9/20/2023 0 Comments Who 5 moments of hand hygiene17, 18 They are “Upon arrival in home,” “Before leaving patient's home,” and “Before accessing clean compartment of nursing bag.” Observers used the checklists to record when they witnessed one of these moments and hand hygiene adherence related to that moment. Instructions on the checklist suggest observing other moments important to protecting the “patient zone.” 16 The 3 additional opportunities are home care–specific and based on home health industry guidelines. Five of the 8 opportunities for hand hygiene were taken directly from the WHO “5 Moments of Hand Hygiene” checklist 14, 15-these include “Before patient contact,” “Before aseptic task,” “After body fluid exposure risk,” “After patient contact,” and “After contact with patient surroundings.” The WHO 5 Moments have been validated and implemented globally and are considered the minimal essential moments. ![]() The hand hygiene observation checklist includes 8 moments that trigger an opportunity for transmission of pathogens (or microorganisms that may cause infection) and the need for hand hygiene. ![]() ![]() The research team used 2 observation checklists. The institutional review boards at the study agency and collaborating academic partner reviewed and approved the study protocol. Observers confirmed patient agreement on arrival to the home. Patients were alerted that a researcher would be accompanying the nurse on the visit and gave verbal agreement in advance. Nurses were informed that the study team was interested in infection control and prevention in HHC but were not told specifically what infection control and prevention activities were going to be recorded. Nurses were recruited with purposive sampling to ensure variation in geographic location and level of experience in HHC. 13 A targeted sample size of 50 nurses (licensed practical or vocational and registered nurses) and 400 observations (8 patient visits per nurse) was selected to provide adequate statistical power to estimate nurse adherence rates and associated characteristics. The Joint Commission suggests a minimum of 200 opportunities for hand hygiene as appropriate for meaningful comparisons. Observations were conducted in the homes of patients who were admitted to the adult acute care program. This study was conducted in a large, US nonprofit certified home health agency serving both urban and suburban neighborhoods, with approximately 100,000 new patient cases and more than 1 million home visits per year. To address the gap in our understanding of HHC practices, we observed HHC nurses' hand hygiene adherence over a large number of nurses and patient visits and examined factors associated with hand hygiene adherence. 11 Compared with hospital and nursing home settings, nurses in HHC work under less direct supervision, changing environments, and with limited space and resources. The Centers for Medicare & Medicaid Services projects home health spending rate to surpass all other care categories in the next 10 years. 10, 11 US HHC spending reached $102.2 billion in 2018, 12 which is up 30% compared with home health spending 5 years ago. Use of HHC has increased over the past decade to meet the health care needs of the growing aging population and as a result of incentives to discharge patients from the hospital sooner. HHC includes skilled, largely post-acute care provided in the patient's home environment. 9 Findings indicated a 59.2% hand hygiene adherence rate, but this study was limited by a small sample size (8 nurses, 40 HHC visits). 8 Only 1 study, an observation study of practices, has been conducted in an Australia home health care (HHC) setting. Most hand hygiene studies to date have been conducted in the inpatient and emergency department settings, with limited evidence in post-acute care settings such as nursing homes. 1, 4 Improving adherence to hand hygiene recommendations has become an important goal for health care organizations 5 and received significant additional attention with the outbreak of SARS-CoV-2. 3 The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) have published guidelines for hand hygiene in health care settings. 2 Hand hygiene to reduce pathogen transmission and prevent infections is one foundational approach for effective infection prevention and control. ![]() 1 Infection prevention and control is a top priority across health care settings to ensure high quality of care and patient safety. Infection is a significant cause of morbidity and preventable deaths, can have emotional consequences for patients and their family, and is associated with high health care costs.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |