- Email: [email protected]
A response to the article, “Comparison of Hand Hygiene Monitoring Using the My 5 Moments for Hand Hygiene Method Versus a Wash in-Wash out Method”
Letters to the Editor / American Journal of Infection Control 43 (2015) 900-3
References
901
To the Editor:
1. Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, et al. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. Lancet Infect Dis 2015;15:212-24. 2. Vandijck D, Cleemput I, Hellings J, Vogelaers D. Infection prevention and control strategies in the era of limited resources and quality improvement: a perspective paper. Aust Crit Care 2013;26:154-7. 3. Strengthening Pharmaceutical Systems. Infection control assessment tool. 2009. Available from: http://pdf.usaid.gov/pdf_docs/PNADK023.pdf. Accessed November 25, 2014. 4. Huskins C, Ross-Degnan D, Goldmann D. Improving infection control in developing countries: the infection control assessment tool. BMC Proc 2011;5:O18. 5. World Health Organization. Prevention of hospital-acquired infections A practical guide 2nd edition. 2002. Available from: http://apps.who.int/medicinedocs/ documents/s16355e/s16355e.pdf. Accessed November 16, 2013. 6. Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). 2004. Available from: http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf. Accessed December 14, 2014. Conflicts of interest: None to report.
Dimie Ogoina, MBBS, FWACP, FMCP-Infectious Diseases* Department of Internal Medicine Niger Delta University/Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Tamaradobra Selekere, BPharm Pharmacy Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Sunday Abisoye Oyeyemi, MBBS, Msc, FMCPH Department of Community Medicine Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Wisdom Tudou Olomo, BNsc, RN, RM Nursing Services Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Toyosi Oladapo, BMLSc, Msc Department of Microbiology Niger Delta University/Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Onyaye Kunle-Olowu, MBBS, FWACP Department of Pediatrics Niger Delta University/Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria *
Address correspondence to Dimie Ogoina, MBBS, FWACP, FMCPInfectious Diseases, Department of Internal Medicine, Niger Delta University/Niger Delta University Teaching Hospital Bayelsa state Nigeria, PMB 100, Yenagoa, Bayelsa State, Nigeria. E-mail address: [email protected] (D. Ogoina). http://dx.doi.org/10.1016/j.ajic.2015.04.198
A response to the article, “Comparison of Hand Hygiene Monitoring Using the My 5 Moments for Hand Hygiene Method Versus a Wash in-Wash out Method”
We read with interest the article by Sunkesula et al1 in the January 2015 issue of the Journal. In it they compare assessment of hand hygiene based on a wash in-wash out method with assessment based on the My 5 Moments for Hand Hygiene method. The authors assert that adherence rates are similar by both methods and suggest that a wash in-wash out method is an acceptable surrogate for adherence to My 5 Moments. We question the generalizability of their findings on several grounds. First, we fear that the health care workers and hand hygiene opportunities (HHOs) studied in their project are not reflective of a typical hospital routine. In the study by Sunkesula et al,1 62% of health care workers observed were physicians, and only 32% were nurses. Previous studies by our group, including 1 using 24-hour inroom video monitoring of 4,522 HHOs, found that only 6% of HHOs involved physicians, whereas 73% involved nurses.2,3 In addition, our studies found that physician visits tended to have fewer moments 2 and 3 than nurse visits, which would tend to minimize any difference between the monitoring methods (unpublished data). Second, we question the assertion that adherence for each of the 5 moments is equal. Our video-monitoring study (unpublished data) indicated that there is a significant difference between adherence for HHOs involving moment 2 (ie, before an aseptic/ clean procedure; adherence ¼ 65%) and moments 1 and 4 (adherence ¼ 79%), which is essentially what is monitored with the wash in-wash out method described by Sunkesula et al.1 Furthermore, we believe that moments 2 and 3 are more high-risk moments for transmission of bacteria, and these 2 moments are not monitored within the wash in-wash out methodology. Finally, Sunsekula et al1 argue that the main barrier to monitoring based on My 5 Moments for Hand Hygiene is the difficulty in assessing in-room behavior. We agree, but believe that the risk of bacterial transmission within patient rooms is too great to rely on a monitoring system that ignores this component of the process. For this reason, we advocate the deployment of nonintrusive automated systems that assess all 5 moments of hand hygiene behavior. References 1. Sunkesula VCK, Kundrapu S, Donskey CJ. Response to the Letter to the Editor regarding Comparison of hand hygiene monitoring using the My 5 Moments for Hand Hygiene method versus the Wash In-Wash Out method. Am J Infect Control 2015;43:16-9. 2. Steed C, Kelly JW, Blackhurst D, Boeker S, Diller T, Alper P, et al. Hospital hand hygiene opportunities: where and when (HOW2)? the HOW2 Benchmark Study. Am J Infect Control 2011;39:19-26. 3. Diller T, Kelly JW, Blackhurst D, Steed C, Boeker S, McElveen D. Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: Validation of the HOW2 Benchmark Study. Am J Infect Control 2014;42:602-7. Conflicts of interest: None to report.
