Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
1
EliPerencevich,MDMSProfessorofInternalMedicine
UniversityofIowa,CarverCollegeofMedicine
PIandDirector,VAHSR&DCenterforComprehensiveAccessandDeliveryResearch&EvaluaDon
ControversiesBlog:stopinfecDons.org
TwiKer:@eliowa
AyliffeLecture:Usingsciencetoguidehandhygienesurveillanceandimprovement
www.webbertraining.com September 28, 2016
ConflictsofInterestStatement
! Nofinancialconflicts! SecDonEditorforGuidelines,PosiDonPapers,andInvitedReviews@ICHE
! FederalFunding! VAHSR&D(COINandCREATE)! CDCPrevenDonEpicenter! AHRQ
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
2
Thistalkwillreviewthesciencebehindmonitoringandimprovinghandhygiene
Handhygienebasics–opportuni<es,barriersandeffec<veinterven<ons
Systemtypesandeffec9veness
Publica9onBias,Hawthorne
Handhygieneisimportant…
hKp://xkcd.com/1161/
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
3
Handhygieneisimportant…
hKp://xkcd.com/1161/
Sneeze into your elbow!!
HandHygieneatCrossroads
! “HandHygieneCompliance:arewekiddingourselves?”1
! Targetssetat>90%,metbymostfaciliDes! 2009-2014SystemaDcReview2
! MeancompliancebeforeintervenDon–34%! AgerintervenDon–57%
! Whatshouldbethetarget?–Fairmonitoring! Achievable
! Beneficial
1. Mahida N. JHI 2016 (92) 307-8 2. Kingston L. et al. JHI 2016:309-20
FOR MORE INFO...
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
4
VeteransHealthAdministraDon
! VHAislargestintegratedhealthsysteminUS
! 168VAMedicalCenters! 132Community-LivingCenters(NursingHomes)
! 1,053OutpaDentClinics
! Servesover9millionenrolledveterans! Centralizedmedicalrecordsandpolicies
HandHygiene2015:Complicated
! CDCGuidelineforHandHygieneinHealth-CareSenngs(2002)-56Pages
! WHOGuidelineonHandHygieneinHealthCare(2009)-270pages
! VHADIRECTIVE2011-007! EffecDve:March1,2011! Expired:February29,2016
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
5
2012VHAHandHygieneSurvey
! VHAHandHygieneWorkgroup! 141VAhealthcaresystemsparDcipated
! AdministeredthroughtheOfficeoftheDeputyUnderSecretaryofHealthcareOperaDonManagement(DUSHOM)Office! “thestaffmemberresponsiblefortheirfacility’shandhygieneprogram”
51-ItemIntranet-BasedSurvey
! Threeareasoffocus:
1. HowhospitalsmeasuredHCWshandhygiene2. Whichinterven9onstrategiesshouldberecommendedtoimprovecompliance
3. Facilitythreshold/goalforcompliance
Reisinger HS et al. Am J Infect Control 2013 Nov;41(11):989-93
FOR MORE INFO...
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
6
HowdidVHAmeasurecompliancein2012?%
(N=
141)
Reisinger HS et al. Am J Infect Control 2013 Nov;41(11):989-93
FOR MORE INFO...
Whendidtheymeasurecompliance?
N=
141
Reisinger HS et al. Am J Infect Control 2013 Nov;41(11):989-93
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
7
WhichWHOMoments?
WHOFiveMomentsfrom“CleanCareisSaferCare”Pa/entSafetyChallengeandGuidelinesonHHinHealthCare(2009)
Reisinger HS et al. Am J Infect Control 2013 Nov;41(11):989-93
Havinga(handhygiene)moment
http://haicontroversies.blogspot.com/2011/11/im-having-hand-hygiene-moment.html
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
8
WhichOpportuniDes?
! ComparecomplianceusingWHO“My5Moments”vs“Before&Ager”or“Before”(2009-201)
! Before&APermayprovideasurrogatemarkerofoverallhandhygienecompliance
Stewardson A. et al. J Hosp Infect Volume 77, Issue 4, April 2011, Pages 358–359
Feasibilityof“WHOMy5Moments”vsEntry/ExitintheUS?
