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P14.20 Direct observation of hand hygiene in a teaching hospital
Abstracts, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90
with bacteria than those made of vinyl. European guidelines and quality norms on bacterial contamination of disposable gloves are needed. P14.20 Direct observation of hand hygiene in a teaching hospital M. Rosales, M.A. Fernandez, O. Munoz, ˜ G. Roca, M. Skodova, P. Garcia, M. Porta. Hospital Universitario Virgen de las Nieves, Spain Background: Healthcare-associated infections (HAIs) are a leading cause of death in the Spain. Hand hygiene (HH) remains a cornerstone intervention for preventing HAIs and transmission of multidrug resistant organisms in the healthcare setting. Unfortunately, adherence among healthcare workers (HCWs) to recommended hand hygiene practices is poor. Objective: To improve HH compliance in a large urban teaching hospital in Granada, Spain. Methods: In February 2010 to April 2010, HH compliance was measured after using ‘undercover’ observers who directly observed HCW practices. HCWs were educated to clean their hands using either alcohol based hand rubs or soap and water before and after patient care, before aseptic procedures, after exposure to bodily fluids and after contact with patient surroundings. To minimize Hawthorne effect and due to patient privacy reasons, observers were instructed not to follow providers into patient rooms and data were collected on HH behaviours upon entry and exit to patient environment Compliance was measured as whether HH was performed per opportunity. Results: We studied 3679 health workers, the overall percentage of correct actions of hand hygiene was 16.5%, confidence interval 95% (15.3–17.7). For professional categories, the nurses were the group with the highest percentage of 18.9%, followed by medical 18.7% and nursing assistants, 11.4% sanitizing hands. The ratio hand washing with soap and water against friction with water-alcohol solution was 2.1. Conclusions: The percentage of HCW that sanitizes their hands after contact with the patient or their environment or after contact with body fluids is very low (16.5%). The nursing staff washed their hands more than the rest of the staff. It still employs twice as washing hands with soap and water that the friction with alcohol. Poster Session 15 – Immunisation P15.01 A toolkit to facilitate rapid immunisation and education of hospital staff during influenza outbreaks S. Redfern1 , S. Marshall1 , E. Railton1 , E. Youlton1 , R. Vivancos2 , G. Thomson3 , N.J. Beeching1 . 1 Royal Liverpool & Broadgreen University Hospitals NHS Trust, United Kingdom; 2 Cheshire & Merseyside Health Protection Unit, United Kingdom; 3 Centre for Emergency Preparedness and Response, HPA Porton, United Kingdom Background: Uptake of yearly influenza immunisation by health care workers (HCW) has been low in most British hospitals, necessitating urgent immunisation programmes during outbreaks. Aim: To describe implementation of rapid immunisation and education programmes in a large hospital Trust in two successive years. Setting and Methods: In Nov 2008 two outbreaks of different influenza A strains simultaneously affected a 1000 bed hospital Trust. A rapid immunisation programme was instituted to immunise health care workers (HCW) (previous uptake <20% per year). This included prioritisation of areas and staff at risk and taking vaccine to those areas. Lessons learnt were applied in 2009 during the H1N1 influenza pandemic. Results: 1390 key staff (77% of target) were immunised over 14 days in late 2008, including 843 over the first weekend. This contributed to low staff sickness rates over the 6-week-long epidemic and
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to overall control of the outbreaks. Urgent face fit testing and repeat education in use of respiratory PPE were delivered in April 2009 to 1532/2575 (59.5%) front-line HCW, at least 75% of whom were reached in the first 2 weeks of the programme. In late 2009, 746/982 (76%) doctors and 1462/1660 (88.1%) nurses in the Trust were vaccinated against seasonal influenza (1891/2208 = 85.6% in 1 month) and 886 (90.2%) and 1343 (80.9%) respectively against H1N1 pandemic influenza strain. Conclusions: 1. Trusts should encourage routine staff immunisation against influenza. 2. Occupational health departments need to be readily accessible to staff. 3. Rapid immunisation and education of large numbers of HCW can be achieved by multidisciplinary teamwork, taking interventions to the workbase of the staff. 4. Local “champions” increase uptake of vaccination. 