J. William Kelly, MD* Department of Infection Prevention and Control Department of Internal Medicine Greenville Health System Greenville, SC Dawn Blackhurst, DrPH Department of Quality Management Greenville Health System Greenville, SC Connie Steed, MSN, RN, CIC Department of Infection Prevention Greenville Health System Greenville, SC
902
Letters to the Editor / American Journal of Infection Control 43 (2015) 900-3
Thomas Diller, MD, MM CHRISTUS Health, Irving, TX *
Address correspondence to J. William Kelly, MD Greenville Health System Infectious Disease Associates 890 W Faris Rd, Ste 520, Greenville, SC 29605. E-mail address: [email protected] (J.W. Kelly). http://dx.doi.org/10.1016/j.ajic.2015.02.032
Response to the Letter to the Editor regarding Comparison of hand hygiene monitoring using the My 5 Moments for Hand Hygiene method versus the Wash In-Wash Out method
and 3 combined was actually greater than compliance with moments 1 and 4 combined (79% vs 52%; P ¼ .03). Finally, although nonintrusive automated systems for monitoring all 5 moments offer advantages over current monitoring methods, it is likely that many facilities will continue to rely on human observers for some or all monitoring of hand hygiene behavior. All methods that rely on human observers have limitations. We have pointed out several important caveats to consider if the Wash In-Wash Out method is used. Although the Wash In-Wash Out and My 5 Moments for Hand Hygiene monitoring methods resulted in similar overall rates of hand hygiene compliance in our facility, additional studies are needed in other settings. Conflicts of interest: None to report.
Venkata C.K. Sunkesula, MD, MS Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH Center for Proteomics and Bioinformatics Case Western Reserve University School of Medicine Cleveland, OH Sirisha Kundrapu, MD, MS Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH
To the Editor: We appreciate the interest in our study and would like to respond to the issues raised regarding the generalizability of the findings. First, we agree with the concern that underrepresentation of nurses in our study population could have affected our conclusions. We therefore reexamined the data to determine whether there were important differences between findings for nurses and physicians. For both groups, the major finding of our study was the same: the Wash In-Wash Out and My 5 Moments for Hand Hygiene monitoring methods resulted in similar overall rates of hand hygiene compliance (Table 1). Second, we agree with the concern that there is the potential for reduced adherence to hand hygiene in moment 2 and moment 3 if monitoring focuses only on hand hygiene upon room entry and exit. To address this concern, we recommended in our article that facilities using the Wash In-Wash Out method should provide ongoing education based on the My 5 Moments for Hand Hygiene approach and conduct intermittent assessments of hand hygiene before clean procedures and after body fluid exposure in patient rooms. This is the current practice in our facility and we found that compliance with moments 2 and 3 combined was similar to overall hand hygiene compliance. For nurses, compliance with moments 2
Table 1 Comparison of hand hygiene compliance using the Wash In-Wash Out versus My 5 Moments for Hand Hygiene monitoring methods, by provider type Physicians My 5 Moments for Hand Hygiene Moment 1 79/94 (84) Moment 2 22/29 (76) Moment 3 28/39 (72) Moment 4 82/96 (85) Moment 5 15/17 (88) Overall 226/275 (82) Wash In-Wash Out Wash In 131/170 (77) Wash Out 147/170 (86) Overall 278/340 (82)
Nurses 47/82 5/7 10/12 38/82 3/5 103/188
(57) (71) (83) (46) (60) (55)
47/82 (57) 49/91 (54) 96/173 (55)
Total 126/176 27/36 38/51 120/178 18/22 329/463
(72) (75) (75) (67) (82) (71)
178/252 (71) 196/261 (75) 374/513 (73)
NOTE. Values are presented as number of compliant hand hygiene episodes/number of hand hygiene opportunities (%).
