{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T14:25:05Z","timestamp":1762352705783},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2018,9,4]],"date-time":"2018-09-04T00:00:00Z","timestamp":1536019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9\u20135.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36\u201316.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piy076","type":"journal-article","created":{"date-parts":[[2018,8,1]],"date-time":"2018-08-01T23:14:34Z","timestamp":1533165274000},"page":"408-413","source":"Crossref","is-referenced-by-count":11,"title":["Addressing Hand Hygiene Compliance in a Low-Resource Neonatal Intensive Care Unit: a Quality Improvement Project"],"prefix":"10.1093","volume":"8","author":[{"given":"Arunava","family":"Biswas","sequence":"first","affiliation":[{"name":"School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sangeeta Das","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arun Kumarendu","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Neonatology, IPGMER & SSKM Hospital, Kolkata, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallika","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Neonatology, IPGMER & SSKM Hospital, Kolkata, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,9,4]]},"reference":[{"key":"2019110600560789800_CIT0001","doi-asserted-by":"crossref","first-page":"e81","DOI":"10.1542\/neo.4-3-e81","article-title":"Nosocomial infections in the neonatal intensive care unit","volume":"4","author":"Polin","year":"2003","journal-title":"NeoReviews"},{"key":"2019110600560789800_CIT0002","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2471\/BLT.14.139790","article-title":"Neonatal cause-of-death estimates for the early and 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