John P Mills1, Ziwei Zhu2,3, Julia Mantey2, Savannah Hatt3, Payal Patel1,4, Keith S Kaye1, Kristen Gibson2, Marco Cassone2, Bonnie Lansing2, Lona Mody2,5. 1. Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan. 2. Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan. 3. University of Michigan School of Public Health, Ann Arbor, Michigan. 4. Division of Infectious Diseases, Department of Internal Medicine, Ann Arbor Veterans' Affairs Healthcare System, Ann Arbor, Michigan. 5. Geriatrics Research Education and Clinical Center, Veterans' Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
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.
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.
Authors: Lona Mody; Kyle J Gontjes; Marco Cassone; Kristen E Gibson; Bonnie J Lansing; Julia Mantey; Mohammed Kabeto; Andrzej Galecki; Lillian Min Journal: JAMA Netw Open Date: 2021-07-01