Making progress with being below the elbows

We have had a recommendation for bare below the elbows (BBE) in the inpatient setting for 5 years at my hospital. No mandate, just a recommendation. And it’s been a fairly soft sell. My perception has been that over time a greater proportion of our health care workers have adopted BBE, but we’ve never formally measured it. Since our hand hygiene observers roam throughout the hospital, we asked them to simultaneously record BBE status while they were collecting their hand hygiene compliance data.

So here’s a first look: 2 weeks of observations (n=1,560). Note that health care workers were not counted repeatedly and our definition of BBE was strict (i.e., a wrist watch or bracelet was defined as noncompliance). The graph below shows the overall compliance and the compliance stratified by job category:

Nurses and nursing students demonstrate high rates of compliance. On the other hand, physicians and medical students are least likely to comply. Nonetheless, nearly 40% compliance in physicians is higher than I would have predicted.

Medical students have 2 problems: they just love the white coat and they are concerned about how they will be perceived by their evaluators if they don’t wear it. Clearly, we have some work to do there. Overall, though, I’m pleased with these results. Two-thirds of patient encounters are by health care workers who are BBE. One caveat is that these data were collected in June. I expect the data will look different in January. We’ll keep watching.

Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. This post originally appeared at the blog Controversies in Hospital Infection Prevention.