1094. Observed Adherence and Challenges to Hand Hygiene in Pediatric Long Term Care Settings
Session: Poster Abstract Session: Infection Prevention: Hand Hygiene and PPE
Friday, October 9, 2015
Room: Poster Hall

Background:   Pediatric long term care facilities (pLTCF) provide supportive, therapeutic and rehabilitative care to children with complex medical conditions.  Infection prevention (IP) in pLTCF is challenging, as care is provided in a homelike environment where children engage in group activities and attend on-site schools.  The aim of this study was to assess hand hygiene (HH) adherence in pLTCF and identify barriers and possible solutions to improved IP.

Methods:   We conducted observations in three pLTCF (137, 97, and 54 beds) in New York.  In February and March of 2015, trained observers used the World Health Organization ‘5 Moments of HH' tool to record adherence during three sessions at each site (two from 10am-3pm and one from 3-7pm).  Observed and stated barriers to adherence and suggested solutions were noted. 

Results:   Observers recorded 847 HH opportunities.  Overall adherence was 40% (N=336), with significant differences observed between personnel types, location within facility, and indication (all p<0.001; Figures 1-3).  The table lists barriers and suggestions for improvement.

Conclusion:   Observing barriers in addition to adherence revealed specific workflow and educational targets for improved IP.




IP interferes with education and rehabilitation

·         Staff expressed that isolation prevents direct contact necessary for development

·         Requirement to clean equipment between each child's use limits group therapy

Discuss risks/benefits of prioritizing psychosocial development over IP.  Dedicate equipment for each child.

Confusion about reasons for HH

·         Staff expressed that purpose of HH is to protect themselves/their families

·         Staff cleaned residents' hands but not their own prior to feeding

·         Staff touch multiple children during group activities, performing HH after the activity but not between each child

Revise IP education to emphasize rationale in addition to rules.

Limited knowledge of isolation precautions

·         Staff expressed confusion about when/how to wear/dispose of personal protective equipment

·         Staff carried personal items between isolation and non-isolation rooms without cleaning them

·         Isolation precautions not used by non-nursing staff

Display point-of-care reminders targeted to each personnel group.

Bevin Cohen, MPH, MPhil1, Borghild Løyland, PhD, RN1, Sibyl Wilmont, BSN, RN1 and Elaine Larson, RN, PhD, FAAN, CIC, FIDSA, FSHEA2, (1)Columbia University School of Nursing, New York, NY, (2)School of Nursing, Columbia University Medical Center, New York, NY


B. Cohen, None

B. Løyland, None

S. Wilmont, None

E. Larson, None

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