here. The study results were clearly presented. Advantages – less water usage, your clothes stay better for longer (Yes it is true, washers literally beat your clothes to death and then we put them in dryers which in all seriousness literally break the fibers in your clothes apart), you get arm muscles (this is not a joke, if you think it is…..try handwashing for a day, washing your own clothes you will also get belly and back muscles! The analysis was based on a single study. It was discounted at an annual rate of 3%. No, Is the Subject Area "Nurses" applicable to this article? This method requires data of the continuous or counted outcome measures, summarized at regular, evenly spaced intervals. To investigate improvements to hand hygiene compliance during the six consecutive hospital-wide surveys, Pearson's chi-squared test for trend was performed. Wash with soap and water when visibly dirty or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids, or if exposure to potential spore forming organisms is strongly suspected or proven, or after using the bathroom. To use hand sanitizer correctly, apply the specified amount as directed by the product's label to the palm of one hand, and rub the sanitizer thoroughly over both hands until they feel dry. Use Section 4 and Annex 8 to learn details about each potential indicator you are considering and how you will operationalize the indicators you have chosen. Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. Facing an increase in overall HAIs and infections caused by multidrug-resistant organisms , the goal of this initiative was to decrease HAIs by blocking the transmission of microorganisms via the hands of healthcare workers (HCW). Compliance with hand hygiene is the ratio of the number of performed actions using correct technique to the number of opportunities , . No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0027163, http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf, http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html, http://www.cdc.gov/hicpac/mdro/mdro_0.html, Methicillin-resistant Staphylococcus aureus. • Commercially prepared hand sanitizers contain ingredients that help prevent skin dryness. Finally, no significant change in the trends or levels of infections caused by MSSA and E. coli during the intervention period was observed, as shown in Fig. This finding led us to introduce alcohol-based hand rubs, and implement a hospital-wide program promoting hand hygiene through using alcohol-based hand rubs. A generalised autoregressive Poisson regression analysis was applied to identify the impact of the intervention on the outcome measure. For people who find that soap causes skin irritation, it is useful to note that soaps can have a different pH – they may be neutral, slightly alkaline or slightly acidic, and perfumes in soap may also cause irritation. Washing hands with soap at the right times can reduce instances of diarrhea by 5–50 percent. Remove any hand or arm jewellery Use soap and running water Wash your hands frequently throughout the day Washing should last for at least 20 seconds, preferably a minute. HAIs have been identified as a fundamental priority, and were selected as the topic of the first Global Patient Safety Challenge. Supplementary costs associated with the increased use of alcohol-based hand rub averaged US$6.07 per 100 patient-days. Our data failed to support the effects of HHP on decreasing HAIs among hemato-oncology patients and patients with infections caused by MSSA and E. coli. One-way sensitivity analyses were performed to explore the influence of the uncertainty of several parameters, such as discount rates, cost of alcohol hand rub, campaign expenses, extra cost per HAI episode, and the number of averted HAIs. They must be supplemented with measures directed at device-associated and endogenous infections in compromised hosts, and augmented by antimicrobial stewardship. However, alcohol-based hand rubs were unavailable. Our recent survey demonstrated that the HH rate for 5 moments was only approximately 60%; whereas the HH rate for two moments exceeded 90% (unpublished data). This study compared hand washing knowledge and practices in BRAC’s water; sanitation and hygiene (WASH) programme areas over time. We observed 8,420 opportunities for hand hygiene during the study period. Hand sanitizer vs. soap and water: Which one should you use? The distribution and time trends of HAIs and infection control programs during 1981 to 2007 have been described previously . Yes Washing hands with soap and water is the best way to get rid of germs in most situations. Other details such as the price year and discount rate were reported appropriately. Handwashing will remove all types of germs from your hands, but hand sanitizers are not able to kill all types of germs or remove harmful chemicals like pesticides and heavy metals. Instead a benefit/cost ratio was presented to show the economic benefit to the hospital of spending additional money on the programme. Continuous emphasis on this intervention has lead to the widespread opinion that HAI rates can be greatly reduced by increased hand hygiene compliance alone. There was an extensive description of the programme. A positive feature of the analysis was the very large sample size and prospective collection of data. However, we were unable to demonstrate a reduction in the HAIs of hematology and oncology services. The hand hygiene program was associated with an estimated reduction of 1,504 (95% confidence interval: 526 to 2,544) HAI episodes (8.9%) during the intervention period without discounting (Table 2). Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Bloodstream (p<.001), urinary tract (trend, p = .03), and skin and soft tissue infections (trend, p<.001) decreased significantly. broad scope, and wide readership – a perfect fit for your research every time. In the interrupted time series, the level and trend of the preintervention segment served as the controls for the postintervention segment, providing a methodologically acceptable design for measuring the intervention effect , . Because of the high alcohol content of most hand sanitizing liquids, these substances are flammable, according to University of Rochester Facilities and Services. The hand hygiene promotion programme consisted of disposable alcohol-based hand rub sanitisers that were wall-mounted between every two beds in general wards, by each bed in special units (such as intensive care units) and affixed to trolleys to ensure accessibility near or at the point of care. Using these products can result in less skin dryness and irritation than hand-washing. We decided to focus first on compliance with hand hygiene. Yes Washing hands with soap and water will remove substantially more disease causing organisms than washing hands with water alone. An unannounced hand hygiene audit by infection control nurses was conducted of hospital wards in December 2003. 1A. 3. Thus, evaluation of the longitudinal effect of a hospital-wide hand hygiene program is only feasible in limited healthcare settings. The economic analysis included costs of the hand hygiene programme (materials and promotional efforts) and cost-savings due to reductions in healthcare-associated infections. Heterogeneity factors were calculated by dividing the deviance with the degrees of freedom, and used as an indicator to assess whether an extra-Poisson variation (overdispersion) was present. The number of healthcare-associated infection episodes was 16,032 without the programme and 14,608 with the programme. Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. https://doi.org/10.1371/journal.pone.0027163.s003, https://doi.org/10.1371/journal.pone.0027163.s004. The study examined the cost-effectiveness of a hand hygiene programme to reduce the burden of healthcare-associated infections. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs. To investigate the impact of the intervention on the levels and trends of cumulative HAI incidence over time, we adopted the generalized autoregressive Poisson regression analyses , . Promotion of the programme was by lectures and/or web-based self-learning with a post test, reminders located near points of care, use of hand hygiene compliance as a quality indicator, observation and verbal reminder by infection control nurses, periodic audits and performance feedback provided to units and departments, and incentives and fines for outstanding performance or failures. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Hand hygiene is generally considered to be the most important measure that can be applied to prevent the spread of healthcare-associated infection (HAI). Six surveys were conducted during the implementation period. The target hand hygiene compliance rate was determined based on the performance in the preceding year. According to a recent, comprehensive review of literature published as a Cochrane Review , the quality of intervention studies intended to increase hand hygiene compliance remains disappointing. 4. The relevant parameters used in the economic evaluation are shown in Table S2. Use 1 hand to rub the back of the other hand and clean in between the fingers. Yes Observed incidences, black solid line, —; mean, red dash line, ---; green and blue shadow, 95% confidence interval of observed incidences; yellow shadow, 95% confidence interval (CI) of predicted incidences. In conclusion, this study demonstrates that implementing a hospital-wide hand hygiene program is feasible. The authorsâ conclusions appear robust. Effectiveness and limitations of hand hygiene promotion on decreasing healthcare-associated infections. The predicted monthly cumulative incidence of HAI using the full and most parsimonious segmented regression models are shown in Table S1. The study examined the cost-effectiveness of a hand hygiene programme to reduce the burden of healthcare-associated infections. ... even with its limitations, that using hand sanitizer can remove the flu virus, but it took much longer than hand-washing did. Alcohol-based handrub is not always the recommended hand hygiene product, there are some situations when washing hands with soap and water is preferred: Bacterial spores. Yes Competing interests: None of the authors declared a conflict of interest. No, Is the Subject Area "Methicillin-resistant Staphylococcus aureus" applicable to this article? Study groups were not well balanced at baseline due to statistically significant differences in number of patient-days, comorbidity index and frequency of underlying comorbidities. We simulated germs with UV gel to show you the difference between washing your hands, and washing your hands properly. However, in the model used in this study, the cost of manpower was underestimated, and the indirect costs related to HAIs were not included. This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. No standard cost-effectiveness ratios were calculated as the programme was the dominant option. It cannot also protect you against from droplet and airborne diseases, … washing hands and can potentially violate ‘do no harm’ principles (i.e. For more information about PLOS Subject Areas, click All economic data (resource quantities and unit costs) were taken directly from the hospital database. The major barrier is poor compliance by healthcare providers, regardless of available resources –. 