Comparison of hand hygiene evaluations: A literature review

Background. Because our hands are the most common mode of transmission for bacteria causing hospital acquired infections, hand hygiene practices are the most effective method of preventing the spread of these pathogens, limiting the occurrence of healthcare-associated infections and reducing transmission of multi-drug resistant organisms. Yet, compliance rates are below 40% on the average. ^ Objective. This culminating experience project is primarily a literature review on hand hygiene to help determine the barriers to hand hygiene compliance and offer solutions on improving these rates and to build on a hand hygiene evaluation performed during my infection control internship completed at Memorial Hermann Hospital during the fall semester of 2005. ^ Method. A review of peer-reviewed literature using Ovid Medline, Ebsco Medline and PubMed databases using keywords: hand hygiene, hand hygiene compliance, alcohol based handrub, healthcare-associated infections, hospital-acquired infections, and infection control. ^ Results. A total of eight hand hygiene studies are highlighted. At a children's hospital in Seattle, hand hygiene compliance rates increases from 62% to 81% after five periods of interventions. In Thailand, 26 nurses dramatically increased compliance from 6.3% to 81.2% after just 7 months of training. Automated alcohol based handrub dispensers improved compliance rates in Chicago from 36.3% to 70.1%. Using education and increased distribution of alcohol based handrubs increased hand hygiene rates from 59% to 79% for Ebnother, from 54% to 85% for Hussein and from 32% to 63% for Randle. Spartanburg Regional Medical Center increased their rates from 72.5% to 90.3%. A level III NICU achieved 100% compliance after a month long educational campaign but fell back down to its baseline rate of 89% after 3 months. ^ Discussion. The interventions used to promote hand hygiene in the highlighted studies varied from low tech approaches such as printed materials to advanced electronic gadgets that alerted individuals automatically to perform hand hygiene. All approaches were effective and increased compliance rates. Overcoming hand hygiene barriers, receiving and accepting feedback is the key to maintaining consistently high hand hygiene adherence. ^

Attitudes of dental students to hand hygiene practices at a dental school

Objectives. The purpose of this study was to elucidate behavioral determinants (prevailing attitudes and beliefs) of hand hygiene practices among undergraduate dental students in a dental school. ^ Methods. Statistical modeling using the Integrative Behavioral Model (IBM) prediction was utilized to develop a questionnaire for evaluating behavioral perceptions of hand hygiene practices by dental school students. Self-report questionnaires were given to second, third and fourth year undergraduate dental students. Models representing two distinct hand hygiene practices, termed "elective in-dental school hand hygiene practice" and "inherent in-dental school hand hygiene practice" were tested using linear regression analysis. ^ Results. 58 responses were received (24.5%); the sample mean age was 26.6 years old and females comprised 51%. In our models, elective in-dental school hand hygiene practice and inherent in-dental school hand hygiene practice, explained 40% and 28%, respectively, of the variance in behavioral intention. Translation of community hand hygiene practice to the dental school setting is the predominant driver of elective hand hygiene practice. Intended elective in-school hand hygiene practice is further significantly predicted by students' self-efficacy. Students' attitudes, peer pressure of other dental students and clinic administrators, and role modeling had minimal effects. Inherent hand hygiene intent was strongly predicted by students' beliefs in the benefits of the activity and, to a lesser extent, role modeling. Inherent and elective community behaviors were insignificant. ^ Conclusions. This study provided significant insights into dental student's hand hygiene behavior and can form the basis for an effective behavioral intervention program designed to improve hand hygiene compliance.^

Restaurant Health and Hygiene: A Model Program with Theory-Based Guidelines for Implementation

Poor hygienic practices and illness of restaurant employees are major contributors to the contamination of food and the occurrence of food-borne illness in the United States, costing the food industry and society billions of dollars each year. Risk factors associated with this problem include lack of proper handwashing; food handlers reporting to work sick; poor personal hygiene; and bare hand contact with ready-to-eat foods. However, traditional efforts to control these causes of food-borne illness by public health authorities have had limited impact, and have revealed the need for comprehensive and innovative programs that provide active managerial control over employee health and hygiene in restaurant establishments. Further, the introduction and eventual adoption by the food industry of such programs can be facilitated through the use of behavior-change theory. This Capstone Project develops a model program to assist restaurant owners and operators in exerting active control over health and hygiene in their establishments and provides theory-based recommendations for the introduction of the program to the food industry.