! 3hospital(6ward,5ICU)studycomparingabilitytomonitorWHOM5MvsEntry/Exitcompliance
! QuesDon:Couldwe“see”it?
! WHOM5MinICUvsWard! M5Mobservedduring39%ofepisodesofcareinICU! Comparedto28%observedonwards,P<0.01
Chung N. et al, Am J Infect Control. 2016
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
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9
Entry/ExitcapturesmostWHOM5MOpportuni9es
ICHE 35:7 (July 2014), pp. 826-832
! 257hours
! 1605opportuni9es! Mean4.2op/hour
! 77%RN,8%MDs
42%
10%
9% 39%
Howmuchmonitoringhappens?
Observa9onspermonthperward/unit/clinic
Minutesperobserva9onperiod
N=121 N=134
Reisinger HS et al. Am J Infect Control 2013 Nov;41(11):989-93
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
10
BarrierstoCompliance:Needmorethanfeedbacktoimprovehandhygiene
! SkindrynessandirritaDon! NoDmetowash,nursingworkload
! Inconvenientsinks,handhygienedispensers! FirecodesinUS
! Carryingsomethinginyourhandswhenentering
! Compliancenotindividuallytracked*
Recognizingthebarriers,whatintervenDonshavebeenproventoincreasecompliance?
! SystemaDcReview2000toApril2012
! 8148arDclesidenDfied,65fullyreviewed
! 45studiesincluded(RCTandQuasi-experimental)
Schweizer et al. Clin Infect Dis 2014 Jan;58(2):248-59
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
11
WHOMulDmodalHandHygieneImprovementStrategy
! EducaDon! Accesstodispensers/pocketsizehandrub! Reminders! InsDtuDonalSafetyClimate(AdministraDveSupport)
! Feedback*! 27studies,onlyoneanalyzedalone
ThereisstrongevidenceforWHObundle
Schweizer et al. Clin Infect Dis 2014 Jan;58(2):248-59
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
12
Howmuchhandhygieneisenough?
! NomaKerhowwemeasureit,whencanwebesaDsfiedthatweareprevenDnginfecDons?
IsthereatargetthresholdforhandhygienecomplianceassociatedwithreducedinfecDons?
Kirkland KB, et al. BMJ Qual Saf 2012;21:1019-26
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
13
Mostofhospitalshavecompliancearound40-60%
Kirkland KB, et al. BMJ Qual Saf 2012;21:1019-26
Handhygienecompliancethreshold?
Kirkland KB, et al. BMJ Qual Saf 2012;21:1019-26
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
14
Handhygienecompliancethreshold?
Kirkland KB, et al. BMJ Qual Saf 2012;21:1019-26
Butwhataboutautomatedsystems?
