"The 3/3 strategy": a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology.
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08/05/2013
08/05/2013
22/10/2012
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Resumo |
BACKGROUND Only multifaceted hospital wide interventions have been successful in achieving sustained improvements in hand hygiene (HH) compliance. METHODOLOGY/PRINCIPAL FINDINGS Pre-post intervention study of HH performance at baseline (October 2007-December 2009) and during intervention, which included two phases. Phase 1 (2010) included multimodal WHO approach. Phase 2 (2011) added Continuous Quality Improvement (CQI) tools and was based on: a) Increase of alcohol hand rub (AHR) solution placement (from 0.57 dispensers/bed to 1.56); b) Increase in frequency of audits (three days every three weeks: "3/3 strategy"); c) Implementation of a standardized register form of HH corrective actions; d) Statistical Process Control (SPC) as time series analysis methodology through appropriate control charts. During the intervention period we performed 819 scheduled direct observation audits which provided data from 11,714 HH opportunities. The most remarkable findings were: a) significant improvements in HH compliance with respect to baseline (25% mean increase); b) sustained high level (82%) of HH compliance during intervention; c) significant increase in AHRs consumption over time; c) significant decrease in the rate of healthcare-acquired MRSA; d) small but significant improvements in HH compliance when comparing phase 2 to phase 1 [79.5% (95% CI: 78.2-80.7) vs 84.6% (95% CI:83.8-85.4), p<0.05]; e) successful use of control charts to identify significant negative and positive deviations (special causes) related to the HH compliance process over time ("positive": 90.1% as highest HH compliance coinciding with the "World hygiene day"; and "negative":73.7% as lowest HH compliance coinciding with a statutory lay-off proceeding). CONCLUSIONS/SIGNIFICANCE CQI tools may be a key addition to WHO strategy to maintain a good HH performance over time. In addition, SPC has shown to be a powerful methodology to detect special causes in HH performance (positive and negative) and to help establishing adequate feedback to healthcare workers. Journal Article; Research Support, Non-U.S. Gov't; In January 2011, Lab HARTMANN S.A, provided 200 bottles of hydroalcoholic gel and gel dispensers as an unrestricted collaboration for an educational program in infection control in Delfos Medical Center. GMR provides part-time consultancy activities for Lab HARTMANN S.A since April 2011. JRB received funding for research from Ministerio de Ciencia e Innovación, Instituto de Salud Carlos III – co-financed by European Development Regional Fund ‘‘A way to achieve Europe’’ ERDF, Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008). The other authors declare no conflicts of interest. This does not alter the authors, adherence to all the PLOS ONE policies on sharing data. The funders had no role in the design of the study, analysis of the data, writing of the manuscript, or decision to publish. |
Identificador |
Mestre G, Berbel C, Tortajada P, Alarcia M, Coca R, Gallemi G, et al. "The 3/3 strategy": a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology. 2012 PLoS ONE; 7(10):e47200 1932-6203 (Online) PMC3478274 http://hdl.handle.net/10668/937 23110061 10.1371/journal.pone.0047200 |
Idioma(s) |
en |
Publicador |
Public Library of Science |
Relação |
PloS one http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0047200 |
Direitos |
Acceso abierto |
Palavras-Chave | #Infecciones #Mano #epidemiología #Control de Infecciones #Enfermería #Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Infection #Medical Subject Headings::Anatomy::Body Regions::Extremities::Upper Extremity::Hand #Medical Subject Headings::Disciplines and Occupations::Social Sciences::Government::Federal Government::United States Government Agencies::United States Dept. of Health and Human Services::United States Public Health Service::Centers for Disease Control and Prevention (U.S.) #Medical Subject Headings::Disciplines and Occupations::Health Occupations::Medicine::Public Health::Epidemiology #Medical Subject Headings::Health Care::Environment and Public Health::Public Health::Public Health Practice::Communicable Disease Control::Infection Control #Medical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality Assurance, Health Care::Credentialing::Accreditation::Joint Commission on Accreditation of Healthcare Organizations #Medical Subject Headings::Disciplines and Occupations::Health Occupations::Nursing |
Tipo |
info:eu-repo/semantics/article info:eu-repo/semantics/published Artículo |