Monitoring hand hygiene compliance in a university-affiliated medical center

Abstract

BACKGROUND: HICPAC hand hygiene (HH) guidelines recommend periodic monitoring of HH compliance. Thus, we carried out a 3-month observational assessment of HH practice in our 719-bed hospital using “light-duty” nursing personnel. OBJECTIVES: To determine the reliability of using alternative available hospital resources to obtain baseline HH compliance data for use in the development of an effective HH program. METHODS: Two light-duty nursing staff members were deployed during the day and evening shifts over a 3-month period (576 hours) to observe compliance with HH policy throughout the adult and pediatric units and departments. Observers were trained and supervised by infection control (IC) staff to ensure inter-observer reliability. Staff members were observed to determine if hands were washed with soap and water or if alcohol-based hand gels was used before and after A) patient contact, after removal of gloves, and when caring for patients on contact precautions. RESULTS: From June through August 2004, 3890 opportunities for HH were observed. Overall compliance with use of soap and water or alcohol-based hand gel was 31% (1216/3890). HH before patient contact was 9% (170/1802) and after patient contact was 50% (1046/2088). Alcohol-based hand gel was used before or after patient contact 69% of the time compared to soap and water. Staff members were more likely to perform HH after contact with contact precautions patients and were more likely to use HH if they worked in pediatrics or intensive care units. HH occurred more often during the day (7 am–3 pm) (p CONCLUSIONS: Light-duty nursing personnel can be an important adjunct to IC departments when monitoring infection control practice. An additional 48 hours/week for 12 weeks (equivalent IC practitioner salary value of $16,883) were devoted to monitoring HH compliance and data entry by light-duty nursing staff. This effectively relieved the IC department staff from the data collection burden and allowed IC staff time to focus on interventions. The additional resources were IC budget-neutral and allowed us to obtain a level of detail that would otherwise not have been possible given our current IC staffing. The experience provided the opportunity to develop additional IC resources as well as provide immediate feedback for staff regarding HH practice. In addition, the data collected will serve as the basis for current and future interventions to improve HH compliance at our institution.