Assessing the sustainability of hand hygiene adherence prior to patient contact in the emergency department: A 1-year postintervention evaluation

Martino, Paolo Di; Ban, Kevin M.; Bartoloni, Alessandro; Fowler, Karen E.; Saint, Sanjay; Mannelli, Francesco

doi:10.1016/j.ajic.2010.06.015

Cited by 42 publications

(59 citation statements)

References 26 publications

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“…In comparison, much of the current literature has relied upon direct observation to study HH compliance. 14,17-22,32-33 Srigley et al demonstrated that the Hawthorne effect can significantly improve HH compliance when HCWs are under direct observation; therefore, true compliance is likely lower than what has previously been reported. In addition, none of these studies have examined compliance with the WHO ‘My 5 Moments’ during initial trauma evaluation and resuscitation when barriers to compliance are likely greatest.…”

Section: Discussionmentioning

confidence: 97%

Hand Hygiene Compliance in the Setting of Trauma Resuscitation

Haac

Rock

Harris

et al. 2017

Injury

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Background Healthcare-associated infections are a significant health burden, and hand hygiene (HH) is an essential prevention strategy. World Health Organization (WHO) 2009 guidelines recommend washing hands during five moments of patient care; 1) before touching a patient; 2) before a clean procedure; 3) after body fluid exposure; and 4) after touching a patient or 5) patient surroundings. HH opportunities at these 5 moments are frequent and compliance is low (22-60%). Infection risk is particularly high in trauma patients, and HH compliance during active trauma resuscitation has yet to be evaluated. Study Design Using video surveillance, all healthcare worker (HCW)-patient interactions for 30 patients were retrospectively reviewed for HH compliance according to WHO guidelines and glove use during initial resuscitation at a level-1 trauma center. Results 342 HCW-patient interactions and 1034 HH opportunities were observed. HH compliance with the WHO moments was 7% (71/1034) overall; 3% (10/375) before patient contact, 0% (0/178) before a clean procedure, 11% (2/19) after body fluid contact, 15% (57/376) after patient contact and 2% (2/86) after contact with the environment. Glove use was more common, particularly before (69%) and after (47%) patient contact and after body fluid contact (58%). No HH was observed before clean procedures, but HCW donned new gloves 75% of the time before bedside procedures. If donning/removing gloves was included with HH as compliant, compliance was 57% overall. Conclusion HH opportunities are frequent and compliance with WHO HH guidelines may be infeasible, requiring significant amounts of time that may be better spent with the patient during the golden hour of trauma resuscitation. In an era where more scrutiny is being applied to patient safety, particularly the prevention of inpatient infections, more research is needed to identify alternative strategies (e.g. glove use, prioritizing moments) that may more effectively promote compliance in this setting.

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Section: Discussionmentioning

confidence: 97%

Hand Hygiene Compliance in the Setting of Trauma Resuscitation

Haac

Rock

Harris

et al. 2017

Injury

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“…Early data from Meengs et al (1994) revealed a hand washing compliance of 32% in the ED [2]. Interestingly, Di Martini et al reported a baseline compliance of 14%, whereas Venkatesh et al observed a 89% compliance rate [3,4]. However, both studies included handwashing as well an hand-rubbing as an HH activity, and therefore, a meaningful comparison is limited [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, studies on HH in an emergency department (ED) setting are limited [2-4]. Notably, there are no data on HH opportunities, hand rubs (HR), or compliance according to the WHO recommendations for individual patient care in an ED setting.…”

Section: Introductionmentioning

confidence: 99%

Improving hand hygiene compliance in the emergency department: getting to the point

et al. 2013

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BackgroundThe emergency department (ED) represents an environment with a high density of invasive, and thus, infection-prone procedures. The two primary goals of this study were (1) to define the number of hand-rubs needed for an individual patient care at the ED and (2) to optimize hand hygiene (HH) compliance without increasing workload.MethodsProspective tri-phase (6-week observation phases interrupted by two 6-week interventions) before after study to determine opportunities for and compliance with HH (WHO definition). Standard operating procedures (SOPs) were optimized for invasive procedures during two predefined intervention periods (phases I and II) to improve workflow practices and thus compliance with HH.Results378 patient cases were evaluated with 5674 opportunities for hand rubs (HR) and 1664 HR performed. Compliance significantly increased from 21% (545/2603) to 29% (467/1607), and finally 45% (652/1464; all p<0.001) in phases 1, 2, and 3, respectively. The number of HR needed for one patient care significantly decreased from 22 to 13 for the non-surgical and from 13 to 7 for the surgical patients (both p<0.001) due to improved workflow practices after implementing SOPs. In parallel, the number of HR performed increased from 3 to 5 for non-surgical (p<0.001) and from 2 to 3 for surgical patients (p=0.317). Avoidable opportunities as well as glove usage instead of HR significantly decreased by 70% and 73%, respectively.ConclusionsOur study provides the first detailed data on HH in an ED setting. Importantly, HH compliance improved significantly without increasing workload.

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“…[4][5][6][7] Improvement of health care workers' hand hygiene practices is therefore a challenge, and multiple studies have indicated that hand hygiene compliance can only be improved and sustained through the use of an approach that takes into account the multifaceted nature of behavior change. [8][9][10] Efforts to improve hand hygiene compliance include continuous education and motivation programs [9][10][11][12] and measurement and feedback of hand hygiene compliance rate to users.…”

mentioning

confidence: 99%