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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 ([email protected])
Mount Sinai Hospital, Room 210, 600 University Avenue, Toronto, ON M5G 1X5, Canada ([email protected])
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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

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Footnotes

a.

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

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