Curtis J. Donskey, MD* Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH Geriatric Research, Education, and Clinical Center Cleveland VA Medical Center Cleveland, OH * Address correspondence to Curtis J. Donskey, MD, Cleveland VA Medical Center, Geriatric Research, Education, and Clinical Center 1110W, 10701 East Blvd, Cleveland, OH 44106. E-mail address: [email protected] (C.J. Donskey).
http://dx.doi.org/10.1016/j.ajic.2015.04.205
Inclusion of social media-based strategies in a health care worker influenza immunization campaign To the Editor: We developed an influenza immunization campaign utilizing social media as a tool to potentially increase vaccination rates for health care workers (HCWs) at our hospital. The hypothesis was that social media sites would help to create awareness and education. Common misconceptions reported among HCWs include the belief that one can develop influenza from the vaccine, the belief that one is not at risk for influenza, and skepticism about vaccine effectiveness and safety.1,2 Employees typically make up the biggest audience for hospital social media.3 In general, adults aged 18-34 years are most likely to use social media, and adults aged 35-40 years are also avid users.4 Given that these age groups make
References
901
To the Editor:
1. Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, et al. Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. Lancet Infect Dis 2015;15:212-24. 2. Vandijck D, Cleemput I, Hellings J, Vogelaers D. Infection prevention and control strategies in the era of limited resources and quality improvement: a perspective paper. Aust Crit Care 2013;26:154-7. 3. Strengthening Pharmaceutical Systems. Infection control assessment tool. 2009. Available from: http://pdf.usaid.gov/pdf_docs/PNADK023.pdf. Accessed November 25, 2014. 4. Huskins C, Ross-Degnan D, Goldmann D. Improving infection control in developing countries: the infection control assessment tool. BMC Proc 2011;5:O18. 5. World Health Organization. Prevention of hospital-acquired infections A practical guide 2nd edition. 2002. Available from: http://apps.who.int/medicinedocs/ documents/s16355e/s16355e.pdf. Accessed November 16, 2013. 6. Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). 2004. Available from: http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf. Accessed December 14, 2014. Conflicts of interest: None to report.
