1099. Sustained High Level of Healthcare Worker Compliance with Hand Hygiene Policy Using the Patient-As-Observer Approach in the Ambulatory Setting
Session: Poster Abstract Session: Infection Prevention: Hand Hygiene and PPE
Friday, October 9, 2015
Room: Poster Hall
Background: Hand hygiene is the most effective method in the prevention and control of healthcare-associated infections.  Adherence monitoring continues to be a challenge.  While direct observation by an independent observer is considered the gold standard in the hospital, monitoring is difficult in the outpatient setting.  Our main objective was to assess our patient-as-observer hand hygiene program in the ambulatory setting.

Methods: The setting is a large ambulatory site with 76 primary care, surgery, and subspecialty clinics.  Data from October 2012 to January 2015 are included in this analysis.  Patients were given a survey asking if their provider (MD, NP, PA), nurse, or other health care workers (HCWs) performed hand hygiene at the beginning of their encounter.   Anonymous surveys were collected at the end of the visit and recorded.  Data are aggregated on a monthly basis and reported back to the individual clinics.  The primary outcome is the proportion of HCWs adherence to the hand hygiene policy over time.  Chi-square analysis was performed to compare groups of HCWs and improvement over time.  A p-value of < 0.05 was considered statistically significant. 

Results:  There were 498,086 observations recorded over the study period.  Providers accounted for 64.3% of observations, nurses for 64% of observations, and technicians for 69.6% of observations.  All 3 groups were found to have 98% compliance.  For providers, compliance improved when comparing the 4th quarter of 2012 to the 4th quarter of 2013 (p <0.001) as well as to the 4th quarter of 2014 (p <0.001).  For nurses, compliance improvement was not significant from the 4th quarter of 2012 to 2013 (p<0.3865) but became significant when comparing 2012 to 2014 (p <0.001).  Technicians improved compliance from the 4thquarter of 2012 to 2013 (p <0.001) and 2014 (p<0.001).   Overall compliance rate improved from 84% to 98% by July 2014 and was maintained through January 2015.

Conclusion: In a large ambulatory setting, the patient-as-observer approach to hand hygiene is a viable and sustainable method for measuring compliance among HCWs.   This approach engages the patient in their care and has successfully integrated the act of hand hygiene as part of the HCWs’ encounters with patients.

Rachael Lee, MD1, Janet Pate, JD, MHA, BSN, RN2 and Bernard Camins, MD, MSc1, (1)Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, (2)University of Alabama at Birmingham, Birmingham, AL


R. Lee, None

J. Pate, None

B. Camins, None

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