Impact of a training strategy on improving compliance of hand hygiene and gloving during the placement of a short peripheral venous catheter: the multicentre study CleanHand4

doi:10.21203/rs.3.rs-2953401/v1

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Research Article

Impact of a training strategy on improving compliance of hand hygiene and gloving during the placement of a short peripheral venous catheter: the multicentre study CleanHand4

https://doi.org/10.21203/rs.3.rs-2953401/v1

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Journal Publication

published 06 Oct, 2023

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Background.

Patients who have short peripheral venous catheters (PVC) face an elevated risk of developing bloodstream infections. Preventing catheter-related infections relies on implementing multiple measures, including practicing proper hand hygiene (HH) during catheter placement.

Methods.

We conducted a four-part study : (1) an evaluation of HH practices through direct observation of PVC placements, coupled with the study of the microbial flora of the HCWs fingers just before the placement; (2) the development of an educational tool based on the collected observational and microbiological data; (3) the training to the HCWs observed during the first part, using this tool; and (4) the subsequent observation of the trained HCWs to measure the impact of the training on practice improvement.

Results.

Compliant HH was observed in 23.5% of the 647 HCWs observed during PVC placement before training. The microbiological study revealed fewer pathogens on the fingertips of the HCWs practicing compliant HH compared other HCWs (2.6 vs 11,7%; p = 0.003). The comparison of practices before and after training, assessed amng 180 HCWs, showed an increase in the proportion of HCWs performing compliant HH (63.2 vs 25.0%; p < 0.001).

Conclusions.

Training HCWs using our educational tool, which combines reminders of best practices and risk factors associated with PVC-related infections, engaging HCWs (presentation of practice evaluation), identifying professionals deviating from best practices (simulation videos), and objectively assessing fingertip contamination (microbiological study), significantly improved compliance with HH gestures and glove usage. We encourage infection control teams to utilize this tool to raise awareness among HCWs responsible for PVC placement about the risk of infection associated inadequate hand hygiene.

Short peripheral venous catheters

asepsis

hand hygiene

gloving

improvement of practices

The placement of short-term peripheral intravenous catheters (PVCs) is a common medical procedure, with an estimated annual rate of approximately 25 million in France in 2005 (1). Patients who undergo the insertion of these catheters are at an increased risk of developing infections that can impact patient care, including prolonged hospital stays, delayed treatment plans, and increased hospitalization costs.

PVC-related infections occur as a result of catheter contamination and the factors favouring these infections are multiple (2). PVC are primarily contaminated by bacteria from the patient's skin flora if the antisepsis at the insertion site is suboptimal, or from the HCW’s flora when strict asepsis is not observed during PVC placement.

PVC-related infections are largely preventable events (4). Preventing these infections relies on implementing a well-recognized bundle of measures during PVC placement, including hand disinfection (5–7). HCWs should have clean hands from the beginning to the end of catheter placement, which requires two hand hygiene (HH) practices: the first, before preparing the equipments, aimed at eliminating microorganisms present on the HCW’s hands and collected during care provided to other patients; and the second, just before catheter insertion, aimed at eliminating microorganisms collected during patient setup and preparation of the insertion site.

Multiple studies have demonstrated that HCWs frequently exhibit poor adherence to HH opportunities and technical compliance (7). However, to our knowledge, there is a lack of data regarding HH during PVC placement. Therefore, the primary objective of our study was to evaluate HH practices during the placement of PVCs.

Changing habits is complex and combating obstacles to compliance with HH practices is a major challenge. Many tools are available to promote HH, including those from the WHO (8;9), but none are specifically dedicated to improving HH during PVC placement. Promoting behaviour change requires HCWs to perceive the risk and understand the mechanisms of microorganisms transmission during patient care (12;13). Therefore, we aimed to develop an educational tool enriched with microbiological data regarding hand contamination based on HH compliance during PVC placement. The second objective of our study was to combine the observation of HCWs’ HH practices with a study of the microbial flora of their fingertips immediately before PVC placement. This combined approach allowed us to compare fingertip contamination among HCWs based on the cleanliness of their hands.

