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Role of Hand Hygiene Ambassador and Implementation of Directly Observed Hand Hygiene Among Residents in Residential Care Homes for the Elderly in Hong Kong

Published online by Cambridge University Press:  27 February 2018

Vincent C. C. Cheng ,
Hong Chen ,
Shuk-Ching Wong ,
Jonathan H. K. Chen ,
Wing-Chun Ng ,
Simon Y. C. So ,
Tuen-Ching Chan ,
Sally C. Y. Wong ,
Pak-Leung Ho  and
Lona Mody
...Show all authors
Vincent C. C. Cheng
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Hong Chen
Affiliation:
Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
Shuk-Ching Wong
Affiliation:
Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Jonathan H. K. Chen
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Wing-Chun Ng
Affiliation:
Community Geriatric Assessment Team, Fung Yiu King Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Simon Y. C. So
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Tuen-Ching Chan
Affiliation:
Community Geriatric Assessment Team, Fung Yiu King Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Sally C. Y. Wong
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Pak-Leung Ho
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
Lona Mody
Affiliation:
Geriatric Research Education and Clinical Center, Ann Arbor Veteran Affairs Healthcare System, Ann Arbor, Michigan
Felix H. W. Chan
Affiliation:
Community Geriatric Assessment Team, Fung Yiu King Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
Andrew T. Y. Wong
Affiliation:
Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region, China
Kwok-Yung Yuen*
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
*
Address correspondence to Kwok-Yung Yuen, Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong Special Administrative Region, China (kyyuen@hku.hk).
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Abstract

OBJECTIVE

Multidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.

METHODS

From July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum β-lactamse (ESBL)–producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.

RESULTS

The overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).

CONCLUSIONS

The direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.

Infect Control Hosp Epidemiol 2018;39:571–577

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 571 - 577
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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