Dimie Ogoina, MBBS, FWACP, FMCP-Infectious Diseases* Department of Internal Medicine Niger Delta University/Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Tamaradobra Selekere, BPharm Pharmacy Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Sunday Abisoye Oyeyemi, MBBS, Msc, FMCPH Department of Community Medicine Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Wisdom Tudou Olomo, BNsc, RN, RM Nursing Services Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Toyosi Oladapo, BMLSc, Msc Department of Microbiology Niger Delta University/Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria Onyaye Kunle-Olowu, MBBS, FWACP Department of Pediatrics Niger Delta University/Niger Delta University Teaching Hospital Okolobiri, Bayelsa State, Nigeria *
Address correspondence to Dimie Ogoina, MBBS, FWACP, FMCPInfectious Diseases, Department of Internal Medicine, Niger Delta University/Niger Delta University Teaching Hospital Bayelsa state Nigeria, PMB 100, Yenagoa, Bayelsa State, Nigeria. E-mail address: [email protected] (D. Ogoina). http://dx.doi.org/10.1016/j.ajic.2015.04.198
A response to the article, “Comparison of Hand Hygiene Monitoring Using the My 5 Moments for Hand Hygiene Method Versus a Wash in-Wash out Method”
We read with interest the article by Sunkesula et al1 in the January 2015 issue of the Journal. In it they compare assessment of hand hygiene based on a wash in-wash out method with assessment based on the My 5 Moments for Hand Hygiene method. The authors assert that adherence rates are similar by both methods and suggest that a wash in-wash out method is an acceptable surrogate for adherence to My 5 Moments. We question the generalizability of their findings on several grounds. First, we fear that the health care workers and hand hygiene opportunities (HHOs) studied in their project are not reflective of a typical hospital routine. In the study by Sunkesula et al,1 62% of health care workers observed were physicians, and only 32% were nurses. Previous studies by our group, including 1 using 24-hour inroom video monitoring of 4,522 HHOs, found that only 6% of HHOs involved physicians, whereas 73% involved nurses.2,3 In addition, our studies found that physician visits tended to have fewer moments 2 and 3 than nurse visits, which would tend to minimize any difference between the monitoring methods (unpublished data). Second, we question the assertion that adherence for each of the 5 moments is equal. Our video-monitoring study (unpublished data) indicated that there is a significant difference between adherence for HHOs involving moment 2 (ie, before an aseptic/ clean procedure; adherence ¼ 65%) and moments 1 and 4 (adherence ¼ 79%), which is essentially what is monitored with the wash in-wash out method described by Sunkesula et al.1 Furthermore, we believe that moments 2 and 3 are more high-risk moments for transmission of bacteria, and these 2 moments are not monitored within the wash in-wash out methodology. Finally, Sunsekula et al1 argue that the main barrier to monitoring based on My 5 Moments for Hand Hygiene is the difficulty in assessing in-room behavior. We agree, but believe that the risk of bacterial transmission within patient rooms is too great to rely on a monitoring system that ignores this component of the process. For this reason, we advocate the deployment of nonintrusive automated systems that assess all 5 moments of hand hygiene behavior. References 1. Sunkesula VCK, Kundrapu S, Donskey CJ. Response to the Letter to the Editor regarding Comparison of hand hygiene monitoring using the My 5 Moments for Hand Hygiene method versus the Wash In-Wash Out method. Am J Infect Control 2015;43:16-9. 2. Steed C, Kelly JW, Blackhurst D, Boeker S, Diller T, Alper P, et al. Hospital hand hygiene opportunities: where and when (HOW2)? the HOW2 Benchmark Study. Am J Infect Control 2011;39:19-26. 3. Diller T, Kelly JW, Blackhurst D, Steed C, Boeker S, McElveen D. Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: Validation of the HOW2 Benchmark Study. Am J Infect Control 2014;42:602-7. Conflicts of interest: None to report.
J. William Kelly, MD* Department of Infection Prevention and Control Department of Internal Medicine Greenville Health System Greenville, SC Dawn Blackhurst, DrPH Department of Quality Management Greenville Health System Greenville, SC Connie Steed, MSN, RN, CIC Department of Infection Prevention Greenville Health System Greenville, SC
902
Letters to the Editor / American Journal of Infection Control 43 (2015) 900-3
Thomas Diller, MD, MM CHRISTUS Health, Irving, TX *
Address correspondence to J. William Kelly, MD Greenville Health System Infectious Disease Associates 890 W Faris Rd, Ste 520, Greenville, SC 29605. E-mail address: [email protected] (J.W. Kelly). http://dx.doi.org/10.1016/j.ajic.2015.02.032
Response to the Letter to the Editor regarding Comparison of hand hygiene monitoring using the My 5 Moments for Hand Hygiene method versus the Wash In-Wash Out method
and 3 combined was actually greater than compliance with moments 1 and 4 combined (79% vs 52%; P ¼ .03). Finally, although nonintrusive automated systems for monitoring all 5 moments offer advantages over current monitoring methods, it is likely that many facilities will continue to rely on human observers for some or all monitoring of hand hygiene behavior. All methods that rely on human observers have limitations. We have pointed out several important caveats to consider if the Wash In-Wash Out method is used. Although the Wash In-Wash Out and My 5 Moments for Hand Hygiene monitoring methods resulted in similar overall rates of hand hygiene compliance in our facility, additional studies are needed in other settings. Conflicts of interest: None to report.
