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Injury. 2017 Jan;48(1):165-170. doi: 10.1016/j.injury.2016.08.004. Epub 2016 Aug 17.

Hand Hygiene Compliance in the Setting of Trauma Resuscitation.

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R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene St., Baltimore, MD 21201, United States.
Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Halsted 831, 600 N. Wolfe Street, Baltimore, MD 21287, United States.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W Baltimore MSTF, Baltimore, MD 21201, United States.
Divisions of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8051, St. Louis, MO 63110, United States.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W Baltimore MSTF, Baltimore, MD 21201, United States. Electronic address:



Healthcare-associated infections are a significant health burden, and hand hygiene (HH) is an essential prevention strategy. World Health Organization (WHO) 2009 guidelines recommend washing hands during five moments of patient care; 1)before touching a patient; 2)before a clean procedure; 3)after body fluid exposure; and 4)after touching a patient or 5)patient surroundings. HH opportunities at these 5 moments are frequent and compliance is low (22-60%). Infection risk is particularly high in trauma patients, and HH compliance during active trauma resuscitation has yet to be evaluated.


Using video surveillance, all healthcare worker (HCW)-patient interactions for 30 patients were retrospectively reviewed for HH compliance according to WHO guidelines and glove use during initial resuscitation at a level-1 trauma center.


342 HCW-patient interactions and 1034 HH opportunities were observed. HH compliance with the WHO moments was 7% (71/1034) overall; 3% (10/375) before patient contact, 0% (0/178) before a clean procedure, 11% (2/19) after body fluid contact, 15% (57/376) after patient contact and 2% (2/86) after contact with the environment. Glove use was more common, particularly before (69%) and after (47%) patient contact and after body fluid contact (58%). No HH was observed before clean procedures, but HCW donned new gloves 75% of the time before bedside procedures. If donning/removing gloves was included with HH as compliant, compliance was 57% overall.


HH opportunities are frequent and compliance with WHO HH guidelines may be infeasible, requiring significant amounts of time that may be better spent with the patient during the golden hour of trauma resuscitation. In an era where more scrutiny is being applied to patient safety, particularly the prevention of inpatient infections, more research is needed to identify alternative strategies (e.g. glove use, prioritizing moments) that may more effectively promote compliance in this setting.


Compliance; Critical Care; Hand Hygiene; Resuscitation; Trauma

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