990. Comprehensive Survey of Hand Hygiene Practices in the Veterans Health Administration
Session: Poster Abstract Session: Hand Hygiene 2012
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
  • Reisinger-Handwash-2012-new.pdf (1.5 MB)
  • Background:

    The Veterans Health Administration is a national healthcare system with variation in hand hygiene (HH) policies and practices across its facilities. The objective of this national survey was to analyze this variation.


    This 51-item intranet survey covered three major areas of HH: 1) methods of measuring healthcare professionals’ (HCP) HH compliance, 2) HCP-directed interventions to improve HH compliance, and 3) site-specific threshold of HH compliance. Pilot testing was completed by a select group of VA infection prevention staff and researchers. The survey was distributed administratively in March 2012 through the Deputy Undersecretary’s of Health Office. A memo from the Deputy Undersecretary requested the person most familiar with HH practices at each VA medical center to complete the survey.


    141 (100%) facilities returned the survey. A vast majority (98.6%) of facilities conduct direct observations of HCPs to measure HH compliance rates. Approximately one quarter monitor product usage and 2.9% use automated monitoring systems. Most facilities (78.0%) train observers individually. Less than half (45.3%) validated the observer process at the onset and fewer (39.6%) continue to validate observers. Variation existed as to which behaviors were considered HH opportunities including room entry (68.1%) and exit (70.9%), after removing gloves (59.6%), and before (53.3%) and after (56.7%) touching a patient. Interventions used posters (97.2%), feedback (to executive leadership [98.6%], units/clinics [93.5%], one-on-one coaching to HCPs observed to be noncompliant [93.5%]), and improved access to HH products (e.g., 90.6% provider individual hand sanitizers to staff). 88.5% have mandatory education programs. The majority of the facilities (77.3%) set their HH compliance target between 90-100%.


    This VA-wide survey reveals variation in HH practices, reflect commonly accepted practices in HH improvement, and identify gaps in measuring and improving compliance. Facilities continue to set high goals for HH compliance rates even though a standardized compliance target does not exist. These data will assist in next steps towards research to systematically disentangle HH “bundles” and improve HH compliance.

    Heather Reisinger, PhD1, Jun Yin, MS2, Lewis Radonovich, MD3,4, Michael Hodgson, MD5 and Eli Perencevich, MD, MS, FIDSA, FSHEA1,6, (1)Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, (2)University of Iowa, Iowa City, IA, (3)Office of Public Health, National Center for Occupational Health and Infection Control, Veterans Health Administration, Gainseville, FL, (4)University of Florida College of Medicine, Gainesville, FL, (5)Office of Public Health, Department of Veterans Affairs, Richmond, VA, (6)Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA


    H. Reisinger, None

    J. Yin, None

    L. Radonovich, None

    M. Hodgson, None

    E. Perencevich, None

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