Abstract:
BACKGROUND:The objectives of this integrative review were to critically examine the overall state of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections (HCAIs) in acute care and long-term care settings, and offer recommendations for future directions in the field based on our findings. METHODS:We searched for original research and reviews of research published between January 1, 1996, and July 31, 2006. Studies were identified through the electronic databases Medline, CINAHL, EMBASE, PUBMED, the Cochrane Library, and through expert consultation. Our comprehensive search strategy included all English articles for which hand hygiene or handwashing-related terms were combined with HCAIs. All studies that investigated a relationship between hand hygiene practices and HCAIs in acute care facilities were considered. These hand hygiene practices included the initiation of multimodal hand hygiene initiatives, the introduction of alcohol sanitizers, the implementation or changes of the infection control practices or infection control policies, and other organizational interventions. Studies only examining hand hygiene compliance, efficacy of alcohol hand gels, plain soap, and antimicrobial soap in reducing bacteria count recovered from hands were excluded. RESULTS:Of the 1120 articles retrieved, 35 publications, including 4 reviews of research discussed at the outset of this article, met our inclusion criteria. The remaining 31 eligible original studies included 18 (58.07%) before and after studies without control groups, 4 (12.90%) before and after studies with a control group, 3 (9.68%) cohort studies with no control group, 4 (12.90%) cohort studies with a control group, and 2 (6.45%) randomized trials. Over 50% (16 or 31) of the studies were conducted in the U.S. Two independent reviewers conducted independent evaluations of all eligible studies, critiquing and scoring each study using a rating scale for examining the fatal flaws of quasi-experimental and before and after studies. CONCLUSIONS:There is a lack of rigorous evidence linking specific hand hygiene interventions with the prevention of HCAIs. The varied nature of the interventions used and the diverse factors affecting the acquisition of HCAIs make it difficult to show the specific effect of hand hygiene alone. The most frequent methodologies currently used in this research area are before and after observational studies without a control comparison group. Based on these findings, we recommend that researchers used a modified version of Larson's 2005 criteria to guide the design and conduct of future before and after observational studies in this area. We also argue that as we accumulate stronger evidence of which interventions are most effective, we need to develop additional research approaches to study how organizations succeed and fail in fostering the uptake of evidence-based hand hygiene interventions.
journal_name
Am J Infect Controljournal_title
American journal of infection controlauthors
Backman C,Zoutman DE,Marck PBdoi
10.1016/j.ajic.2007.08.007subject
Has Abstractpub_date
2008-06-01 00:00:00pages
333-48issue
5eissn
0196-6553issn
1527-3296pii
S0196-6553(07)00812-7journal_volume
36pub_type
杂志文章,评审abstract:BACKGROUND:Surgical site infections increase the morbidity, mortality, and costs associated with surgical care. An estimated 96.2 million surgical procedures are performed in low- and middle-income countries (LMICs) each year. This pilot study assessed the steam sterilization aspect of the surgical instrument reprocess...
journal_title:American journal of infection control
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ajic.2015.06.025
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:Health care-associated opportunistic pathogens Staphylococcus aureus and Enterococcus faecium persist on dry environments and can contribute to organism transmission through contact. These organisms can be monitored on surfaces by culture, molecular methods, or metabolic assays. This study was designed to de...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2017.07.027
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Health care-associated infections (HAIs) can be associated with increased health care costs. We examined extra length of hospital stay (LOS) and associated per diem costs attributable to HAIs in a large academic medical center. METHODS:Data for analysis were acquired in a preinterventional phase of a prospe...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2015.09.005
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Routine hand hygiene effectively removes methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin resistant Enterococcus (VRE) from the ungloved hands of healthcare workers (HCWs) who are caring for patients under contact precautions, when exposure to bodily fluids is not expected. METHODS:HCWs'...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2018.01.013
更新日期:2018-07-01 00:00:00
abstract::We describe influenza immunization coverage trends from the New York State (NYS) Department of Health long-term care facility (LTCF) reports. Overall median immunization coverage levels for NYS LTCF residents and employees were 84.0% (range: 81.6%-86.0%) and 37.7% (range: 32.7%-50.0%), respectively. LTCF resident immu...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2012.09.025
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:The removal of personal protective equipment (PPE) after patient care may result in transfer of virus to hands and clothing of health care workers (HCWs). The risk of transfer can be modeled using harmless viruses to obtain quantitative data. To determine whether double-gloving reduces virus transfer to HCWs...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2011.04.324
更新日期:2012-05-01 00:00:00
abstract::Disease transmission from percutaneous injury occurs in 2% to 40% of health care workers (HCWs) after exposure to the hepatitis B virus (HBV), in 3% to 10% after exposure to the hepatitis C (HCV) virus, and in 0.2% to 0.5% after exposure to the HIV virus. According to a recently published case-control study from the C...
