RESUMO
Objective: To review and study implementation of an automated hand hygiene reminder system (AHHRS). Design: Prospective, nonrandomized, before-after quality improvement pilot study conducted over 6 months. Setting: Medical-surgical unit (MSU) and medical intensive care unit (MICU) at a public hospital in New York City. Participants: There were 2,642 healthcare worker observations in the direct observation (DO) period versus 265,505 in the AHHRS period, excluding AHHRS observations collected during the 1-month crossover period when simultaneous DO occurred. Intervention: We compared hand hygiene adherence (HHA) measured by DO prior to the pilot and after AHHRS implementation. We compared changes in HHA and potential cross-contamination events (CCEs) (room exit and subsequent entry without HHA) from baseline for each biweekly period during the pilot. Results: Engagement, education/training, data transparency, and optimization period resulted in successful implementation and adoption of the AHHRS. Observations were greater utilizing AHHRS than DO (265,505 vs 2,642, P < .01). Due to the expected Hawthorne effect, HHA was significantly less for AHHRS than DO in MSU (90.99% vs 97.21%, P < .01) and MICU (91.21% vs 98.65%, P < .01). HHA significantly improved from 86.47% to 89.68% in MSU (P < .001) and 85.93% to 91.24% in the MICU (P < .001) from the first biweekly period of AHHRS utilization to the last. CCE decreased from 73.42% to 65.11% in the MSU and significantly decreased from 81.22% to 53.19% in the MICU (P < .05). Conclusions: We describe how an AHHRS approach was successfully implemented at our facility. With ongoing feedback and system optimization, AHHRS improved HHA and reduced CCE over time.
RESUMO
El objetivo de la investigación fue clasificar donantes seropositivos atendiendo a procedencia, edad, sexo y ocupación y determinar prevalencia de infección. Se trató de un estudio descriptivo, de campo, no experimental, de corte transversal. Se analizaron datos registrados del Libro de Donantes del Banco de Sangre de la Cruz Roja de Guayaquil, durante los años 2016-2018. Se comprobó seropositividad de pacientes para detectar anticuerpos IgG para Trypanosoma cruzi empleando Ensayo por inmunoabsorción ligado a enzimas (ELISA), Hemaglutinación Indirecta (HAI) e Inmunofluorescencia Indirecta (IFI). Se contabilizaron 315 donantes seropositivos con prevalencia mayor para 2017, procedentes del área urbana (n=105; 76,64%). En el área rural, se registró mayor prevalencia en 2016 (n=34; 33,33%). El grupo edad mayormente comprometido fue el rango de 18-22 años, correspondiente al sexo masculino (n=68, 21,58%; n= 103, 32,69%; n= 53, 16,68%). La ocupación principal para 2018, correspondió a estudiantes (43,47%). Para 2017, quehaceres del hogar (32,35%) y para 2016, ocupaciones elementales (13,82%), tales como vender mercancías en las calles, agricultura, pesca, construcción de obras públicas e industrias manufactureras. La prevalencia de infección para 2016, 2017 y 2018 fue 0,038%, 0,028% y 0,051% respectivamente
Research objective is to classify seropositive donors according to origin, age, sex and occupation and to determine the prevalence of infection. It was a descriptive, non-experimental, cross-sectional study. Data recorded from the Donors Book of the Blood Bank of the Red Cross of Guayaquil, during the years 2016-2018, were analyzed. Patient seropositivity was checked for IgG antibodies to Trypanosoma cruzi using Enzyme-Linked ImmunoSorbent Assay (ELISA), Indirect Hemagglutination (HAI) and Indirect Immunofluorescence (IFI). 315 seropositive donors with the highest prevalence for 2017, from the urban area (n = 105; 76.64%) were counted. In rural areas, the highest prevalence was recorded in 2016 (n = 34; 33.33%). The age group most compromised was the range of 18-22 years, corresponding to the male sex (n=68, 21,58%; n= 103, 32,69%; n= 53, 16,68%). The main occupation for 2018 corresponded to students (43.47%). For 2017, household chores (32.35%) and for 2016, elementary occupations (13.82%), such as selling goods on the streets, agriculture, fishing, construction of public works and manufacturing industries. The infection prevalence for 2016, 2017 and 2018 was 0.038%, 0.028% and 0.051% respectively