Hand Hygiene: An analysis of one hospital’s intervention and a discussion of the limitations of observational hand hygiene studies

Abstract

Healthcare-associated infections affect over one million people in the US each year, costing patients and hospitals large amounts of resources and time. Hand hygiene is one of the most effective ways to prevent the spread of these costly infections. However, hand hygiene compliance rates among healthcare workers remain startlingly low. Many institutions have been searching for interventions that will increase the compliance rates of their healthcare staff. Successful interventions found in the literature include increased access to hand hygiene resources, the installation of visual reminders, the implementation of campaigns modeled from the World Health Organization (WHO), and other similar measures. A rural 99-bed hospital (Hospital A) designed a hand hygiene intervention that included the installation of additional alcohol-based hand rub dispensers with visual reminders to one 18-bed unit (Unit 1). The hand hygiene compliance rates were covertly observed pre- and post-intervention. The pre-intervention hand hygiene compliance rate was 46.7% for nurses entering patient rooms and 68.8% compliance upon exiting patient rooms. The post-intervention rates were lower than expected, at only 28.1% upon entering patient room and 42.6% upon exiting. The Unit 1 nurses were surveyed following the intervention to assess their attitudes toward the changes. The survey results indicated that the nurses had responded positively to the intervention and believed that their hand hygiene compliance had increased. This thesis aims to analyze the data obtained from Hospital A’s study, as well as discuss the numerous limitations of observational hand hygiene studies. Future research recommendations will be discussed as well.