We designed an educational tool utilizing the collected observational and microbiological data, then trained the HCWs observed during the first part of the study using this tool, and finally evaluated their HH practices during the placement of PVCs after the training to measure the impact of the training using our tool on the improvement of HH.

Study design. All infection control teams from French hospitals were invited to participate in the study. The study, conducted from January to September 2022, consisted of four phases: (1) an evaluation of HH practices was conducted in each participating center, with direct observation of HCWs placing PVCs and the study of the microbial flora present on the fingers of the observed HCWs; (2) the national-level development of an educational tool was conducted using the data obtained during the first phase, including the results of the HH practices evaluation and microbiological data; (3) the local infection control teams trained the HCWs observed during the first phase using the tool; and (4) a second observation of HH practices was conducted by the local infection control teams. This second evaluation aimed to measure the impact of the training on the improvement of HH practices.

Observational study. In each center, the local infection teams had to observe graduate or student HCWs placing a PVC in adult patients. The observations were conducted during the first phase for eight different HCWs, and during the fourth phase, for all the HCWs observed during the first phase and trained during the third phase, with a minimum of 2 months between the second observation and the training. The observations were conducted using a standardized grid examining HH at the beginning of the procedure and immediately prior to PVC insertion (presence/absence of action, type of HH (hand washing or alcohol-based hand rubbing), presence/absence of prerequisites (exposed forearms, short nails, no jewelry) and conformity of the gesture if applicable (7)), and glove use (presence/absence of gloves and time of gloving if applicable), and skin preparation (skin cleansing, antiseptic solution used, spontaneous drying). The observation sheets were sent to the national level for analysis. The results were firstly used for the initial evaluation of practices. Secondly, the practices of the HCWs observed before and after training were compared to measure the impact of training on HH compliance. In this study, only the data related to HH and glove use are presented.

Microbiological study. During the first phase, the local infection control teams used sterile systems (Amies transport media, Mast, Copan-Brescia, Italy) to swab the fingertips and palm of the hands of the HCWs immediately prior to PVC insertion, following a standardised procedure. The swabs were stored at room temperature and sent to the national laboratory. Upon receipt, they were labeled and paired with observation sheets, and then inoculated onto Trypticase Soja sheep blood agar (bioMérieux, Marcy l’Etoile, France). All visible microbial colonies after a 48-hour incubation at 37°C under aerobic conditions were identified using MALDI-TOF technology (Bruker Daltonics, France). S. aureus, Enterobacteriales and Enterococci were tested for antibiotic susceptibility according to French guidelines (14). The microbiological data firstly provided an overview of the contamination of the fingers of the HCWs just before PVC placement. Secondly, the microbiological data, along with the data obtained from the observation of practices, were entered into an Excel table to investigate the correlation between the presence of pathogens on the fingers and the level of compliance of HH among the HCWs.

Design and use of the educational tool. A training tool was developed by the national team and distributed with a technical guide. The local infection control teams then trained the HCWs observed during the first phase of the study using the national tool. An evaluation of the acceptability of the tool was conducted using a questionnaire intended for trained HCWs and trainers.

Initial evaluation of practices. A total of 91 French hospitals participated in the first phase of the study: seven university/regional/military hospitals, 38 general hospitals, 37 short-stay clinics, three home care centers, two oncology centers, two rehabilitation centers, one long-stay hospital and one haemodialysis center. The number of observations varied between 3 and 9 depending on the center (median 8). A total of 647 HCWs were observed, of whom 90% (n = 581) were nurses, 6% radiographers (n = 40), 2% were doctors (n = 10), and 1% were midwives (n = 8). For 8 cases, the status was not documented (1%).

Out of the 647 HCWs observed, 23.5% (n = 152) performed the two expected HH gestures in a compliant manner (Table 1). Among the 495 remaining HCWs, 53.1% (n = 263) performed a single compliant HH, while 46.9% (n = 232) did not comply with either of the 2 HH gestures. HH compliance was higher for the first HH (i.e., the one performed at the beginning of care) than for the second one (i.e., the one performed just before catheter placement) (390 (60.3%) vs 177 (37.3%); p < 0.001). For the first opportunity, H was not performed at all in 10.8% of cases (n = 70), and for the second opportunity, this omission was observed in 45.9% of cases (n = 297) (p < 0.001).

