Maintaining a near perfect Hand Hygiene (HH) and Isolation (Iso) Compliance (C) despite high Isolation Density
Background: HH is among the most important way to prevent healthcare-associated infections (HAIs). There are a multitude of reasons why HHC is not perfect. In 7/12, UPMC – Presbyterian Campus (P) implemented measures to Just Culture (JC) system design to create an environment of accountability for HH practices. Previously
HHC rates averaged 62.7% but since JC implementation HHC rates have been nearly perfect (96.9%). In addition to HH practices, the Centers for Disease Control and Prevention (CDC) recommends that personal protective equipment (PPE) be worn for patients who require pathogen-specific isolation. A recent study (Dhar S. et al. ICHE 2014;35(3):213) suggested that when the proportion of patient in contact IsoDays increase, HHC and IsoC decreases. The objective of this study was to access whether HHC is influenced by Iso Density at UPMC-P.
HH is expected for all patient zone interactions. ~800 standardized HH observations were collected monthly (evenly distributed over 36 patient care areas) by 4 trained covert monitors (CoM). HH C is measured across all health care personnel (HCP) types for all WHO HH opportunities (some before, some after contact with the patient zone).
PTDays - the # of days that in-patients are hospitalized and extracted from our medical healthcare record a
IsoDays - the # of PTDAYs spent in contact precaution and are determined using Theradoc software
Iso Density - the proportion of patient (PT) days that are spent in contact Iso (contact Iso Days)/PTDays)
IsoDensity better quantifies potential exposures and risk for transmission and was calculated monthly and compared to
HHC/IsoC over a 13 month period.
• Iso Density had no effect on HHC or IsoC.
• HH and IsoC were both high, often approaching 100%.
• Providers/IP programs should consider the potential for transmission if when developing infection control policies/practices.