![]() The intervention should therefore be adapted to their educational level by using simple language and hands-on exercises. Another difference is that nurses in nursing homes generally have less education than nurses who work in hospitals. For example, hanging hand sanitizer dispensers on beds could be perceived as transforming the homelike environment to a medicalized one. For example, should touching a resident’s walking frame in the living room be considered touching a resident’s environment (after which HH is indicated)? Is a section of a table in a living room a particular “resident’s environment” because that resident is sitting there at that moment? Second, interventions should minimally disturb the homelike setting. Nursing home residents are generally mobile, sharing communal areas. ![]() At the same time, a patient’s surroundings in a nursing home is a fluid concept. The 5 moments of the WHO dictate that HH should be done before touching a patient, before a clean/aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. First, the 5 HH moments of the WHO are difficult to interpret and use in the nursing home setting. HH interventions developed for hospitals are not necessarily appropriate for nursing homes. ĭue to a paucity of HH studies in nursing home settings using the WHO hand hygiene standards, we designed a trial to evaluate the impact of an intervention package tailored to the specific context of nursing homes. In Taiwan, nursing assistants showed significantly better HHC (from 9% to 30%, P<.001) 3 months after participating in a 1-hour class and 30 minutes of hands-on training. For example, 2 studies in long-term care facilities in Hong Kong showed significant increases in HHC in intervention arms (27% to 61%, P<.001 22% to 49%, P<.001 and 26% to 33%, P=.10), no significant changes in control arms after implementing multifaceted HH interventions involving the provision of hand sanitizer, reminder materials, education, and, in one case, performance feedback. While most HH intervention studies document HHC rates in hospitals, there are a few published studies showing that interventions can significantly influence HHC in a nursing home. There is some evidence that infectious disease rates and mortality rates decrease in nursing homes when HHC increases through HH interventions. The few published studies that recorded HHC in nursing homes according to the World Health Organization (WHO) standards show estimates of 6% to 27% HHC before an intervention. Most studies focus on hand hygiene compliance (HHC) in hospitals, ignoring other settings with vulnerable populations, such as nursing homes. Hand hygiene (HH) can play a role in an infection prevention strategy. Not only do residents become ill from HAI but HAI may also affect staff due to their own illness and increased workload, further disrupting care. If we include urinary tract infections, we see on average more than one HAI per resident per year in European nursing homes. Health care–associated infections (HAI) are a significant source of morbidity in nursing home residents. Outcomes will be compared with the presence of norovirus, rhinovirus, and Escherichia coli on surfaces in the nursing homes, as measured using quantitative polymerase chain reaction. Infectious disease incidence was documented by a staff member at each nursing home unit. The secondary outcome is infectious disease incidence among residents. The primary outcome is hand hygiene compliance of the nurses to the standards of the World Health Organization. We documented compliance with the World Health Organization’s 5 moments of hand hygiene, specifically before touching a patient, before a clean/aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. Hand hygiene was evaluated in nursing homes by direct observation at 4 timepoints. Nursing homes were randomly allocated to 1 of 3 trial arms: receiving the intervention at a predetermined date, receiving the identical intervention after an infectious disease outbreak, or serving as a control arm.
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