The search for an evidence-based intervention to improve hand hygiene compliance in a residential aged care facility
Gail Abernethy A D and Wendy Smyth B C
+ Author Affiliations
- Author Affiliations
A Queensland Health, Herberton Hospital, Herberton, Qld 4887, Australia.
B Tropical Health Research Unit for Nursing and Midwifery Practice, Townsville Hospital and Health Service, Townsville, Qld 4814, Australia.
C School of Nursing, Midwifery and Nutrition, James Cook University, Townsville, Qld 4811, Australia.
D Corresponding author. Email: Gail.Abernethy@health.qld.gov.au
Healthcare Infection 18(4) 156-161 https://doi.org/10.1071/HI13021
Submitted: 5 July 2013 Accepted: 20 August 2013 Published: 17 September 2013
Abstract
Introduction: Healthcare-acquired infections are a major source of morbidity and mortality in people living in residential aged care facilities. Compliance with hand hygiene by healthcare workers can reduce the risk of infection to residents, yet compliance rates are generally low. Infection-control advocates within the aged care sector are looking to conduct programs to improve rates among their staff. This review was conducted to identify a reproducible intervention to improve staff hand hygiene compliance within an Australian residential aged care facility.
Method: Medline, Embase, and CINAHL databases were searched for combinations of ‘hand hygiene’, ‘hand washing’, ‘residential aged care facility’, ‘aged care’, ‘nursing home’ and ‘long-term care facility’ from 2000 to current. Articles were excluded if the information was not clearly stated as pertaining to a residential aged care facility or if the data investigated staff knowledge or perceptions of hand hygiene.
Results: Most of the five articles included in the review reported an improvement in compliance rates. Studies were multimodal, had an education or training component, and included the promotion of alcohol-based hand rubs. Several used aspects of the World Health Organization’s hand hygiene initiatives. Compliance audit tools across the studies were not consistent; thus, results may not be comparable.
Conclusion: There are few published studies which report interventions that improve hand hygiene compliance among healthcare workers within residential aged care facilities. Successful studies included the promotion of alcohol-based hand rubs. More research is needed to improve hand hygiene compliance in the aged care sector.
References
[1] Australian Institute of Health and Welfare. Residential Aged Care in Australia 2010–11: A Statistical Overview. Aged care statistics series no. 36, Cat no. AGE 68. Canberra: AIHW; 2012.[2] Code of Practice for Private Hospitals, Nursing Homes and Maternity Homes. Hong Kong: Department of Health; 2010.
[3] Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, et al SHEA/APIC Guideline: Infection prevention and control in the long-term care facility. Am J Infect Control 2008; 36 504–35.
| SHEA/APIC Guideline: Infection prevention and control in the long-term care facility.Crossref | GoogleScholarGoogle Scholar | 18786461PubMed |
[4] Reilly M, Noy DL, Creedy D, Moyle W. Infections in aged care facilities. Healthc Infect 2001; 6 111–8.
| Infections in aged care facilities.Crossref | GoogleScholarGoogle Scholar |
[5] Suetens C. Healthcare-associated infections in European long-term care facilities: how big is the challenge? Euro Surveill 2012; 17 2–4.
[6] Schweon SJ, Edmonds SL, Kirk J, Rowland DY, Acosta C. Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility. Am J Infect Control 2013; 41 39–44.
| Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility.Crossref | GoogleScholarGoogle Scholar | 22750034PubMed |
[7] Roberts C, Roberts J, Roberts R. Investigation into the effect of an alcohol-based hand product on infection rate in a nursing home setting. Journal of Infection Prevention 2009; 10 138–42.
| Investigation into the effect of an alcohol-based hand product on infection rate in a nursing home setting.Crossref | GoogleScholarGoogle Scholar |
[8] Kruger K, Jansen K, Grimsmo A, Eide GE, Geitung JT. Hospital admissions from nursing homes: rates and reasons. Nurs Res Pract 2011; 2011 247623
| 21994816PubMed |
[9] Eilers R, Veldman-Ariesen MJ, Haenen A, van Benthem BH. Prevalence and determinants associated with healthcare-associated infections in long-term care facilities (HALT) in the Netherlands, May to June 2010. Euro Surveill 2012; 17 1–6.
[10] Heudorf U, Boehlcke K, Schade M. Healthcare-associated infections in long-term care facilities (HALT) in Frankfurt am Main, Germany, January to March 2011. Euro Surveill 2012; 17 5–11.
