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      Systemic mistakes in hand hygiene practice in Ukraine: detection, consequences and ways of elimination Translated title: Systemische Fehler in der Händehygienepraxis in der Ukraine: Erkennung, Folgen und Möglichkeiten der Beseitigung

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          Abstract

          Aim: Every year, millions of people around the world suffer from different infectious diseases, considerable part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to reduce the level of infection. We evaluated various aspects related to the situational behavior and prioritization regarding hand hygiene measures among the healthcare workers of Ukraine.

          Method: Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315 master-classes and presentations on proper hand hygiene were realized. The target audience included health care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took part in anonymous survey on hand hygiene practice.

          Results: The most common mistakes were to regard hand washing and hand disinfection equally, to wash hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and pharmaceutical industry workers highlighted the need for practical and understandable instructions of various hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground for us to create individual master classes on hand hygiene for each cluster of healthcare workers.

          Conclusions: Changing hand hygiene behavior and attitude is possible by beginning to observe clinical practice and by involving healthcare workers in teaching and training.

          Zusammenfassung

          Ziel: Jedes Jahr erleiden Millionen Menschen weltweit Infektionen, von denen ein beträchtlicher Anteil nosokomial ist. Die WHO betrachtet Händehygiene als wichtigste Maßnahme zu ihrer Prävention. Ziel dieser Studie war es, verschiedene Aspekte der Händehygiene zum situativen Verhalten und zur Präferenz von Maßnahmen bei Mitarbeitern im Gesundheitswesen der Ukraine zu erfahren.

          Methoden: Die Bewertung grundsätzlicher Fehler in der Händehygiene wurde in erster Linie mittels direkter und indirekter Beobachtung vorgenommen. Hierzu wurden Tätigkeiten von medizinischem und pharmazeutischem Personal im Berufsalltag sowie während Schulungen zur Händehygiene beobachtet. Zusätzlich wurden Fragenbögen zur Bewertung der Händehygiene genutzt. Insgesamt wurden 112 Schulungen, 315 Fortbildungen und Präsentationen zur Händehygiene in die Auswertung eingeschlossen. Die Zuhörer waren Mitarbeiter aus Praxen, Kliniken, Geburtskliniken, Apotheken und Arzneimittelherstellern aus allen Regionen der Ukraine. An der anonymen Befragung zur Praxis der Händehygiene nahmen 638 Personen teil.

          Ergebnisse: Die häufigsten Fehler waren die Betrachtung der Händedesinfektion und des Händewaschens als gleichwertig, das Waschen der Hände vor einer Händedesinfektion, das Vernachlässigen der 5 Momente der Händehygiene sowie das Ignorieren der Händehygiene vor und nach dem Tragen von Schutzhandschuhen. Alle Teilnehmer äußerten den Bedarf an praxisnahen und verständlichen Anweisungen zu den verschiedenen Händehygiene-Tätigkeiten einschließlich der Erklärung möglicher technischer Fehler in der Durchführung. Auf dieser Basis wurden individuelle berufsgruppenspezifische Masterklassen für Händehygiene erstellt.

          Fazit: Das Verhalten und die Einstellung zur Händehygiene kann verändert werden, in dem zu Beginn die praktische Durchführung beobachtet wird und in dem die Mitarbeiter in die Schulung und Ausbildung eingebunden werden.

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          Most cited references33

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          Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs.

          The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.
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            Improving adherence to hand hygiene practice: a multidisciplinary approach.

            D Pittet (2001)
            Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol- based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene.
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              Focus group study of hand hygiene practice among healthcare workers in a teaching hospital in Toronto, Canada.

              To understand the behavioral determinants of hand hygiene in our hospital. Qualitative study based on 17 focus groups. Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto. We recruited 153 healthcare workers (HCWs) representing all major patient care job categories. Focus group discussions were transcribed verbatim. Thematic analysis was independently conducted by 3 investigators. Participants reported that the realities of their workload (eg, urgent care and interruptions) make complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and participants expressed that their judgement is adequate to determine when to perform hand hygiene. Discussions revealed gaps in knowledge among participants; most participants expressed interest in more information and education. Participants reported self-protection as the primary reason for the performance of hand hygiene, and many admitted to prolonged glove use because it gave them a sense of protection. Limited access to hand hygiene products was a source of frustration, as was confusion related to hospital equipment as potential vehicles for transmission of infection. Participants said that they noticed other HCWs' adherence and reported that others HCWs' hygiene practices influenced their own attitudes and practices. In particular, HCWs perceive physicians as role models; physicians, however, do not see themselves as such. Our results confirm previous findings that hand hygiene is practiced for personal protection, that limited access to supplies is a barrier, and that role models and a sense of team effort encourage hand hygiene. Educating HCWs on how to manage workload with guideline adherence and addressing contaminated hospital equipment may improve compliance.
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                Author and article information

                Journal
                GMS Hyg Infect Control
                GMS Hyg Infect Control
                GMS Hyg Infect Control
                GMS Hygiene and Infection Control
                German Medical Science
                2196-5226
                14 January 2015
                2015
                : 10
                : Doc01
                Affiliations
                [1 ]Organization and Economy Department, P.L. Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
                [2 ]Bode Science Center, Bode Chemie GmbH, Hamburg, Germany
                [3 ]Institute of Hygiene and Environmental Medicine, University Medicine, Greifswald, Germany
                Author notes
                *To whom correspondence should be addressed: Iryna Klymenko, Organization and Economy Department, P.L. Shupyk National Medical Academy of Postgraduate Education, Str. Dorogozhytska 9, 04112 Kiev, Ukraine, Phone: +38 050 3536596, E-mail: iryna.v.klymenko@ 123456gmail.com
                Article
                dgkh000244 Doc01 urn:nbn:de:0183-dgkh0002443
                10.3205/dgkh000244
                4332274
                d064408f-3d09-4b80-8013-8b2e3c4b96f3
                Copyright © 2015 Klymenko et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.

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                hand hygiene,hand disinfection,hand washing,hand care,compliance,healthcare settings,medical staff,ukraine

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