these areas needing improvement: Using ABHR, rubbing until dry, and thoroughly covering all surfaces of hands when using soap and water. Remembering to turn off the faucet with a paper towel had the lowest compliance (3%–5%). Arntz and colleagues (2016) observed hand hygiene adherence in an emergency department in a Dutch tertiary care teaching hospital and a level-one trauma center. The approach was a before and after study evaluating their multimodal hand hygiene awareness campaign. The baseline period showed adherence to hand hygiene was 18%, and after interventions, adherence went up to between 45% and 50%. As other authors have found, hand hygiene compliance was lowest with moments one and two, the before moments compared with the after moments.
The authors suggest empowering HCWs to provide and receive feedback regarding observed hand hygiene practices to increase compliance. A similar study found compliance with the WHO’s five moments of hand hygiene at 35%, with the before moments lower than the after moments (Woodard et al., 2019). The WHO’s five moments of hand hygiene compliance (35%) was compared to the gel in and gel out compliance (90%), and there was quite a difference in performance. In addition, the authors found gloves used in 26% of the opportunities in place of hand hygiene. Educating staff on the WHO’s five moments of hand hygiene and identifying where the highest risk opportunities are, may be a practical approach to improving compliance.
Adherence (Percentage) to the WHO’s Five Moments of Hand Hygiene. Literature Review Moment 1 Before Patient Contact Moment 2 Before Aseptic Task
Moment 3 After Body Fluid Exposure
Moment 4 After Patient Contact
Moment 5 After Contact with Surroundings
Chavali, et al. (2016) - Nurses - Allied staff Arntz et al. (2016) Postintervention Musu et al. (2017) - Physicians - Nurses - Nurses’ aides
63
39
93
91
59
92
89
96
81
70
25
30
50
70
42
38 42 37
63 64 100
67 63 100
55 82 97
28 40 86
Woodard et al. (2019)
37
9
5
63
35
A recent study looked at observed versus self-reported compliance with the five moments of hand hygiene and correlated adherence to the participant’s empathy level (Diefenbacher et al., 2022). Nurses and physicians from 20 wards in three tertiary care medical centers were observed in March 2017 and March 2018. Observed and self-reported compliance was similar except for moments two and three; self-reports during those moments were higher. Similar to other studies, the before moments had lower compliance (68%) than the after (82%) moments. The participants with higher hand hygiene compliance also had higher empathy levels. In Japan, two long-term care facilities implemented a before and after study between September 2018 and July 2020 (Sasahara et al., 2021). The authors modified the five moments of hand hygiene to fit four situations: ● Before touching around a resident’s mucous membrane area. ● Before medical practice or clean/aseptic procedures. ● After body fluid exposure/risk or after touching a resident’s mucous membrane area. ● After touching a resident’s contaminated environment. In addition, a self-assessment was completed on hand hygiene practices. The overall compliance went from 17% (soap and water) in the preintervention phase to 77% in the postintervention phase (soap and water or ABHR). After touching a resident’s contaminated environment, Moment four had the lowest compliance (11%) in the preintervention phase and increased to 62% after the intervention phase. Moment two, before a clean/aseptic procedure, had the highest compliance (43%) and increased to 100% after the intervention phase. The primary reason for such low compliance was the misunderstanding or lack of awareness of the benefits of ABHR. Hand hygiene compliance was even challenging to sustain during the COVID-19 pandemic. Using an automated hand hygiene monitoring program, Moore and colleagues (2021) measured compliance during the 10 weeks prior to the
pandemic and the 10 weeks after it began. Initial hand hygiene compliance prior to the pandemic was 46%–56% and remained over 60% for four weeks before dropping to 54% at the end of the 10 weeks. The authors suggest using an automated monitoring system to gather data over extended periods, which would benefit a multimodal long-term hand hygiene program. Sax and colleagues (2007) compared hand hygiene to using a seatbelt while driving. The risk may appear low when omitting a single moment; however, omitting multiple moments over time may result in a patient’s death due to the increased risk. Boyce (2019) indicates that the appropriate use of products, strategies for improvement, and finding the best ways to monitor performance are current issues in hand hygiene. The WHO developed a guide for hand hygiene improvement as part of a multimodal (multistep) approach (WHO, 2009a). Chavali and colleagues (2016) used a multimodal approach to improving hand hygiene and concluded that ongoing training, feedback, and verbal reminders are needed to sustain adherence and improvement. Boyce (2019) concluded that additional studies are needed to determine the most effective programs to monitor and provide feedback to change staff behavior related to hand hygiene practices. Self-Assessment Quiz Question #3 How are antibiotic-resistant pathogens most frequently spread from one patient to another in healthcare settings? a. Airborne spread resulting from patients coughing or sneezing. b. Patients encountering contaminated equipment. c. From one patient to another via the contaminated hands of clinical staff. d. Poor environmental maintenance.
Page 98
Book Code: RPTTX2024
EliteLearning.com/Pharmacy-Technician
Powered by FlippingBook