Table 1

HH compliance observed for the 647 HCWs (%).
Observation of HH	No compliant HH				One compliant HH				Two compliant HH	All
1^rst HH gesture	ND	ND	NC	NC	ND	NC	C	C	C	390
2nd HH gesture	ND	NC	ND	NC	C	C	ND	NC	C	177
N HCWs	50	7	87	88	13	12	160	78	152 (23,5)	647
N HCWs	232 (35,9)				263 (40,6)				152 (23,5)	647

*ND not performed; NC performed but non-compliant HH; C compliant HH.

The hands of HCWs must be protected from accidental blood exposure during catheter insertion. To achieve this goal without compromising HH, gloves should be donned after the second HH gesture. The observations revealed that 22.7% of the HCWs (n = 147) gloved their hands at the correct time (Table 2). The remaining HCWs placed the PVC without gloves (275; 42.5%) or gloved their hands too early (225; 34.8%).

Table 2

Gloving compliance observed for the 647 HCWs (%).
Observation of gloving	No compliant HH (n = 232)	One compliant HH (n = 263)	Two compliant HH (n = 152)	All (n = 647)
No	95 (40.9)	100 (38.0)	80 (52.6)	275
Non-compliant	96 (41.4)	129 (49.0)	0	225
Compliant	41 (17.7)	34 (12.9)	72 (47.4)	147

The remaining HCWs (34.8%; n = 225) gloved too early (i.e., either before starting to prepare the material (5.7%; n = 37) or before carrying out the skin preparation (29.1%; n = 188)), and missed the second HH opportunity. Gloving compliance was higher among HCWs who performed two compliant HH compared to those who performed one or none in a compliant manner (72 (47.4%) vs 75 (15.1%); p < 0,001).

Contamination of the fingers of the HCWs just before PVC placement. Each observation of PVC placement led to a microbiological sampling of the HCWs’ fingertips (gloved or not). Out of the 647 swabs analysed, 9.6% (n = 62) revealed the presence of at least one pathogen (one pathogen (n = 56) or more (n = 6)), and 42.0% (n = 272) showed a culture of various microorganisms, mainly skin organisms, such as non-aureus Staphylococci and Micrococci, without any presence of pathogenic bacteria. Among the 334 swabs exhibiting visible microbial growth, 75.0% (n = 251) presented at least one bacterium commonly found in the skin flora. The most common species were coagulase-negative Staphylococci (n = 126), Micrococcus (n = 63), Moraxella (n = 55) and Corynebacterium (n = 18). Additionally, 43.7% (n = 146) of the swabs contained at least one environmental microorganism such as Bacillus species not belonging to the cereus complex (n = 76), Paenibacillus (n = 20), Brevundimonas (n = 17) and Brachybacterum (n = 13). Among the 71 identified pathogens, the predominant ones were Acinetobacter (n = 27; 38.0%), 13 Bacillus belonging to the cereus complex (18.3%), ten Enterobacteriales (14.1%) including one Enterobacter cloacae, one Proteus mirabilis, one Serratia proteamaculans, one Ewingella americana and six Pantoea, eight Enterococci (11.3%) including six E. faecalis, two E. faecium, eight S. aureus (11.3%), two Stenotrophomonas (2.8%) and three yeasts (4.2%). Among the S. aureus isolates, six had a wild phenotype, one was an erythromycin and fluoroquinolone resistant MSSA, and one was a fluoroquinolone resistant MRSA. The Enterobacteriales were susceptible to third generation cephalosporins and carbapenems, and the Enterococci were susceptible to vancomycin. The pathogens identified did not vary based on the number of compliant HH performed prior to swabbing.