5. We have established a prototype “Toolkit” for rapid immunisation of HCW in the hospital setting, which can be used for influenza or other outbreaks. P15.02 Influenza vaccination coverage among healthcare workers and determinants of vaccination during the 2009–2010 season C. Villanueva-Ruiz, J. Sanchez-Pay ´ a, ´ L. Cartagena-Llopis, J. Barrenengoa-Sanudo, ˜ R. Camargo-Angeles, H.R. Mart´ınez, Mª. Gonzalez-Hern ´ andez, ´ A. Rincon. Servicio de Medicina Preventiva, Hospital General Universitario de Alicante, Spain Background: Influenza vaccination of a healthcare worker (HCW) protects his health, patients’ health and reduces absenteeism from work. Objectives: Determine seasonal influenza and new A(H1N1) influenza vaccination coverage during the 2009–2010 season and to know its determinant factors. Methods: 2009–2010 influenza vaccination campaign was subdivided into two phases. In the first one, from October 1st to November 13th 2009, seasonal influenza vaccine was administered, and in the second one, carried out from November 16th to December 30th 2009, new A(H1N1) influenza vaccination was administered. Each of the vaccine programs was preceded by an specific promotional campaign, where signs, posters and leaflets were used, and also informative notes were addressed to the different services, so all the HCW were invited to be vaccinated. HCW was asked to fill out a brief self-administered questionnaire were a list of reasons to receive vaccination was included. Coverage during both vaccination campaigns were calculated, and then these results were compared, both the overall and for each profession (medical, nursing, nursing assistant and others) using Chi-square test. Results: Seasonal influenza vaccination coverage was 31% and new A(H1N1) influenza coverage was 22% (p < 0.05); in medical personnel these were 36% and 34% respectively (N.S.); in nursing personnel, 33% and 24% respectively (p < 0.05); in nursing assistant, 21% and 12% respectively (p < 0.05). The main reasons given for receiving vaccination were self-protection and protection of the family. Conclusions: In non-medical personnel, frequency of new A(H1N1) influenza vaccination was significantly lower than frequency of seasonal influenza vaccination. Low coverage achieved constitute a public health problem and it becomes necessary to implement specific intervention programs for each profession, as well as beginning to consider in our environment to demand HCW be vaccinated.
with bacteria than those made of vinyl. European guidelines and quality norms on bacterial contamination of disposable gloves are needed. P14.20 Direct observation of hand hygiene in a teaching hospital M. Rosales, M.A. Fernandez, O. Munoz, ˜ G. Roca, M. Skodova, P. Garcia, M. Porta. Hospital Universitario Virgen de las Nieves, Spain Background: Healthcare-associated infections (HAIs) are a leading cause of death in the Spain. Hand hygiene (HH) remains a cornerstone intervention for preventing HAIs and transmission of multidrug resistant organisms in the healthcare setting. Unfortunately, adherence among healthcare workers (HCWs) to recommended hand hygiene practices is poor. Objective: To improve HH compliance in a large urban teaching hospital in Granada, Spain. Methods: In February 2010 to April 2010, HH compliance was measured after using ‘undercover’ observers who directly observed HCW practices. HCWs were educated to clean their hands using either alcohol based hand rubs or soap and water before and after patient care, before aseptic procedures, after exposure to bodily fluids and after contact with patient surroundings. To minimize Hawthorne effect and due to patient privacy reasons, observers were instructed not to follow providers into patient rooms and data were collected on HH behaviours upon entry and exit to patient environment Compliance was measured as whether HH was performed per opportunity. Results: We studied 3679 health workers, the overall percentage of correct actions of hand hygiene was 16.5%, confidence interval 95% (15.3–17.7). For professional categories, the nurses were the group with the highest percentage of 18.9%, followed by medical 18.7% and nursing assistants, 11.4% sanitizing hands. The ratio hand washing with soap and water against friction with water-alcohol solution was 2.1. Conclusions: The percentage of HCW that sanitizes their hands after contact with the patient or their environment or after contact with body fluids is very low (16.5%). The nursing staff washed their hands more than the rest of the staff. It still employs twice as washing hands with soap and water that the friction with alcohol. Poster Session 15 – Immunisation P15.01 A toolkit to facilitate rapid immunisation and education of hospital staff during influenza outbreaks S. Redfern1 , S. Marshall1 , E. Railton1 , E. Youlton1 , R. Vivancos2 , G. Thomson3 , N.J. Beeching1 . 