Hand hygiene opportunities in pediatric extended care facilities.

INTRODUCTION: Introduction: Children in extended care facilities (ECFs) are at risk of healthcare-associated infections, but little hand hygiene (HH) research has been conducted in this unique setting. METHODS: Eight children across four pediatric ECFs were observed for a cumulative 128 hours, and all care giver HH opportunities were characterized by the World Health Organization's '5 Moments for HH'. Data were analyzed using Pearson's χ2 test. RESULTS: Observers documented 865 HH opportunities. Overall HH adherence was 43% and was significantly higher among clinical care givers than among non-clinical care givers (61% and 14%, respectively, (p < .01). CONCLUSIONS: Hand hygiene adherence was low, suggesting multiple opportunities for transmission of infectious agents.

Time lag for posting transmission-based isolation precaution signs.

BACKGROUND: Rapid identification and isolation of patients colonized or infected with virulent pathogens is essential to minimize risk of exposure to other patients, visitors, and health care workers. OBJECTIVE: Our objective was to determine the time lag between when a patient is identified as requiring isolation precautions and when an isolation sign is posted outside of their room. METHODS: Patients requiring assessment of isolation precautions because of a new positive culture, readmission, or transfers within the institution were identified through an electronic surveillance system. Observers recorded the presence of isolation signs at the patient's door at time (T) 0hr, T2hr, T4hr, T24hr, and T48hr or until an isolation sign was posted. RESULTS: The majority of patients was adults in nonintensive care units. Isolation signs were present for 79.0% of the patients at T0hr and increased to 83.8% by T48hr. No difference was seen between the unit type or indications for isolation. The most common organisms for which isolation was indicated were influenza and resistant enterococci, Staphylococcus aureus; isolation sign postings at T0hr were 87.9%, 85.7%, and 80.7%, respectively. There was a significant difference seen in compliance among the adult (82.8%) and pediatrics (66.7%) sites (P = .0268). CONCLUSION: Isolation precautions are indicated to prevent transmission of virulent pathogens; however, their implementation in a timely manner can be challenging. In this study, approximately 20% of patients for whom isolation was needed had no sign posted within the first 24 hours, and there were only minimal increases thereafter. Simple processes are needed for early identification of patients, communication of the protective equipment needed, and continuous monitoring of adherence to guidelines.

Measuring compliance with transmission-based isolation precautions: comparison of paper-based and electronic data collection.

BACKGROUND: Decreasing the transmission of resistant organisms in hospitals is a key goal of infection prevention plans. Studies have consistently shown inadequate health care worker (HCW) compliance with isolation precautions. Evaluating adherence through direct observation of HCW behavior is considered the "gold standard" but is labor-intensive, requiring the collection and analysis of a large volume of observations. METHODS: Two methods of data collection to assess HCW compliance were evaluated: a manual method using a paper form (PF), with subsequent data entry into a database, and an electronic method using a Web-based form (WBF) with real-time data recording. Observations were conducted at 4 hospitals (a total of 2,065 beds) to assess the availability of gloves, gowns, and masks; isolation sign postings; and HCW isolation practices. RESULTS: A total of 13,878 isolation rooms were observed in 2009. The median number of rooms observed per day was 61 for PF and 60 for WBF, and the respective mean observation times per room were 149 seconds and 60 seconds. Thus, use of the WBF provided a time savings of 89 seconds per room. CONCLUSION: Simple electronic forms can significantly decrease the required resources for monitoring HCW adherence to hospital policies. Use of the WBF decreased the observation time by 60%, allowing for increases in the frequency and intensity of surveillance activities.