Vårdrelaterade infektioner är ett globalt problem, patienter i utvecklingsländer är speciellt utsatta på grund av att många sjukhus har begränsade resurser. Därför kom idén upp att göra en studie som belyser hur sjuksköterskor hanterar handhygien med avseende att förebygga vårdrelaterade infektioner på Bulongwa Lutheran Hospital i Tanzania. Data samlades in genom en observationsstudie som varade i fyra dagar. Anteckningar från observationen skrevs ner i löpande text och analyserades genom en detaljerad innehållsanalys. I analysen växte ett antal kategorier fram, vilka resulterade i fyra övergripande teman: tvättmöjligheter, handtvätt, handskanvändning och övriga hygienaspekter. Resultatet av studien visade att sjukhusmiljön medförde vissa svårigheter för sjuksköterskorna att förhålla sig till god handhygien. Då handtvätt utfördes gjordes det med varierad noggrannhet och inträffade framförallt efter städmoment. Skyddshandskar användes vid städning och i vissa fall vid hantering av kroppsvätskor. Sjukhuset var försett med information i form av affischer för hur handhygien bör genomföras och sjuksköterskorna hyste kunskap i när tillfällen för handtvätt var aktuellt och på vilket sätt det skulle utföras. Slutsatsen som kan dras av denna studie är att bristfällig tillgänglighet av resurser troligtvis medförde en försämrad följsamhet till rekommenderade riktlinjer på Bulongwa Lutheran Hospital. / Healthcare associated infections are a global issue, patients in developing countries are especially vulnerable because of many hospitals' limited resources. The purpose of this study was to highlight how nurses manage hand hygiene for preventing healthcare associated infections at Bulongwa Lutheran Hospital in Tanzania. Data were collected during a four days observational study. Notes from the observation were written in linear form and analyzed using a detailed content analysis. The analysis brought a number of categories, which in the end resulted in four themes: places for hand washing, hand washing, glove usage and other health aspects. The results showed that the hospital environment caused a few problems for the nurses to respond to good hand hygiene. When hand washing was performed, it was made with varying accuracy and occurred most frequently after cleaning. Gloves were used during cleaning and in some cases when handling body fluids. The hospital was provided with information in the form of posters showing how hand hygiene should be performed and the nurses had knowledge of the occasions when hand washing was disclosed and the manner in which it should be performed. The conclusion to be drawn from this study is the lack of availability of resources likely led to deterioration in adherence to recommended guidelines at Bulongwa Lutheran Hospital.

Master of Public Health / Department of Diagnostic Medicine and Pathobiology / Katherine S. KuKanich / Hand hygiene by healthcare workers is an effective means of preventing healthcare-acquired infections. However, hand hygiene compliance can be low among healthcare workers. This study used introduction of a gel sanitizer and informational poster as interventional tools in attempt to improve hand hygiene in two outpatient healthcare clinics. Healthcare workers at two outpatient clinics were observed for frequency of hand hygiene (attempts vs. opportunities). Gel sanitizer and informational posters were introduced together as an intervention. Direct observation of hand hygiene frequency was performed during baseline, intervention, and follow-up. A post-study survey of healthcare workers was collected. In both clinics, baseline hand hygiene was poor (11% and 21%) but significantly improved (p[less than or equal to]0.0001) after interventions (36 and 54%), and was maintained (p>0.05) through the follow-up period (32 and 51%). Throughout the study, post-contact hygiene was statistically observed more than pre-contact hygiene. In both clinics, healthcare workers self-reported a preference for soap and water, yet observations showed that sanitizer use predominated over soap and water use when sanitizer was available after the intervention. Fifty per cent of the surveyed healthcare workers considered the introduction of gel sanitizer to be an effective motivating tool for improving hand hygiene. Hand hygiene performance by healthcare workers in outpatient clinics may benefit from promoting gel sanitizer and using informational posters. Direct observation by trained observers may provide more accurate information of hand hygiene tool preference compared with survey results.

