Improving Adherence to Hand Hygiene Practice: a Multidisciplinary Approach
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Didier Pittet, Md, Ms, Cbe
Professor DIDIER PITTET, MD, MS, CBE Didier Pittet, MD, MS, born 20/03/1957, is Professor of Medicine, the Hospital Epidemiologist and Director of the Infection Control Programme and World Health Organization (WHO) Collaborating Centre on Patient Safety at the University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. He holds Honorary Professorships at Imperial College London, UK, Hong Kong Polytechnic University School of Health Science, and the First Medical School of the Fu, Shanghai, China. Professor Pittet is Lead Adviser of the first WHO Global Patient Safety Challenge “Clean Care is Safe Care” and the African Partnerships for Patient Safety, Patient Safety, WHO Headquarter. Prof Pittet is the recipient of several national and international honours including a CBE (Commander of the British Empire) awarded by Her Majesty Queen Elisabeth II for services to the prevention of healthcare-associated infection in the UK (2007), the Society for Healthcare Epidemiology of America Lectureship for his contribution to infection control and healthcare epidemiology (2008) and the European Society of Clinical Microbiology and Infectious Diseases’ Award for Excellence (2009). The book “Clean Hands Save Lives” by the French writer Thierry Crouzet (Editions L’Âge d’Homme, 2014), translated in 11 languages as of December 2014, describes Didier Pittet medical odyssey to promote hand hygiene and patient safety worldwide. D Pittet is co-author of more than 500 publications in peer- reviewed journals and 50 textbook chapters (H-index 66; total citations 15960 as of 25/1/2015). He serves on the editorial boards of several journals and is an editorial consultant of the Lancet. -
The World Health Organization Guidelines on Hand Hygiene in Health Care and Their Consensus Recommendations
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY JULY 2009, VOL. 30, NO. 7 WHO GUIDELINE The World Health Organization Guidelines on Hand Hygiene in Health Care and Their Consensus Recommendations Didier Pittet, MD, MS; Benedetta Allegranzi, MD; John Boyce, MD; for the World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative. The Guidelines represent the contribution of more than 100 international experts and provide a comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensus- based recommendations, and lessons learned from testing their Advanced Draft and related implementation tools. Infect Control Hosp Epidemiol 2009; 30:611-622 The World Health Organization (WHO) First Global Patient propriate practice performance. According to WHO rec Safety Challenge, launched in October 20051 and aimed at ommendations for guideline preparation, a test phase of the reducing healthcare-associated infection worldwide, iden Advanced Draft guidelines was undertaken by using the im tified the promotion of hand hygiene practices in health care plementation strategy and tools in eight pilot healthcare set as a priority measure and the entry point to improve infection tings in seven countries representing all WHO regions world control in Member States.2 -
Hand Hygiene: Clean Hands for Healthcare Personnel
Core Concepts for Hand Hygiene: Clean Hands for Healthcare Personnel 1 Presenter Russ Olmsted, MPH, CIC Director, Infection Prevention & Control Trinity Health, Livonia, MI Contributions by Heather M. Gilmartin, NP, PhD, CIC Denver VA Medical Center University of Colorado Laraine Washer, MD University of Michigan Health System 2 Learning Objectives • Outline the importance of effective hand hygiene for protection of healthcare personnel and patients • Describe proper hand hygiene techniques, including when various techniques should be used 3 Why is Hand Hygiene Important? • The microbes that cause healthcare-associated infections (HAIs) can be transmitted on the hands of healthcare personnel • Hand hygiene is one of the MOST important ways to prevent the spread of infection 1 out of every 25 patients has • Too often healthcare personnel do a healthcare-associated not clean their hands infection – In fact, missed opportunities for hand hygiene can be as high as 50% (Chassin MR, Jt Comm J Qual Patient Saf, 2015; Yanke E, Am J Infect Control, 2015; Magill SS, N Engl J Med, 2014) 4 Environmental Surfaces Can Look Clean but… • Bacteria can survive for days on patient care equipment and other surfaces like bed rails, IV pumps, etc. • It is important to use hand hygiene after touching these surfaces and at exit, even if you only touched environmental surfaces Boyce JM, Am J Infect Control, 2002; WHO Guidelines on Hand Hygiene in Health Care, WHO, 2009 5 Hands Make Multidrug-Resistant Organisms (MDROs) and Other Microbes Mobile (Image from CDC, Vital Signs: MMWR, 2016) 6 When Should You Clean Your Hands? 1. Before touching a patient 2. -
Clean Your Hands in the Context of Covid-19