! SystemaDcreview:1Jan2000–31March2013
! 3,463arDclesidenDfied,42included! EnhanceddirectobservaDon! Videomonitoring! Electronicdispensercounters! Automatedmonitoringnetworks
Ward M et al. AJIC 2014
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
15
EnhanceddirectobservaDonsystems
! 5studies
! iScrub–free
! Customizable,Dme-stamped
! Emailspreadsheet
! Maysimplifyaudit-feedback
! Noevidenceofbenefit
http://compepi.cs.uiowa.edu/index.php/Research/IScrub
Video-monitoringshowspotenDaltoimprovecompliance
! 4studies
! Generallyassociatedwithimprovedcompliance
! Placementimportant! 5moments
! “BigBrother”
! Costs-$50,000plus$1000/monthin17bedunit
Ward M et al. AJIC 2014
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
16
Third-partyremotevideomonitoringeffecDveintervenDoninMICUandSICU
! 2yearstudy
! Cameraofsinks/dispensers
! SensorforEntry/Exit
! MonitorsinIndia
! Pre-feedback10%
! Post-feedback81.6%
! At75weeks87.9%
Armellino D et al. Clin Infect Dis 2012 Armellino D et al AJIC 2013
ElectronicDispenserCounters
! 15studies
! Time-stamped
! Can’tdetermineappropriateness,lacksdenominator
! AssociatedwithimprovedaccuracyvsdirectobservaDon*
*MorganDMAJIC2012
*MarraARICHE2010
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
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A Webber Training Teleclass www.webbertraining.com
17
CounterswithfeedbacknoteffecDve
! 6-monthintervenDonvscontrolstep-downunits
! IntervenDon:countsgiventoindividualnurses2x/week,placedinchart,comparedtoothernurses
MarraARICHE2008
OutcomeVariable Interven9onUnit ControlUnit p
AlcoholGel 33.6 30.2 .54
CHG 7.5 5.6 .59
Total 41.1 35.8 .56
ButwhenthePosiDveDeviancemodelapplied,handhygieneincreased
! Samestep-downunits(SDU)andcounters
! 9monthstudy–3x3-monthperiods
MarraARICHE2010
Pre-intervention PD East SDU PD Both SDU
alcohol East West East West East West
dispense/1000 pt-days
46,890 44,460 62,000* 33,570 57,930 43,980
L / 1000 pt-days
136 115 250* 126 239 205
P <0.01
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
18
Automatedhand-hygienemonitoringnetworks
! 18studies
! DetectwhenHCWentersandhandhygieneevent,remindHCW,wearablecomponent
! Audiblereminderonwardentranceraisedhandhygienefrom8%to50%inHCWandvisitors*
! Urgent-care,13HCWstudywithmonthlyreminders:37%to49%compliancep<0.01#
*FakhryMetal.AJIC2012
#SahudAGetal.JHI2012
Alcohol-sensingbadgeswithaudio-visualreminders
! 35-bedorthopaedicsward
! 19nursesworecredit-card-sizedalcoholsensorbadge(BioVigilLLC,SantaRosa,CA,USA)fortwoweeks
! Doorsensortriggeredbyentry
! Ifalcoholdetected–green+ping
! Ifalcoholnot-detected–red+beep
! 31-daystudy
Edmondetal.JHI2010,76;354-372
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
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19
Alcoholsensorbadgeraisedcompliance
Phase 1: Direct Observation
Compliance=66%
Phase 2: Electronic monitoring
Compliance=93%
Edmondetal.JHI2010,76;354-372
P =0.01
SystemaDcReviewRecommendaDon–Holdoffonbuyingthesesystems
! Small,uncontrolled,quasi-experimentalstudies
! “LimiteddataiscurrentlyavailabletorecommendadopDonofspecificautomaDcorelectronically-assistedhandhygienesurveillancesystems…GiventherestrictedclinicalandinfecDonprevenDonbudgetsofmostfaciliDes,cost-effecDvenessanalysisofspecificsystemswillberequiredbeforethesesystemsarewidelyadopted”
Ward M et al. AJIC 2014
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
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20
Caveatemptor-“Letthebuyerbeware”
Effect Measure (ln RR)
Stan
dard
Err
or
! Buyersvs.sellers“informaDon”
! “Publica9onBias”:invesDgatorsdon’tpublishsmalland/ornegaDvestudies
CochraneDatabaseSystRev.2007Apr18;(2):MR000005
DID THEY PUBLISH THEIR ABSTRACTS?
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
21
CochraneDatabaseSystRev.2007Apr18;(2):MR000005
Whichabstractsarelikelytobepublished?
! “Posi9ve”results(RR=1.30;CI1.14-1.47)
! Oralvs.poster(RR=1.28;CI1.09-1.49)
! Higherqualityofabstracts(RR=1.30,CI1.00-1.71)
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
22
Real-DmelocaDonsystem(RTLS)abstract
! Before/AgerQEDesign! 10-monthstudy
! RTLSbadges
! IRbeaconsinstalledinrooms
! Outcome:directlyobservedentry-exitcompliance
BoyceJMIDWeek2012#37759
RTLSelectronicmonitoringsystemassociatedwithlowercompliance
! 36% decline in entry compliance (p=0.191) ! 32% decline in the exit compliance (p<0.001)
! The average accuracy of the badge RTLS system was 60% ! False-negative results led to HCW frustration
! Negative study – not published
BoyceJMIDWeek2012#37759
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
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23
Reminder:MostusedirectobservaDon%
(N=
141)
Reisinger HS et al. Am J Infect Control 2013 Nov;41(11):989-93
FOR MORE INFO...