Master of Public Health / Department of Diagnostic Medicine/Pathobiology / Douglas Powell / Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. These outbreaks demonstrate that although contact with animals in public settings can provide educational and entertainment opportunities, the potential to spread disease exists if risk-reduction tools are not implemented, proper hygiene measures aren’t practiced, and precautions are not taken and reinforced. This thesis is divided into two parts. Part one is an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas and Missouri, U.S., petting zoos. Part two delineates best practices for organizing events where human-animal interactions are encouraged, in hopes it will lower the risk of zoonotic disease transmission. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors performed hand hygiene more often when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; P < 0.001, OR = 4.863, 95% CI = 3.380–6.998), and in petting zoos where animal contact occurred over a fence (188/460, 40.9%) as opposed to visitors entering an animals’ yard for contact (26/114, 22.8%; P < 0.001, OR = 2.339, 95% CI = 1.454–3.763). Inconsistencies existed in tool availability, signage, and supervision of animal- contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks. Recommendations made in the second part of this thesis were based on these observations, recent publications, and the suggestions of many health agencies. It focuses on what event planners can do to design and plan a safer event, and what staff working at the event should be aware of in order to inform visitors and lower the risk of zoonotic disease transmission. Part two discusses two primary tools to reduce risk of zoonotic disease transmission: sanitation and awareness of risk behaviors. Keeping facilities, animals, and visitors clean, and informing visitors of risky behaviors to avoid, while reinforcing positive messages within the animal- contact area, can lower the risk of zoonotic infection. Included with the second part, is a checklist (see appendix A) designed for visitors to assess whether an event that encourages human-animal interaction poses a high or low risk. By identifying possible risk factors, teachers and parents will be able to make an informed decision about the safety of the human-animal encounter.

Low hand hygiene compliance among health staff is a problem globally in health care settings. Improving hand hygiene could prevent many of the health care associated infections that affects hundreds of millions of patients every year around the globe. The aim of this literature study was to describe obstacles to maintain proper hand hygiene in hospitals, seen from a global perspective. Eight articles from seven countries, all based on qualitative research have been analysed according to Friberg's five-step method that contributes to evidence-based nursing. The challenges to sustain hand hygiene found in the results were split into two main categories: Organizational factors and Individual factors. Organizational factors included five subcategories: Work environment, Inadequate education, Infrastructure, Insufficient management and Power structures. The results showed that when these factors were negatively affected so was compliance regarding proper hand hygiene. These were often issuesthat the health staff felt powerless to change and affect. Individual factors included two subcategories: Attitudes and social factors. Example of this could be healthcare workers neglected hygiene guidelines out of personal reasons or healthcare workers giving care to patients that didn’t accept how it was carried out because of social and cultural differences. The complex issues revolving these matters need to be addressed on an overall perspective. Cooperation between management and health staff is fundamental to obtain changes within healthcare organizations. Both parties need to work together to be able to improve hand hygiene compliance and to reduce healthcare associated infections.

Bakgrund: Socialstyrelsens basala hygienrutiner och främst handhygien är en viktig och grundläggande del av sjuksköterskans arbete inom hälso- och sjukvården. Korrekt utförande av rutinerna skapar minskad smittspridning som ska minska VRI som idag är den främsta orsaken till skada inom hälso- och sjukvården. VRI leder till ett ökat lidande för patienten, förlängd vårdtid och stora kostnader. En av sjuksköterskans uppgifter är att förebygga sjukdom genom att exempelvis tillämpa handhygien. Syfte: Syftet med studien är att belysa vilka faktorer som orsakar bristande följsamhet av handhygien hos sjuksköterskor. Metod: Examensarbetet är en litteraturöversikt med kvantitativt och kvalitativt ansats. Tolv vetenskapliga artiklar har analyserats. Fokus på analysen av artiklarna ligger till grund i en analys på fem steg. Resultat: Resultatet visar olika faktorer som leder till bristande följsamhet av handhygien. Personliga faktorer kan sjuksköterskan påverka, som sin attityd, sin kunskap och sin roll som förebild. Organisatoriska faktorer däremot, som hinder i vårdmiljön, kontinuerlig utbildning och brist på tid är svårare för sjuksköterskan att förändra. Slutsats: Olika faktorer påverkar sjuksköterskans följsamhet av handhygienrutiner. Idag förekommer VRI i stor utsträckning och det krävs en förståelse från sjuksköterskan angående dessa faktorer för att förbättra det preventiva arbetet mot VRI. / Background: Swedish basal hygiene routines are an important and essential part of the healthcare. Correct execution of the routines creates a decline in proliferation of contagions which will shrink the number of HAI which today is the foremost reason of damage in the healthcare. HAI leads to an increase of suffering for the patient, extended nursing time and costs. The nurses primary task is to prevent disease through the usage of hand hygiene. Aim: Factors causing lack of hand hygiene among nurses. Method: A descriptive literature review with results from 12 scientific articles. Articles were analysed with a five-stage model. Results: This bachelor thesis result displays different factors which contributes to deficient use of hand hygiene. The nurse can affect the personal factors, like their attitude, knowledge and their ideal to be a role model. However organizational factors like hindrance in the healthcare environment, lack of continuous education and time constraints are harder for the nurse to affect. Conclusion: Different factors are causing lack of hand hygiene among nurses. Today HAI occurs at a large scale and its demands certain understanding from the nurse regarding these factors in order to improve preventive work against HAI.

