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

OBJECTIVEMultidrug-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.METHODSFrom July to Au...

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Published in:Infection control and hospital epidemiology 2018-05, Vol.39 (5), p.571-577
Main Authors: Cheng, Vincent C C, Chen, Hong, Wong, Shuk-Ching, Chen, Jonathan H K, Ng, Wing-Chun, So, Simon Y C, Chan, Tuen-Ching, Wong, Sally C Y, Ho, Pak-Leung, Mody, Lona, Chan, Felix H W, Wong, Andrew T Y, Yuen, Kwok-Yung
Format: Article
Language:English
Subjects:
Antibiotics
Consent
Contamination
Disease control
Hospitals
Hygiene
Intervention
Laboratories
Long term health care
Meals
Medical equipment
Multidrug resistant organisms
Nosocomial infections
Nurses
Nursing
Nursing care
Older people
Personal hygiene
Staphylococcus infections
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Summary:OBJECTIVEMultidrug-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.METHODSFrom 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.RESULTSThe 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
ISSN:0899-823X
1559-6834
DOI:10.1017/ice.2018.21