Predictors of Hand Hygiene in the Emergency Department

Venkatesh, Arjun K.; Pallin, Daniel J.; Kayden, Stephanie; Schuur, Jeremiah D.

doi:10.1086/662374

Cited by 25 publications

(42 citation statements)

References 8 publications

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“…High intensity of patient care has previously been shown to be correlated negatively with correct hand hygiene [23]. A recent study showed that hallway patient location was the strongest predictor of poor hand hygiene compliance in a US ED [24]. In our study, perceived lack of ED capacity and crowding (hallway care, prolonged length of stay and boarding) were not significantly associated with hand hygiene compliance.…”

Section: Discussioncontrasting

confidence: 51%

Infection prevention practices in Swedish emergency departments

Yanagizawa-Drott

Kurland

Schuur

2015

European Journal of Emergency Medicine

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Section: Discussioncontrasting

confidence: 51%

Infection prevention practices in Swedish emergency departments

Yanagizawa-Drott

Kurland

Schuur

2015

European Journal of Emergency Medicine

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“…20 We found that hallway care was associated with lower hand hygiene compliance, a finding consistent with published reports. 7 We likely lacked the power to demonstrate that compliance differed between semiprivate and private areas as only 1.4% of all hand hygiene opportunities were observed among private locations. Hallway care areas are designed to facilitate the prompt assessment and treatment of ED patients, 6 yet care should be taken to ensure that modifications to the ED environment support infection prevention practices.…”

Section: Discussionmentioning

confidence: 99%

“…Based on a previous study that found the relative risk of hand hygiene compliance among hallway patient care locations was 0.89 compared with compliance among private patient beds, 7 we set out to calculate a 10% difference in hand hygiene compliance between high and low periods of ED crowding. To detect a 10% difference in hand hygiene compliance between high and low levels of ED crowding, with an α of 0.05 and a power of 0.80, a minimum number of 388 hand hygiene observations per high and low periods of crowding was needed.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…To expedite patient care when treatment rooms are full, EDs provide care in nontraditional areas such as hallways, 6 a practice found to be predictive of lower hand hygiene compliance. 7 Crowding, "a situation in which the identified need for emergency services outstrips available resources in the ED", 8 9 is another common condition of EDs. 10 While ED crowding is associated with several aspects of poor care quality, 11 12 its relationship with hand hygiene compliance is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Environmental factors and their association with emergency department hand hygiene compliance: an observational study

et al. 2015

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Objectives Hand hygiene is effective in preventing healthcare-associated infections. Environmental conditions in the emergency department (ED), including crowding and the use of nontraditional patient care areas (i.e. hallways), may pose barriers to hand hygiene compliance. We examined the relationship between these environmental conditions and proper hand hygiene. Methods This was a single-site, observational study. From October 2013 to January 2014, trained observers recorded hand hygiene compliance among staff in the ED according to the World Health Organization “My 5 Moments for Hand Hygiene.” Multivariable logisitic regression was used to analyze the relationship between environmental conditions and hand hygiene compliance, while controlling for important covariates (e.g., hand hygiene indication, glove use, shift, etc.). Results A total of 1,673 hand hygiene opportunities were observed. In multivariable analyses, hand hygiene compliance was significantly lower when the ED was at its highest level of crowding than when the ED was not crowded and lower among hallway care areas than semi-private care areas (OR=0.39, 95% CI 0.28-0.55; OR= 0.73, 95% CI 0.55-0.97). Conclusions Unique environmental conditions pose barriers to hand hygiene compliance in the ED setting and should be considered by ED hand hygiene improvement efforts. Further study is needed to evaluate the impact of these environmental conditions on actual rates of infection transmission.

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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%

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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Predictors of Hand Hygiene in the Emergency Department

Cited by 25 publications

References 8 publications

Infection prevention practices in Swedish emergency departments

Infection prevention practices in Swedish emergency departments

Environmental factors and their association with emergency department hand hygiene compliance: an observational study

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

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