Hand Hygiene Compliance in an Emergency Department: The Effect of Crowding

Abstract

Objectives: Emergency department (ED) crowding results from the need to see high volumes of patients of variable acuity within a limited physical space. ED crowding has been associated with poor patient outcomes and increased mortality. The authors evaluated whether ED crowding is also associated with reduced hand hygiene compliance among health care workers.Methods: A trained observer measured hand hygiene compliance using standardized definitions for 22 months in the 40-bed ED of a 475-bed academic hospital in Toronto, Ontario, Canada. ED crowding measures, including mean daily patient volumes, time to initial physician assessment, and daily nursing hours, were obtained from hospital administrative and human resource databases. Known predictors of hand hygiene compliance, including the indication for hand hygiene and the health care workers' professions, were also measured. Hand hygiene data, measured during 20-minute observation sessions, were linked to aggregate daily results for each crowding metric. Crowding metrics and known predictors of hand hygiene compliance were then included in a multivariate model if associated with hand hygiene compliance at a p-value of <0.20.Results: Hand hygiene compliance was 29% (325 of 1,116 opportunities). Alcohol-based hand rinse was used 66% of the time. Nurses accounted for 68% of hand hygiene opportunities and physicians for 18%, with the remaining 14% attributed to nonphysician, nonnurse health care workers. The most common indications for hand hygiene were hand hygiene prior to (35%) and hand hygiene following (52%) contact with the patient or his or her environment. In multivariate analysis, time to physician assessment > 1.5 hours was associated with lower compliance (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.51 to 0.89). Additionally, compliance was lower for nonnurse, nonphysician health care workers (OR = 0.51, 95% CI = 0.33 to 0.79) and higher for hand hygiene performed after contact with the patients or his/her environment, compared to hand hygiene performed before contact with the patient or his/her environment (OR = 2.0, 95% CI = 1.5 to 2.7). Daily patient volumes and nursing hours were not associated with hand hygiene compliance.Conclusions: ED hand hygiene compliance was low. Increased time to physician assessment was associated with reduced compliance, suggesting an association between crowding and compliance. Strategies that minimize ED crowding may improve ED hand hygiene compliance.

Hand Hygiene Compliance in the Setting of Trauma Resuscitation

“…In comparison, much of the current literature has relied upon direct observation to study HH compliance. 14,17-22,32-33 Srigley et al demonstrated that the Hawthorne effect can significantly improve HH compliance when HCWs are under direct observation; therefore, true compliance is likely lower than what has previously been reported. In addition, none of these studies have examined compliance with the WHO ‘My 5 Moments’ during initial trauma evaluation and resuscitation when barriers to compliance are likely greatest.…”

Hand hygiene compliance of healthcare professionals in an emergency department

“…Research has shown variations in the compliance rates with hand hygiene reported by healthcare professionals, with percentages ranging from 8% to 84.5% (5,(7)(8)(9)16,(22)(23)(24) . However, different factors may be related to low compliance (4,25) .…”

“…Among them, the following are highlighted: healthcare services with limited resources; overcrowding, with inadequate or no spatial separation between beds (26) ; physical structure, which includes poorly located sinks (3,22) ; the use of gloves (16) ; ability, attitudes, and motivation (25) ; the importance given by healthcare professionals to the risks of not being in compliance with the recommendations for hand hygiene; and the training received and the time provided for it (27) . Researchers also continue to point to factors related to inadequate flow of patient care due to overcrowding, heavy workloads, stress, activities with high risk of cross-transmission of pathogens, lack of knowledge about protocols for hand hygiene, lack of positive examples by their superiors, bad habits, simple forgetfulness, and skin irritation and drying caused by the successive use of products (1,4,9,15,20) . In the present study, nurses and physiotherapists showed the highest percentage of compliance (66.6%), and resident physicians, the lowest (41.4%).…”

“…There are efforts to increase this practice; however, the general rate of hand hygiene compliance has been around 40%, varying from 5% to 81% (6) . Scientific evidence has shown a compliance rate of 20% by ICU healthcare professionals (nurses, physicians and physiotherapists) (7)(8) , 29% in emergency rooms (9) , and 40% among medical students in open units (10) , confirming the low consistency rates.Intensive care units are among the most investigated sites for checking hand hygiene compliance rates. However, the development of studies in other healthcare settings that are as complex and dynamic as ICUs is very important.…”

Conhecimento Da Prática De Higienização Das Mãos Na Perspectiva De Profissionais De Enfermagem

“…Esta é atribuída conforme autores, a carga de trabalho na referida unidade a fatores contribuintes imprevisíveis, tais como demanda de pacientes, necessidade de escuta terapêutica, insuficiência de profissionais, dentre outros. 8 Ainda, em relação à baixa adesão dos profissionais à HM, autores reforçam a sobrecarga de trabalho, irritação da pele devido à frequente lavagem das mãos, uso excessivo de luvas, pias mal localizadas, conhecimento incipiente dos profissionais de saúde sobre as indicações para higienizá-las, esquecimento e falta de informação sobre o impacto da HM nas taxas das IRAS. 9,10 Com base nas considerações, estabeleceu-se para este estudo a questão de pesquisa: Qual é o conhecimento dos profissionais de enfermagem de um hospital privado quanto à higienização das mãos?…”