Jan 272015
 
Related Articles

Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene.

J Hosp Infect. 2014 Dec 16;

Authors: Davis R, Parand A, Pinto A, Buetow S

Abstract
BACKGROUND: Patients could help to improve the hand hygiene (HH) compliance of healthcare professionals (HCPs) by reminding them to sanitize their hands.
AIM: To review the effectiveness of strategies aimed at increasing patient involvement in reminding HCPs about their HH.
METHODS: A systematic review was conducted across Medline, EMBASE and PsycINFO between 1980 and 2013.
FINDINGS: Twenty-eight out of a possible 1956 articles were included. Of these, 23 articles evaluated the effectiveness of developed patient-focused strategies and five articles examined patients' attitudes towards hypothetical strategies. Sixteen articles evaluated single-component strategies (e.g. videos) and 12 articles evaluated multi-modal approaches (e.g. combination of video and leaflet). Overall, the strategies showed promise in helping to increase patients' intentions and/or involvement in reminding HCPs about their HH. HCP encouragement appeared to be the most effective strategy. However, the methodological quality of the articles in relation to addressing the specific aims of this review was generally weak.
CONCLUSION: A number of strategies are available to encourage patients to question HCPs about their HH. Better controlled studies with more robust outcome measures will enhance understanding about which strategies may be most successful and why.

PMID: 25617088 [PubMed - as supplied by publisher]

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Jan 152015
 

Comparison of different hand-drying methods: the potential for airborne microbe dispersal and contamination.

J Hosp Infect. 2014 Dec 17;

Authors: Best EL, Redway K

Abstract
Efficient washing and drying of hands is important in prevention of the transfer of micro-organisms. However, knowledge surrounding the potential for microbial contamination according to hand-drying methods is limited. This study assessed the potential for airborne microbe dispersal during hand drying by four methods (paper towels, roller towel, warm air and jet air dryer) using three different models. The jet air dryer dispersed liquid from users' hands further and over a greater range (up to 1.5m) than the other drying methods (up to 0.75m), demonstrating the differing potential risks for airborne microbe dissemination, particularly if handwashing is suboptimal.

PMID: 25586988 [PubMed - as supplied by publisher]

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Jan 132015
 

Airborne transmission and precautions: facts and myths.

J Hosp Infect. 2014 Dec 13;

Authors: Seto WH

Abstract
Airborne transmission occurs only when infectious particles of <5μm, known as aerosols, are propelled into the air. The prevention of such transmission is expensive, requiring N95 respirators and negative pressure isolation rooms. This lecture first discussed whether respiratory viral infections are airborne with reference to published reviews of studies before 2008, comparative trials of surgical masks and N95 respirators, and relevant new experimental studies. However, the most recent experimental study, using naturally infected influenza volunteers as the source, showed negative results from all the manikins that were exposed. Modelling studies by ventilation engineers were then summarized to explain why these results were not unexpected. Second, the systematic review commissioned by the World Health Organization on what constituted aerosol-generating procedures was summarized. From the available evidence, endotracheal intubation either by itself or combined with other procedures (e.g. cardiopulmonary resuscitation or bronchoscopy) was consistently associated with increased risk of transmission by the generation of aerosols.

PMID: 25578684 [PubMed - as supplied by publisher]

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Jan 132015
 

Epidemiology of meticillin-resistant Staphylococcus aureus bloodstream infections in Alberta, Canada.

J Hosp Infect. 2014 Dec 16;

Authors: Taylor G, Bush K, Leal J, Henderson E, Chui L, Louie M

Abstract
Most studies of meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) reflect a convenience sample from a single hospital or a small group of hospitals. From April 2011 to March 2013, cases of MRSA BSI diagnosed in all hospitals in Alberta, Canada were captured prospectively. Isolates were spa typed. In total, there were 299 cases of MRSA BSI, equating to 3.95 cases per 100,000 population. Community-acquired BSI accounted for 66.9% of cases, and 33.1% of cases were hospital acquired. Cases were predominantly seen in tertiary care (36.4%) and large urban hospitals (34.3%), but were also common in regional and rural hospitals. Paediatric hospitals had very few cases (3.0%). Two clones, CMRSA 10 (USA 300; 40.2%) and CMRSA 2 (USA 100/800; 38.0%), predominated.

