Background: Healthcare Acquired Infections (HAI) result in over 100 thousand deaths each year with one third of these deaths preventable via behaviors such as hand washing among health care providers in inpatient settings. Less research has been conducted in outpatient exercise settings such as cardiac rehabilitation (CR) among patients. Purpose: The purpose of this study was to examine the effectiveness of HAI prevention strategies in a CR setting among patients. Methods: Observations of the frequency of hand washing among CR patients pre and post four HAI strategies including provision of HAI education and signs, hand washing demonstrations, a HAI prevention video, and hand sanitizer samples. Washing hands prior to CR (WI) was observed as well as washing hands prior to leaving the CR center (WO). Methods included recording the frequency of WI and WO among all patients at baseline and after each of the four interventions. Mean frequencies of WI and WO were compared among a mean of 22 - 43 CR patient visits over 12 weeks using descriptive statistics and t-tests to determine if changes were significant pre and post intervention strategies. Results: At baseline, no patients WI or WO during an outpatient CR visit. Post interventions 1 - 4, the percentage of patients WI and WO was 33 and 34, 32 and 26, 32 and 29, 33 and 22 respectively. At a one-year follow up, the percentage of patients WI and WO was 40%. Conclusion: Increases in frequency and the percentage of WI and WO were observed among patients meriting continued examination of HAI prevention strategies among patients in outpatient exercise settings such as CR.
Umscheid, C.A., Rajender, A., Williams, K. and Brennan, P. (2011) Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs. Infection Control and Hospital Epidemiology, 32, 101-114. https://doi.org/10.1086/657912
Centers for Disease Control and Prevention (2016) HAI Surveillance. http://www.cdc.gov/hai/surveillance/
Magill, S.S., Edwards, J.R., Bamberg, W., Beldavs, Z.G., Dumyati, G., Kainer, M. A., Ray, S.M., et al. (2014) Multistate Point-Prevalence Survey of Health Care-Associated Infections. New England Journal of Medicine, 370, 1198-1208. https://doi.org/10.1056/NEJMoa1306801
Nelson, K. and Williams, C. (2007) Infectious Disease Epidemiology: Theory and Practice. Jones and Bartlett, Sudbury.
Lobdell, K.W., Stamou, S. and Sanchez, J.A. (2012) Hospital-Acquired Infections. Surgical Clinics of North America, 92, 65-77. https://doi.org/10.1016/j.suc.2011.11.003
Thompson, D., Bowdey, L., Brett, M. and Cheek, J. (2016) Using Medical Student Observers of Infection Prevention, Hand Hygiene, and Injection Safety in Outpatient Settings: A Cross-Sectional Survey. American Journal of Infection Control, 44, 374-380. https://doi.org/10.1016/j.ajic.2015.11.029
Schmier, J.K., Hulme-Lowe, C.K., Semenova, S., Klenk, J.A., DeLeo, P.C., Sedlak, R. and Carlson, P.A. (2016) Estimated Hospital Costs Associated with Preventable Health Care-Associated Infections If Health Care Antiseptic Products Were Unavailable. ClinicoEconomics and Outcomes Research: CEOR, 8, 197. https://doi.org/10.2147/CEOR.S102505
Centers for Disease Control and Prevention (2016) Outpatient Care HAI Guidelines. https://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html
Avci, M., Ozgenc, O., Coskuner, S.A. and Olut, A.I. (2012) Hospital Acquired Infections (HAI) in the Elderly: Comparison with the Younger Patients. Archives of Gerontology and Geriatrics, 54, 247-250. https://doi.org/10.1016/j.archger.2011.03.014
Centers for Disease Control and Prevention (2016) Influenza. http://www.cdc.gov/flu/protect/vaccine/index.htm.
Biddle, C. (2009) Semmelweis Revisited: Hand Hygiene and Nosocomial Disease Transmission in the Anesthesia Workstation. AANA Journal, 77, No. 3.
Schaefer, M., Jhung, M., Dahl, M., Schille, S., Simpson, C., Llata, E., et al. (2010) Infection Control Assessment of Ambulatory Surgical Centers. JAMA, 303, 2273-2279. https://doi.org/10.1001/jama.2010.744
Bjerke, W., Standish, S. and Pastore, A. (2013) Infection Prevention Strategies in Cardiac Rehabilitation Programs. Poster Presented at the American Association of Cardiovascular and Pulmonary Rehabilitation October 3-5, Nashville.