We investigated the correlation between the presence of pathogens on the fingers and the level of HH compliance among HCWs before PVC placement, and found a lower presence of pathogens on the fingertips of HCWs who performed 2 compliant HH gestures in a compliant manner compared to other HCWs (2.6% vs 11.7%; p = 0.003) (Table 3). For the HCWs who performed 2 compliant HH gestures, the presence of pathogens on the fingers was not influenced by the use of gloves (p = 0.539). By contrast, for the HCWs who did not perform two compliant HH, we found a higher presence of pathogens on the fingertips of HCWs who did not glove compared to other HCWs (16.9% vs 8.3%; p = 0.004).

Table 3

Pathogen detection according to HH compliance observed for the 647 HCWs.
Observations	No compliant HH (n = 232)	One compliant HH (n = 263)	Two compliant HH (n = 152)	All (n = 647)
Swabs with ≥1 pathogen	25 (10.8)	33 (12.5)	4 (2.6)	62 (9.6)
Without gloves	14/95 (14.7)	19/100 (19.0)	1/80 (1.2)	34/275 (12.4)
With gloves	11/137 (8.0)	14/163 (8.6)	3/72 (4.2)	28/372 (7.5)

Training. A training tool was developed at the national level and distributed to local teams. The tool includes a user guide that outlines the topics to be covered during the training session, and a slideshow that presents the following topics in a specific order: (1) Reminder of the importance of PVC-related infection prevention, (2) current guidelines for HH during PVC placement, with a particular focus on the necessity of performing two HH gestures, (3) results of the practice evaluation and microbiological study conducted in Phase 1, (4) correlation between the level of finger contamination among HCWs and HH compliance, (5) three short videos: the first two videos illustrating common inappropriate situations observed (i.e., PVC placement without proper HH, and PVC placement with compliance for the first HH but premature gloving), and the third video showing proper PVC placement with both HH performed, and (6) a debriefing framework designed to ensure that training participants have a thorough understaanding of the mechanisms of finger contamination during CVP placement when HH is not adequate. A total of 48 local teams conducted on-site training sessions using the provided tool for the HCWs observed during the first phase. An evaluation of the tool’s acceptability was conducted using a questionnaire administred to trained HCWs and trainers. The analysis of the questionnaires completed by 48 trainers and 280 trained HCWs at the end of the training, revealed an average training duration of 70 minutes (15–180), divided into an average training time of 44 minutes (10–90) and an average discussion time of 26 minutes (5–90). Trained HCWs expressed a strong interest in the microbiological results (mean score of 8.5/10) and the videos (mean value 7.7/10). They reported a willingness to change their practices (mean 8.2/10) and recommend the training (mean 8.8/10). The duration of the training was considered satisfactory, as was the duration of the discussion with the trainer. For the trainers, the training helped them better understand the challenges faced by HCWs in carrying out the two HH gestures at the right time (mean value 7.1/10). They appreciated the educational tool (8.4/10) and the technical guide (8.6/10) and expressed readiness to use the tool again (mean 8.5/10).

impact of the training on the improvement of HH and gloving. In total, 48 centers participated in both first and fourth phases of the study, allowing for a comparison of the results of practice observations before and after the training for the 280 HCWs in these centers. HH compliance was higher after the training, with 63.2% (n = 177) of the 280 HCWs performing the two expected HH gestures, compared to only 25.0% (n = 70) of these HCWs before the training (p < 0.001) (Fig. 1). The highest progression in HH compliance was observed among HCWs who performed one compliant HH gesture before training, with 65.5% of them performing two HH gestures in a compliant manner after training. Gloving compliance significantly improved after the training, with 52.1% (n = 146) of the 280 HCWs donning gloves immediately before PVC placement, compared to 24.6% (n = 69) before the training (p < 0.001) (Fig. 2). Among HCWs who performed two compliant HH gestures, gloving compliance was even higher, with 67.2% of them correctly donning gloves after the training (p < 0,001).

The 280 HCWs followed in Phase 4 and the 367 lost to follow-up after Phase 1 performed the two expected HH gestures in the same proportion (25.0% vs 22.3%; p = 0.430). Furthermore, the proportion of HCWs who donned gloves immediately prior to PVC placement was similar in both populations (24.6% vs 21.2%; p = 0.308). Therefore, we considered the 280 HCWs observed before and after the training to be representative of the entire population of HCWs observed in Phase 1.

