Reducing the number of necessary hand hygiene events by optimizing workflow more than doubled hand hygiene compliance in a German emergency department, according to a study in BMC Infectious Diseases.
The ED of the RWTH Aachen (Germany) University Hospital between February 2011 and September 2011 implemented two sets of interventions to reduce the number of hand rubs needed and to increase hand hygiene compliance. Both sets of interventions included education and immediate, individual feedback after observation. The first set also included the implementation of standard operating procedures for five practices to improve workflow:
• Blood culture withdrawal
• Placing and handling with intravasal devices
• Performance of IV medication
• Wound dressing
• Placement of urinary catheter
In the second intervention, the SOPs were reevaluated and improved and a flowchart for standardized patient admission and workflow practices was created.
Hand hygiene compliance increased from 21 percent to 45 percent over the study period, primarily due to the reduction in the number of hand rubs needed for one patient. The improved workflow and SOPs decreased the number of hand rubs needed from 22 to 13 for one non-surgical patient and from 13 to seven for one surgical patient. Concurrently, the number of hand rubs performed increased from three to five and from two to three for non-surgical and surgical patients, respectively.
In addition, the rate of using gloves instead of performing hand rubs decreased by 73 percent.
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