Compliance of Health Care Workers with Hand Hygiene Practices: Independent Advantages of Overt and Covert Observers
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{"title"=>"Compliance of Health Care Workers with Hand Hygiene Practices: Independent Advantages of Overt and Covert Observers", "type"=>"journal", "authors"=>[{"first_name"=>"Sung Ching", "last_name"=>"Pan", "scopus_author_id"=>"7402713234"}, {"first_name"=>"Kuei Lien", "last_name"=>"Tien", "scopus_author_id"=>"54581858400"}, {"first_name"=>"I. Chen", "last_name"=>"Hung", "scopus_author_id"=>"55555667100"}, {"first_name"=>"Yu Jiun", "last_name"=>"Lin", "scopus_author_id"=>"54785975800"}, {"first_name"=>"Wang Huei", "last_name"=>"Sheng", "scopus_author_id"=>"7103379375"}, {"first_name"=>"Ming Jiuh", "last_name"=>"Wang", "scopus_author_id"=>"7406692070"}, {"first_name"=>"Shan Chwen", "last_name"=>"Chang", "scopus_author_id"=>"36850651000"}, {"first_name"=>"Calvin M.", "last_name"=>"Kunin", "scopus_author_id"=>"7102410554"}, {"first_name"=>"Yee Chun", "last_name"=>"Chen", "scopus_author_id"=>"7601447585"}], "year"=>2013, "source"=>"PLoS ONE", "identifiers"=>{"doi"=>"10.1371/journal.pone.0053746", "sgr"=>"84872286338", "issn"=>"19326203", "pui"=>"368116157", "isbn"=>"1932-6203", "pmid"=>"23341991", "scopus"=>"2-s2.0-84872286338"}, "id"=>"5cb9fc43-225c-3902-b41c-e28c5124731d", "abstract"=>"BACKGROUND: Evaluation and feedback of hand hygiene (HH) compliance are important elements of the WHO multimodal strategy for hospital infection control. Overt observation is recommended, but it may be confounded by Hawthorne effect. Covert observation offers the opportunity to decrease observer bias. In this study we conducted a one year hospital-wide HH promotion program that included medical students (MS) as covert observers.\\n\\nMETHODS: HH compliance for the five WHO indications was determined by trained and validated observers. The overt observers consisted of eleven infection control nurses (ICNs) and two unit HH ambassadors (UAs) in each of 83 wards. The covert observers consisted of nine MS during their rotating clinical clerkships. Feedback was provided to department heads and staff each quarter.\\n\\nRESULTS: Of the 23,333 HH observations 76.0% were by MS, 5.3% by ICNs and 18.7% by UAs. The annual compliance rates were MS 44.1%, ICNs 74.4% and UAs 94.1%; P<0.001. The MS found significantly lower annual compliance rates for 4/5 HH indications compared to ICNs and UAs; P<0.05. The ICNs reported significantly improvement from the first to the fourth quarter; P<0.001. This was associated with feedback from the MS of very poor compliance by nurses during the first quarter.\\n\\nCONCLUSIONS: Based on these findings we recommend a two-pronged approach to HH programs. The role of ICNs and UAs is to educate, serve as role models, establish, sustain good HH practices and provide direct feedback. The role of the covert observers is to measure compliance and provide independent feedback.", "link"=>"http://www.mendeley.com/research/compliance-health-care-workers-hand-hygiene-practices-independent-advantages-overt-covert-observers", "reader_count"=>49, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>3, "Researcher"=>7, "Student > Doctoral Student"=>3, "Student > Ph. D. Student"=>10, "Student > Postgraduate"=>2, "Student > Master"=>13, "Other"=>1, "Student > Bachelor"=>6, "Lecturer"=>1, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>3, "Researcher"=>7, "Student > Doctoral Student"=>3, "Student > Ph. D. Student"=>10, "Student > Postgraduate"=>2, "Student > Master"=>13, "Other"=>1, "Student > Bachelor"=>6, "Lecturer"=>1, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>8, "Engineering"=>1, "Environmental Science"=>2, "Nursing and Health Professions"=>4, "Agricultural and Biological Sciences"=>4, "Medicine and Dentistry"=>18, "Design"=>1, "Business, Management and Accounting"=>3, "Psychology"=>1, "Social Sciences"=>5, "Immunology and Microbiology"=>1, "Earth and Planetary Sciences"=>1}, "reader_count_by_subdiscipline"=>{"Design"=>{"Design"=>1}, "Engineering"=>{"Engineering"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>18}, "Social Sciences"=>{"Social Sciences"=>5}, "Psychology"=>{"Psychology"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Earth and Planetary Sciences"=>{"Earth and Planetary Sciences"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>4}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>4}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>3}, "Unspecified"=>{"Unspecified"=>8}, "Environmental Science"=>{"Environmental Science"=>2}}, "reader_count_by_country"=>{"Indonesia"=>1}, "group_count"=>6}