[11] Forrest J, Tucker A, Brnabic AJM. A 9-year infection-control surveillance program in Sydney-based residential aged-care facilities. Healthc Infect 2011; 16 108–14.
| A 9-year infection-control surveillance program in Sydney-based residential aged-care facilities.Crossref | GoogleScholarGoogle Scholar |
[12] Lim CJ, McLellan SC, Cheng AC, Culton JM, Parikh SN, Peleg AY, et al Surveillance of infection burden in residential aged care facilities. Med J Aust 2012; 196 327–31.
| Surveillance of infection burden in residential aged care facilities.Crossref | GoogleScholarGoogle Scholar | 22432671PubMed |
[13] Smith M, Bull AL, Richards M, Woodburn P, Bennett NJ. Infection rates in residential aged care facilities, Grampians region, Victoria, Australia. Healthc Infect 2011; 16 116–20.
| Infection rates in residential aged care facilities, Grampians region, Victoria, Australia.Crossref | GoogleScholarGoogle Scholar |
[14] Backman C, Zoutman DE, Marck PB. An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections. Am J Infect Control 2008; 36 333–48.
| An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections.Crossref | GoogleScholarGoogle Scholar | 18538700PubMed |
[15] Gould DJ, Moralejo D, Drey N, Chudleigh JH. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2010; CD005186
| 20824842PubMed |
[16] Huang TT, Wu SC. Evaluation of a training programme on knowledge and compliance of nurse assistants’ hand hygiene in nursing homes. J Hosp Infect 2008; 68 164–70.
| Evaluation of a training programme on knowledge and compliance of nurse assistants’ hand hygiene in nursing homes.Crossref | GoogleScholarGoogle Scholar | 18226418PubMed |
[17] Grayson ML, Russo PL, Cruickshank M, Bear JL, Gee CA, Hughes CF, et al Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med J Aust 2011; 195 615–9.
| Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative.Crossref | GoogleScholarGoogle Scholar | 22107015PubMed |
[18] Australian Commission on Safety and Quality in Healthcare. Safety and Quality Improvement Guide Standard 3: Preventing and Controlling Healthcare Associated Infections October 2012. Sydney: ACSQHC; 2012.
[19] Australian Government Department of Health and Ageing. Standards and Guidelines for Residential Aged Care Services Manual. Canberra; DoHA: 2004.
[20] Geary A, Moyle W, Evans K. Infection control in Queensland long-term care facilities. Healthc Infect 2001; 6 122–7.
| Infection control in Queensland long-term care facilities.Crossref | GoogleScholarGoogle Scholar |
[21] Erasmus V, Huis A, Oenema A, van Empelen P, Boog MC, van Beeck EH, et al The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections. BMC Public Health 2011; 11 721
| The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections.Crossref | GoogleScholarGoogle Scholar | 21943482PubMed |
[22] Erasmus V, Kuperus MN, Richardus JH, Vos MC, Oenema A, van Beeck EF. Improving hand hygiene behaviour of nurses using action planning: a pilot study in the intensive care unit and surgical ward. J Hosp Infect 2010; 76 161–4.
| Improving hand hygiene behaviour of nurses using action planning: a pilot study in the intensive care unit and surgical ward.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cfgtFSnsw%3D%3D&md5=fe12bffa42ed93579d8456b8e023452aCAS | 20619931PubMed |
[23] Mestre G, Berbel C, Tortajada P, Alarcia M, Coca R, Gallemi G, et al “The 3/3 strategy”: a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology. PLoS ONE 2012; 7 e47200
| “The 3/3 strategy”: a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38Xhs1ehtrbP&md5=2a2f11432df4d91f9823f807cd8af434CAS | 23110061PubMed |
[24] Pantle AC, Fitzpatrick KR, McLaws ML, Hughes CF. A statewide approach to systematising hand hygiene behaviour in hospitals: clean hands save lives, part I. Med J Aust 2009; 191 S8–12.
| 19835530PubMed |
[25] Whitby M, McLaws ML, Slater K, Tong E, Johnson B. Three successful interventions in health care workers that improve compliance with hand hygiene: is sustained replication possible? Am J Infect Control 2008; 36 349–55.
| Three successful interventions in health care workers that improve compliance with hand hygiene: is sustained replication possible?Crossref | GoogleScholarGoogle Scholar | 18538701PubMed |
[26] Huis A, van Achterberg T, de Bruin M, Grol R, Schoonhoven L, Hulscher M. A systematic review of hand hygiene improvement strategies: a behavioural approach. Implement Sci 2012; 7 92
| A systematic review of hand hygiene improvement strategies: a behavioural approach.Crossref | GoogleScholarGoogle Scholar | 22978722PubMed |
[27] Ho ML, Seto WH, Wong LC, Wong TY. Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial. Infect Control Hosp Epidemiol 2012; 33 761–7.
| Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 22759542PubMed |
[28] Kacelnik O, Forland OJ, Iversen B. Evaluation of the national campaign to improve hand hygiene in nursing homes in Norway. J Hosp Infect 2011; 77 359–60.
| Evaluation of the national campaign to improve hand hygiene in nursing homes in Norway.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3M3otFShsg%3D%3D&md5=87c5624c432151258ea69b2b7edca958CAS | 21194790PubMed |
[29] Mody L, McNeil SA, Sun R, Bradley SE, Kauffman CA. Introduction of a waterless alcohol-based hand rub in a long-term-care facility. Infect Control Hosp Epidemiol 2003; 24 165–71.
| Introduction of a waterless alcohol-based hand rub in a long-term-care facility.Crossref | GoogleScholarGoogle Scholar | 12683506PubMed |
[30] Yeung WK, Tam WS, Wong TW. Clustered randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities. Infect Control Hosp Epidemiol 2011; 32 67–76.
