The results and discussion of this article refer to the number of hand hygiene opportunities (HHOs) reported in published works but, unfortunately, failed to include those described in works by von Lengerke et al. [1, 2]. This has been addressed in a revised Table IV. In addition, the results and discussion sections have been revised to include the HHOs missing previously.
References:
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[1]
von Lengerke T, Ebadi E, Schock B, Krauth C, Lange K, Stahmeyer JT, et al. Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE. Antimicrob Resist Infect Control 2019;8:56.
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[2]
von Lengerke T, Lutze B, Krauth C, Lange K, Stahmeyer JT, Chaberny IF. Promoting hand hygiene compliance: PSYGIENE - a Cluster-Randomized Controlled Trial of Tailored Interventions. Dtsch Arztebl Int 2017;114:29–36.
Table IV.
Hand hygiene opportunities (HHOs)
| Study | Clinical setting (N) | Observation method (number of HHOs) |
|---|---|---|
| van der Kooi et al. [58] | Medical/surgical ward (1) | Direct (59,122) |
| Vander Weg et al. [67] | Medical/surgical ward (1) | Direct (52,065) |
| Derde et al. [35] | Adult ICUs (13) | Direct (41,558) |
| Chhapola and Brar [79] | Neonatal ICU (1) | Direct (28,726) |
| Mu et al. [82] | Whole organization (1) | Direct (27,852) |
| Aghdassi et al. [43] | Medical/surgical wards (20) | Direct (21,424) |
| von Lengerke et al. [46] | ICU, HSCTU (10,2) | Direct (19,470) |
| von Lengerke et al. [45] | ICU, HSCTU(10,2) | Direct (19,470) |
| Reisinger et al. [44] | Medical/surgical wards + ICU (11) | Direct (13,195) |
| Stewardson et al. [61] | Whole organization (1) | Direct (12,579) |
| Rodriguez et al. [87] | Adult ICU (1) | Direct (10,429) |
| Saharman et al. [84] | Adult ICUs (2) | Direct (7187) |
| Kuruno et al. [72] | Adult ICU (1) | Direct (6050) |
| Lee et al. [62] | Medical/surgical wards (2) | Direct (4895) |
| Medeiros et al. [89] | Adult ICU (1) | Direct (4837) |
| Labi et al. [40] | Whole organization (2) | Direct (4296) |
| Primary healthcare centre (13) | ||
| Chakravarthy et al. [41] | Adult ICUs (3) | Direct (3612) |
| Tschudin-Sutter et al. [80] | Medical/surgical wards (12) | Direct (2923) |
| Santoaningsih et al. [77] | Medical/surgical wards (5) | Direct (2766) |
| Stevenson et al. [83] | Whole organization (1) | Direct (2654) |
| Su et al. [86] | Medical/surgical wards (5) | Direct (2079) |
| Schmitz et al. [37] | Medical/surgical wards (4) | Direct (2000) |
| Diefenbacher et al. [65] | Medical/surgical wards (4) | Direct (1894) |
| Apisarnthanarak et al. [55] | Adult ICUs (6) | Direct (1872) |
| Fouad and Eltaher [71] | Medical/surgical ward (1) | Direct (1374) |
| Teesing et al. [90] | Nursing homes (18) | Direct (1000) |
| Renaudin et al. [60] | Adult ICU (1) | Direct (801) |
| Nyamadzawo et al. [39] | Adult ICU (1) | Direct (659) |
| Neonatal ICU (1) | ||
| Paediatric ICU (1) | ||
| High-dependency unit (1) | ||
| Medical/surgical wards (6) | ||
| Donati et al. [85] | Medical/surgical wards (6) | Direct (448) |
| Derksen et al. [74] | Whole organization (2) | Direct (267) |
| Farhoudi et al. [88] | Whole organization (1) | Direct (255) |
| Staats [42] | Whole organization (42) | |
| Dispensaries (155) | Electronic (20 million) | |
| Ellison et al. [48] | Adult ICUs (2) | Electronic (>13.7 million) |
| Marra et al. [73] | Medical/surgical wards (2) | Electronic (648,815) |
| Pong et al. [64] | Rehabilitation centre units (5) | Electronic (402,849) |
| Kai et al. [50] | - | - |
| Khan and Nausheen [54] | - | - |
| King et al. [75] | - | - |
| Yilmaz et al. [52] | - | - |
| Nour-Eldein and Ali Mohamed [59] | - | - |
| Wiedenmayer et al. [38] | - | - |
| Xiong et al. [56] | - | - |
| Lea et al. [70] | - | - |
| Fox et al. [81] | - | - |
| Lytsy et al. [36] | - | - |
| Moller-Sorenson et al. [47] | - | - |
| Harrabi et al. [57] | - | - |
| Muller et al. [68] | - | - |
| Ng et al. [78] | - | - |
| Visnovsky et al. [69] | - | - |
| Benudis et al. [66] | - | - |
| Beyfus et al. [49] | - | - |
| Larson et al. [63] | - | - |
| Laurikainen et al. [53] | - | - |
| Nobile et al. [3] | - | - |
| Sopirala et al. [12] | - | - |
| Mukherjee et al. [51] | - | - |
| Total | Direct (338,289) Electronic (>34.8 million) |
|
| Range | Direct (255–59,122) Electronic (402,849–20 million) |
|
| Mean | Direct (11,276) Electronic (8.7 million) |
ICU, intensive care unit.
HSCTU, hematopoietic stem cell transplantation units.
Note- For both papers by von Lengerke et al. [45, 46], a total HHO of 19,470 (control arm 9,386 and trial arm 10,084) is included in the sum total as both papers draw on the same compliance data.
The HHO paragraph in Results section
Hand hygiene opportunities
HH opportunities (HHOs) are ubiquitous and can be defined as a point of time when any one or more of the ‘Five Moments’ outlined by WHO is present and observed, either directly or electronically [5]. 35 of the included studies (61%) quantified HHOs across multiple clinical settings (Table IV). For example, Nyamadzawo et al. reported 659 HHOs across four medical wards, two surgical wards, one adult ICU, one paediatric ICU, one neonatal ICU and one HDU [39]. Furthermore, a large data set was reported by Staats, gathered over 3 years and involving 20 million HHOs within 42 hospitals and 155 dispensaries [42]. Of similar scale, Ellison et al. reported over 13.7 million HHOs over a period of 25 weeks within two adult ICUs [48]. Among the remaining 1,389,953 opportunities observed, a large proportion were observed from 40 adult ICUs (N=76,346), 57 medical and surgical wards (N=813,000), or both ICU and HSCTU (N=19,470) [45, 46].
The HHO paragraph in Discussion section
In text
Aside from those using electronic monitors linked to ABHR dispensers, a further five studies recorded whether HH had taken place and whether this had included the use of ABHR [[35],[59],[78],[82],[90]].
to
Aside from those using electronic monitors linked to ABHR dispensers, a further seven studies recorded whether HH had taken place and whether this had included the use of ABHR [[35],[45],[46],[59],[78],[82],[90]].