Venkata C.K. Sunkesula, MD, MS Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH Center for Proteomics and Bioinformatics Case Western Reserve University School of Medicine Cleveland, OH Sirisha Kundrapu, MD, MS Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH
To the Editor: We appreciate the interest in our study and would like to respond to the issues raised regarding the generalizability of the findings. First, we agree with the concern that underrepresentation of nurses in our study population could have affected our conclusions. We therefore reexamined the data to determine whether there were important differences between findings for nurses and physicians. For both groups, the major finding of our study was the same: the Wash In-Wash Out and My 5 Moments for Hand Hygiene monitoring methods resulted in similar overall rates of hand hygiene compliance (Table 1). Second, we agree with the concern that there is the potential for reduced adherence to hand hygiene in moment 2 and moment 3 if monitoring focuses only on hand hygiene upon room entry and exit. To address this concern, we recommended in our article that facilities using the Wash In-Wash Out method should provide ongoing education based on the My 5 Moments for Hand Hygiene approach and conduct intermittent assessments of hand hygiene before clean procedures and after body fluid exposure in patient rooms. This is the current practice in our facility and we found that compliance with moments 2 and 3 combined was similar to overall hand hygiene compliance. For nurses, compliance with moments 2
Table 1 Comparison of hand hygiene compliance using the Wash In-Wash Out versus My 5 Moments for Hand Hygiene monitoring methods, by provider type Physicians My 5 Moments for Hand Hygiene Moment 1 79/94 (84) Moment 2 22/29 (76) Moment 3 28/39 (72) Moment 4 82/96 (85) Moment 5 15/17 (88) Overall 226/275 (82) Wash In-Wash Out Wash In 131/170 (77) Wash Out 147/170 (86) Overall 278/340 (82)
Nurses 47/82 5/7 10/12 38/82 3/5 103/188
(57) (71) (83) (46) (60) (55)
47/82 (57) 49/91 (54) 96/173 (55)
Total 126/176 27/36 38/51 120/178 18/22 329/463
(72) (75) (75) (67) (82) (71)
178/252 (71) 196/261 (75) 374/513 (73)
NOTE. Values are presented as number of compliant hand hygiene episodes/number of hand hygiene opportunities (%).
Curtis J. Donskey, MD* Infectious Diseases Division, Department of Medicine Case Western Reserve University School of Medicine Cleveland, OH Geriatric Research, Education, and Clinical Center Cleveland VA Medical Center Cleveland, OH * Address correspondence to Curtis J. Donskey, MD, Cleveland VA Medical Center, Geriatric Research, Education, and Clinical Center 1110W, 10701 East Blvd, Cleveland, OH 44106. E-mail address: [email protected] (C.J. Donskey).
http://dx.doi.org/10.1016/j.ajic.2015.04.205
Inclusion of social media-based strategies in a health care worker influenza immunization campaign To the Editor: We developed an influenza immunization campaign utilizing social media as a tool to potentially increase vaccination rates for health care workers (HCWs) at our hospital. The hypothesis was that social media sites would help to create awareness and education. Common misconceptions reported among HCWs include the belief that one can develop influenza from the vaccine, the belief that one is not at risk for influenza, and skepticism about vaccine effectiveness and safety.1,2 Employees typically make up the biggest audience for hospital social media.3 In general, adults aged 18-34 years are most likely to use social media, and adults aged 35-40 years are also avid users.4 Given that these age groups make