WHO SAVE LIVES: CLEAN YOUR HANDS IN THE CONTEXT OF COVID-19 Hand Hygiene in the Community You can play a critical part in fighting COVID-19 • Hands have a crucial role in the transmission of COVID-19. • COVID-19 virus primarily spreads through droplet and contact transmission. Contact transmission means by touching infected people and/or contaminated objects or surfaces. Thus, your hands can spread virus to other surfaces and/or to your mouth, nose or eyes if you touch them. Why is Hand Hygiene so important in preventing infections, including COVID-19? • Hand Hygiene is one of the most effective actions you can take • Community members can play a critical role in fighting COVID-19 to reduce the spread of pathogens and prevent infections, by adopting frequent hand hygiene as part of their day-to-day including the COVID-19 virus. practices. https://www.who.int/news-room/campaigns/connecting-the-world-to-combat-coronavirus/safehands-challengeJoin the #SAFEHANDS challenge now and save lives! Post a video or picture of yourself washing your hands and tag #SAFEHANDS https://www.who.int/who-documents-detail/interim-recommendations-on-obligatory-hand-hygiene-against-transmission-of-covid-19WHO calls upon policy makers to provide • the necessary infrastructure to allow people to eectively perform hand hygiene in public places; • to support hand hygiene supplies and best practices in health care facilities. Hand Hygiene in Health Care Why is it important to participate in the WHO global hand hygiene campaign for the fight against COVID-19? • The WHO global hand hygiene campaign SAVEhttps://www.who.int/infection-prevention/campaigns/clean-hands/en/ LIVES: Clean Your Hands mobilizes people around the world to increase adherence to hand hygiene in health care facilities, thus protecting health care workers and patient from COVID-19 and other pathogens. -
Hand Hygiene Behaviors in a Representative Sample of Polish
pathogens Article Hand Hygiene Behaviors in a Representative Sample of Polish Adolescents in Regions Stratified by COVID-19 Morbidity and by Confounding Variables (PLACE-19 Study): Is There Any Association? Dominika Skolmowska 1, Dominika Gł ˛abska 1,* and Dominika Guzek 2 1 Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; [email protected] 2 Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; [email protected] * Correspondence: [email protected]; Tel.: +48-22-593-71-34 Received: 1 October 2020; Accepted: 28 November 2020; Published: 1 December 2020 Abstract: The hand hygiene may possibly influence the course of the COVID-19 pandemic, but the multifactorial influence on hand hygiene knowledge and behaviors is proven. The aim of the study was to analyze hand hygiene behaviors in a national representative sample of Polish adolescents in regions stratified by COVID-19 morbidity, while taking socioeconomic status of the region, as well rural or urban environment, into account as possible interfering factors. The study was conducted Polish Adolescents’ COVID-19 Experience (PLACE-19) Study population (n = 2323) that was recruited based on a random sampling of schools, while the pair-matching procedure was applied within schools and age, in order to obtain adequate number of boys and girls, representative for the general Polish population (n = 1222). The participants were asked about their handwashing habits while using Handwashing Habits Questionnaire (HHQ) and about applied procedure of washing hands. -
The Role of Hand Hygiene and Hospital Environmental Hygiene”
Securing Patient Safety, Bruxelles - Sept 2019 Clean Care is Safer Care : “The role of hand hygiene and hospital environmental hygiene” Professor Didier Pittet, MD, MS, Infection Control Programme WHO Collaborating Centre on Patient Safety University of Geneva Hospitals and Faculty of Medicine, Switzerland Lead Adviser, SAVE LIVES: Clean Your Hands World Health Organization (WHO) Service Delivery & Safety. WHO Headquarter, Geneva, Switzerland at least 0.5 million each day in hospitals only © Hospital infections 500,000 patients each day 16 million deaths every year Daily impact of hospital infections in the USA…. Healthcare-associated infections A silent pandemic © No hospital, no country, no health- care system in the world can claim to have solved the problem Compliance < 40% Why ? Relation between opportunities for hand hygiene for nurses and compliance across hospital wards 65 pediatrics On average, 55 medicine 22 opp / hour for an ICU nurse surgery 45 ob / gyn ICU 35 Compliance with hand hygiene ( , %) with hygiene hand Compliance 8 12 16 20 Opportunities for hand hygiene per patient-hour of care adapted from Pittet D et al. Annals Intern Med 1999; 130:126 Time constraint = major obstacle for hand hygiene handwashing alcohol-based soap + water hand rub 1 to 1.5 min 15 to 20 sec Handwashing … an action of the past (except when hands are visibly soiled) System change Alcohol-based hand rub is standard of care Alcohol-based hand rub at the point of The University care of Geneva Hospitals, 1995 Before and after any patient contact After glove use In between different body site care Would it work ? Would it make a difference ? Mashhad, Iran April 2015 Changing behavior …. -
