Improving handhygiene compliance by e-health initiatives: at distance education program. Med-e-Tel International Conference 2012 Luxembourg

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1 Improving handhygiene compliance by e-health initiatives: at distance education program Med-e-Tel International Conference 2012 Luxembourg

2 Porto Alegre RS Brasil - HCPA 749 beds University- affiliate Tertiary level public hospital 22 non-critical wards 3 intensive care units (adult, neonatal, and pediatric). The adult intensive care units have 42 for medical and surgical patients.

3 1 Introduction Improving handhygiene compliance by e-health Freedom from accidental injury due to medical care or medical errors ADMISSIONS DEATHS - ERRORS DEATHS FROM OTHER DISEASES 33 MILLION ADMISSIONS IN USA 44,000-98,000 DEATHS Car accidents- 43,458 Breast cancer 42,297 AIDS 16,517 The AHA National Hospital Survey for 2005 IHI Global Trigger Tool Guiding Record Review

4 1 Introduction Improving handhygiene compliance by e-health 2005 Reduction of infections related to Healthcare My Five Moments

5 1 Introduction Improving handhygiene compliance by e-health IMPACT OF HAND HYGIENE PROMOTION Allegranzi B, J Hosp Infection, 2009

6 The story so far, 28 April 2010 Facilities registered registered health-care facilities from 135 countries; over 6 million health-care staff, and over 2.5 million patient beds

7 1 Introduction Improving handhygiene compliance by e-health Adherence to hand hygiene P<0, % Compliance with hand hygiene (%) Pittet D. Lancet Erasmus V. Infect Control Hosp Epidemioll.2010

8 1 Introduction Improving handhygiene compliance by e-health Adherence to hand hygiene P<0, % Compliance with hand hygiene (%) Pittet D. Lancet Erasmus V. Infect Control Hosp Epidemioll.2010

9 1 Introduction Improving handhygiene compliance by e-health Adherence to hand hygiene % Nurses Nurse Assistants Doctors Enfermeiros Técnicos em Enfermagem Médicos Pittet D. Lancet. 2000

10 1 Introduction Improving handhygiene compliance by e-health Hand hygiene adherence rate at Hospital de Clínicas de Porto Alegre ( ) % jun-06 Sep-06 Dec-06 mar-07 jun-07 Sep-07 Dec-07 mar-08 jun-08 Sep-08 Dec-08 mar-09 jun-09 Sep-09 Dec-09 mar-10 ADHERENCE RATE In submission. 2011

11 1 Introduction Improving handhygiene compliance by e-health Hand hygiene adherence rate at Hospital de Clínicas de Porto Alegre ( ) % jun/06 Sep-06 Dec-06 mar/07 jun/07 Sep-07 Dec-07 mar/08 jun/08 Sep-08 Dec-08 mar/09 jun/09 Sep-09 Dec-09 mar/10 Nurses Doctors In submission. 2011

12 1 Introduction Improving handhygiene compliance by e-health The hands are the most common form of infection dissemination Lower rate of adherence to hand hygiene practices (~40%) The WHO campaign in 2005 Dificulties in on site trainings New tecnologies for at distance training Objectives Disseminate the concepts of hand hygiene to a great number of healthcare workers

13 2 Methods Improving handhygiene compliance by e-health Before and After Trial 2006 Period 1 Pre-intervention (54 months) 2010 Period 2 After Intervention (12 months) Hand hygiene adherence rate Bacterial resistance rate Hospital Infection rates Antimicrobial consumptions Mortality

14 3 Infrastructure Improving handhygiene compliance by e-health Infrastructure Modular Object-Oriented Dynamic Learning Environment E-health Tool MOODLE Open-Source learning tools Quiz Three tests composed of 12 questions The healthcare worker had to score at least 80% to be approved. Support material for consultation

15 4 Logística - Educação à Distância em Higiene de Mãos Logística

16 4 Logística - Educação à Distância em Higiene de Mãos Logística

17 4 Logística - Educação à Distância em Higiene de Mãos Logística

18 4 Logística - Educação à Distância em Higiene de Mãos Logística

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23 3 Infrastructure Improving handhygiene compliance by e-health Support Material NEJM Hand Hygiene video

