Abstract
BackgroundHand Hygiene (HH) compliance was shown to be poor in several studies. Improving the availability of alcohol-based hand rub (ABHR) is a cornerstone for increasing HH compliance.MethodsIn this study, we introduced wearable dispensers for ABHR in an Emergency Department (ED) well equipped with mounted ABHR dispensers and accompanied this single-modal intervention by a quasi-experimental mixed-method study. The study was performed in the ED of the University Hospital Zurich, Switzerland, a 950-bed tertiary teaching hospital. During a five-week baseline period and a seven-week intervention period, we observed HH compliance according to the WHO ‘Five Moments’ concept, measured ABHR consumption, and investigated perceived ABHR availability, self-reported HH compliance and knowledge of HH indications by questionnaire. Multivariable logistic regression was used to identify independent determinants for HH compliance. In addition, semi-structured interviews were conducted and thematically analyzed to assess barriers and facilitators for the use of the newly introduced dispensers.ResultsAcross 811 observed HH opportunities, the HH compliance for all moments was 56% (95% confidence interval (CI), 51–62%) during baseline and 64% (CI, 59–68%) during intervention period, respectively. In the multivariable analysis adjusted for sex, profession, and WHO HH moment, there was no difference in HH compliance between baseline and intervention (adjusted Odds ratio: 1.22 (0.89–1.66), p = 0.22), No significant changes were observed in consumption and perceived availability of ABHR. During intervention, 7.5% ABHR was consumed using wearable dispensers. HCP perceived wearable dispensers as unnecessary since mounted dispensers were readily accessible. Poor ergonomic design of the wearable dispenser emerged as a main barrier, especially its lid and fastening mechanism. Interviewees identified two ideal situations for wearable dispensers, HCP who accompany patients from ED to other wards, and HCP approaching a patient from a non-patient areas in the ED such as the central working station or the meeting room.ConclusionThe introduction of wearable dispensers did not increase observed hand hygiene compliance or ABHR consumption in an ED already well equipped with mounted dispensers. For broader acceptance and use, wearable dispensers might benefit from an optimized ergonomic design.
Highlights
Hand Hygiene (HH) compliance was shown to be poor in several studies
Increasing availability of alcohol-based hand rub (ABHR) is an often-mentioned facilitator for HH compliance and the “World health organization (WHO) Guidelines on Hand Hygiene in Health Care” declare ABHR availability as a prerequisite for good HH compliance [16,17,18]
Yeung et al found that the introduction of wearable dispensers with education led to increased HH compliance in long-term care facilities [10] and Koff et al found improvement in HH compliance of anesthesia providers through the use of wearable dispensers with an audible alarm [19]
Summary
Hand Hygiene (HH) compliance was shown to be poor in several studies. Improving the availability of alcohol-based hand rub (ABHR) is a cornerstone for increasing HH compliance. HH compliance has been shown to be poor in a multitude of studies [4, 5]. Data about HH compliance in Emergency Departments (ED) is limited, and results vary greatly [6]. ED physicians had a higher risk for non-adherence to HH compared to physicians working in other departments [7]. The mean rate of HH indications is higher in the ED than in medical or surgical wards [8], and high workload has been identified as a risk factor for low HH compliance [5]
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