5. This study demonstrates that excellent compliance with hand hygiene by HCW was achieved and maintained over 4 years through an intensive hospital-wide program. The numbers of patients and patient-days were 290,056 and 648,305 Â± 32,109 in the pre-intervention period (January 1999 to March 2004) and 262,090 and 720,564 Â± 9,543 in the intervention period (April 2004 to December 2007). Wet your hands with water. Economic benefits from savings were estimated to have been $5,289,364 and the ratio (net benefit minus costs) was $23.7, which meant that every $1 spent on the programme resulted in a $23.7 economic benefit to the hospital. The price year was 2007. Past initiatives in Kenya have We appreciate members of the Biostatistics Laboratory of the College of Public Health, National Taiwan University, and Dr. Grace Hui-Min Wu for their assistance and suggestions regarding the statistical analysis; they received no compensation for their contribution. Lather for 15 seconds Wash the front and back of your hands, as well as between your fingers and under your nails We also observed an increased use of alcohol-based hand rubs (p = .001), liquid soap (p = .03), and antiseptics (p = 0.04), as shown in Fig. Rub your hands together. Studies suggest that there is a minimum RLU level that is attain-able following an effective hand wash. The benefit was measured by subtracting the cost savings from the extra costs caused by HAIs, which was determined by a case-control study conducted in our hospital . Safety glasses do not cover the whole face from chemical splashes and other hazardous materials; Psychological affect: the wearer may feel more protected than they actually are, leading to health and safety abuses The annual consumption of liquid soap, antiseptics, and alcohol hand rub (product volume use per 1,000 patient-days) was used as a surrogate marker of hand hygiene over time. Analyzed the data: YCC WHS LYH. Poisson regression analyses were employed to evaluate the densities and trends of HAIs during the preintervention (January 1999 to March 2004) and intervention (April 2004 to December 2007) periods. Sensitivity analyses showed that the programme remained cost saving in all alternative scenarios. 2. 3A and 3B. To provide consistent care and protect patient safety throughout the hospital, a hand hygiene program requires multidisciplinary efforts and encompasses all hospital units. No significant changes in the respiratory tract and gastrointestinal tract infection rates were observed during the intervention. p A disease-specific measure was used to examine the clinical impact of the programme on patientsâ health. However, when savings from future costs associated to healthcare-associated infection were considered the programme was dominant (more effective and less expensive). The cost of personnel was not taken into account in the base case analysis as no change in staff was required. Performed the experiments: KLT. The authors concluded that the hand hygiene programme was feasible and reduced both healthcare-associated infection rates and hospital costs. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Healthcare-associated infection rates by type of infection and site were estimated. The economic evaluation in this study produced similar results. A multidisciplinary approach involving cognition, equipment, and behavior was designed based on literature, the baseline evaluation, and the concept of total quality improvement . Several potentially confounding factors are relevant to this study. Third, the hand hygiene programs in this study focused only on HCWs. The opportunity cost of personnel involved in the programme was considered in a sensitivity analysis. Pittet and colleagues  estimated the program costs to be less than US$57,000 per year for a 2,600-bed hospital, an average of US$1.42 per admitted patient. If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol. 2A. In addition, the impact of hand hygiene improvement on HAI incidence varied , . This type of washing machine is up to 24 inches in width making it great for small spaces such as in a small condo or apartment. https://doi.org/10.1371/journal.pone.0027163.t001. Hand sanitizer is efficient at killing some microbes, but not all of them. The extra cost of the programme to prevent one episode of healthcare-associated infection was $163.6. Discover a faster, simpler path to publishing in a high-quality journal. The cost of personnel involved in the program (including planning, training, and auditing) was not considered in the base-case analysis (Table S2), because the program did not incur any increases in staff or manpower costs. The factors considered by the model (see Text S1) include the levels and trends in the preintervention period, the changes in levels and trends during the intervention period, and autoregressive terms. Endogenous infection may be reduced through improvements in host immunity. This enabled us to determine the differences in HAI incidences over 4-year preintervention and postintervention periods, and conduct numerous observations while adjusting to changes in the frequency and severity of underlying diseases. The hand hygiene compliance rates recorded for comparison between hospital services or between years were limited to the opportunities before and after patient contact to maintain consistency during the study period. Time trends in the consumption of alcohol-based hand rubs, soap, and antiseptics were examined using simple linear regression. To avoid the Hawthorne effect , the duration and number of opportunities for hand hygiene monitoring were increased gradually for the six surveys (Fig. Alcohol-based hand sanitizers work by killing germs on your hands, while washing your hands with soap and water removes germs from your hands. e27163. A 3% annual discount rate was applied. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, https://doi.org/10.1371/journal.pone.0027163.g001. An antimicrobial stewardship program was not conducted during the study period. We elected to use Poisson regression analysis with an interrupted time series ,  to assess the efficacy of the hospital-wide hand hygiene intervention over time, and determine whether factors other than the intervention could explain the change. https://doi.org/10.1371/journal.pone.0027163.g002. However, hand hygiene programs are only one component of hospital infection control. The authors stated that the perspective was that of the hospital. (A) hospital-wide (change in levels, p = 0.02; change in trends, p = 0.04); (B) intensive care units (change in levels, p = 0.26; change in trends, p<0.001); (C) hematology ward (p = 0.21, p = 0.38, respectively). 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