Borghild Løyland1, Sibyl Wilmont2, Bevin Cohen2, Elaine Larson2. 1. Department of Nursing and Health Promotion, Oslo and Akershus University College, Oslo, Norway. 2. School of Nursing, Columbia University, New York City, NY, USA.
Abstract
OBJECTIVE: To describe hand-hygiene practices in pediatric long-term care (pLTC) facilities and to identify observed barriers to, and potential solutions for, improved infection prevention. DESIGN: Observational study using (i) the World Health Organization's '5 Moments for Hand Hygiene' validated observation tool to record indications for hand hygiene and adherence; and (ii) individual logs of subjective impressions of behavioral and/or systemic barriers witnessed during direct observation. SETTING: Staff in three pLTC facilities (284 beds total) were observed by two trained nurses 1 day a week for 3 weeks in February and March 2015. PARTICIPANTS: Direct providers of health, therapeutic and rehabilitative care, and other staff responsible for social and academic activities for children with complex, chronic medical conditions. MAIN OUTCOME MEASURES: Hand-hygiene indications, adherence and barriers. RESULTS: Hand hygiene was performed for 40% of the 847 indications observed and recorded. Adherence increased at one site and decreased in the other two sites during the study period. Adherence appeared to be influenced by individuals' knowledge, attitudes, beliefs and work setting. CONCLUSIONS: Poor hand-hygiene adherence was observed overall. Specific barriers were identified, which suggest a contextual approach to the interpretation of results indicated in this uniquely challenging setting. We offer some practical suggestions for overcoming those barriers or mitigating their effect. Ultimately, an adaptation of the '5 Moments for Hand Hygiene' may be necessary to improve infection prevention in pLTC.
OBJECTIVE: To describe hand-hygiene practices in pediatric long-term care (pLTC) facilities and to identify observed barriers to, and potential solutions for, improved infection prevention. DESIGN: Observational study using (i) the World Health Organization's '5 Moments for Hand Hygiene' validated observation tool to record indications for hand hygiene and adherence; and (ii) individual logs of subjective impressions of behavioral and/or systemic barriers witnessed during direct observation. SETTING: Staff in three pLTC facilities (284 beds total) were observed by two trained nurses 1 day a week for 3 weeks in February and March 2015. PARTICIPANTS: Direct providers of health, therapeutic and rehabilitative care, and other staff responsible for social and academic activities for children with complex, chronic medical conditions. MAIN OUTCOME MEASURES: Hand-hygiene indications, adherence and barriers. RESULTS: Hand hygiene was performed for 40% of the 847 indications observed and recorded. Adherence increased at one site and decreased in the other two sites during the study period. Adherence appeared to be influenced by individuals' knowledge, attitudes, beliefs and work setting. CONCLUSIONS: Poor hand-hygiene adherence was observed overall. Specific barriers were identified, which suggest a contextual approach to the interpretation of results indicated in this uniquely challenging setting. We offer some practical suggestions for overcoming those barriers or mitigating their effect. Ultimately, an adaptation of the '5 Moments for Hand Hygiene' may be necessary to improve infection prevention in pLTC.
Authors: Elaine L Larson; Meghan T Murray; Bevin Cohen; Edwin Simpser; Marianne Pavia; Olivia Jackson; Haomiao Jia; R Gordon Hutcheon; Linda Mosiello; Natalie Neu; Lisa Saiman Journal: Behav Med Date: 2017-03-03 Impact factor: 3.104