Table M1. Examples of ‘‘sameness’’ by organism speciation Culture Companion Culture Report as … S. epidermidis Coagulase‐negative staphylococci S. epidermidis Bacillus spp (not anthracis) B. cereus B. cereus S. salivarius S. viridans S. salivarius Table M2. Examples of ‘‘sameness’’ by organism antibiogramme Organism name Isolate A Isolate B Interpret as … S. epidermidis All drugs S All drugs S Same S. epidermidis OX R OX S Different CEFAZ R CEFAZ S Corynebacterium spp PENG R PENG S Different CIPRO S CIPRO R S. viridans All drugs S All drugs S except ERYTH R Same S: sensitive; R: resistant CEFAZ: cefazolin; CIPRO: ciprofloxacin; ERYTH: erythromycin; OX: oxacillin; PENG: penicillin G General description of the interventions Hand hygiene intervention (HHi) To improve awareness of and compliance to hand hygiene (HH) the World Health Organization (WHO) multimodal hand hygiene improvement strategy is used. The WHO, in cooperation with the University of Geneva, has both developed material for promoting HH and tools for evaluation of compliance (http://www.who.int/gpsc/information_centre/en/) which were used for this study. The multimodal approach identifies five key components. Hospitals formed an intervention team that evaluated these five components and intervened where necessary. The challenges they encountered differed, depending on the centre, Table 1A specifies the activities of the individual hospitals. 1. System change (infrastructure): - ensuring access to safe continuous water supply as well as to soap and towels - ensuring access to accessible alcohol‐based handrub at the point of care 2. Training/education: - providing training on the importance of HH, based on the “My 5 moments for Hand Hygiene” approach, and the correct procedures for hand rubbing and hand washing, to all healthcare workers Healthcare workers were also educated on the advantages of using alcohol based handrub, which was not yet routine in all centres. 3. Evaluation and feedback: - monitoring hand hygiene practices and infrastructure, along with related perceptions and knowledge among healthcare workers about the appropriated indications and procedures for performing it. HH practices were frequently observed for study purposes. Study nurses were encouraged to give both individual and ward level feedback after the start of the intervention. Perceptions and knowledge were assessed during small‐group/ bedside training and, in a few hospitals, with a questionnaire too. 4. Reminders in the workplace: - prompting and reminding healthcare workers about the importance of HH and about the appropriate indications and procedures for performing it.
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