Skip to main content
SpringerLink
Log in

Long-term sustainability of hand hygiene improvements in the hemodialysis setting

  • Brief Report
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

In a previous observational intervention study, we achieved a more than 100 % increase in overall hand hygiene (HH) compliance in the hemodialysis setting by increasing the number of hand rubs (HR) performed and concomitantly optimizing HH standard operating procedures (SOPs). SOPs were mainly aimed at reducing the number of avoidable opportunities due to a less than perfect workflow. However, the long-term sustainability of this successful intervention was not evaluated. The present study was carried out to evaluate the long-term effects of our previous successful intervention.

Methods

We conducted a follow-up observational study 1 year after the first intervention study in the same hemodialysis unit to assess the sustainability. No HH-related interventions were performed in the 1 year between studies. The main outcome was HH compliance, and the secondary outcome was opportunities per hemodialysis procedure.

Results

A total of 1,574 opportunities for HH and 871 hand rubs (HR) were observed during the follow-up observational study. Overall, compliance was 55 %, which was significantly than that at the end of the first study (62 %; p < 0.0001), but significantly higher than that at the start and mid-term phases of the first study (37 and 49 %, p < 0.0001). Both the decrease in HH opportunities and the increase in HR were sustained over the course of this observational study. The number of avoidable opportunities in the present study was similar to that at the end of the previous study. Thus, in 320 opportunities (20 %), gloves were worn instead of HR performed, representing 46 % of all missed HR.

Conclusions

Despite a decrease in HH compliance compared to the last postintervention period, a multifaceted intervention focusing on standardization and workflow optimization resulted in a sustained improvement in HH. We therefore propose that standardization of the hemodialysis workflow aimed at improving HH is a promising avenue for improving the quality of patient care and outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Fabrizi F, Martin P. Health care-associated transmission of hepatitis B and C viruses in hemodialysis units. Clin Liver Dis. 2010;14:49–60.

    Article  PubMed  Google Scholar 

  2. David A, Risitano DC, Mazzeo G, Sinardi L, Venuti FS, Sinardi AU. Central venous catheters and infections. Minerva Anestesiol. 2005;71:561–4.

    PubMed  CAS  Google Scholar 

  3. Tacconelli E. New strategies to identify patients harbouring antibiotic-resistant bacteria at hospital admission. Clin Microbiol Infect. 2006;12:102–9.

    Article  PubMed  CAS  Google Scholar 

  4. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet. 2000;356:1307–12.

    Article  PubMed  CAS  Google Scholar 

  5. Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73:305–15.

    Article  PubMed  CAS  Google Scholar 

  6. Johnson PD, Martin R, Burrell LJ, et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust. 2005;183:509–14.

    PubMed  Google Scholar 

  7. Siegel JD, Rhinehardt E, Jackson M, Chiarello L; The Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings. Healthcare Infection Control Practices Advisory Committee (HICPAC), Centers of Disease Control, Atlanta; 2006. p. S1–S74.

  8. World Health Organization (WHO). Guidelines on hand hygiene in health care. World Health Organization, Geneva; 2009.

  9. Arenas MD, Sánchez-Payá J, Barril G, et al. Multicentric survey of the practice of hand hygiene in haemodialysis units: factors affecting compliance. Nephrol Dial Transpl. 2005;20:1164–71.

    Article  Google Scholar 

  10. Erasmus V, Daha TJ, Brug H, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010;31:283–94.

    Article  PubMed  Google Scholar 

  11. Scheithauer S, Eitner F, Mankartz J, et al. Improving hand hygiene compliance rates in the haemodialysis setting: more than just more hand rubs. Nephrol Dial Transpl. 2012;27:766–70.

    Article  Google Scholar 

  12. Mayer J, Mooney B, Gundlappali A, et al. Dissemination and sustainability of a hospital wide hand hygiene program emphasizing positive reinforcement. Infect Control Hosp Epidemiol. 2011;32:59–66.

    Article  PubMed  Google Scholar 

  13. Tromp M, Huis A, de Guchteneire I, et al. The short-term and long-term effectiveness of a multidisciplinary hand hygiene improvement program. Am J Infect Control. 2012;40:732–6.