PMID: 25578685 [PubMed - as supplied by publisher]

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Dec 072014
 

Hand hygiene monitoring technology: a systematic review of efficacy.

J Hosp Infect. 2014 Oct 31;

Authors: Srigley JA, Gardam M, Fernie G, Lightfoot D, Lebovic G, Muller MP

Abstract
Electronic and video monitoring systems (EMS/VMS) may improve hand hygiene by providing feedback, real-time reminders or via the Hawthorne effect. The aim of this systematic review was to assess the efficacy of EMS/VMS in improving hand hygiene or reducing the incidence of healthcare-associated infection (HCAI). Experimental and quasi-experimental studies were included if they measured any hand hygiene outcome and/or HCAI incidence. Of the studies included, seven used system-defined compliance (SDC) (N = 6) or hand hygiene event rate (N = 1) as their outcome. SDC differed for all systems. Most (N = 6) were single ward studies. Two uncontrolled pretest‒post-test studies evaluating EMS that provided voice prompts showed increases in SDC, but risk of bias was high. Two uncontrolled time-series analyses of VMS that provided aggregate feedback demonstrated large, sustained improvement in SDC and were at moderate risk of bias. One non-randomized controlled trial of EMS with aggregate feedback found no difference in hand hygiene frequency but was at high risk of bias. Two studies evaluated EMS providing individual feedback and real-time reminders. A pretest‒post-test study at high risk of bias showed an increase in SDC. An RCT at low risk of bias showed 6.8% higher SDC in the intervention arm partially due to a fall in SDC in the control arm. In conclusion, the overall study quality was poor. The study at lowest risk of bias showed only a small increase in SDC. VMS studies at moderate risk of bias showed rapid and sustained increases in SDC. Data were insufficient to recommend EMS/VMS. Future studies should prioritize testing of VMS using stronger study designs including control arms and validated, system-independent measures of hand hygiene.

PMID: 25480021 [PubMed - as supplied by publisher]

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Dec 072014
 

Analysis of interventions to reduce the incidence of Clostridium difficile infection at a London teaching hospital trust, 2003‒2011.

J Hosp Infect. 2014 Oct 24;

Authors: Marufu O, Desai N, Aldred D, Brown T, Eltringham I

Abstract
BACKGROUND: Since 2008 there has been a substantial fall in the incidence of Clostridium difficile infection (CDI) in the UK, though it is unclear what contribution local and governmental interventions have made to this reduction.
AIM: To assess the value of retrospective analysis using a segmented regression model and single factor analysis of variance (ANOVA) in assessing the impact of interventions to reduce hospital-acquired CDI.
METHODS: A retrospective time-series analysis of 28 interventions implemented over an eight-year period by a large teaching hospital trust. Single factor ANOVA was used to analyse the association between CDI rates and changes in antibiotic usage and hand hygiene compliance data.
FINDINGS: Whereas several interventions were associated with a reduction in CDI rates, insufficient time-points were available between interventions to allow meaningful interpretation of all the data. Reduction of cephalosporin and quinolone use was associated with reduction in CDI rates. There was little association between observed variations in hand hygiene compliance and CDI rates.
CONCLUSION: Though several interventions were associated with a reduction in CDI, this study illustrates the inherent limitations of retrospective time-series methodology for the investigation of infection control measures where large numbers of interventions are introduced over a short time-period. Single factor ANOVA demonstrated an association between fall in CDI and restriction of high-risk antibiotic use. Little association was demonstrated between compliance rates documented in hand hygiene audits and CDI, though compliance was relatively high throughout the period of study.

PMID: 25480022 [PubMed - as supplied by publisher]

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