of these are critical elements in hand hygiene best practices, yet they are often ignored. We need more precise definitions of what hand hygiene best practices are and when they should be done and measured. From the patient's perspective, moments 1 and 2 are most important. From the healthcare worker's perspective, moments 3, 4, and 5 are most important. These chapters also raise questions about who should monitor hand hygiene compliance (self-reporting appears to generally be inaccurate), when and how.
The next general area includes a discussion of behavior and hand hygiene, hand hygiene promotion strategies, the WHO five moments for hand hygiene, system change, and education of healthcare professionals. These chapters illustrate the continual struggle that those of us in infection control/quality improvement have trying to educate our healthcare workers about the importance of hand hygiene and methods to improve behavior, reduce barriers to compliance, and try to change our systems. Do we continue to invest enormous resources (time, personnel, and funding) to these activities to try to get our healthcare “professionals” to comply with hand hygiene best practices, or do we follow the dictates of the chapter on “Personal Accountability for Hand Hygiene”? As we have learned in the United States, if we do not regulate ourselves (e.g., through mandatory reporting of HAI rates, reduced funding for preventable HAIs), outside regulatory agencies will (i.e., the government). We all agree that proper performance of hand hygiene will reduce HAIs and improve patient safety. Then why do we accept noncompliance?
The chapter on monitoring hand hygiene compliance is critical. What should the gold standard be for measuring hand hygiene compliance? The majority of those measuring hand hygiene compliance (and/or publishing such studies) use “trained observer” visual observation. This chapter describes some flaws in such an approach: it is prone to bias, overestimates true performance, often captures <1% of hand hygiene opportunities at the time in the institution (yet is generalized to the entire facility), has large inter-rater variation, etc. As these authors state, “Today, a unique reliable and robust method to measure hand hygiene performance does not exist.” We know that indirect and less costly (time, personnel, etc.) methods for estimating hand hygiene compliance, such as measuring the amount of agent used, are not accurate. We know that merely measuring hand hygiene compliance on patient room entry or exit does not predict in-room practices (which are most important for the prevention of pathogen transmission to the patient). We know that self-reporting is grossly inaccurate. However, at least in developing countries, emerging technologies may be the answer for the future. The question becomes what we want the system to measure. Currently, electronic systems can measure whether hand hygiene is performed. Such systems generally do not assess the volume of the specific product, the method and duration of application, or specific compliance with each of the five moments or with specific invasive procedures. Video systems are just emerging and have the capacity not only to measure all these elements, but also to be a record to play back for healthcare workers who deny their noncompliance. In the future, where our systems truly demand individual accountability, such video/electronic systems may become essential. It does appear that at least in the developing world – as personnel clinician accountability is enforced and systems insist that hand hygiene best practices be a patient safety issue and thus must be complied with, for cost and personnel reasons – electronic or video systems for hand hygiene measure will become integral components of our measuring systems.
The book ends with chapters on national and international campaigns and regulatory/accrediting body approaches. Undoubtedly, such campaigns – whether local, system-wide, state or nationwide or worldwide – have improved hand hygiene awareness, importance, and compliance. Given the large number of elements we have learned in this book are required for true “hand hygiene best practices compliance” – that is, the best agent, the correct volume, application in compliance with the five moments, application in the correct fashion and for the correct duration – it is hard to believe local or national hand hygiene compliance rates of 85%–95% or that such levels – even if they can be achieved – can be sustained.
This book provides the most contemporary comprehensive summary of what we do and do not know about hand hygiene. It is essential reading for all those who are involved in infection control, patient safety, and quality improvement, or who practice clinical medicine. We must realize that until we have a reliable and robust method to measure hand hygiene performance, we really do not know what our hand hygiene compliance rates really are, nor can we calculate what percentage of HAIs actually can be prevented with high hand hygiene compliance rates. It is my hope that through reading this book and understanding the challenges ahead, video or electronic systems for measuring true hand hygiene compliance with best practices will be developed, and that we will require clinician accountability with hand hygiene recommendations. Then, we will be able to calculate what percentage of HAIs are prevented with different levels of hand hygiene compliance (or with higher or lower compliance with different moments of the WHO five moments) and through achievement of high sustainable hand hygiene compliance rates, we will be leaders in a worldwide campaign to improve patient safety and prevent HAIs through this simple intervention – hand hygiene!
William R. Jarvis, MD Jason and Jarvis Associates, LLC Hilton Head Island, South Carolina, USA
Chapter 1The Burden of Healthcare-Associated Infection
Benedetta Allegranzi1, Sepideh Bagheri Nejad2 and Didier Pittet3
1Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, and Faculty of Medicine, University of Geneva, Geneva, Switzerland
2Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
3Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Key Messages
The World Health Organization (WHO) estimates that hundreds of millions of patients are affected by healthcare-associated infection (HAI) worldwide each year, leading to significant mortality and financial losses for health systems, but precise data of the global burden are not available.
Of every 100 hospitalized patients at any given time, 6 to 7 will acquire at least one HAI in developed countries and 10 in developing countries.
In low- and middle-income countries, HAI frequency, especially in high-risk patients, is at least two to three times higher than in high-income countries, and device-associated infection densities in intensive care units are up to 13 times higher.
Healthcare-associated infections (HAIs) affect patients in hospitals and other healthcare settings. These infections are not present or incubating at time of admission, but include infections appearing after discharge, and occupational infections among staff. HAIs are one of the most frequent adverse events during healthcare delivery. No institution or country can claim to have solved this problem, despite many efforts. Healthcare workers' (HCWs') hands are the most common vehicle of microorganisms causing HAI. The transmission of these pathogens to the patient, the HCW, and the environment can be prevented through hand hygiene best practices.
What We Know – The Evidence
Although a national HAI surveillance system is in place in most high-income countries, only 23 developing countries (23/147 [15.6%]) reported a functioning system when assessed in 2010.1 In 2010, all 27 European Union (EU) Member States and Norway contributed to at least one of the four components of the Healthcare-Associated Infections Surveillance Network (HAI-Net), coordinated by the European Centre for Disease Prevention and Control (ECDC). Among these, 25 and 23 countries participated in the point prevalence surveys of HAI and antimicrobial use in long-term care facilities (LTCF) and acute care hospitals, respectively; 13 countries participated in the surveillance of surgical site infections (SSI); 14 in surveillance of HAI in intensive care units (ICUs); and 7 countries contributed to all surveillance components.2
Based on a 1995–2010 systematic review and meta-analysis of national and multicenter studies from high-income countries conducted by the WHO, the prevalence of hospitalized patients who acquired at least one HAI ranged from 3.5% to 12%. Pooled HAI prevalence was 7.6 episodes per 100 patients (95% confidence interval [CI], 6.9–8.5) and 7.1 infected patients per 100 patients admitted (95% CI, 6.5–7.8).1 Very similar data were issued in 2008 by the ECDC based on a review of studies carried out between 1996 and 2007 in 19 countries.3 Mean HAI prevalence was 7.1%; the annual number of infected patients was estimated at 4,131,000 and the annual number of HAI at 4,544,100.3