Our study, carried out in 91 diverse French hospitals, brought new data over HH during the placement of a PVC.

Rigourous antisepsis during catheter placement, particularly proper HH, is a well-known factor contributing to the prevention of catheter-related infection (ref). However, to our knowledge, HH practices during PVC placement have not been the subject of many studies (doi: 10.1186/s12909-021-02868-5). By conducting direct observations of a substantial number of PVC placements, we have identified a concerning trend in HH practices. Three out of four HCWs fail to perform the two necessary compliant HH gestures during the procedure. Enhancing HH during PVC placement is a crucial priority in the prevention of PVC-related infections.

While studying HH practices, we observed the use of gloves among HCWs erforming PVC insertions. It was found that one in three HCWs donned gloves prematurely, either at the start of the procedure or before applying the antiseptic. Consequently, in theses cases, HCWs inserted the PVC without conducting the second HH gesture. These data demonstrate how wearing gloves can be a major barrier to implementing HH guidelines, as previously suggested (10). Considering the significance of this barrier, efforts to improve HH should fully address the issue of glove usage and its interaction with HH practices.

To our knowledge, there is a lack of recent data demonstrating how the hands of HCWs performing PVC insertions become contaminated throughout the procedure when HH practices are suboptimal. We conducted a study examining the microbial flora present on the fingertips of observed HCWs immedately before PVC insertion. The major pathogens associated with catheter-related infections such as S. aureus, Enterobacteriales, and Enterococci, were found on the fingertips of one in ten HCWs. Combining the microbiological data with direct observation of HCWs, we found that the presence of pathogens on the fingertips was influenced by the number of compliant HH gestures performed during the procedure, regardless of glove usage. Our findings emphasize the importance of performing two compliant HH gestures, the first before material preparation and the second just before PVC insertion, to ensure clean fingers during catheter insertion. However, zero risk cannot be achieved, as evidenced by the presence of pathogens on the fingers of four HCWs who performed the two compliant HH gestures. These data show that HH is just one of a bundle of preventive measures for catheter-related infections. Several hypotheses can be proposed to explain finger contamination despite compliant HH gestures, including contamination from the glove box or through contact with the patient's skin or handling of the tourniquet. The presence of microorganisms with a high ability to survive in the environment, such as Acinetobacter, Enterococci and Bacillus cereus, on the fingertips underscores the importance of maintaining a clean environment around the patient. We do not in any way advocate for the routine microbiological study of finger contamination among HCWs. However, we consider the findings from this specific study to be valuable for utilization in training sessions, as they effectively illustrate how HCWs' fingers can become contaminated when HH practices are not optimal.

Using short videos depicting nurses failing to perform one or both of the required HH gestures during PVC placement procedures, along with the evaluation results of HH practices and the microbiological data obtained in the initial phase of the study, we have developed an educational tool specifically tailored to assist HCWs performing PVC insertions in comprehending the significance of adhering to HH and glove usage recommendations.

The participation of 48 hospitals in all four phases of the study provided with the opportunity to evaluate the impact of the training conducted with the developed tool on a representative sample of 280 HCWs. The training of these professionals with the educational tool led to a significant improvement in adherence to both HH practices and proper glove usage during PVC placement.

Our study has several limitations. Firstly, due to the demanding nature of the study, half of the centers did not continue their participation beyond the 1^st phase, which may have reduced the robustness of the impact study. However, the HCWs who were lost to follow-up and those whose practices could be studied before and after training, having been similar before training, we consideres as a significant population of 280 HCWs. Secondly, the microbiological analysis was conducted using a single culture medium (Trypticase Soja sheep blood agar), which may have limited the growth of fastidious bacteria present on the hands of HCWs. However, since the objective of the study was to detect the pathogens tipically responsible for PVC-BSI (particularly S. aureus and Enterobacteriales), our results demonstrated that this objective was achieved. A third limitation was the two-month delay between the training and the second observation of PVC placement. The choice of a relatively short period was made to minimize the number of subjects lost to follow-up and to facilitate the observation of same HCWs before and after training, considering the high rate among HCWs in French hospitals. A third observation of practices will be conducted remotely to assess the effectiveness of the training.

