Becker's Clinical Quality & Infection Control

42 Hand Hygiene I mproving hand hygiene compliance is an on- going battle hospitals face, and there is major room for improvement in hospital reception areas, which may be overlooked, according to a study published in the American Journal of Infec- tion Control. Researchers performed a 33-week-long study to evaluate hand hygiene compliance rates of pa- tients, visitors and employees at two hospital en- trances and reception areas. The researchers used direct observation via remote review of video sur- veillance and electronic observers. The researchers found low hand hygiene compli- ance rates of 2.2 percent and 1.7 percent in the two reception areas using direct observation. Us- ing the electronic observer, they measured com- pliance rates of 17 percent and 7.1 percent in the reception areas. Overall, the human observer captured 1 percent of the hand hygiene events detected by the elec- tronic observer. The study authors recognize that hand hygiene is most crucial when temporally related to patient care, but call the low compliance rates in recep- tion areas "unacceptable." "This information can stimulate hospital admin- istrators and infection preventionists to establish strategies to promote improved safety in the hos- pital by encouraging patients, visitors and health- care workers to use alcohol gel when they enter the hospital," wrote the study authors. "This is the first action to promote and practice the WHO's slogan, Clean Care is Safer Care." n S enior health professionals and mentors play an important role in improving hand hygiene compliance, according to a study published in Infection Control & Hospital Epidemiology. To study how social dynamics influence compli- ance, researchers examined nearly 3,000 oppor- tunities for hand hygiene at four adult inpatient care units at a single tertiary care hospital over a two week span in February 2014. Observers collected data on four hand hygiene opportunities: upon patient room entry, after ex- iting patient rooms, before putting on gloves and after glove removal. Successful hand hygiene was defined as the use of soap and water or alcohol- based hand rub. Observations were categorized as either "group" — when two or more healthcare workers were pre- sented with the same hand hygiene opportunity at the same time — or "individual." Groups and in- dividuals with and without leaders were observed. The researchers found compliance was marginally higher among groups with (53 percent) or with- out leaders (57 percent) than among individuals (49 percent). They also found significantly higher compliance among group members whose leaders practiced hand hygiene (71 percent) than among groups whose leaders did not (29 percent). "Medical students imitate the hand hygiene prac- tices of their superiors, which often leads to low hand hygiene compliance when superiors fail to perform hand hygiene," wrote study authors. "Further, healthcare workers (and others) change behavior when they are being observed. There- fore, role models who are actively present may have a strong influence on healthcare workers' behaviors, including hand hygiene." n Hand Hygiene Compliance Lags in Hospital Reception Areas, Study Finds By Shannon Barnet Direct Observation Dramatically Boosts Hand Hygiene Compliance By Shannon Barnet Study: Following the Hand Hygiene Leader By Shannon Barnet H ealthcare workers under direct observation perform hand hy- giene events nearly three times more often every hour than those not under observation, according to a study published in Infection Control and Hospital Epidemiology. To test the effect of observation on hand hygiene performance, research- ers conducted 48 direct observation hand hygiene audits, each lasting two hours. They recorded hand hygiene events using electronic alcohol-based hand rub dispensers. The number of events recorded during direct observation were then com- pared to the number of events recorded just using the electronic dispens- ers in the remaining six hours of the healthcare workers' eight-hour shift. During the study, 4,180 hand hygiene events were recorded by the dis- pensers, 2,029 of which were recorded during direct observation times and 2,151 of which were performed during working shifts that were not under direct observation. Healthcare workers performed eight hand hygiene events per hour when not under observation, while healthcare workers under direct observation performed 21 hand hygiene events per hour. n

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