5 Factors Associated With High Hand Hygiene Compliance

A multifaceted hand hygiene initiative increased compliance rates among all healthcare workers at a 719-bed tertiary care teaching hospital, according to a study in Infection Control and Hospital Epidemiology.

Rhode Island Hospital in Providence measured hand hygiene compliance through observation of hand hygiene behavior when entering and existing a patient room from July 2008 to December 2012. Interventions were ongoing throughout the observation period; a sampling of these is below:


•    Education modules
•    Posters and table tents
•    Monthly compliance reports by discipline to staff and administration
•    Pizza parties for patient care unit staff with high compliance
•    Increased number of automated alcohol hand hygiene product dispensers
•    "Foam In-Foam Out" labels on hand hygiene dispensers
•    Hand hygiene compliance rates posted on all inpatient units

The overall compliance rate across the study period was 83 percent. In 2008, the average overall hand hygiene compliance rate was 60 percent, which increased to a high of 96 percent in 2011 and decreased to 89 percent in 2012. Each group of healthcare workers — nursing, physician, support and technical staff — increased their adherence rates from 2008 to 2012. Support staff included patient transporters, environmental services and pastoral care, among others, while technical staff included respiratory therapists, rehabilitative and therapeutic service staff, radiology technicians and others.

Here are some factors associated with higher hand hygiene compliance:

•    Nursing and technical staff. At 84 percent and 85 percent, respectively, nursing staff and technical staff were more compliant than physician staff, who had an overall compliance rate of 78 percent, and support staff, who had a 69 percent compliance rate.
•    Pediatric units and intensive care units. Both pediatric units and ICUs had an 84 percent overall compliance rate, compared with 82 percent in medical units and 81 percent in surgical units.
•    Exiting rooms. Compliance rates were 86 percent when exiting a patient room and 80 percent when entering a room.
•    Contact precautions. Compliance rates were higher when patients were under contact precautions, at 85 percent compared with 83 percent for patients not under contact precautions.
•    Night shifts. Compliance was 90 percent at night, compared with 80 percent during the day.

The authors noted that there was likely an observer bias, because observers were instructed to document the names of staff who were noncompliant.

More Articles on Hand Hygiene:

How to Maintain More Than 85% Hand Hygiene Compliance
Hand Hygiene Attitudes Among Medical Students, Residents: 10 Findings

Which Type of Healthcare Worker Has the Best Hand Hygiene?

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