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Infect Control Hosp Epidemiol. 2014 Mar;35(3):225-30. doi: 10.1086/675286. Epub 2014 Feb 5.

Rate of healthcare worker-patient interaction and hand hygiene opportunities in an acute care setting.

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  • 1Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

Abstract

OBJECTIVE:

Identify factors affecting the rate of hand hygiene opportunities in an acute care hospital.

DESIGN:

Prospective observational study.

SETTING:

Medical and surgical in-patient units, medical-surgical intensive care unit (MSICU), neonatal intensive care unit (NICU), and emergency department (ED) of an academic acute care hospital from May to August, 2012.

PARTICIPANTS:

Healthcare workers.

METHODS:

One-hour patient-based observations measured patient interactions and hand hygiene opportunities as defined by the "Four Moments for Hand Hygiene." Rates of patient interactions and hand hygiene opportunities per patient-hour were calculated, examining variation by room type, healthcare worker type, and time of day.

RESULTS:

During 257 hours of observation, 948 healthcare worker-patient interactions and 1,605 hand hygiene opportunities were identified. Moments 1, 2, 3, and 4 comprised 42%, 10%, 9%, and 39% of hand hygiene opportunities. Nurses contributed 77% of opportunities, physicians contributed 8%, other healthcare workers contributed 11%, and housekeeping contributed 4%. The mean rate of hand hygiene opportunities per patient-hour was 4.2 for surgical units, 4.5 for medical units, 5.2 for ED, 10.4 for NICU, and 13.2 for MSICU (P < .001). In non-ICU settings, rates of hand hygiene opportunities decreased over the course of the day. Patients with transmission-based precautions had approximately half as many interactions (rate ratio [RR], 0.55 [95% confidence interval (CI), 0.37-0.80]) and hand hygiene opportunities per hour (RR, 0.47 [95% CI, 0.29-0.77]) as did patients without precautions.

CONCLUSIONS:

Measuring hand hygiene opportunities across clinical settings lays the groundwork for product use-based hand hygiene measurement. Additional work is needed to assess factors affecting rates in other hospitals and health care settings.

PMID:
24521585
[PubMed - in process]
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