Butifdirect-observaDonissoterrible,shouldn’twejustbuyasystemanyway?
! HandhygieneopportuniDesaretoonumerous! Nightandweekendshigs! ToomuchDme/moneytomonitor! Doweneedtocounteveryone?
! HawthorneEffect
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
24
Lotsofhandhygieneopportuni9esgoingon
Am J Infect Control. 2014 Jun;42(6):602-7
! 12bedsingenmedward
! Video–5moments
! 72op/pa9ent/day
! 75%RN,5%MD
! If140,000pa9entdays
! 10million/year!!!
HowmanyobservaDonsneeded?
! ProspecDvecohort,3hospitals! 7,743HCWvisits! 1,989hoursofobservaDon! 3.89/hour/room
! Samplepowercalcula9ons! 10%absolutecompliancechangemonth-to-month! 2-sidedtest,typeIerrorat5%significance,80%power
Yin J. ICHE 2014;35 (9):1163-8
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
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25
UsecharttoesDmatenumberofopportuniDesandhoursofdirectobservaDon
BaselineHH TargetHH #opportuni9es#hours
(1roomat9me)#hours
(2roomsat9me)
40 50 191 50 25
50 60 194 50 25
60 70 182 47 23.5
70 80 153 40 20
80 90 108 28 14
Yin J. ICHE 2014;35 (9):1163-8
TheHawthorneEffectisalimitaDonofdirect-observaDonsurveillance
! Improvementofhumanbehaviorwhenasubjectknowstheyarebeingobserved
1932
HawthorneWorks,CiceroIL
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
26
LengthofObservaDonPeriods?
Chen LF ICHE 2013; 34(2): 207-10
EvidenceofHawthorneEffect
! ProspecDveCohort:March2011–May2013
! 3VAhospitals! 5ICUs! 6medical/surgicalwards
! Research-assistantobservers! Hallway,didnotannouncepresence! Monitoredforfixed1-hourintervals! OpportuniDesEntry/Exit
Yin J. ICHE 2014;35 (9):1163-8
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
27
Hypothesis
! IftheHawthorneeffectwasconDnuousacrossallDmeperiods,expectcompliancetoremainunchangedduringenDre1-hourobservaDonperiod
! Askedwhethermeanhandhygienecomplianceratechangedsignificantlyoverthe1-hourperiod! Finnglinearregressiontothehandhygienecompliancerate
Results
! 11,444HHopportuniDes! 3,432hoursofdirectobservaDons
! EntryCompliance:41.3%! (4,546/11,018opportuniDes)
! ExitCompliance59.4%! (6,225/10,488opportuniDes)
Yin J. ICHE 2014;35 (9):1163-8
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
28
Entrycomplianceshowsincreasedbiasagerobserveronward>38minutes
! Before38minutes! 40.4%
! Ager38minutes! 43.4%
! p=0.005
Yin J. ICHE 2014;35 (9):1163-8
LimiDngobserverDmeonwardtolessthan14minutesreducesbias
! Before14minutes! 56.2%
! Between14-50minutes! 60.5%
! Ager50minutes! 66.0%
! P<0.001
YinJ.ICHE2014;35(9):1163-8
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
29
Punngitalltogether
VHAHandHygieneWorkgroup
! BradleyBender,MD–ChiefofStaff(Gainesville)
! ElizabethEckstein,RN–IP(Cleveland)
! KimFindley,RN–AssocClinResearch(COHIC)! CarolKeller–SystemsRedesignManager(WestLA)
! TroyKnighton,EdS–IDPIO(OPH)
! CarylLee,RNMSN–NaDonalCenterPaDentSafety
! MichaelMarDn–NAGE(MarDnsburg)
! RichardMarDnello,MDClinicalPublicHealth(OPH)
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
30
VHAHandHygieneWorkgroup
! DanielMorgan,MD–HospitalEpi(BalDmore)
! EliPerencevich,MD–WorkgroupChair)(IowaCity)
! LesleyRoyal,RN–IP(Omaha)! HeatherReisinger,PhD–MedAnthro(IowaCity)
! CarolVanDeusenLukas,EdD–COLMR(Boston)
! AmyZoll,RN–ClinicalNurse(KansasCity)
! LewisRadonovich,MD–COHIC,OPH(Gainesville)
DRAFTUNDERSECRETARYFORHEALTH’SINFORMATIONLETTERESTABLISHINGASTANDARDFORHANDHYGIENESURVEILLANCEINHEALTHCARESETTINGS
! (1)MonitorHandHygiene:! “Beforepa9entinterac9on”definedashandhygieneimmediatelyonorbeforeenteringthespaceoccupiedbyapaDent.
