Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: a cross-sectional study

Abstract

BackgroundThe impact of sink location on hand washing compliance after contact with patients with Clostridium difficile infection (CDI) is poorly understood. The aim of this study is to determine the location of hand wash sinks available to healthcare workers (HCWs) after caring for patients with CDI and to assess the impact on hand washing compliance.MethodsWe performed a cross-sectional study in a 637-bed tertiary care hospital, Canada. HCW hand hygiene compliance after contact with CDI patients was measured through direct unobtrusive observations. Location of sinks in relation with the patients’ rooms was assessed on the day of diagnosis. Predictors of compliance were assessed through univariate and multivariate logistic regression.Results247 hand hygiene opportunities following care of a CDI patient were observed. Glove use compliance was 85.4 % (211/247), but hand washing compliance after care of CDI patients was only 14.2 % (35/247). Hand rubbing was performed instead of hand washing in 33.2 % of opportunities (82/247). The median distance between the patient zone of CDI patients and the nearest sink was 13.1 m (interquartile range, 7.6-23.2). Sinks were directly visible upon exiting the patient’s room on only 33.2 % (82/247) occasions. By multivariate analysis, an increasing distance between the patient zone and the nearest sink was inversely associated with hand washing compliance (adjusted OR, 0.90, 95 % CI, 0.84-0.97; P = 0.008), while proper timing of glove removal upon leaving the patient zone was directly associated with hand washing compliance (adjusted OR, 14.87; 95 % CI, 1.93-114.43; P = 0.01).ConclusionsHand washing compliance following contact with patients with C. difficile infections was low. Poor access to sinks is associated with decreased hand washing compliance. Improvement strategies are urgently needed.

Low Adherence To Hand Hygiene: Analysis Of The Impact Factors In Critical Sectors Of A Hospital

“…Each additional meter, which should be covered by the health professional to reach a sink, decreased the probability of hand washing by approximately 10%. 9 Similarly, a study in the pediatric and neonatal ICU in the United Kingdon found that, as the visibility of the sink increased, the number of HH actions also increased statistically (p <0.05). 22 In our study, although alcoholic preparations were made available in the hospital units in the form of dispensers on the walls, they were not always available at the service centers.…”

“…Different factors may be related to the low adherence to said safety behavior. Among them, health services with inadequate physical structure, including poorly located sinks 9,16 , dispensers of inoperative and out-of-reach alcoholic solutions 3 , use of gloves [17][18] , lack of training, among others. 4,11 It was verified that the participation in training offered by the institution did not influence in the increase of the adhesion to HH.…”

“…The difficulty of access to sinks and dispensers, as well as installation in ergonomically incorrect points can hinder adherence to HH. 9 A cross-sectional study conducted in Canada showed that the greater distance between the patient's site and the sink is associated with a decrease in HH adhesion. Each additional meter, which should be covered by the health professional to reach a sink, decreased the probability of hand washing by approximately 10%.…”

“…[4][5][6][7] Despite the evidence that better HH practices reduce cross-contamination of microorganisms and consequently HAI rates, the adoption of this practice in clinical settings, when monitored, has achieved below-acceptable levels of adherence in several countries. [5][6][7][8] Among the factors contributing to the low adhesion to HH is the infrastructure of the health units (9), represented by the insufficient number of washbasins, a deficit in the supply of liquid soap and paper towels, the absence of posters on HH, the availability of alcoholic preparations outside patient care points, among others.…”

Challenges Encountered in Compliance to Hand Hygiene in the Pediatric Department of a Hospital in Central Vietnam

“…A study in the United States found an increased compliance of hand washing following interaction with patient with Clostridium difficile infection when the sinks were closer to the patients' rooms [20]. Hence, one solution to increase hand-washing compliance at QTGH consists of installing more sinks in the patient bed areas, where the health care staff could easily access them.…”