Abstract
BackgroundHand hygiene is considered one of the most important infection control measures in human healthcare settings, but there is little information available regarding hand hygiene frequency and technique used in veterinary clinics. The objectives of this study were to describe hand hygiene practices associated with routine appointments in companion animal clinics in Ontario, and the effectiveness of a poster campaign to improve hand hygiene compliance.ResultsObservation of hand hygiene practices was performed in 51 clinics for approximately 3 weeks each using 2 small wireless surveillance cameras: one in an exam room, and one in the most likely location for hand hygiene to be performed outside the exam room following an appointment. Data from 38 clinics were included in the final analysis, including 449 individuals, 1139 appointments before and after the poster intervention, and 10894 hand hygiene opportunities. Overall hand hygiene compliance was 14% (1473/10894), while before and after patient contact compliance was 3% (123/4377) and 26% (1145/4377), respectively. Soap and water was used for 87% (1182/1353) of observed hand hygiene attempts with a mean contact time of 4 s (median 2 s, range 1-49 s), while alcohol-based hand rub (ABHR) was used for 7% (98/1353) of attempts with a mean contact time of 8 s (median 7 s, range 1-30 s). The presence of the posters had no significant effect on compliance, although some staff reported that they felt the posters did increase their personal awareness of the need to perform hand hygiene, and the posters had some effect on product contact times.ConclusionsOverall hand hygiene compliance in veterinary clinics in this study was low, and contact time with hand hygiene products was frequently below current recommendations. Use of ABHR was low despite its advantages over hand washing and availability in the majority of clinics. The poster campaign had a limited effect on its own, but could still be used as a component of a multimodal hand hygiene campaign. Improving the infection control culture in veterinary medicine would facilitate future campaigns and studies in this area, as well as overall patient and staff safety.
Highlights
Hand hygiene is considered one of the most important infection control measures in human healthcare settings, but there is little information available regarding hand hygiene frequency and technique used in veterinary clinics
Eleven other clinics were excluded due to lack of sufficient data to complete a minimum data set due to the following reasons: power failures (4), technical issue with the programming of the camera schedule (3), inadequate number of appointments (2), computer memory error (1), limited recording based on the work schedule of a single technician who did not wish to participate in the study (1)
This study provided a unique opportunity for detailed observation of hand hygiene practices of staff in companion animal veterinary clinics in Ontario
Summary
Hand hygiene is considered one of the most important infection control measures in human healthcare settings, but there is little information available regarding hand hygiene frequency and technique used in veterinary clinics. The objectives of this study were to describe hand hygiene practices associated with routine appointments in companion animal clinics in Ontario, and the effectiveness of a poster campaign to improve hand hygiene compliance. The gold standard for measuring hand hygiene compliance in human healthcare facilities remains direct observation by individuals on the clinic floor [2,12,13,14]. In most primary care veterinary clinics, where there is typically a relatively small number of staff and a substantial amount of animal contact takes place during outpatient appointments in private exam rooms, the presence of a designated hand hygiene observer would likely be considered unacceptably cumbersome and intrusive, and result in significant bias due to Hawthorne effects (whereby individuals may alter their behaviour because they know they are being observed [15]). Video observation of hand hygiene practices is not frequently used in healthcare settings [16], but has been used successfully in food handling studies [17,18]
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