Hand hygiene compliance monitoring in anaesthetics: Feasibility and validity

Abstract

Background:

Hand hygiene compliance scores in the anaesthetic department of an acute NHS hospital were persistently low.

Aims:

To determine the feasibility and validity of regular accurate measurement of HHC in anaesthetics and understand the context of care delivery, barriers and opportunities to improve compliance.

Methods:

The hand hygiene compliance of one anaesthetist was observed and noted by a senior infection control practitioner (ICP). This was compared to the World Health Organization five moments of hand hygiene and the organisation hand hygiene tool.

Findings:

In one sequence of 55 min, there were approximately 58 hand hygiene opportunities. The hand hygiene compliance rate was 16%. The frequency and speed of actions in certain periods of care delivery made compliance measurement difficult and potentially unreliable. During several activities, taking time to apply alcohol gel or wash hands would have put the patients at significant risk.

Discussion:

We concluded that hand hygiene compliance monitoring by direct observation was invalid and unreliable in this specialty. It is important that hand hygiene compliance is optimal in anaesthetics particularly before patient contact. Interventions which reduce environmental and patient contamination, such as cleaning the patient and environment, could ensure anaesthetists encounter fewer micro-organisms in this specialty.

Keywords

Audit hand hygiene quality assurance

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References

Ayliffe

GAJ

. (1991) Role of the environment of the operating suite in surgical wound infection. Review of Infectious Diseases 13 (Supplement 10): S800–S804.

Bellaard-Smith

Gillespie

. (2012) Implementing hand hygiene strategies in the operating suite. Healthcare Infection 17: 33–37.

Bennett

McNeil

Bland

Arduino

Villarino

Perrotta

Burwen

Welbel

Pegues

Stroud

Zeitz

. (1995) Postoperative infections traced to contamination of an intravenous anesthetic, propofol. New England Journal of Medicine 333: 147–154.

Biddle

Shah

. (2012) Quantification of anesthesia providers’ hand hygiene in a busy metropolitan operating room: What would Semmelweis think? American Journal of Infection Control 40: 756–759.

Boyce

Pittet

. (2002) Guideline for hand hygiene in health-care settings Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. Morbidity and Mortality Weekly Report 51: 1–45.

Brady

Fraser

Dunlop

Paterson-Brown

Gibb

. (2007). Bacterial contamination of mobile communication devices in the operative environment. Journal of Hospital Infection 66: 397–398.

Call

Auerbach

Riddell

Kiska

Thongrod

Tham

Nussmeier

. (2009) Nosocomial contamination of laryngoscope handles: challenging current guidelines. Anesthesia and Analgesia 109: 479–483.

Chakravarthy

. (2010). Enhanced risk of needlestick injuries and exposure to blood and body fluids to cardiac anesthesiologists: Need for serious introspection. Annals of cardiac anaesthesia 13: 1–2.

Dancer

White

Lamb

Girvan

Robertson

. (2009). Measuring the effect of enhanced cleaning in a UK hospital: a prospective cross-over study. BMC Medicine 7: 28.

10.

Dixon

. (2009) Review of ethics issues related to clinical audit and quality improvement activities. London: Healthcare Quality Improvement Partnership.

11.

Eckmanns

Bessert

Behnke

Gastmeier

Rüden

. (2006). Compliance with antiseptic hand rub use in intensive care units the Hawthorne effect. Infection Control 27: 931–934.

12.

El Mikatti

Dillon

Healy

TE J

. (1999). Hygienic practices of consultant anaesthetists: a survey in the North-West region of the UK. Anaesthesia 54: 13–18.

13.

Goldmann

. (2006). System failure versus personal accountability—the case for clean hands. New England Journal of Medicine 355: 121–123.

14.

Gould

Drey

Creedon

. (2011) Routine hand hygiene audit by direct observation: has nemesis arrived? Journal of Hospital Infection 77: 290–293.

15.

Gwet

. (2014) Handbook of inter-rater reliability: The definitive guide to measuring the extent of agreement among raters. Gaithersburg: Advanced Analytics, LLC.

16.

Hall

. (1994). Blood contamination of anesthesia equipment and monitoring equipment. Anesthesia & Analgesia 78: 1136–1139.

17.

Jeanes

Coen

Wilson

Drey

Gould

. (2015). Collecting the data but missing the point: validity of hand hygiene audit data. Journal of Hospital Infection 90: 156–162.

18.

Jeske

Tiefenthaler

Hohlrieder

Hinterberger

Benzer

. (2007). Bacterial contamination of anaesthetists’ hands by personal mobile phone and fixed phone use in the operating theatre. Anaesthesia 62: 904–906.

19.

Krediet

Kalkman

Bonten

Gigengack

Barach

. (2011) Hand-hygiene practices in the operating theatre: an observational study. British Journal of Anaesthesia 107: 553–558.

20.

Loftus

Brown

Koff

Reddy

Heard

Patel

Fernandez

Beach

Corwin

Jensen

Kispert

. (2012) Multiple reservoirs contribute to intraoperative bacterial transmission. Anesthesia & Analgesia 114: 1236–1248.

21.

