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Am J Infect Control. 2019 Jan;47(1):38-44. doi: 10.1016/j.ajic.2018.07.004. Epub 2018 Sep 5.

Secondary measures of hand hygiene performance in health care available with continuous electronic monitoring of individuals.

Author information

1
iDAPT, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada. Electronic address: steven.pong@uhn.ca.
2
iDAPT, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
3
iDAPT, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

Hand hygiene (HH) compliance in health care is usually measured against versions of the World Health Organization's "Your 5 Moments" guidelines using direct observation. Such techniques result in small samples that are influenced by the presence of an observer. This study demonstrates that continuous electronic monitoring of individuals can overcome these limitations.

METHODS:

An electronic real-time prompting system collected HH data on a musculoskeletal rehabilitation unit for 12 weeks between October 2016 and October 2017. Aggregate and professional group scores and the distributions of individuals' performance within groups were analyzed. Soiled utility room exits were monitored and compared with performance at patient rooms. Duration of patient room visits and the number of consecutive missed opportunities were calculated.

RESULTS:

Overall, 76,130 patient room and 1,448 soiled utility room HH opportunities were recorded from 98 health care professionals. Aggregate unit performance for patient and soiled utility rooms were both 67%, although individual compliance varied greatly. The number of hand wash events that occurred while inside patient rooms increased with longer visits, whereas HH performance at patient room exit decreased. Eighty-three percent of missed HH opportunities occurred as part of a series of missed events, not in isolation.

CONCLUSIONS:

Continuous collection of HH data that includes temporal, spatial, and personnel details provides information on actual HH practices, whereas direct observation or dispenser counts show only aggregate trends.

KEYWORDS:

Compliance; Electronic monitoring; Hand hygiene; Health care acquired; Infection control

PMID:
30195406
DOI:
10.1016/j.ajic.2018.07.004
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