Hospital-acquired infections cost hospitals approximately $30.5 billion per year and also result in longer hospital stays, chronic conditions, and even death with associated malpractice costs. According to the Centers for Disease Control and Prevention, hand hygiene is a simple, effective way to prevent illness and infection. The purpose of this research was to determine if visitors to a neonatal intensive care unit (NICU) in a regional medical center comply with hand-washing policies and procedures. If NICU visitors wash their hands properly, they can prevent potentially fatal infections from spreading to patients, healthcare workers, and unaffected family members. Hand-washing compliance has been previously studied in NICU staff and other healthcare workers, but not solely visitors. The researcher observed more than 120 visitors as they entered the NICU to determine the number who washed their hands for the required three minutes. Based on the findings, NICU staff and administration will be encouraged to provide more effective education, post informative signs, and install equipment to encourage visitors to use proper hand-washing techniques. Effective hand-washing should result in lower infection rates among NICU patients and lower health care costs.

Healthcare-associated infections (HAI) are a significant issue in healthcare facilities worldwide. Hand hygiene (HH) remains the most effective method for preventing the incidence of HAI in routine patient care. Past and current interventions focused on the overall improvement of HH compliance, but studies found that the amount of time required to achieve full HH compliance with the existing guidelines may not be practical. Improving HH compliance at critical moments during patient care may be more effective than improving HH compliance at all opportunities. However, there are little to no studies on healthcare workers’ (HCWs) behavior regarding HH during the patient care process. Secondary data analysis on a prospective dataset from the STAR-ICU trial was completed to identify HCWs’ behavior patterns regarding HH during the patient care process. Multiple logistic regression for transitions with random effects using repeated measures and transition modeling was used to identify possible associations between HH compliance and patient care tasks, the order of tasks, and workload. The models adjusted for the effects of HCW type, glove use, and isolation precautions. The study identified 28,826 task sequences and 42,349 HH opportunities. HCWs were slightly less likely to do HH before critical tasks compared with other tasks (OR: 0.97, 95% CI: 0.96-0.99), but more likely to do HH after contaminating tasks compared with other tasks (OR: 1.12, 95% CI: 1.10-1.13). HCWs are also more likely to move from task sequences that have a relatively lower risk to patients to task sequences that have a relatively higher risk to patients than vice versa (65.4% versus 34.7%). HCWs are also less likely to do HH after moving from tasks that have a relatively lower risk to patients to tasks that have a relatively higher risk to patients than vice versa (OR: 0.93, 95% CI:0.92-0.95). HCWs’ HH compliance rates decreased as the workload level increased (OR: 0.93, 95% CI: 0.89-0.98). Workload did not appear to affect HH compliance before critical tasks or after contaminating tasks and did not affect the order in which HCWs perform patient care tasks. Increase in workload was associated with an increase in the odds of critical tasks occurring (OR: 1.55, 95% CI: 1.45-1.65). In conclusion, HCWs are more likely to perform HH after contaminating tasks to prevent contaminating themselves and to reduce the risk of transmission in subsequent task sequences. However, they do not perform tasks in an order that minimizes risk to the patient; instead, it appears that they perform tasks as they come up in routine care. Furthermore, HH is not being performed at critical moments during patient care. Lastly, workload did not affect the order in which HCWs perform patient care tasks, suggesting that HCWs behavior patterns contribute significantly to how they care for patients and perform HH. Interventions targeting the order in which HCWs perform patient care tasks and improving HH compliance before critical tasks may be more effective than those designed to improve HH compliance at all HH opportunities for reducing HAI rates.

