41734. Hand Hygiene: Compliant/Non-Compliant vs. Intrasubject Variation
Session: Poster Abstract Session: Medical Student Poster Session
Friday, October 4, 2013
Room: Yerba Buena Ballrooms

Background: A frequent assumption of the hand hygiene (HH) compliance rates that are published by hospitals is that a certain percentage of health care workers (HCW) is fully HH compliant, while the other fraction is not.  This ignores the possibility that there is variation in compliance for a single HCW, and therefore do not reflect true HH compliance.   This study measures intrasubject variation of HH compliance rates.

Methods: This investigator acted as a covert observer at The Miriam Hospital in Providence, RI.  Different HCWs from various groups were followed and multiple observations were recorded for each HCW.  Observations were collected between 6/15/12-9/26/12 and 3/29/13-4/16/13.  Observations were recorded both before and after patient encounters using the Infection Control Hand Hygiene Monitoring Tool form.  Compliance was recorded if the HCWs washed their hands before touching the patient or after touching the patient and/or the surrounding environment.  Observations where the HCW did not touch the patient or environment were not included in the analysis.  Individual compliance rates for each HCW were calculated for both before and after the patient encounter, as well as the total compliance rate.  Only HCWs with 3 or more observations were used in each analysis.

Results:   A total of 428 observations for 62 HCWs were included in the analysis.  Results are shown in the figure below.  For observations done before the patient encounter, 31 HCWs were analyzed, and 41.9% of HCWs had a compliance rate of 100%, while 6.5% had a compliance rate of 0%.  The analysis of observations done after the encounter included 35 HCWs, and 45.7% had a compliance rate of 100%, while no HCW had a rate of 0%.  In the analysis for total observations, 45 HCWs were included and only 31.8% of HCWs had 100% total compliance, but no HCWs had a 0% rate.  The total compliance rates for HCWs with 3 or more observations were 63.4%, 84.2%, and 74.2% for the Before, After, and Total groups, respectively.

Conclusion: There is intrasubject variation of HH compliance rates.  No HCW was found to have a 0% total compliance rate.  Compliance rates are lower before a patient encounter compared to afterwards.   This study shows that compliance exists as a spectrum, not as dichotomous populations (compliant/non-compliant).

J Bradford Bertumen, M.D., Internal Medicine, Alpert Medical School/Brown University, Providence, RI and John Lonks, M.D., Infectious Diseases, The Miriam Hospital, Alpert Medical School/Brown University, Providence, RI


J. B. Bertumen, None

J. Lonks, None

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