Predictors of Hand Hygiene in the Emergency Department (ED): Impact of ED Crowding
Background: Hand hygiene (HH) is not well studied in the emergency department (ED). In other settings, increased workload is associated with reduced compliance. We tested this hypothesis in the ED.
Methods: ED HH compliance was tracked at our facility by direct observation from Jan 2011 to Oct 2013. Daily ED patient volumes, staffing levels and mean time to MD assessment (TMDA) were used as measures of ED crowding. Predictors associated with compliance in univariate analysis (p<0.2) were included in a multivariate logistic regression model.
Results: Average compliance was 29% (325/1116): 10% before aseptic procedures, 22% before patient/environmental contact, 26% after body fluid exposure and 37% after patient/environmental contact. Alcohol-based sanitizer was used 66% (215/325) of the time. Nurse staffing levels and patient volumes were not associated with compliance but TMDA was. Compliance was 38% for TMDA in the 1st quartile and 25% for TMDA in the 4th quartile (Fig. 1). Predictors of reduced compliance that remained significant (p<0.05) in the multivariate model included: longer TMDA; HH prior to patient/environmental contact or aseptic procedures (vs. HH after contact); and professional designation of ‘housekeeping' or ‘other' (vs. nursing).
Conclusion: HH compliance in the ED was low. Soap/water are still used for 33% of HH. Increased TMDA and indication for HH were the strongest predictors of compliance. The drop in compliance seen with increasing TMDA indicates that ED crowding contributes to poor ED HH. Strategies to reduce the time required for HH in the ED (including optimal placement of dispensers or use of personal dispensers) and improve workflow practices are logical targets for improvement.
M. P. Muller,
N. Siddiqui, None
E. Larson, None