Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing Healthcare–Associated Infections

BACKGROUND: Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs. METHODS AND FINDINGS: A 4-year hospital-wide HHP, with particular emphasis on using an alcohol-based hand rub, was implemented in April 2004 at a 2,200-bed teaching hospital in Taiwan. Compliance was measured by direct observation and the use of hand rub products. Poisson regression analyses were employed to evaluate the densities and trends of HAIs during the preintervention (January 1999 to March 2004) and intervention (April 2004 to December 2007) periods. The economic impact was estimated based on a case-control study in Taiwan. We observed 8,420 opportunities for hand hygiene during the study period. Compliance improved from 43.3% in April 2004 to 95.6% in 2007 (p<.001), and was closely correlated with increased consumption of the alcohol-based hand rub (r = 0.9399). The disease severity score (Charlson comorbidity index) increased (p = .002) during the intervention period. Nevertheless, we observed an 8.9% decrease in HAIs and a decline in the occurrence of bloodstream, methicillin-resistant Staphylococcus aureus, extensively drug-resistant Acinetobacter baumannii, and intensive care unit infections. The intervention had no discernable impact on HAI rates in the hematology/oncology wards. The net benefit of the HHP was US$5,289,364, and the benefit-cost ratio was 23.7 with a 3% discount rate. CONCLUSIONS: Implementation of a HHP reduces preventable HAIs and is cost effective

Compliance of health care workers with hand hygiene practices: independent advantages of overt and covert observers.

BACKGROUND: Evaluation and feedback of hand hygiene (HH) compliance are important elements of the WHO multimodal strategy for hospital infection control. Overt observation is recommended, but it may be confounded by Hawthorne effect. Covert observation offers the opportunity to decrease observer bias. In this study we conducted a one year hospital-wide HH promotion program that included medical students (MS) as covert observers. METHODS: HH compliance for the five WHO indications was determined by trained and validated observers. The overt observers consisted of eleven infection control nurses (ICNs) and two unit HH ambassadors (UAs) in each of 83 wards. The covert observers consisted of nine MS during their rotating clinical clerkships. Feedback was provided to department heads and staff each quarter. RESULTS: Of the 23,333 HH observations 76.0% were by MS, 5.3% by ICNs and 18.7% by UAs. The annual compliance rates were MS 44.1%, ICNs 74.4% and UAs 94.1%; P<0.001. The MS found significantly lower annual compliance rates for 4/5 HH indications compared to ICNs and UAs; P<0.05. The ICNs reported significantly improvement from the first to the fourth quarter; P<0.001. This was associated with feedback from the MS of very poor compliance by nurses during the first quarter. CONCLUSIONS: Based on these findings we recommend a two-pronged approach to HH programs. The role of ICNs and UAs is to educate, serve as role models, establish, sustain good HH practices and provide direct feedback. The role of the covert observers is to measure compliance and provide independent feedback

The Potential Implications of Hydrogen Sulfide in Aging and Age-Related Diseases through the Lens of Mitohormesis

The growing increases in the global life expectancy and the incidence of chronic diseases as a direct consequence have highlighted a demand to develop effective strategies for promoting the health of the aging population. Understanding conserved mechanisms of aging across species is believed helpful for the development of approaches to delay the progression of aging and the onset of age-related diseases. Mitochondrial hormesis (or mitohormesis), which can be defined as an evolutionary-based adaptive response to low-level stress, is emerging as a promising paradigm in the field of anti-aging. Depending on the severity of the perceived stress, there are varying levels of hormetic response existing in the mitochondria called mitochondrial stress response. Hydrogen sulfide (H2S) is a volatile, flammable, and toxic gas, with a characteristic odor of rotten eggs. However, H2S is now recognized an important gaseous signaling molecule to both physiology and pathophysiology in biological systems. Recent studies that elucidate the importance of H2S as a therapeutic molecule has suggested its protective effects beyond the traditional understanding of its antioxidant properties. H2S can also be crucial for the activation of mitochondrial stress response, postulating a potential mechanism for combating aging and age-related diseases. Therefore, this review focuses on highlighting the involvement of H2S and its sulfur-containing derivatives in the induction of mitochondrial stress response, suggesting a novel possibility of mitohormesis through which this gaseous signaling molecule may promote the healthspan and lifespan of an organism

The distribution of opportunities for three types of observers to assess hand hygiene program during a one-year study conducted during 2010 and 2011 by the Center of Excellence for Hand Hygiene (HH) at the National Taiwan University Hospital.

*<p>The differences among the observers in frequency of opportunities to witness HH performances were significant; P<0.001.</p>†<p>The differences among the observers in proportion of observations according to professional categories, department or HH indications were significant; P<0.001.</p

Comparison of the characteristics of three types of observers and the pros and cons their ability to assess the efficacy of the hand hygiene program during a one-year study conducted during 2010 and 2011 by the Center of Excellence for Hand Hygiene at the National Taiwan University Hospital.

<p>MS: medical students; UA: unit HH ambassador.</p

Hand hygiene compliance rates according to professional category of the healthcare workers and type of observers.

<p>Compliance observed by medical students (MS) was significantly lower as than by infection control nurses (ICNs) and unit HH ambassadors (UAs) (all P<0.001). The numbers in parenthesis are the hand hygiene opportunities. T-bar represents one standard deviation.</p

Hand hygiene compliance rates by type of observers and quarter.

<p>The compliance rates observed by medical students (MS) were significantly lower than those by infection control nurses (ICNs) and unit HH ambassadors (UAs) in each quarter (all the <i>P</i> value <0.001). The numbers in parenthesis represented hand hygiene opportunities observed. T-bar represented one standard deviation.</p

Hand hygiene compliance rate by type of observers (A. medical student (MS), B. Infection control nurses, C. unit HH ambassadors (UAs)), professional category, department, indication of hand hygiene, and period.

<p>Hand hygiene compliance rate by type of observers (A. medical student (MS), B. Infection control nurses, C. unit HH ambassadors (UAs)), professional category, department, indication of hand hygiene, and period.</p