Sustained improvement in hand hygiene compliance using a multi-modal improvement programme at a Swiss multi-site regional hospital.

BACKGROUND: Evidence of sustained improvement in hand hygiene compliance at the institutional level is scarce. AIM: To assess the impact and sustainability of a hospital-wide improvement programme on hand hygiene compliance of staff. METHODS: Analysis of trends of hand hygiene compliance for all clinical staff, measured through direct observation by trained observers, within a 450-bed multi-centre teaching hospital in the county of Neuchâtel, Switzerland. INTERVENTION: Implementation of a multi-modal improvement programme based on the World Health Organization (WHO) strategy, with the goal of reaching overall compliance of at least 80%. The strategy content included increasing access to alcohol hand rub; healthcare worker education; two-month interval compliance measurement; and hospital-wide open communication about ward-level results, point-of-care reminders, communication via a dedicated in-house newsletter and leadership engagement. The implementation phase was followed by a consolidation phase. FINDINGS: In total, 33,476 observations were collected from September 2012 to March 2014 (mean >3000 opportunities per audit). Overall compliance improved from 61.4% at baseline to 83.6% after the 18-month improvement programme (P<0.001), and was sustained at 85.3% 18 months later (i.e. 18 months after the programme finished) (P=0.08). The same trend (significant and clinically relevant improvement during the intervention, sustained after 18 months) was measured for all professional categories. CONCLUSIONS: This WHO-inspired improvement programme was associated with a significant improvement in hand hygiene compliance, globally and for each professional category. The results were sustained over an 18-month period.

[Norovirus gastroenteritis: frequent, often epidemic, with potentially severe complications]. / Gastroentérites à norovirus: fréquentes, souvent épidémiques et potentiellement graves.

Norovirus are the most frequent causes of epidemic gastroenteritis. Infections generally resolve spontaneously, but may lead to severe complications including death, or become chronic in immunocompromised hosts. Complications preferentially occur in immunocompromised hosts and their consequences are sometimes severe in vulnerable individuals living in confined spaces, such as healthcare settings. Norovirus have a high capacity to mutate. This and their capacity to persist in the water and on everyday objects of our surroundings favor the occurrence of epidemics. As a vaccination protective against most relevant strains is currently not available and in view of their high contagiousness, the prevention and control of the norovirus gastroenteritis remains a major clinical challenge.

[Percutaneous valvuloplasty in the treatment of mitral stenosis: results in Geneva]. / Valvuloplastie percutanée pour le traitement de la sténose mitrale: l'expérience genevoise.

Percutaneous balloon valvotomy is a recognized form of treatment of mitral stenosis. In Geneva between 1986 and 1993, 62 procedures were attempted in 60 patients (87% females) aged 48 +/- 17 years (12 to 80 years). Patient selection was based on symptoms (NYHA class), echocardiography (valve area, Boston score), and hemodynamics. 11 patients (18%) had undergone surgical commissurotomy in the past, 28 patients (47%) were in atrial fibrillation, and 12 patients (30%) had a history of peripheral emboli. Mild or moderate mitral insufficiency was present angiographically in 17 patients (28%) and echographically in 42 patients (70%). Esophageal echocardiography was performed in 37 patients (62%) before the procedure. In 52 patients (84%) a single balloon (Inoue technique) was used. Technical success was obtained in 59 procedures (95%). Following the procedure, mitral valve area increased from 1.1 +/- 0.3 to 1.8 +/- 0.3 cm2 (p < 0.0001) at echocardiography and from 1.1 +/- 0.3 to 1.9 +/- 0.5 cm2 (p < 0.0001) based on invasive hemodynamic data. There were 5 complications directly related to the procedure. In two cases cardiac tamponade developed, one after pericardial perforation during the transseptal approach and one because of left ventricular perforation. The second patient required surgical treatment. In two other cases, a moderate pericardial effusion without clinical consequences was observed. In one case the venous sheath malfunctioned, rendering surgical repair of the right femoral vein necessary. A residual atrial septal defect was observed at echography in 13 patients (22%). Mitral insufficiency was increased in 6 patients (10%) angiographically and in 9 patients (15%) at echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)