Käsihygienian toteutuminen yliopistollisessa sairaalassa:suoran havainnoinnin ja palautteen vaikutus sekä esihenkilöiden rooli käsihygienian edistämisessä

Abstract The purpose of this study was to demonstrate the impact of direct observation and feedback on staff hand hygiene compliance and its impact on the incidence of healthcare-associated infections at a university hospital during an eight-year follow-up. In addition, the managers’ roles in promoting hand hygiene were described. The data consisted of 52,115 hand hygiene observations and confirmed healthcare-associated infections at hospital level from 2013–2018 (publication I) and 31,010 hand hygiene observations and healthcare-associated infections of the corresponding period in six medical and seven surgical wards from 2013–2020 (publication II). Pearson’s Correlation Coefficient, Poisson’s regression model and logistic regression analysis were used in the data analysis. The open responses to the survey of managers (n=168) were analysed by inductive content analysis (publication III). The incidence of healthcare-associated infections started to decline at the hospital level when hand hygiene compliance was more than 80% for two years. A weak negative correlation was observed between the increase in hand hygiene compliance and the decrease in the incidence of healthcare-associated infections. In medical and surgical wards, hand hygiene among both nurses and doctors improved in all WHO’s five moments for hand hygiene. During the same period, the incidence of healthcare-associated infections decreased statistically significantly in medical and surgical wards. Managers were committed and promoted hand hygiene in many ways but also identified challenges and presented development ideas. The results can be utilized to develop hand hygiene practices, to reduce adverse events caused by healthcare-associated infections and to develop effective management in hospital organisations.Tiivistelmä Tutkimuksen tarkoituksena oli selvittää suoran havainnoinnin ja palautteen vaikutusta henkilökunnan käsihygieniakomplianssiin ja hoitoon liittyvien infektioiden ilmaantuvuuteen kahdeksan vuoden seurannassa sekä kuvata esihenkilöiden roolia käsihygienian edistämisessä yliopistollisessa sairaalassa. Aineisto koostui 52 115:sta yhden sairaalan käsihygieniahavainnosta ja todetuista hoitoon liittyvistä infektiosta vuosilta 2013–2018 (osajulkaisu I) sekä vuosina 2013–2020 kuudella sisätautien ja seitsemällä kirurgian vuodeosastolla tehdystä 31 010:sta käsihygieniahavainnosta ja vastaavan ajan hoitoon liittyvistä infektiosta (osajulkaisu II). Aineistojen analyysissa käytettiin Pearsonin korrelaatiokerrointa, Poissonin regressiomallia ja logistista regressioanalyysia. Esihenkilökyselyn (n=168) avoimet vastaukset analysoitiin induktiivisella sisällönanalyysillä (osajulkaisu III). Hoitoon liittyvien infektioiden ilmaantuvuus kääntyi sairaalatasolla laskuun, kun käsihygieniakomplianssi oli yli 80 % kahden vuoden ajan. Käsihygieniakomplianssin nousun ja hoitoon liittyvien infektioiden ilmaantuvuuden laskun välillä todettiin heikko negatiivinen korrelaatio. Sisätautien ja kirurgian vuodeosastoilla sekä hoitajien että lääkäreiden käsihygienia parani kaikissa viidessä WHO:n käsihygieniatilanteessa. Saman ajanjakson aikana hoitoon liittyvien infektioiden ilmaantuvuus laski sisätautien ja kirurgian vuodeosastoilla tilastollisesti merkitsevästi. Esihenkilöt olivat sitoutuneita ja edistivät käsihygieniaa monin tavoin, mutta havaitsivat myös haasteita ja esittivät kehitysideoita. Tuloksia voidaan hyödyntää parannettaessa käsihygienian toteutumista, pyrittäessä vähentämään hoitoon liittyvien infektioiden aiheuttamia haittatapahtumia ja kehitettäessä vaikuttavaa johtamista sairaalaorganisaatioissa

Hand-hygiene compliance by hospital staff and incidence of health-care-associated infections, Finland

Abstract Objective: To determine changes in hand-hygiene compliance after the introduction of direct observation of hand-hygiene practice for doctors and nurses, and evaluate the relationship between the changes and the incidence of health-care-associated infections. Methods: We conducted an internal audit survey in a tertiary-care hospital in Finland from 2013 to 2018. Infection-control link nurses observed hand-hygiene practices based on the World Health Organization’s strategy for hand hygiene. We calculated hand-hygiene compliance as the number of observations where necessary hand-hygiene was practised divided by the total number of observations where hand hygiene was needed. We determined the incidence of health-care-associated infections using a semi-automated electronic incidence surveillance programme. We calculated the Pearson correlation coefficient (r) to evaluate the relationship between the incidence of health-care-associated infections and compliance with hand hygiene. Findings: The link nurses made 52 115 hand-hygiene observations between 2013 and 2018. Annual hand-hygiene compliance increased significantly from 76.4% (2762/3617) in 2013 to 88.5% (9034/10 211) in 2018 (P < 0.0001). Over the same time, the number of health-care-associated infections decreased from 2012 to 1831, and their incidence per 1000 patient-days fell from 14.0 to 11.7 (P < 0.0001). We found a weak but statistically significant negative correlation between the monthly incidence of health-care-associated infections and hand-hygiene compliance (r = −0.48; P < 0.001). Conclusion: The compliance of doctors and nurses with hand-hygiene practices improved with direct observation and feedback, and this change was associated with a decrease in the incidence of health-care-associated infections. Further studies are needed to evaluate the contribution of hand hygiene to reducing health-care-associated infections

The role of managers in promoting good hand hygiene in a Finnish tertiary care hospital

Abstract Background: Hospital managers play an essential role in implementing strategies to promote good hand hygiene (HH) among health care workers. We investigated the managers’ views on their roles, challenges and developmental ideas in promoting good HH practice. Methods: A descriptive cross-sectional study with an online survey of both medical and nursing managers was conducted within a single tertiary care hospital in Finland. Three open-ended questions were analyzed using inductive content analysis. Results: A total of 78 managers out of 168 responded to the survey (response rate 46%). Managers helped promote HH practices by enabling the proper environment for adherence to good HH, visible commitment, and using various means to instruct staff about HH. Challenges included the acute hospital setting and practical problems related to the managers’ numerous responsibilities. Developmental ideas included information communication technology applications for monitoring HH as an indicator of the quality of care, versatile responses to HH audits, and clarifying the roles of different management levels. Conclusions: Managers are committed to and use various methods to promote HH. Managers would benefit from information communication technology applications to provide easy and targeted information regarding compliance with HH