Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-31T23:04:23.341Z Has data issue: false hasContentIssue false
  • English
  • Français

The devil is in the details: Factors influencing hand hygiene adherence and contamination with antibiotic-resistant organisms among healthcare providers in nursing facilities

Published online by Cambridge University Press:  24 October 2019

John P. Mills Open the ORCID record for John P. Mills [Opens in a new window] ,
Ziwei Zhu ,
Julia Mantey ,
Savannah Hatt ,
Payal Patel ,
Keith S. Kaye ,
Kristen Gibson ,
Marco Cassone ,
Bonnie Lansing  and
Lona Mody
John P. Mills*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Ziwei Zhu
Affiliation:
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan University of Michigan School of Public Health, Ann Arbor, Michigan
Julia Mantey
Affiliation:
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Savannah Hatt
Affiliation:
University of Michigan School of Public Health, Ann Arbor, Michigan
Payal Patel
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan Division of Infectious Diseases, Department of Internal Medicine, Ann Arbor Veterans’ Affairs Healthcare System, Ann Arbor, Michigan
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
Kristen Gibson
Affiliation:
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Marco Cassone
Affiliation:
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Bonnie Lansing
Affiliation:
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Lona Mody
Affiliation:
Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Geriatrics Research Education and Clinical Center, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
*
Author for correspondence: John P. Mills, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Antibiotic-resistant organism (ARO) colonization rates in skilled nursing facilities (NFs) are high; hand hygiene is crucial to interrupt transmission. We aimed to determine factors associated with hand hygiene adherence in NFs and to assess rates of ARO acquisition among healthcare personnel (HCP).

Methods:

HCP were observed during routine care at 6 NFs. We recorded hand hygiene adherence, glove use, activities, and time in room. HCP hands were cultured before and after patient care; patients and high-touch surfaces were cultured. HCP activities were categorized as high-versus low-risk for self-contamination. Multivariable regression was performed to identify predictors of hand hygiene adherence.

Results:

We recorded 385 HCP observations and paired them with cultures performed before and after patient care. Hand hygiene adherence occurred in 96 of 352 observations (27.3%) before patient care and 165 of 358 observations (46.1%) after patient care. Gloves were worn in 169 of 376 observations (44.9%). Higher adherence was associated with glove use before patient care (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.44–4.54) and after patient care (OR, 3.11; 95% CI, 1.77–5.48). Compared with nurses, certified nurse assistants had lower hand hygiene adherence (OR, 0.31; 95% CI, 0.15–0.67) before patient care and physical/occupational therapists (OR, 0.22; 95% CI, 0.11–0.44) after patient care. Hand hygiene varied by activity performed and time in the room. HCP hands were contaminated with AROs in 35 of 385 cultures of hands before patient care (0.9%) and 22 of 350 cultures of hands after patient care (6.3%).

Conclusions:

