306. Rates of Patient Interactions and Hand Hygiene Opportunities in Acute Care Settings: Implications for Measuring Compliance with Product Usage
Session: Poster Abstract Session: Hand Hygiene in Healthcare Settings
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Hand hygiene (HH) is critical for preventing nosocomial infections. Measurement of adherence by direct observation is the gold standard but is resource intensive and limited by the Hawthorne effect. Estimating adherence by measuring alcohol handrub (AH) use is a possible alternative. This study aimed to define rates of hand hygiene opportunities (HHO) to permit evaluation of HH compliance through AH use.

Methods: One-hour patient-based observations were conducted on in-patient areas of our 472-bed hospital, measuring HHOs as defined by Ontario’s 4 Moments for Hand Hygiene. Rates of HHO/patient-hour were calculated, examining variation by unit type, room type, healthcare worker (HCW), time of day and presence of infection control precautions. Compliance estimated by product usage was compared to observational audit results.

Results: In 257 hours of observation, 948 HCW-patient interactions and 1,605 HHO were observed. Twenty-seven percent of patient interactions did not require HH. Moments 1 and 4 (before/after contact with patient/environment) comprised 42.2% and 39.4% of HHOs, respectively; moments 2 and 3 accounted for 9.8% and 8.7%. Seventy-five percent of HHOs occurred during interactions involving nurses, 8% physicians, 4% housekeeping and 13% other HCW. The mean rate of HHO/patient-hour was 4.5 for medical units, 4.2 for surgical units (p=0.65), 5.2 for the emergency department (p=0.14) and 11.8 for the medical-surgical intensive care unit (p<0.001). After adjustment for time of day and unit type, the rate of patient interactions and HHOs were significantly lower for patients requiring additional precautions (Rate Ratio for interactions = 0.47 (95%CI: 0.33-0.67); Rate Ratio for HHO = 0.45 (95%CI: 0.29-0.71)). The Pearson correlation coefficient between HH adherence as measured by observational audit and product consumption was 0.33 (R2=0.11); the median difference in estimated overall hand hygiene adherence was 43% (range 4-53%).

Conclusion: A product usage based HH adherence assessment may be an important complement to observational audit which overestimates HH adherence. Accurate adherence measurement requires a unit-based understanding of factors affecting the rate of HHO.

Laura Goodliffe, MPH1,2, Kelsey Ragan, MPH1, Michael Larocque1, Emily Borgundvaag1, Sophia Khan1, Christine Moore, BSc, MLT1, Liz McCreight1 and Allison Mcgeer, MD, MSc, FRCPC1,2, (1)Infection Prevention and Control, Mount Sinai Hospital, Toronto, ON, Canada, (2)Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada


L. Goodliffe, None

K. Ragan, None

M. Larocque, None

E. Borgundvaag, None

S. Khan, None

C. Moore, None

L. McCreight, None

A. Mcgeer, None

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