Loftus

Koff

Brown

Patel

Jensen

Reddy

Ruoff

Heard

Yeager

Dodds

. (2015) The epidemiology of Staphylococcus aureus transmission in the anesthesia work area. Anesthesia & Analgesia 120: 807–818.

22.

Loftus

Koff

Burchman

Schwartzman

Thorum

Read

Wood

Beach

. (2008) Transmission of pathogenic bacterial organisms in the anesthesia work area. Anesthesiology 109: 399–407.

23.

Loftus

Muffly

Brown

Beach

Koff

Corwin

Surgenor

Kirkland

Yeager

. (2011) Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesthesia & Analgesia 112: 98–105.

24.

Magee

Godsiff

Matthews

Farrington

Park

. (1995) Anaesthetic drugs and bacterial contamination. European Journal of Anaesthesiology Supplement 12: 41–43.

25.

Martin

Rampersad

Geiduschek

Zerr

Weiss

Martin

. (2013) Modification of anesthesia practice reduces catheter-associated bloodstream infections: a quality improvement initiative. Pediatric Anesthesia 23: 588–596.

26.

McArdle

Lee

Gibb

Walsh

. (2006) How much time is needed for hand hygiene in intensive care? A prospective trained observer study of rates of contact between healthcare workers and intensive care patients. Journal of Hospital Infection 62: 304–310.

27.

McLaughlin

Kaluzny

. (1999) Continuous quality improvement in healthcare, theory implementation and application. 2nd ed. Burlington, MA: Jones and Bartlett.

28.

Munoz-Price

Birnbach

Lubarsky

Arheart

Fajardo-Aquino

Rosalsky

Cleary

DePascale

Coro

Namias

Carling

. (2012) Decreasing operating room environmental pathogen contamination through improved cleaning practice. Infection Control & Hospital Epidemiology 33: 897–904.

29.

Munoz-Price

Lubarsky

Arheart

Prado

Cleary

Fajardo-Aquino

DePascale

Eber

Carling

Birnbach

. (2013). Interactions between anesthesiologists and the environment while providing anesthesia care in the operating room. American Journal of Infection Control 41: 922–924.

30.

National Institute for Health and Clinical Excellence. (2011) Prevention and control of healthcare-associated infections. NICE public health guidance PH36. London: NICE.

31.

O’Leary

Kent

Kanowitz

. (1975) Shaping data collection congruent with experimental hypotheses. Journal of Applied Behavior Analysis 8: 43–51.

32.

Pittet

Boyce

. (2001) Hand hygiene and patient care: pursuing the Semmelweis legacy. Lancet Infectious Diseases 1: 9–20.

33.

Pittet

Hugonnet

Harbarth

Mourouga

Sauvan

Touveneau

Perneger

. (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 356: 1307–1312. Erratum in: Lancet (2000) 356: 2196.

34.

Pittet

Stephan

Hugonnet

Akakpo

Souweine

Clergue

. (2003). Hand-cleansing during postanesthesia care. Anesthesiology 99: 530–535.

35.

Pronovost

Goeschel

Marsteller

Sexton

Pham

Berenholtz

. (2009) Framework for patient safety research and improvement. Circulation 119: 330–337.

36.

Rao

Jeanes

Osman

Aylott

Green

. (2002). Marketing hand hygiene in hospitals—a case study. Journal of Hospital Infection 50: 42–47.

37.

Rowlands

Yeager

Beach

Patel

Huysman

Loftus

. (2014) Video observation to map hand contact and bacterial transmission in operating rooms. American Journal of Infection Control 42: 698–701.

38.

Sax

Allegranzi

Chraıti

Boyce

Larson

Pittet

. (2009) The World Health Organization hand hygiene observation method American Journal of Infection Control 37: 827–834.

39.

Sax

Allegranzi

Uckay

Larson

Boyce

Pittet

. (2007). ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. Journal of Hospital Infection 67: 9–21.

40.

Scheithauer

Rosarius

Rex

Post

Heisel

Krizanovic

Schulze-Röbbecke

Rossaint

Lemmen

. (2013) Improving hand hygiene compliance in the anesthesia working room work area: more than just more hand rubs. American Journal of Infection Control 41: 1001–1006.

41.

Steed

Kelly

Blackhurst

Boeker

Diller

Alper

Larson

. (2011) Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 Benchmark Study. American Journal of Infection Control 39: 19–26

42.

Storr

. (2005) The effectiveness of the national cleanyourhands campaign. Nursing Times Feb 22–28; 101: 50–51.

43.

Voss

Widmer

. (1997) No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infection Control and Hospital Epidemiology 18: 205–208.

44.

Wilson

Smyth

Moore

Singleton

Jackson

Gant

Jeanes

Shaw

James

Cooper

Kafatos

Cookson

Singer

Bellingan

. (2011) The impact of enhanced cleaning within the intensive care unit on contamination of the near-patient environment with hospital pathogens: a randomized crossover study in critical care units in two hospitals. Critical Care Medicine 39: 651–658.

45.

World Health Organization. (2009) WHO Guidelines on Hand Hygiene in Health Care. Geneva: WHO.