Son, C., Chuck, T., Childers, T., Usiak, S., Dowling, M., Andiel, C., et al. (2011) Practically Speaking: Rethinking Hand Hygiene Improvement Programs in Health Care Settings. American Journal of Infection Control, 39, 716-724. https://doi.org/10.1016/j.ajic.2010.12.008
Grace, S.L., Turk-Adawi, K.I., Contractor, A., Atrey, A., Campbell, N.R., Derman, W., Buckley, J., et al. (2016) Cardiac Rehabilitation Delivery Model for Low-Resource Settings: An International Council of Cardiovascular Prevention and Rehabilitation Consensus Statement. Progress in Cardiovascular Diseases, 59, 303-322. https://doi.org/10.1016/j.pcad.2016.08.004
Lavie, C.J., Arena, R. and Franklin, B.A. (2016) Cardiac Rehabilitation and Healthy Life-Style Interventions: Rectifying Program Deficiencies to Improve Patient Outcomes. American Journal of Infection Control, 67, 13-15. https://doi.org/10.1016/j.jacc.2015.09.103
Balady, G., Ades, P., Bittner, V., Franklin, B., Gordon, N., Thomas, R., et al. (2011) Referral, Enrollment, and Delivery of Cardiac Rehabilitation/Secondary Prevention Programs at Clinical Centers and beyond a Presidential Advisory from the American Heart Association. Circulation, 124, 2951-2960. https://doi.org/10.1161/CIR.0b013e31823b21e2
Beatty, A.L., Li, S., Thomas, L., Amsterdam, E.A., Alexander, K.P. and Whooley, M.A. (2014) Trends in Referral to Cardiac Rehabilitation after Myocardial Infarction: Data from the National Cardiovascular Data Registry 2007 to 2012. Journal of the American College of Cardiology, 63, 2582-2583. https://doi.org/10.1016/j.jacc.2014.03.030
Lutarewych, M., Morgan, P. and Hall, M. (2004) Improving Outcomes of Coronary Artery Bypass Graft Infections with Multiple Interventions: Putting Science and Data to the Test. Infection Control & Hospital Epidemiology, 25, 517-519. https://doi.org/10.1086/502433
Erasmus, V., Daha, T., Brug, H., Hendrik, J., Richardus, M., Behrendt, M., et al. (2010) Systematic Review of Studies on Compliance with Hand Hygiene Guidelines in Hospital Care. Infection Control, 31, 283-294. https://doi.org/10.1086/650451
Pittet, D., Panesar, S., Wilson, K., Yongtin, Y., Morris, T., et al. (2011) Involving the Patient to Ask about Hospital Hand Hygiene: A National Patient Safety Agency feasibility study. Journal of Hospital Infection, 77, 299-303. https://doi.org/10.1016/j.jhin.2010.10.013
McGuckin, M., Storr, J., Longtin, Y., Allegranzi, B., Pittet, D., et al. (2011) Patient Empowerment and Multimodal Hand Hygiene Promotion: A Win-Win Strategy. American Journal of Medical Quality, 26, 10-17. https://doi.org/10.1177/1062860610373138
Blaser, M. (2014) Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues. Macmillan, New York.
Maskerine, C. and Loeb, M. (2006) Improving Adherence to Hand Hygiene among Health Care Workers. The Journal of Continuing Education in the Health Professions, 26, 244-251. https://doi.org/10.1002/chp.77
Michie, S. and Johnson, M. (2010) Theories and Techniques of Behavior Change: Developing a Cumulative Science of Behavior Change. Health Psychology Review, 6, 1-6. https://doi.org/10.1080/17437199.2012.654964
McGuckin, M., Govednik, J., Hyman, D. and Black, B. (2013) Public Reporting of Health Care-Associated Infection Rates Are Consumers Aware and Engaged?. American Journal of Medical Quality, 29, No. 1.
Harbarth, S., Sax, H. and Gastmeier, P. (2003) The Preventable Proportion of Nosocomial Infections. Journal of Hospital Infection, 54, 258-260. https://doi.org/10.1016/S0195-6701(03)00150-6