Our study demonstrated that training HCWs using our educational tool, which combines reminders of best practices and risk factors associated with PVC-related infections, engaging HCWs (presentation of practice evaluation), identifying professionals deviating from best practices (simulation videos), and objectively assessing fingertip contamination (microbiological study), significantly improved compliance with HH gestures and glove usage. We encourage infection control teams to utilize this tool to raise awareness among HCWs responsible for PVC placement about the risk of infection associated inadequate hand hygiene.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE. All experiments were performed in accordance with relevant guidelines and regulations. The study was conducted within the framework of the national agency Santé Publique France and the national program for the prevention of healthcare-associated infections (National Health Strategy 2018-2022), which advocates for regular evaluation of healthcare professionals' practices by local infection control teams. All work related to this program has been authorized by the CNIL (National Commission on Informatics and Liberties; file 2212596 dated March 27, 2019).

The protocol for the CleanHand4 study was approved on June 15, 2021 by an ethics committee/institutional review board during a meeting of the scientific council of Santé Publique France agency, responsible for overseeing the implementation of the SPIADI program. The implementation of the study was monitored by the scientific committee overseeing the SPIADI program (March 8, 2022).

Locally, participation in the study required written commitment from the hospital director and the infection control team leader. The commiment charters were collected at the national level by the SPIADI team. In the departments where the study was conducted, the observed professionals were informed about the study (observational component, microbiological component, and impact study of the proposed training). Informed consent was obtained from all observed professionals and all subjects for whom the placement of a CVP was observed and/or their legal guardian(s).

CONSENT FOR PUBLICATION. Not applicable.

AVAILABILITY OF DATA AND MATERIALS. The datasets used and/or analysed during the current study are available from the corresponding author N. van der Mee-Marquet on reasonable request. The educational tool is available using this link https://www.spiadi.fr/tools?tab=1

COMPETING INTERESTS. The authors declare that they have no competing interests.

FUNDING. Not applicable.

AUTHORS' CONTRIBUTIONS. MF was a major contributor in the operational implementation of the study and field data collection, and analyzed the observationnal data ; LR and SDS carried out the microbiological study and analyzed the microbiological data ; AP designed the study and contributed to the analysis of the results ; ASV designed the study, supervised the microbiological study and contributed to the analysis of the results ; NVDM designed and coordinated the study, contributed to the interpretation of the data and wrote the manuscript ; each member of the CleanHand4 collaboration group carried out in his healthcare institution, the observation of the HCWs, and took the microbiological samples. All authors read and approved the final manuscript.

ACKNOWLEDGEMENTS.