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  • {"files"=>["https://ndownloader.figshare.com/files/276826", "https://ndownloader.figshare.com/files/276849"], "description"=>"<div><h3>Background</h3><p>Evaluation and feedback of hand hygiene (HH) compliance are important elements of the WHO multimodal strategy for hospital infection control. Overt observation is recommended, but it may be confounded by Hawthorne effect. Covert observation offers the opportunity to decrease observer bias. In this study we conducted a one year hospital-wide HH promotion program that included medical students (MS) as covert observers.</p> <h3>Methods</h3><p>HH compliance for the five WHO indications was determined by trained and validated observers. The overt observers consisted of eleven infection control nurses (ICNs) and two unit HH ambassadors (UAs) in each of 83 wards. The covert observers consisted of nine MS during their rotating clinical clerkships. Feedback was provided to department heads and staff each quarter.</p> <h3>Results</h3><p>Of the 23,333 HH observations 76.0% were by MS, 5.3% by ICNs and 18.7% by UAs. The annual compliance rates were MS 44.1%, ICNs 74.4% and UAs 94.1%; P<0.001. The MS found significantly lower annual compliance rates for 4/5 HH indications compared to ICNs and UAs; P<0.05. The ICNs reported significantly improvement from the first to the fourth quarter; P<0.001. This was associated with feedback from the MS of very poor compliance by nurses during the first quarter.</p> <h3>Conclusions</h3><p>Based on these findings we recommend a two-pronged approach to HH programs. The role of ICNs and UAs is to educate, serve as role models, establish, sustain good HH practices and provide direct feedback. The role of the covert observers is to measure compliance and provide independent feedback.</p> </div>", "links"=>[], "tags"=>["workers", "hygiene", "advantages", "overt", "covert", "observers"], "article_id"=>114554, "categories"=>["Cancer", "Science Policy", "Medicine", "Biotechnology"], "users"=>["Sung-Ching Pan", "Kuei-Lien Tien", "I-Chen Hung", "Yu-Jiun Lin", "Wang-Huei Sheng", "Ming-Jiuh Wang", "Shan-Chwen Chang", "Calvin M. Kunin", "Yee-Chun Chen"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0053746.s001", "https://dx.doi.org/10.1371/journal.pone.0053746.s002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Compliance_of_Health_Care_Workers_with_Hand_Hygiene_Practices_Independent_Advantages_of_Overt_and_Covert_Observers__/114554", "title"=>"Compliance of Health Care Workers with Hand Hygiene Practices: Independent Advantages of Overt and Covert Observers", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2013-01-14 01:15:54"}
  • {"files"=>["https://ndownloader.figshare.com/files/508662"], "description"=>"<p>The compliance rates observed by medical students (MS) were significantly lower than those by infection control nurses (ICNs) and unit HH ambassadors (UAs) in each quarter (all the <i>P</i> value <0.001). The numbers in parenthesis represented hand hygiene opportunities observed. T-bar represented one standard deviation.</p>", "links"=>[], "tags"=>["hygiene", "rates", "observers"], "article_id"=>179146, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Sung-Ching Pan", "Kuei-Lien Tien", "I-Chen Hung", "Yu-Jiun Lin", "Wang-Huei Sheng", "Ming-Jiuh Wang", "Shan-Chwen Chang", "Calvin M. Kunin", "Yee-Chun Chen"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0053746.g001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Hand_hygiene_compliance_rates_by_type_of_observers_and_quarter_/179146", "title"=>"Hand hygiene compliance rates by type of observers and quarter.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-01-14 02:32:26"}