journal_title:American journal of infection control
pub_type: 杂志文章,评审
doi:10.1016/s0196-6553(97)90094-8
更新日期:1997-10-01 00:00:00
abstract::The appropriate use of antibiotics in nosocomial infections has been a goal of infectious disease practitioners and hospital epidemiologists since the emergence of resistant staphylococci more than 30 years ago. This challenge has assumed new proportions in the 1980s for many reasons. First, resistant gram-positive an...
journal_title:American journal of infection control
pub_type: 杂志文章,评审
doi:10.1016/0196-6553(89)90188-0
更新日期:1989-10-01 00:00:00
abstract::A questionnaire survey was carried out anonymously among 2557 health care workers in Denmark and Norway to identify and quantify factors that affect the handwashing behavior of physicians, nurses, and other staff groups who perform direct patient care. For number of daily patient contacts physicians reported significa...
journal_title:American journal of infection control
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/s0196-6553(05)80002-1
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:The prevalence of surgical site infections (SSI) is second only to urinary tract infections in hospitalized patients. They continue to threaten the health of hospitalized patients and impact negatively on the financial solvency of hospitals through prolonged hospitalization, increased rates of rehospitalizat...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2005.04.244
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:Long-term acute care hospitals (LTACHs) have a unique patient population, with multiple risk factors for carbapenem-resistant Enterobacteriaceae (CRE) colonization and infection. METHODS:We performed a retrospective analysis of patients in LTACHs who were diagnosed with and treated for CRE infections. Basel...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2019.07.006
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Chlorhexidine gluconate (CHG) and povidone iodine (PI) are rarely used concurrently despite a lack of evidence regarding functional incompatibility of these agents. METHODS:CHG and PI, alone and combined, were evaluated against Staphylococcus aureus (methicillin-susceptible S aureus [MSSA] and methicillin-r...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2010.06.022
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:Community-based points of dispensing (POD) will be used during disasters to distribute mass quantities of anti-infective therapy/prophylaxis and/or vaccination to an entire community in a short period of time. Without proper planning, staff training, and implementation of infection prevention strategies, dis...
journal_title:American journal of infection control
pub_type: 杂志文章,评审
doi:10.1016/j.ajic.2009.09.001
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Studies taken from different hospitalized patient populations, environments, and geographic regions reveal differences in the numbers and species of organisms colonizing the skin. Our aim was to determine the types and amounts of skin flora, and examine the factors associated with variations in microbial ski...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1067/mic.2003.64
更新日期:2003-04-01 00:00:00
abstract:BACKGROUND:Health care personnel (HCP) working while experiencing influenza-like illness (ILI) contribute to influenza transmission in health care settings. Studies focused on certain HCP occupations or work settings have demonstrated that some HCP often continue to work while ill. METHODS:Using a national nonprobabil...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2017.04.008
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Needleless intravenous devices have now been implemented by many institutions worldwide. A rationale for their use has been a reduction in the number of needlestick injuries. OBJECTIVE:The aim of this review is to outline the possible benefits and dangers of needleless intravenous systems. REVIEW:Many earl...
