A prospective cohort study on closed-circuit television monitoring and direct observation for hand hygiene compliance in a pediatric intensive care unit

Lohiya Balkisanji, P. Satheesh, R. Rameshkumar, P. Jain, V. Jayaseelan, S. Mahadevan
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Abstract

Background: Intensive care patients are at risk for healthcare-associated infections (HCAIs), and hand hygiene (HH) compliance in health-care workers (HCWs) is reportedly low. This study aimed to compare closed-circuit television (CCTV) monitoring to direct observation on the HH compliance and its impact on HCAIs. Methods: In a prospective cohort study, HCWs were observed for HH compliance and HCAIs were studied. The study period was August 1, 2014–December 31, 2014 (direct observation period), and March 1, 2015–July 31, 2015 (CCTV monitoring period), with 2 months washout period. A HH education module (running a video daily, reinforcement of HH everyday evening, 2-weekly classes about HH importance, and posters reinforcing the importance of HH on the prominent sites of pediatric intensive care unit) was implemented in both periods. Each day was divided into blocks of 6-h. One hour from each block was randomly selected stratified by day and night shifts. HH compliance was observed according to the World Health Organization, “My Five Moments of HH.” Results: A total of 751 patients (direct observation period n = 369, CCTV monitoring period n = 382) were admitted. The HH compliance rate was higher in the CCTV monitoring period (56.6%, n = 5953 / 10519) as compared to that of the direct observation period (36.1%, n = 2178 / 6028) (relative risk = 1.57, 95% confidence interval: 1.51 - 1.63, P ≤ 0.001). Ventilator-associated pneumonia (4.7 vs. 12 / 1000 ventilation-day) and central line-associated bloodstream infection (1.9 vs. 6.6 / 1000 central line-day) were lower in the CCTV monitoring period. There was no difference in mortality between the study periods (18.3%, n = 70 / 382 vs. 21.1%, n = 78 / 369, relative risk = 0.87, 95% confidence interval: 0.65–1.16, P = 0.333). Conclusion: CCTV monitoring was associated with improved HH compliance, which was associated with lower HCAIs.
儿童重症监护室手部卫生依从性闭路电视监测和直接观察的前瞻性队列研究
背景:重症监护患者面临卫生保健相关感染(HCAIs)的风险,据报道卫生保健工作者(HCWs)的手部卫生(HH)依从性较低。本研究旨在比较闭路电视(CCTV)监测与直接观察HH依从性及其对hcai的影响。方法:在一项前瞻性队列研究中,观察HCWs的HH依从性,并研究hcai。研究期为2014年8月1日- 2014年12月31日(直接观察期),2015年3月1日- 2015年7月31日(闭路电视监控期),洗脱期2个月。在两个时期都实施了HH教育模块(每天播放视频,每天晚上加强HH,每两周进行一次关于HH重要性的课程,并在儿科重症监护病房的突出位置张贴HH重要性的海报)。每天被分成6小时一组。每个街区随机抽取1小时,按白班和夜班分层。遵循世界卫生组织的“我的五个健康时刻”。结果:共收治751例患者,其中直接观察期369例,闭路电视监测期382例。闭路电视监测期间HH依从率(56.6%,n = 5953 / 10519)高于直接观察期(36.1%,n = 2178 / 6028)(相对危险度= 1.57,95%可信区间:1.51 ~ 1.63,P≤0.001)。在CCTV监测期间,呼吸机相关肺炎(4.7 vs 12 / 1000通气日)和中央静脉相关血流感染(1.9 vs 6.6 / 1000通气日)较低。研究期间的死亡率无差异(18.3%,n = 70 / 382 vs. 21.1%, n = 78 / 369,相对危险度= 0.87,95%可信区间:0.65-1.16,P = 0.333)。结论:闭路电视监测与改善HH依从性相关,而HH依从性与较低的hcai相关。
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