Research for infection protection
  • germs
  • Adenovirus
  • Aspergillus niger
  • Bovine virus diarrhea
  • Clostridium difficile
  • Candida albicans
  • Candida albicans
  • Coronavirus
  • Corynebacterium
  • Escherichia coli
  • Helicobacter pylori

Author: Scheithauer et al. (2013) Source: Scheithauer et al. (2013) Improving hand hygiene compliance in the emergency department: getting to the point. BMC Infect Dis 2013; 13:367.


Scheithauer et al. (2013)

Improving hand hygiene compliance rates in the emergency department

Background: Hand hygiene (HH) is considered the effective tool to prevent healthcare-associated infections. The emergency department (ED) is an environment in which many invasive and therefore infection-prone procedures are performed. In addition, many factors negatively influencing HH compliance are prevalent in the ED, e.g. high workload and patient turnover, crowding, variety of healthcare workers. The study aimed to define numbers of hand rubs (HR) needed for individual patient care episodes in the ED and optimise HH compliance without increasing workload.

Method: The prospective, three-phase, observational study was conducted at the University Hospital of the RWTH Aachen University between February and September 2011. HH indications were classified according to the guidelines of the World Health Organization (WHO). Documentation was performed using a modified version of the WHO observation record. A trained observer directly observed HH indications, the number of HR (with and without indication), glove usage, avoidable opportunities, etc. Observed healthcare workers were assigned to four profession groups: physicians, nurses, medical students, and trainees (nurses, paramedics). Patients were included in the study continuously (five patients daily, each patient only once) and assigned to four medical subject groups: medical-thoracic, medical-abdominal, neurological, and surgical. The study consisted of three 6-week observation phases (phase I, II, III) interrupted by two 6-week intervention phases. Interventions (e.g. teachings on HH, individual teachings on work performance with direct feedbacks, development and implementation of optimised standard operation procedures (SOPs), compilation of flowcharts for patient admission) focused on problems that had been identified during the preceding observation phase.

Results: In total, 5,674 opportunities for HH and 1,664 HR were recorded during the whole study period. The number of opportunities declined from phase I to phase III, indicating a workflow optimisation. For example, avoidable opportunities decreased by 70%, HR without indication by 63%, and glove use instead of HR by 73%. In contrast to that, the number of HR increased from phase I to phase III.

Overall, in the course of the study compliance significantly increased from 21% to 45% (p<0.001) in the course of the study. Profession-specific analysis of compliance rates revealed an increase in all groups but trainees.

In addition, compliance increased throughout the study for all HH indications. However, the greatest improvement was seen for the HH indication ‘before aseptic tasks’ (660% of baseline) and the lowest for ‘after contact with a patient’ (150% of baseline). Subgroup analysis revealed only minor differences in HH compliance when comparing the four medical subject groups.

Conclusions: Standardising primarily invasive procedures through the implementation of optimised SOPs and the introduction of flowcharts in combination with individual on-the-job training significantly improved HH compliance in the ED. Optimising workflow practices seems to be a promising way to improve HH compliance and thus patient safety without increasing workload.

Source: Scheithauer et al. (2013) Improving hand hygiene compliance in the emergency department: getting to the point. BMC Infect Dis 2013; 13:367.

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