Hand hygiene adherence in NFs remain low; it is influenced by job title, type of care activity, and glove use. Hand hygiene programs should incorporate these unique care and staffing factors to reduce ARO transmission.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 12 , December 2019 , pp. 1394 - 1399
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Smith, A, Carusone, SC, Loeb, M. Hand hygiene practices of health care workers in long-term care facilities. Am J Infect Control 2008;36:492–494.CrossRefGoogle ScholarPubMed
Pan, A, Domenighini, F, Signorini, L, et al. Adherence to hand hygiene in an Italian long-term care facility. Am J Infect Control 2008;36:495–497.CrossRefGoogle Scholar
Burdsall, DP, Gardner, SE, Cox, T, et al. Exploring inappropriate certified nursing assistant glove use in long-term care. Am J Infect Control 2017;45:940–945.CrossRefGoogle ScholarPubMed
Eveillard, M, Joly-Guillou, ML, Brunel, P. Correlation between glove use practices and compliance with hand hygiene in a multicenter study with elderly patients. Am J Infect Control 2012;40:387–388.CrossRefGoogle Scholar
Girou, E, Chai, SH, Oppein, F, et al. Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission? J Hosp Infect 2004;57:162–169.CrossRefGoogle ScholarPubMed
Mody, L, Bradley, SF, Huang, SS. Keeping the “home” in nursing home: implications for infection prevention. JAMA Intern Med 2013;173:853–854.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Mody, L, Foxman, B, Bradley, S, et al. Longitudinal assessment of multidrug-resistant organisms in newly admitted nursing facility patients: implications for an evolving population. Clin Infect Dis 2018;67:837–844.CrossRefGoogle ScholarPubMed
Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007; 35(10 suppl 2):S65–S164.CrossRefGoogle ScholarPubMed
Cassone, M, Mantey, J, Perri, MB, et al. Environmental panels as a proxy for nursing facility patients with methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus colonization. Clin Infect Dis 2018;67:861–868.CrossRefGoogle ScholarPubMed
Cao, J, Min, L, Lansing, B, Foxman, B, Mody, L. Multidrug-resistant organisms on patients’ hands: a missed opportunity. JAMA Intern Med 2016;176:705–706.CrossRefGoogle ScholarPubMed
Pittet, D, Allegranzi, B, Boyce, J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30:611–622.CrossRefGoogle ScholarPubMed
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;33:761–767.CrossRefGoogle Scholar
Pineles, L, Petruccelli, C, Perencevich, EN, et al. The impact of isolation on healthcare worker contact and compliance with infection control practices in nursing homes. Infect Control Hosp Epidemiol 2018;39:683–687.CrossRefGoogle ScholarPubMed
Schweon, SJ, Kirk, J. A realistic approach towards hand hygiene for long-term care residents and health care personnel. Am J Infect Control 2011;39:336–338.CrossRefGoogle ScholarPubMed
Fuller, C, Savage, J, Besser, S, et al. “The dirty hand in the latex glove”: a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol 2011;32:1194–1199.CrossRefGoogle ScholarPubMed
Cusini, A, Nydegger, D, Kaspar, T, Schweiger, A, Kuhn, R, Marschall, J. Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions—is less more? Am J Infect Control 2015;43:922–927.CrossRefGoogle ScholarPubMed
Kuruno, N, Kasahara, K, Mikasa, K. Hand hygiene compliance in a universal gloving setting. Am J Infect Control 2017;45:830–834.CrossRefGoogle Scholar
Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.Google ScholarPubMed
Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital infection control program. Ann Intern Med 1999;130:126–130.CrossRefGoogle Scholar
Conly, JM, Hill, S, Ross, J, Lertzman, J, Louie, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;17:330–339.CrossRefGoogle Scholar
Blanco, N, Pineles, L, Lydecker, AD, et al. Transmission of resistant gram-negative bacteria to health care worker gowns and gloves during care of nursing home residents in Veterans’ Affairs community living centers. Antimicrob Agents Chemother 2017; 61(10): pii: e00790–17. doi: 10.1128/AAC.00790-17.CrossRefGoogle Scholar
Blanco, N, Johnson, JK, Sorkin, JD, et al. Transmission of resistant gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities. Infect Control Hosp Epidemiol 2018;39:1425–1430.CrossRefGoogle ScholarPubMed
Pineles, L, Morgan, DJ, Lydecker, A, et al. Transmission of methicillin-resistant Staphylococcus aureus to healthcare worker gowns and gloves during care of residents in Veterans’ Affairs nursing homes. Am J Infect Control 2017;45:947–953.CrossRefGoogle Scholar
Jackson, SS, Thom, KA, Magder, LS, et al. Patient contact is the main risk factor for vancomycin-resistant Enterococcus contamination of healthcare workers’ gloves and gowns in the intensive care unit. Infect Control Hosp Epidemiol 2018;39:1063–1067.CrossRefGoogle ScholarPubMed
Wolfensberger, A, Clack, L, Kuster, SP, et al. Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity—a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2018;39:1093–1107.CrossRefGoogle ScholarPubMed
Supplementary material: File

Mills et al. supplementary material

Mills et al. supplementary material 1

Download Mills et al. supplementary material(File)
File 298.7 KB
Supplementary material: File

Mills et al. supplementary material

Mills et al. supplementary material 2

Download Mills et al. supplementary material(File)
File 28.8 KB