Age Distribution of Influenza-Like Illness+ (ILI) Cases in New Hampshire
Bureau of Infectious Disease Control Coronavirus Disease 2019 (COVID-19) Guidance for Long-term Care Facilities (LTCF) March 12, 2020 Persons older than 60 years and those with chronic medical conditions such as diabetes, hypertension and cardiovascular disease may be at higher risk for severe illness and death from COVID-19. Long-term care facilities have experience managing respiratory infections and outbreaks among residents and staff and should apply the same outbreak management principles to COVID-19. These recommendations are specific for nursing homes, including skilled nursing facilities, and may be applicable to some assisted living facilities. The New Hampshire Division of Public Health Services (DPHS) recommends adherence to CMS Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes. Based on the regional epidemiology, we suggest limiting visitation (rather than the more permissive “discouraging visitation”) as described in CMS guidance. Facilities may elect to implement stricter visitor policies, according to their circumstances including resources and setting. Facilities should immediately implement active screening of visitors. Visitors should be instructed to wash hands or use alcohol-based hand rub upon entry. NH DPHS provides a visitor screening tool here for facilities to utilize. Note this is modified from the CMS tool to more accurately reflect the evolving epidemic. The NH screening tool assesses visitors for the following: o Signs or symptoms of respiratory infection, such as fever, cough, shortness of breath, or sore throat. o In the last 14 days, contact with someone with a confirmed diagnosis of COVID-19, or who is under investigation for COVID-19, or is ill with respiratory illness. -
Implementation of Infection Control Best Practice in Intensive Care Units Throughout Europe: a Mixed-Method Evaluation Study
Implementation Science This Provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Implementation of infection control best practice in intensive care units throughout Europe: a mixed-method evaluation study Implementation Science 2013, 8:24 doi:10.1186/1748-5908-8-24 Hugo Sax ([email protected]) Lauren Clack ([email protected]) Sylvie Touveneau ([email protected]) Fabricio da Jantarada ([email protected]) Didier Pittet ([email protected]) Walter Zingg ([email protected]) ISSN 1748-5908 Article type Study protocol Submission date 29 December 2012 Acceptance date 8 February 2013 Publication date 19 February 2013 Article URL http://www.implementationscience.com/content/8/1/24 This peer-reviewed article can be downloaded, printed and distributed freely for any purposes (see copyright notice below). Articles in Implementation Science are listed in PubMed and archived at PubMed Central. For information about publishing your research in Implementation Science or any BioMed Central journal, go to http://www.implementationscience.com/authors/instructions/ For information about other BioMed Central publications go to http://www.biomedcentral.com/ © 2013 Sax et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work -
Preventing Healthcare-Associated Infection: a Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical
Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com Preventing Healthcare-Associated Infection; a Worldwide Strategy Professor Didier Pittet, MD, MS, Infection Control Program University of Geneva Hospitals, Switzerland and Division of Investigative Science Imperial College of Science, Technology, and Medicine, London, UK Hosted by Paul Webber Sponsored by [email protected] Maunco Medical www.webbertraining.com www.mauncomedical.com 1 2 3 4 Nosocomial infections Nosocomial infections Every year in the US, Every year in the US, preventable hospital-acquired diseases, preventable hospital-acquired diseases, including nosocomial infections, including nosocomial infections,/ year 9 billion are responsible for 44’000-98’000 deaths are responsible7 to US$ for2 44’000-98’000 deaths Kohn Institute of Medicine 1999 US$1 Kohn Institute of Medicine 1999 at least £ 1 b In UK, nosocomial infections may be In UK, nosocomial infectionsillio mayn / y beear responsible for > 5’000 deaths/year responsible for > 5’000 deaths/year BMJ 2.12.2000 BMJ 2.12.2000 5 6 Hosted by Paul Webber [email protected] A Webber Training Teleclass www.webbertraining.com Page 1 Preventing Healthcare-Associated Infection: A Worldwide Strategy Professor Didier Pittet, University of Geneva Sponsored by Maunco Medical www.mauncomedical.com Maternal mortality rates, First and Second Obstetric Clinics, GENERAL HOSPITAL OF VIENNA, 1841-1846 Ignaz Philipp Semmelweis -
Emergency Sanitation the Loss of Clean Running Water Or Loss of A