The members of the CleanHand4 collaboration group areKimberley ALEXANDRE (SSC, Béziers), Alexandra ALLAIRE (GH, Saint-Lo), Karine AMANDIER (GH, Nogaro), Nathalie AUDRAIN (Univ. H, AP-HP, Paris), Amina AZZAM (OC, Villejuif), Mehdi BASTARD (HCC, Marseille), Mélika Berrahal (GH, Salon-de-Provence), Yasmina BERROUANE (Univ. H, Nice), Marie-Camille BETTI (SSC, Vendôme), Claire BIANCHI (GH, Lens), Mathilde BLANIÉ (GH, Périgueux), Laetitia BORRELYS (GH, Blaye), Caroline BOSCHET (GH, Ponteils-et-Brésis), Myriem BOUNOUA (SSC, Aubervilliers), Alexandre BOURDET (GH, Cayenne), Frédérique BOUSQUET (GH, Bourges), Jihane BRISSON (SSC, Strasbourg), Anne BRRECHAT (SSC, Angoulême), Dominique BUIGUEZ (SSC, Marseille), Sandra CAFFORT (SSC, Boujan-sur-Libron), Céline CHATELET (GH, Beauvais), Catherine CHATIN (SSC, Périgueux), Karine CHEVALIER (SSC, Macon), Armelle CHOQUET (RC, Illiers-Combray), Christine CHRETIEN (GH, Château-Gontier), Amélie COIRE (GH, Vire), Karine COURCELLE (SSC, Thionville), Nathalie CREMOUX (SSC, Brive), Michèle DANGEL (HDC, Vandoeuvre-les-Nancy), Marion DAVID (OC, Rouen), Cécile DEBARRE (GH, Chateaubernard), Lydia DECRUYENAERE (SSC, Ermont), Peggy DELAVAULT (SSR, Puilboreau), Frédérique DIAW (GH Diaconesses, Paris), Marie DOBRAS (LSH, Marseille), Carole DOMRAULT-TANGUY (GH, Henin-Beaumont), Sylvie DROT (SSR, Antony), Audrey DUCHEMIN (SSR, Nice), Isabelle DURAND-JOLY (GH, Dunkerque), Claude EL KALLAS (SSC, Mont-St-Martin), Christelle FORMERY (SSC, St-Avold), Pierre FOURNIER (SSC, Malestroit), Aline FRANCK (SSC, Baie Mahault), Blanche GHALLOUSSI (SSC, Coudekerque-Branche), Nathalie GHIRONI (GH, Firminy), Marie GODET (HCC, Beauvois-en-Cambresis), Anne GOUDOUNECHE (SSC, Pessac), Jill GREGOIRE (SSC, Essey-les-Nancy), Hedia GUERMAZI (SSC, Furiani), Nadia IDRI (Univ. H, AP-HP, Colombes), Emmanuelle JACQUES–GUSTAVE (Univ. H, Martinique), Sylvie JORON (GH, Calais), Laurence JOSEPH (GH, St-Grégoire), Anne-Marie KAYOULOU-BOUR (GH, Val-de-Briey), Maha KESWANI (GH, Clermont), Annick KMIECIK (SSC, Guéret), Marie LAFARGUE (SSC, Arès), Magalie LAFFON (SSC, Castres), Elodie LAFOND (GH, Bergerac), Bruno LE FALHER (GH, Argenteuil), Cécile LE GOUIL (GH, Lillebonne), Sophie LECONTE (SSC, Vire), Florence MALFONDET (GH, Sens), Sandrine MARTY (SSC, Marseille), Nadine MERTEL (LSH, Sarreguemines), Virginie MORANGE (Univ. H, Tours), Floriane MORETTE (GH, Montfermeil), Jennifer MOURONVAL (SSC, Berck), Sylvie MOUTARDE (SSC, Mougins), Nadine NEGRIN (GH, Grasse), Dominique OLLIVIER (GH, La Ferté-Mace), Anne PEREZ (GH, Foix), Pauline POMMIER (SSC, Vichy), Kahina POUPONNOT (GH, Chaumont), Kahina POUPONNOT (GH, Langres), Isabelle POUY BERLEMONT (OC, Nice), Samantha RAUMEL (SSC, Fort-de-France), Patricia ROSSI (AH, Toulon), Noella ROUDAUT (SSC, Draguignan), Bénédicte ROUX-SIBILLON (GH, Marvejols), Dominique SAEZ DE IBARRA (SSC, Désertines), Muriel SCHREVENS (SSC, Rouen), Ousseini SIDIKOU (GH, Ussel), Bertille TAMBURRO (SSC, Ollioules), Catherine THEAUDE (GH, Epinal), Sarah THEVENOT (Univ. H, Poitiers), Jessica TURPIN (RC, Cabris), Morgane VALSAQUE (SSC, Cornebarrieu), Séverine VEJA (HCC, Vandoeuvre-Les-Nancy), Lucie WOJCIECHOWSKI (GH, Neuchateau), Laure ZANGOLI (GH, Aix en Provence).

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published 06 Oct, 2023

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Impact of a training strategy on improving compliance of hand hygiene and gloving during the placement of a short peripheral venous catheter: the multicentre study CleanHand4

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