Blog | Friday, June 16, 2017

Hand hygiene: facilitators and barriers

Although there are many papers on hand hygiene, this new one in American Journal of Infection Control caught my eye. In this study 3,260 hand hygiene opportunities among 64 ICU nurses in 4 hospitals were overtly observed. When hand hygiene noncompliance was observed, the reason was documented. Nearly 20% of missed opportunities were accounted for by four activities: carrying something, even as small as a syringe or 4x4 (9%), donning gloves or personal protective equipment (6%), pushing or pulling a work station (2%), and using a mobile device (1%).

The investigator observed that nurses who were super-compliant (90-100% compliant) found ways to deal with the barriers. For example, if they were carrying something, they shifted the object to one hand and reached for gel with the other. They were positive deviants.

The high performers were asked to explain why their compliance was high and four themes emerged:
1. They had internalized standard precautions,
2. They had experienced a previous exposure and were determined to not allow it to occur again,
3. Bonuses and pay raises were linked to compliance, and
4. Pregnancy and concern for their unborn child.

A better understanding of the barriers and facilitators may allow us to move the needle a bit on one of the most perplexing problems in infection prevention.

Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on improving the quality and safety of health care, and sees patients in the inpatient and outpatient settings. This post originally appeared at the blog Controversies in Hospital Infection Prevention.