Emergency Sanitation The loss of clean running water or loss of a functional sewer system after a disaster can dramatically increase the chances of diarrheal diseases and outbreaks. Just one gram of human feces may have 100 parasite eggs, 1,000 parasite cysts, 1 million bacteria, and as many as 10 million viruses! With this risk all around us, it underscores the importance of staying clean and disposing of human and other waste properly after a disaster. Pathogens that may present a risk after a disaster include Escherichia Coli (E. Coli), Leptospirosis, hepatitis A, norovirus, and in some situations Vibrio cholerae and Salmonella enterica. Exposure to disease causing pathogens may occur as a result of contaminated water, sharing of water containers and cooking equipment, or the loss of basic sanitation such as the ability to wash hands thoroughly. Even brushing your teeth with water that is not safe for consumption can result in exposure to pathogens. Avoiding exposure to these pathogens starts with a careful assessment of water quality following a disaster. Because municipal water lines run parallel to sewer lines, even a small break in both lines can result in cross-contamination. Follow guidance from local officials on use of municipal water following a disaster (e.g., shutting off water to house, treating water before use, or flushing system). Once a reliable, clean water source has been established, emphasis should be placed on two key priorities: a) providing a mechanism for personal hygiene and handwashing and b) managing human waste. Personal Hygiene and Handwashing Any questionable tap water used for drinking and personal hygiene (hand-washing, brushing teeth) must be boiled or otherwise disinfected. -
Factsheet: Hand Hygiene
Sub Factsheet: Hand Hygiene Measure Background Framework.”7 Leapfrog’s new hand hygiene standard replaces the National Quality Forum’s Safe Practice #19 Unclean hands are one of the primary ways pathogens – Hand Hygiene - which had previously been used in the are transmitted throughout the healthcare Leapfrog Hospital Survey. environment. Evidence shows that microorganisms can survive on hands for varying lengths of time, some Leapfrog’s new hand hygiene standard applies to both surviving for multiple hours.1 If those caring for patients hospitals and ASCs and includes five domains: do not take the proper steps to clean their hands, these monitoring, feedback, training and education, pathogens can easily be transmitted from one patient to infrastructure, and culture. The standard encourages another patient. In addition to patient-to-patient facilities to adopt a multimodal approach to hand transfer of pathogens, contaminated hands can also hygiene, emphasizing the importance of monitoring and transfer bacteria to clean surfaces. It is estimated that feedback. up to 13% of contact between contaminated hands and clean surfaces can result in cross-contamination.1 This Hospitals and ASCs meeting the Hand Hygiene risk of spreading bacteria in a healthcare environment standard… makes hand hygiene a pivotal patient safety practice.2 • Adhere to the monitoring domain by: o Collecting hand hygiene compliance data Despite the clear evidence and guidelines for proper on at least 200 hand hygiene hand hygiene procedures, studies have shown that on -
The State of Handwashing in 2017: Annual Research Summary What We Learned About Handwashing in 2017
The State of Handwashing in 2017: Annual Research Summary What We Learned about Handwashing in 2017 Introduction The Global Burden of Disease study 2016 (GBD 2016) found that from 2006-2016, the number of global deaths attributable to unsafe water, sanitation, and hygiene (WASH) decreased by 25%, while lost disability-adjusted life years (DALYs) decreased by more than 35%.1 Among the top ten leading risks in 1990, rates of unsafe sanitation and unsafe water (in addition to child growth failure) have declined the most over the period of 1990–2016. However, in low socio-demographic index (SDI) countries, unsafe WASH is still the third largest contributor to the global burden of disease at 7.8% of DALYs. It is estimated that inadequate hand hygiene results in nearly 300,000 deaths annually, with the majority of deaths being among children younger than 5 years old.2 In this summary, we outline key themes and findings from 117 handwashing-related research papers published in 2017. Findings are summarized in narrative form, with methodology and findings of individual studies summarized in tables. This summary presents the overarching findings of the literature on handwashing published in 2017, and explores specific data and context. Findings are categorized by six key themes: • Access and coverage (page 1) • Benefits of handwashing with soap (page 2) • Measuring handwashing compliance (page 5) • Handwashing behavior change (page 8) • Drivers of handwashing (page 12) • Measuring the efficacy of handwashing hardware including various types of soaps and rubs (page 16). Access and Coverage Research continues to show disparities in access to water and soap for handwashing at the household level in low and middle-income countries.