1 Royal Liverpool & Broadgreen University Hospitals NHS Trust, United Kingdom; 2 Cheshire & Merseyside Health Protection Unit, United Kingdom; 3 Centre for Emergency Preparedness and Response, HPA Porton, United Kingdom Background: Uptake of yearly influenza immunisation by health care workers (HCW) has been low in most British hospitals, necessitating urgent immunisation programmes during outbreaks. Aim: To describe implementation of rapid immunisation and education programmes in a large hospital Trust in two successive years. Setting and Methods: In Nov 2008 two outbreaks of different influenza A strains simultaneously affected a 1000 bed hospital Trust. A rapid immunisation programme was instituted to immunise health care workers (HCW) (previous uptake <20% per year). This included prioritisation of areas and staff at risk and taking vaccine to those areas. Lessons learnt were applied in 2009 during the H1N1 influenza pandemic. Results: 1390 key staff (77% of target) were immunised over 14 days in late 2008, including 843 over the first weekend. This contributed to low staff sickness rates over the 6-week-long epidemic and
S51
to overall control of the outbreaks. Urgent face fit testing and repeat education in use of respiratory PPE were delivered in April 2009 to 1532/2575 (59.5%) front-line HCW, at least 75% of whom were reached in the first 2 weeks of the programme. In late 2009, 746/982 (76%) doctors and 1462/1660 (88.1%) nurses in the Trust were vaccinated against seasonal influenza (1891/2208 = 85.6% in 1 month) and 886 (90.2%) and 1343 (80.9%) respectively against H1N1 pandemic influenza strain. Conclusions: 1. Trusts should encourage routine staff immunisation against influenza. 2. Occupational health departments need to be readily accessible to staff. 3. Rapid immunisation and education of large numbers of HCW can be achieved by multidisciplinary teamwork, taking interventions to the workbase of the staff. 4. Local “champions” increase uptake of vaccination. 5. We have established a prototype “Toolkit” for rapid immunisation of HCW in the hospital setting, which can be used for influenza or other outbreaks. P15.02 Influenza vaccination coverage among healthcare workers and determinants of vaccination during the 2009–2010 season C. Villanueva-Ruiz, J. Sanchez-Pay ´ a, ´ L. Cartagena-Llopis, J. Barrenengoa-Sanudo, ˜ R. Camargo-Angeles, H.R. Mart´ınez, Mª. Gonzalez-Hern ´ andez, ´ A. Rincon. Servicio de Medicina Preventiva, Hospital General Universitario de Alicante, Spain Background: Influenza vaccination of a healthcare worker (HCW) protects his health, patients’ health and reduces absenteeism from work. Objectives: Determine seasonal influenza and new A(H1N1) influenza vaccination coverage during the 2009–2010 season and to know its determinant factors. Methods: 2009–2010 influenza vaccination campaign was subdivided into two phases. In the first one, from October 1st to November 13th 2009, seasonal influenza vaccine was administered, and in the second one, carried out from November 16th to December 30th 2009, new A(H1N1) influenza vaccination was administered. Each of the vaccine programs was preceded by an specific promotional campaign, where signs, posters and leaflets were used, and also informative notes were addressed to the different services, so all the HCW were invited to be vaccinated. HCW was asked to fill out a brief self-administered questionnaire were a list of reasons to receive vaccination was included. Coverage during both vaccination campaigns were calculated, and then these results were compared, both the overall and for each profession (medical, nursing, nursing assistant and others) using Chi-square test. Results: Seasonal influenza vaccination coverage was 31% and new A(H1N1) influenza coverage was 22% (p < 0.05); in medical personnel these were 36% and 34% respectively (N.S.); in nursing personnel, 33% and 24% respectively (p < 0.05); in nursing assistant, 21% and 12% respectively (p < 0.05). The main reasons given for receiving vaccination were self-protection and protection of the family. Conclusions: In non-medical personnel, frequency of new A(H1N1) influenza vaccination was significantly lower than frequency of seasonal influenza vaccination. Low coverage achieved constitute a public health problem and it becomes necessary to implement specific intervention programs for each profession, as well as beginning to consider in our environment to demand HCW be vaccinated.