Hostname: page-component-848d4c4894-5nwft Total loading time: 0 Render date: 2024-06-02T23:26:56.059Z Has data issue: false hasContentIssue false
  • English
  • Français

Rate of Healthcare Worker–Patient Interaction and Hand Hygiene Opportunities in an Acute Care Setting

Published online by Cambridge University Press:  10 May 2016

Laura Goodliffe ,
Kelsey Ragan ,
Michael Larocque ,
Emily Borgundvaag ,
Sophia Khan ,
Christine Moore ,
Liz McCreight ,
Brenda L. Coleman ,
Allison J. McGeer  and
Mount Sinai Infection Control Team
Laura Goodliffe
Affiliation:
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Division of Infection Control, Mount Sinai Hospital, Toronto, Ontario, Canada
Kelsey Ragan
Affiliation:
Division of Infection Control, Mount Sinai Hospital, Toronto, Ontario, Canada
Michael Larocque
Affiliation:
Division of Infection Control, Mount Sinai Hospital, Toronto, Ontario, Canada
Emily Borgundvaag
Affiliation:
Division of Infection Control, Mount Sinai Hospital, Toronto, Ontario, Canada
Sophia Khan
Affiliation:
Division of Infection Control, Mount Sinai Hospital, Toronto, Ontario, Canada
Christine Moore
Affiliation:
Division of Infection Control, Mount Sinai Hospital, Toronto, Ontario, Canada
Liz McCreight
Affiliation:
Division of Infection Control, Mount Sinai Hospital, Toronto, Ontario, Canada
Brenda L. Coleman*
Affiliation:
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Infectious Diseases Epidemiology Research Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
Allison J. McGeer*
Affiliation:
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Division of Infection Control, Mount Sinai Hospital, Toronto, Ontario, Canada
*
Mount Sinai Hospital, Room 210, 600 University Avenue, Toronto, ON M5G 1X5, Canada (amcgeer@mtsinai.on.ca)
Mount Sinai Hospital, Room 210, 600 University Avenue, Toronto, ON M5G 1X5, Canada (amcgeer@mtsinai.on.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Identify factors affecting the rate of hand hygiene opportunities in an acute care hospital.

Design.

Prospective observational study.

Setting.

Medical and surgical in-patient units, medical-surgical intensive care unit (MSICU), neonatal intensive care unit (NICU), and emergency department (ED) of an academic acute care hospital from May to August, 2012.

Participants.

Healthcare workers.

Methods.

One-hour patient-based observations measured patient interactions and hand hygiene opportunities as defined by the “Four Moments for Hand Hygiene.” Rates of patient interactions and hand hygiene opportunities per patient-hour were calculated, examining variation by room type, healthcare worker type, and time of day.

Results.

During 257 hours of observation, 948 healthcare worker-patient interactions and 1,605 hand hygiene opportunities were identified. Moments 1, 2, 3, and 4 comprised 42%, 10%, 9%, and 39% of hand hygiene opportunities. Nurses contributed 77% of opportunities, physicians contributed 8%, other healthcare workers contributed 11%, and housekeeping contributed 4%. The mean rate of hand hygiene opportunities per patient-hour was 4.2 for surgical units, 4.5 for medical units, 5.2 for ED, 10.4 for NICU, and 13.2 for MSICU (P < .001). In non-ICU settings, rates of hand hygiene opportunities decreased over the course of the day. Patients with transmission-based precautions had approximately half as many interactions (rate ratio [RR], 0.55 [95% confidence interval (CI), 0.37-0.80]) and hand hygiene opportunities per hour (RR, 0.47 [95% CI, 0.29-0.77]) as did patients without precautions.

Conclusions.

Measuring hand hygiene opportunities across clinical settings lays the groundwork for product use-based hand hygiene measurement. Additional work is needed to assess factors affecting rates in other hospitals and health care settings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 3 , March 2014 , pp. 225 - 230
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a.

L.G. and K.R. contributed equally to this work

References

1. World Health Organization. Guidelines for hand hygiene in healthcare. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf. Updated 2009. Accessed July 4, 2013.Google Scholar
2. Boyce, JM. Hand hygiene compliance monitoring: current perspectives from the USA. J Hosp Infect 2008;70(suppl I):S2–S7.Google Scholar
3. Hass, JP, Larson, EL. Measurement of compliance with hand hygiene. J Hosp Infect 2007;66:6–14.Google Scholar
4. Braun, BI, Kusek, L, Larson, E. Measuring adherence to hand hygiene guidelines: a field survey for examples of effective practices. Am J Infect Control 2009;37:282–288.Google Scholar
5. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. 2007 Guidelines for isolation precautions: preventing transmission of infectious agents in healthcare settings. Am J Infect Control 2007;35(10 suppl 2):S65–S164.Google Scholar
6. Provincial Infectious Diseases Advisory Committee. Best practices for hand hygiene, http://www.publichealthontario.ca/en/eRepository/2010-12%20BP%20Hand%20Hygiene.pdf. Updated 2010. Accessed July 4, 2013.Google Scholar
7. Scheithauer, S, Haefher, H, Schwanz, T, et al. Compliance with hand hygiene on surgical, medical, and neurologic intensive care units: direct observation versus calculated disinfectant usage. Am J Infect Control 2009;37:835–841.CrossRefGoogle ScholarPubMed
8. Scheithauer, S, Oude-Aost, J, Heimann, K, et al. Hand hygiene in pediatric and neonatal intensive care unit patients: daily opportunities and indication- and profession-specific analysis of compliance. Am J Infect Control 2011;39:732–737.Google Scholar
9. Steed, C, Kelly, JW, Blackhurst, D, et al. Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 benchmark study. Am J Infect Control 2011;39:19–26.Google Scholar
10. Kim, PW, Roghmann, MC, Perencevich, EN, Harris, AD. Rates of hand disinfection associated with glove use, patient isolation, and changes between exposure to various body sites. Am J Infect Control 2003;31:97–103.Google Scholar
11. Nijssen, S, Bonten, MJ, Franklin, C, Verhoef, J, Hoepelman, AI, Weinstein, RA. Relative risk of physicians and nurses to transmit pathogens in a medical intensive care unit. Arch Intern Med 2003;163:2785–2786.Google Scholar
12. Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354:1177–1178.Google Scholar
13. Saint, S, Higgins, LA, Nallamothu, BK, Chenoweth, C. Do physicians examine patients in contact isolation less frequently? a brief report. Am J Infect Control 2003;31:354–356.Google Scholar