  • {"files"=>["https://ndownloader.figshare.com/files/508735"], "description"=>"<p>Compliance observed by medical students (MS) was significantly lower as than by infection control nurses (ICNs) and unit HH ambassadors (UAs) (all P<0.001). The numbers in parenthesis are the hand hygiene opportunities. T-bar represents one standard deviation.</p>", "links"=>[], "tags"=>["hygiene", "rates", "healthcare", "workers"], "article_id"=>179221, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Sung-Ching Pan", "Kuei-Lien Tien", "I-Chen Hung", "Yu-Jiun Lin", "Wang-Huei Sheng", "Ming-Jiuh Wang", "Shan-Chwen Chang", "Calvin M. Kunin", "Yee-Chun Chen"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0053746.g002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Hand_hygiene_compliance_rates_according_to_professional_category_of_the_healthcare_workers_and_type_of_observers_/179221", "title"=>"Hand hygiene compliance rates according to professional category of the healthcare workers and type of observers.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-01-14 02:33:41"}
  • {"files"=>["https://ndownloader.figshare.com/files/508868"], "description"=>"<p>Hand hygiene compliance rate by type of observers (A. medical student (MS), B. Infection control nurses, C. unit HH ambassadors (UAs)), professional category, department, indication of hand hygiene, and period.</p>", "links"=>[], "tags"=>["hygiene", "observers", "hh", "ambassadors"], "article_id"=>179348, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Sung-Ching Pan", "Kuei-Lien Tien", "I-Chen Hung", "Yu-Jiun Lin", "Wang-Huei Sheng", "Ming-Jiuh Wang", "Shan-Chwen Chang", "Calvin M. Kunin", "Yee-Chun Chen"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0053746.g003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Hand_hygiene_compliance_rate_by_type_of_observers_A_medical_student_MS_B_Infection_control_nurses_C_unit_HH_ambassadors_UAs_professional_category_department_indication_of_hand_hygiene_and_period_/179348", "title"=>"Hand hygiene compliance rate by type of observers (A. medical student (MS), B. Infection control nurses, C. unit HH ambassadors (UAs)), professional category, department, indication of hand hygiene, and period.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-01-14 02:35:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/508978"], "description"=>"<p>MS: medical students; UA: unit HH ambassador.</p>", "links"=>[], "tags"=>["characteristics", "types", "observers", "pros", "cons", "efficacy", "hygiene", "one-year", "conducted", "2010", "2011", "excellence", "taiwan"], "article_id"=>179448, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Sung-Ching Pan", "Kuei-Lien Tien", "I-Chen Hung", "Yu-Jiun Lin", "Wang-Huei Sheng", "Ming-Jiuh Wang", "Shan-Chwen Chang", "Calvin M. Kunin", "Yee-Chun Chen"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0053746.t002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparison_of_the_characteristics_of_three_types_of_observers_and_the_pros_and_cons_their_ability_to_assess_the_efficacy_of_the_hand_hygiene_program_during_a_one_year_study_conducted_during_2010_and_2011_by_the_Center_of_Excellence_for_Hand_Hygiene_at_th/179448", "title"=>"Comparison of the characteristics of three types of observers and the pros and cons their ability to assess the efficacy of the hand hygiene program during a one-year study conducted during 2010 and 2011 by the Center of Excellence for Hand Hygiene at the National Taiwan University Hospital.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-01-14 02:37:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/509024"], "description"=>"*<p>The differences among the observers in frequency of opportunities to witness HH performances were significant; P<0.001.