    Google Scholar 

  14. Whitby M, Pessoa-Silva CL, McLaws ML, et al. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect. 2007;65:1–8.

    Article  PubMed  CAS  Google Scholar 

  15. Larson E, Killien M. Factors influencing handwashing behavior of patient care personnel. Am J Infect Control. 1982;10:93–9.

    Article  PubMed  CAS  Google Scholar 

  16. Weeks A. Why I don’t wash my hands between each patient contact. BMJ. 1999;319:518.

    Article  PubMed  CAS  Google Scholar 

  17. Voss A, Widmer AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol. 1997;18:205–8.

    Article  PubMed  CAS  Google Scholar 

  18. Pittet D, Simon A, Hugonnet S, Pessoa-Silva CL, Sauvan V, Perneger TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med. 2004;141:1–8.

    Article  PubMed  Google Scholar 

  19. Pittet D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol. 2000;21:381–6.

    Article  PubMed  CAS  Google Scholar 

  20. Gould DJ, Drey NS, Moralejo D, Grimshaw J, Chudleigh J. Interventions to improve hand hygiene compliance in patient care. J Hosp Infect. 2008;68:193–202.

    Article  PubMed  CAS  Google Scholar 

  21. Pittet D, Allegranzi B, Sax H, et al. Considerations for a WHO European strategy on healthcare-associated infection, surveillance, and control. Lancet Infect Dis. 2005;5:242–50.

    Article  PubMed  Google Scholar 

  22. Aboumatar H, Ristaino P, Davis RO, et al. Infection prevention promotion program based on the PRECEDE model: improving hand hygiene behaviors among healthcare personnel. Infect Control Hosp Epidemiol. 2012;33:144–51.

    Article  PubMed  Google Scholar 

  23. Berhe M, Edmond MB, Bearman G. Measurement and feedback of infection control process measures in the intensive care unit: impact on compliance. Am J Infect Control. 2006;34:537–9.

    Article  PubMed  Google Scholar 

  24. Mayer J, Mooney B, Gundlapalli A, et al. Dissemination and sustainability of a hospital-wide hand hygiene program emphasizing positive reinforcement. Infect Control Hosp Epidemiol. 2011;32:59–66.

    Article  PubMed  Google Scholar 

  25. Doron SI, Kifuji K, Hynes BT, et al. Multifaceted approach to education, observation, and feedback in a successful hand hygiene campaign. Jt Commun J Qual Patient Saf. 2011;37:3–10.

    Google Scholar 

  26. Scheithauer S, Oude-Aost J, Heimann K, et al. Hand hygiene in pediatric and neonatologic intensive care unit patients: daily opportunities and indication- and profession-specific analyses of compliance. Am J Infect Control. 2011;39:732–7.

    Article  PubMed  Google Scholar 

  27. Scheithauer S, Haefner H, Schwanz T, et al. Compliance with hand hygiene on a surgery, a medical and a neurological ICU: direct observation versus calculating disinfectant usage. Am J Infect Control. 2009;37:835–41.

    Article  PubMed  Google Scholar 

  28. Scheithauer S, Oberröhrmann A, Haefner H, et al. Compliance with hand hygiene in patients with methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing enterobacteria. J Hosp Infect. 2010;76:320–3.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The support and cooperation of the motivated dialysis nursing staff at the University Hospital of the RWTH Aachen who participated in improving dialysis-associated hand hygiene procedures throughout the study are gratefully acknowledged.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Infection Control and Infectious Diseases, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany

    S. Scheithauer, H. Häfner & S. W. Lemmen

  2. Division of Nephrology and Clinical Immunology, RWTH Aachen University Hospital, Aachen, Germany

    F. Eitner & J. Floege

  3. Kidney Diseases Research, Bayer Pharma AG, Wuppertal, Germany

    F. Eitner

Authors
  1. S. Scheithauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Eitner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Häfner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Floege
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. W. Lemmen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Scheithauer.

Additional information

S. Scheithauer and F. Eitner contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scheithauer, S., Eitner, F., Häfner, H. et al. Long-term sustainability of hand hygiene improvements in the hemodialysis setting. Infection 41, 675–680 (2013). https://doi.org/10.1007/s15010-013-0424-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-013-0424-0

Keywords

Search

Navigation