Investigators Study Hand Hygiene in the ED

The emergency department (ED) represents an environment with a high density of invasive, and thus, infection-prone procedures. The two primary goals of the study by Scheithauer, et al. (2013) were to define the number of handrubs needed for an individual patient care at the ED and to optimize hand hygiene (HH) compliance without increasing workload.

The researchers conducted a prospective tri-phase (six -week observation phases interrupted by two six-week interventions) before/after study to determine opportunities for and compliance with HH (WHO definition). Standard operating procedures (SOPs) were optimized for invasive procedures during two predefined intervention periods (phases I and II) to improve workflow practices and thus compliance with HH.

Three hundred seventy-eight patient cases were evaluated with 5674 opportunities for handrubs (HR) and 1664 HR performed. Compliance significantly increased from 21 percent (545/2603) to 29 percent (467/1607), and finally 45 percent (652/1464; all p<0.001) in phases 1, 2, and 3, respectively. The number of HR needed for one patient care significantly decreased from 22 to 13 for the non-surgical and from 13 to seven for the surgical patients (both p<0.001) due to improved workflow practices after implementing SOPs. In parallel, the number of HR performed increased from three to five for non-surgical (p<0.001) and from two to three for surgical patients (p=0.317). Avoidable opportunities as well as glove usage instead of HR significantly decreased by 70 percent and 73 percent, respectively. Their research was published in BMC Infectious Diseases.

Reference: Scheithauer S, Kamerseder V, Petersen P, Christian Brokmann JC, Lopez-Gonzalez LA, Mach C, Schulze-Röbbecke R and Lemmen SW. Improving hand hygiene compliance in the emergency department: getting to the point. BMC Infectious Diseases 2013, 13:367 doi:10.1186/1471-2334-13-367