Nosocomial infections are acquired in health care settings and they can lead to catastrophic health care consequences for patients. These infections can also pose significant financial burdens on society and health care systems. Educating nurses on hand hygiene is essential to reducing infection rates. The research question for the study examined the effectiveness of hand hygiene among nurses in reduction of nosocomial infections and how can health care organizations develop educational strategies to reduce nosocomial infections to improve public confidence in health care systems. The purpose of this study was to educate nurses on how to reduce the incidence of nosocomial infections. The evidence-based practice model for this project was Florence Nightingale's environmental theory. The health belief model was used to identify the reasons for health care culture and how they inspire change. In this study, 2 licensed practical nurses and 2 registered nurses were educated on how to reduce nosocomial infections in acute care settings. Participants then completed a questionnaire to assess their knowledge of hand hygiene as a means of reducing nosocomial infections when caring for patients. All participants agreed that hand hygiene; reduces the risk of contracting a nosocomial infection, suggesting that the incidence of nosocomial infections within acute care settings maybe reduced through this education. This project has potential positive social change by educating first and second year nursing students on the importance of hand hygiene in reduction of nosocomial infections and preventing patients from sustaining further injuries while admitted in acute care settings.

Hand hygiene is an important part of preventing disease transmission in the hospital. Due to this importance, electronic systems have been proposed for automatically monitoring healthcare worker adherence to hand hygiene guidelines. However, these systems can miss certain hand hygiene events and do not include quality metrics such as duration or technique. We propose that hand hygiene duration and technique can be automatically inferred using the motion of the wrist. This work presents a system utilizing wrist-based 3-dimensional accelerometers and orientation sensors, signal processing (including novel features), and machine learning to detect healthcare worker hand hygiene and report quality metrics such as duration and whether the healthcare worker used recommended rubbing technique. We validated the system using several different types of data sets with up to 116 healthcare workers and activities ranging from synthetically generated hand hygiene movements to observation of healthcare worker hand hygiene on the hospital floor. In these experiments our system detects up to 98.4% of hand hygiene events, detects hand hygiene technique with up to 92.1% accuracy, and accurately estimates hand hygiene duration.

Vårdpersonalens låga följsamhet av riktlinjer för handhygien är ett globalt problem och en av orsakerna till vårdrelaterade infektioner (VRI). Att förmedla säker vård och arbeta förebyggande så att vårdskador undviks är en av vårdpersonalens kärnkompetenser. Syftet var att belysa vad som kan påverka vårdpersonalens följsamhet till riktlinjer för handhygien inom hälso- och sjukvården. Examensarbetet utfördes som en allmän litteraturstudie där 18 vetenskapliga artiklar fördes till resultatet, vilket visade att följsamheten påverkas av både arbetsmiljö och mänskliga faktorer. Arbetsmiljö innefattade Fysisk miljö; Organisatorisk och Social arbetsmiljö; Teknik. I de mänskliga faktorerna ingick Individ; Vårdteam; Kunskap och Utbildning. Två huvudresultat lyftes till diskussion. I den organisatoriska och sociala arbetsmiljön sågs tidsbrist och ett tydligt ledarskap ha en påverkan på vårdpersonalens följsamhet till riktlinjer för handhygien. I vårdteamet kunde patientinvolvering och fler medarbetare i personalens närhet, samt positiva eller negativa förebilder påverka vårdpersonalens följsamhet till riktlinjer för handhygien. Vidare forskning behövs om vad som kan leda till ökad och mer bestående följsamhet av riktlinjer för handhygien. Ny teknik kan komma att skapa nya förutsättningar för vårdpersonalen att öka följsamheten till riktlinjer för handhygien. / Healthcare workers´ (HCW) low adherence to guidelines on hand hygiene is a global challenge and one of the causes of healthcare associated infections (HCAI). HCW are to provide safe care and take precautions as not to harm the patient. Safe care is one of the core competences for HCW. The aim was to illustrate factors that can have an impact on HCW adherence to guidelines on hand hygiene in a healthcare setting. The thesis was carried out as a general literature study, where 18 articles were included in the result. The result showed that both the work environment and human factors have an impact on HCW adherence to guidelines on hand hygiene. Work environmental factors included the Physical environment; the Organizational and Social work environment; Technical equipment. Human factors included the Individual; the Nursing team; Knowledge and Education. Two main findings were lifted for discussion from the result; in regards of the organizational work environment, lack of time and a clear leadership was found to have an effect on HCW adherence to guidelines on hand hygiene. In regards of the nursing team; involvement of the patient reminding about hand hygiene, more coworkers in near proximity and positive or negative role models, affected adherence to guidelines on hand hygiene. Further research is required as to what can lead to increased and sustained adherence to guidelines on hand hygiene. New technical equipment may become important in the future and create new ways for HCW to follow the guidelines on hand hygiene.