24 4 Agenda Improving handhygiene compliance by e-health AGENDA Dec/10 ICU Nurses Jan/11 Adult ICU, pediatric ICU, Neonatology ICU, emergency Feb/11 residency, oncology service, annesthesiology Apr/11 Clinical and Surgical wards May/11 Obstretic ward, Pediatric wards, operating rooms Jun/11 - Transplant ward, psyquiatric ward

25 4 Agenda Improving handhygiene compliance by e-health AGENDA Dec/10 ICU Nurses Jan/11 Adult ICU 227 professionals included 100% of nurse staff 57% of medical staff 40 years old; 10 years of hospital service 92% trained before 95% approved 3.5% not approved

26 5 Results Improving handhygiene compliance by e-health TAXA de HIGIENIZAÇÃO das MÃOS entre PROFISSIONAIS das UTIs adultos- Hand hygiene adherence rate in ICU janeiro/2006 a maio/2011 % ja n/06 mar/ mai/06 ju l/06 69,7 65,3 67,2 60,7 63,9 60,1 55,255,1 57,4 63,2 65,5 64,861, ,1 54,6 56,2 59,1 58,4 56, ,1 55,4 5455, ,4 53,3 56,555,3 58,4 66,5 57,5 55,1 46,2 54,1 59,2 53, ,5 53,7 49,7 53,9 50,1 52,3 52,5 50,3 47, ,6 45,3 41,4 set/06 nov/06 ja n/07 mar/07 mai/07 ju l/07 set/07 nov/07 ja n/08 mar/08 mai/08 ju l/08 set/08 nov/08 ja n/09 mar/09 mai/09 ju l/09 set/09 nov/09 ja n/10 mar/10 mai/10 ju l/10 set/10 nov/10 77,7 71,2 76,5 76,1 75,4 76,9 68,3 66,8 ja n/11 mar/11 mai/11 Média Geral de Adesão 58,6%

27 5 Results Improving handhygiene compliance by e-health Adesão à Higienização das Mãos - CTI adultos Médias Hand hygiene adherence rate in ICU anuais a maio 2011 % ,4 56,1 56,2 59,4 52,9 76,

28 5 Results Improving handhygiene compliance by e-health Taxa de adesão à higienização das mãos - CTI - por categoria profissional Hand hygiene adherence rate in ICU junho de 2006 a maio de 2011 jul/06 s et/06 no v/06 jan/07 m ar/07 m ai/07 jul/07 s et/07 no v/07 jan/ m ar/08 m ai/08 jul/08 s et/08 no v/08 jan/09 m ar/09 m ai/09 jul/09 s et/09 no v/09 jan/10 m ar/10 m ai/10 jul/10 s et/10 no v/10 jan/11 m ar/11 m ai/11 % Enfermeiros Nurses N.Assist Técn Enf Médicos Doctors

29 5 Results Improving handhygiene compliance by e-health Before After Segmented Regression Analysis Level change from 0.05 to (P<0.01)

30 There is still not enough evidence to be certain what strategies improve hand hygiene compliance. Introducing alcohol-based hand rub accompanied by education/training is not enough, while using multiple strategies, including involvement of staff in planning activities or applying social marketing strategies, may be helpful. More research is needed.

31 6 Conclusions Improving handhygiene compliance by e-health Intervention: An e-health program in 2010 improved hand hygiene compliance in our ICU This is the first report of the feasibility of an e-health program to increase hand hygeine adherence There was a great number o HCW trainned

32 Acknowledgements: E-Health Group from Hospital de Clínicas de Porto Alegre Elisa Conter Jamila Grigolo Ticiana Schossler Infection Control Committee Hospital de Clínicas de Porto Alegre Carem Gorniak Lovatto - RN Cristópher Farias PharmaD Jessica Dale RN Loriane Konkewicz - RN Márcia Rosane Pires - RN Nádia Mora Kuplich - RN Sandra Gastal - MD Thalita Jacoby - PharmaD Higiene de mãos é uma Ação Conjunta, Estratégias de Educação e Estímulo Devem Atingir a Todos os Profissionais da Instituição Thank You rpsantos@hcpa.ufrgs.br