| Clustered randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities.Crossref | GoogleScholarGoogle Scholar | 21087125PubMed |
[31] Chami K, Gavazzi G, Bar-Hen A, Carrat F, de Wazieres B, Lejeune B, et al A short-term, multicomponent infection control program in nursing homes: a cluster randomized controlled trial. J Am Med Dir Assoc 2012; 13 569.e9
| A short-term, multicomponent infection control program in nursing homes: a cluster randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |
[32] Makris AT, Morgan L, Gaber DJ, Richter A, Rubino JR. Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities. Am J Infect Control 2000; 28 3–7.
| Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7ktlCjtA%3D%3D&md5=7994d684fb5ec42861caaa2d8b33e2e6CAS | 10679130PubMed |
[33] Forrester LA, Bryce EA, Mediaa AK. Clean Hands for Life: results of a large, multicentre, multifaceted, social marketing hand-hygiene campaign. J Hosp Infect 2010; 74 225–31.
| Clean Hands for Life: results of a large, multicentre, multifaceted, social marketing hand-hygiene campaign.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3c7otlyqtg%3D%3D&md5=c16978e7168bda48532683f2ea68e11fCAS | 20153550PubMed |
[34] Trick WE, Vernon MO, Welbel SF, Demarais P, Hayden MK, Weinstein RA. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 2007; 28 42–9.
| Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance.Crossref | GoogleScholarGoogle Scholar | 17230386PubMed |
[35] Eveillard M, Raymond F, Guilloteau V, Pradelle MT, Kempf M, Zilli-Dewaele M, et al Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units. J Clin Nurs 2011; 20 2744–51.
| Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units.Crossref | GoogleScholarGoogle Scholar | 21366742PubMed |
[36] Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, et al Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol 2010; 31 283–94.
| Systematic review of studies on compliance with hand hygiene guidelines in hospital care.Crossref | GoogleScholarGoogle Scholar | 20088678PubMed |
[37] Allegranzi B, Sax H, Pittet D. Hand hygiene and healthcare system change within multi-modal promotion: a narrative review. J Hosp Infect 2013; 83 S3–10.
| Hand hygiene and healthcare system change within multi-modal promotion: a narrative review.Crossref | GoogleScholarGoogle Scholar | 23453174PubMed |
[38] Larson E. Monitoring hand hygiene: Meaningless, harmful, or helpful? Am J Infect Control 2013; 41 S42–5.
| Monitoring hand hygiene: Meaningless, harmful, or helpful?Crossref | GoogleScholarGoogle Scholar | 23622747PubMed |
[39] Stewardson A, Allegranzi B, Sax H, Kilpatrick C, Pittet D. Back to the future: rising to the Semmelweis challenge in hand hygiene. Future Microbiol 2011; 6 855–76.
| Back to the future: rising to the Semmelweis challenge in hand hygiene.Crossref | GoogleScholarGoogle Scholar | 21861619PubMed |
[40] Gould D, Drey N. Types of interventions used to improve hand hygiene compliance and prevent healthcare associated infection. Journal of Infection Prevention 2013; 14 88–93.
| Types of interventions used to improve hand hygiene compliance and prevent healthcare associated infection.Crossref | GoogleScholarGoogle Scholar |
[41] Schweon SJ, Kirk J. A realistic approach towards hand hygiene for long-term care residents and health care personnel. Am J Infect Control 2011; 39 336–8.
| A realistic approach towards hand hygiene for long-term care residents and health care personnel.Crossref | GoogleScholarGoogle Scholar | 21531273PubMed |
[42] Mody L, McNeil SA, Sun R, Bradley SE, Kauffman CA. Introduction of a waterless alcohol-based hand rub in a long-term-care facility. Infect Control Hosp Epidemiol 2003; 24 165–71.
| Introduction of a waterless alcohol-based hand rub in a long-term-care facility.Crossref | GoogleScholarGoogle Scholar | 12683506PubMed |
[43] Huang TT, Wu SC. Evaluation of a training program on knowledge and compliance of nurse assistants’ hand hygiene in nursing homes. J Hosp Infect 2008; 68 164–70.
| Evaluation of a training program on knowledge and compliance of nurse assistants’ hand hygiene in nursing homes.Crossref | GoogleScholarGoogle Scholar | 18226418PubMed |
[44] Yeung WK, Tam WS, Wong TW. Clustered randomised controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities. Infect Control Hosp Epidemiol 2011; 32 67–76.
| Clustered randomised controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities.Crossref | GoogleScholarGoogle Scholar | 21087125PubMed |
[45] Kacelnik O, Forland OJ, Iversen B. Evaluation of the national campaign to improve hand hygiene in nursing homes in Norway. J Hosp Infect 2011; 77 359–60.
| Evaluation of the national campaign to improve hand hygiene in nursing homes in Norway.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3M3otFShsg%3D%3D&md5=87c5624c432151258ea69b2b7edca958CAS | 21194790PubMed |
[46] Ho ML, Seto WH, Wong LC, Wong TY. Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomised controlled trial. Infect Control Hosp Epidemiol 2012; 33 761–7.
| Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 22759542PubMed |