journal_title:American journal of infection control
pub_type: 杂志文章,评审
doi:10.1016/s0196-6553(99)70009-x
更新日期:1999-10-01 00:00:00
abstract:BACKGROUND:Ventilator-associated pneumonia (VAP) prevention is an important patient safety initiative. We describe the impact of a multidisciplinary surveillance program on VAP rates in a tertiary medical-surgical-trauma intensive care unit (ICU). METHODS:An epidemiologic surveillance program was established in 2003 a...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2011.10.004
更新日期:2012-11-01 00:00:00
abstract::Personal protective equipment (PPE) training aims to reinforce the Centers for Disease Control and Prevention guidelines for donning and doffing; however, many health care and ancillary personnel use non-guideline methods to don and doff their PPE gowns and gloves. We found that hospital personnel commonly deviated fr...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2019.03.013
更新日期:2019-09-01 00:00:00
abstract::Using an innovative, covert, in-room observer method to evaluate infection control practices for patients with Clostridioides difficile infection, we found no difference between physician and nursing hand hygiene compliance and contact precaution usage. There was also no diurnal variation in hand hygiene practices, bu...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2019.03.031
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Comparability of the 2 commercially available tuberculin skin testing (TST) preparations, Aplisol (Parkdale Pharmaceuticals, Inc, Rochester, MI) and Tubersol (Aventis Pasteur, Inc, Swiftwater, PA), remains uncertain, particularly in groups that undergo repeated testing, such as health care workers. METHODS:...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2006.05.288
更新日期:2006-12-01 00:00:00
abstract::Viridans group streptococci (VGS), a leading cause of bloodstream infection (BSI) in cancer patients, are thought to arise from the gastrointestinal tract. We sought to determine whether central venous catheters may serve as the source of VGS BSI, and to compare the ability of the newly proposed mucosal barrier injury...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2014.06.012
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:Hospitalized carriers of carbapenem-resistant Enterobacteriaceae (CRE) are cohorted under contact precautions, including in the days between rehospitalization and surveillance culture results. This study investigates duration of CRE carriage to define populations requiring precautions upon readmission. METH...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2012.09.020
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Although hand hygiene (HH) is key to reducing health care-associated infections, it is well documented that health care worker (HCW) adherence to appropriate HH protocols is relatively low. METHODS:This was a collaborative quality improvement project with multiple interventions conducted in a 570-bed academ...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2014.07.003
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:Insufficient use of behavioral theory to understand health care workers' (HCWs) hand hygiene compliance may result in suboptimal design of hand hygiene interventions and limit effectiveness. Previous studies examined HCWs' intended, rather than directly observed, compliance and/or focused on just 1 behaviora...
journal_title:American journal of infection control
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajic.2013.07.019
更新日期:2014-02-01 00:00:00
abstract:BACKGROUND:Occupational blood exposures among operating room personnel have been substantially underreported in incident reports. Recent research has indicated several common factors influencing exposure rates: surgical service (thoracic, neurosurgery, orthopedic), length of operation, and emergency status. METHODS:Th...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/0196-6553(93)90402-p
更新日期:1993-12-01 00:00:00
abstract:BACKGROUND:Hospital rooms play an important role in the transmission of several health care-associated pathogens. During the last few years, a number of innovative cleaning-disinfecting products have been brought to market. In this study, commercially available products combining cleaning and disinfection were compared...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2017.04.290
更新日期:2017-08-01 00:00:00
abstract::We describe 1,132 contacts between anesthesiologists and the operating room. Objects most commonly touched included anesthesia machines and keyboards. Only 13 hand hygiene events were witnessed during 8 hours of observations. Line insertions, bronchoscopies, or blood exposures were not followed by hand hygiene. Stopco...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2013.03.306
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:It is generally recognized that the health care system does not have adequate isolation capacity to meet the surge in demand during a major outbreak of airborne infectious disease. Alternatives to engineered isolation rooms undoubtedly will be required as surge isolation requirements exceed the available res...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2008.05.011
更新日期:2009-03-01 00:00:00
abstract::Six hundred twenty-two isolates from 554 samples taken from hands of 103 hospital personnel and 50 controls were obtained over a mean period of 35 days. Eighty-five were obtained immediately before and after handwashing (HW), the remainder after HW only. The relationship of HW agent used, clinical area and job, and fr...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/0196-6553(84)90020-8
更新日期:1984-04-01 00:00:00
abstract:BACKGROUND:This study described and analyzed the age, gender, infection sources, and timing characteristics of the 416 confirmed cases in two cities near the center of China's COVID-19 outbreak. METHODS:This study used publicly available data to examine gender, age, source of infection, date returned from Hubei, date ...
journal_title:American journal of infection control
pub_type: 杂志文章
doi:10.1016/j.ajic.2020.06.191
更新日期:2020-09-01 00:00:00