</p>†<p>The differences among the observers in proportion of observations according to professional categories, department or HH indications were significant; P<0.001.</p>", "links"=>[], "tags"=>["opportunities", "types", "observers", "hygiene", "one-year", "conducted", "2010", "2011", "excellence", "taiwan"], "article_id"=>179500, "categories"=>["Biotechnology", "Science Policy", "Medicine", "Infectious Diseases"], "users"=>["Sung-Ching Pan", "Kuei-Lien Tien", "I-Chen Hung", "Yu-Jiun Lin", "Wang-Huei Sheng", "Ming-Jiuh Wang", "Shan-Chwen Chang", "Calvin M. Kunin", "Yee-Chun Chen"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0053746.t001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_distribution_of_opportunities_for_three_types_of_observers_to_assess_hand_hygiene_program_during_a_one_year_study_conducted_during_2010_and_2011_by_the_Center_of_Excellence_for_Hand_Hygiene_HH_at_the_National_Taiwan_University_Hospital_/179500", "title"=>"The distribution of opportunities for three types of observers to assess hand hygiene program during a one-year study conducted during 2010 and 2011 by the Center of Excellence for Hand Hygiene (HH) at the National Taiwan University Hospital.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-01-14 02:38:20"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"14", "full-text"=>"20", "pdf"=>"2", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2018", "month"=>"4"}
  • {"unique-ip"=>"19", "full-text"=>"22", "pdf"=>"7", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"5"}
  • {"unique-ip"=>"22", "full-text"=>"20", "pdf"=>"3", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"6"}
  • {"unique-ip"=>"18", "full-text"=>"14", "pdf"=>"5", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2018", "month"=>"7"}
  • {"unique-ip"=>"15", "full-text"=>"18", "pdf"=>"1", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"9", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"8"}
  • {"unique-ip"=>"24", "full-text"=>"24", "pdf"=>"5", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2018", "month"=>"10"}
  • {"unique-ip"=>"26", "full-text"=>"27", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2018", "month"=>"12"}
  • {"unique-ip"=>"41", "full-text"=>"42", "pdf"=>"7", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"3", "supp-data"=>"1", "cited-by"=>"0", "year"=>"2018", "month"=>"11"}
  • {"unique-ip"=>"22", "full-text"=>"29", "pdf"=>"0", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"2"}
  • {"unique-ip"=>"32", "full-text"=>"33", "pdf"=>"5", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2019", "month"=>"3"}
  • {"unique-ip"=>"47", "full-text"=>"52", "pdf"=>"6", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"1", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2019", "month"=>"4"}
  • {"unique-ip"=>"44", "full-text"=>"50", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"2", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"5"}
  • {"unique-ip"=>"37", "full-text"=>"50", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2019", "month"=>"8"}
  • {"unique-ip"=>"29", "full-text"=>"38", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"9"}
  • {"unique-ip"=>"36", "full-text"=>"48", "pdf"=>"4", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"7", "supp-data"=>"2", "cited-by"=>"0", "year"=>"2019", "month"=>"10"}

Relative Metric

{"start_date"=>"2013-01-01T00:00:00Z", "end_date"=>"2013-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Medicine and health sciences/Health care", "average_usage"=>[278, 463, 587, 692, 804, 897, 984, 1068, 1165, 1254, 1339, 1429, 1490]}, {"subject_area"=>"/Medicine and health sciences/Pediatrics", "average_usage"=>[248, 430, 563, 680, 778, 859, 949, 1017, 1115, 1199, 1281, 1364, 1431]}, {"subject_area"=>"/People and places", "average_usage"=>[270, 456, 573, 676, 773, 867, 955, 1037, 1120, 1205, 1286, 1363, 1436]}, {"subject_area"=>"/People and places/Population groupings", "average_usage"=>[265, 456, 578, 682, 782, 881, 965, 1053, 1133, 1223, 1310, 1391, 1457]}]}
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