! “APerpa9entinterac9on”definedashandhygieneimmediatelyonorbeforeexiDngthespaceoccupiedbyapaDent.
! (2)DuraDonofDirectObservaDonPeriods! “monitoringbyoneormorepersonnelinasinglelocaDonshouldpersistfornomorethan15minutesateachlocaDon”
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
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31
! (3)NumberofobservaDonsrequiredperquarter! Minimumof200beforeandaPer(i.e.,200beforeentryand200agerexit)
! Note:approximately4-5opportuniDesareobservedperhour
! Wouldrequire40-50hoursofobservaDonperquarterorabout13-17hoursofobservaDonpermonth
DRAFTUNDERSECRETARYFORHEALTH’SINFORMATIONLETTERESTABLISHINGASTANDARDFORHANDHYGIENESURVEILLANCEINHEALTHCARESETTINGS
Conclusions:KeepHandHygieneSimple!
! Automatedsystemscanmonitorbutcompliancebenefitsunproven! Norandomizedtrials! NoevidenceforlowerinfecDons! SignificantpublicaDonbias
! Don’tgiveupondirect-observa9on! Focusonentry/exitmonitoring
! Lessthan14minutes!
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
32
Thankyou
Fistbumpsandweakhandshakesonly…
Mela et al. AJIC 42 (8): 916-7, August 2014
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
33
Fistbumpsandweakhandshakesonly…
Mela et al. AJIC 42 (8): 916-7, August 2014
Fistbumpsandweakhandshakesonly…
Mela et al. AJIC 42 (8): 916-7, August 2014
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
34
QuesDonsandThankyou!
! Automatedsystemscanmonitorbutcompliancebenefitsunproven! Norandomizedtrials! NoevidenceforlowerinfecDons! SignificantpublicaDonbias
! Don’tgiveupondirect-observa9on! Focusonentry/exitmonitoring
! Lessthan14minutes!
QUESTIONS?@[email protected]
September 29 ADHERENCE ENGINEERING TO REDUCE CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS Prof. Frank Drews, University of Utah
October 13 UPDATE ON STRATEGIES FOR CLEANING AND DISINFECTION OF ENVIRONMENTAL SURFACES IN HEALTHCARE Prof. John Boyce, J.M. Boyce Consulting Sponsored by Sealed Air Diversey Care (www.sealedair.com)
October 19 (South Pacific Teleclass) TECHNOLOGY FOR MONITORING HAND HYGIENE IN THE 21ST CENTURY – WHY ARE WE USING IT? Prof. Mary-Louise McLaws, University of New South Wales, Australia
October 20 (FREE Teleclass) THE HISTORY OF CBIC AND WHY CERTIFICATION IS STILL IMPORTANT TODAY
Using Science to Guide Hand Hygiene Surveillance and Improvement Prof. Eli Perencivich, University of Iowa
Broadcast live from the Infection Prevention Society conference
A Webber Training Teleclass www.webbertraining.com
35