- •Many attempts have been made to improve and sustain hand hygiene compliance in emergency departments.
- •A quality improvement methodology was used to understand the barriers, opportunities, and context of care to improve compliance.
- •Hand hygiene expectations were ambiguous, and clinicians were disengaged.
- •Hand hygiene imperatives were developed and agreed on with clinicians.
- •The conclusion was drawn that sometimes requirements of urgent care supersede rigid hand hygiene requirements.
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- Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.Lancet. 2000; 356 (Erratum in: Lancet 2000;356:2196): 1307-1312
- WHO guidelines on hand hygiene in health care 2009.WHO Press, Geneva, Switzerland2009
- Prevention and control of healthcare-associated infections NICE public health guidance PH36.(Available from:)https://www.nice.org.uk/guidance/ph36Date accessed: July 1, 2015
- Risk of infection following a visit to the emergency department: a cohort study.Can Med Assoc J. 2012; 184: E232-E239
- Healthcare workers and health care-associated infections: knowledge, attitudes, and behavior in emergency departments in Italy.BMC Infect Dis. 2010; 10: 35
- Hand washing frequency in an emergency department.Ann Emerg Med. 1994; 23: 1307-1312
- Hand hygiene and aseptic technique in the emergency department.J Hosp Infect. 2004; 56: 137-141
- Hand hygiene behavior in a pediatric emergency department and a pediatric intensive care unit: comparison of use of 2 dispenser systems.Am J Crit Care. 2005; 14: 304-311
- Hand hygiene compliance: exploring variations in practice between hospitals.Nurs Times. 2008; 104: 32-35
- Hand hygiene in the emergency department: degree of compliance, predictors and change over time.Emergencias. 2012; 24: 107-112
- Predictors of hand hygiene in the emergency department.Infect Control Hosp Epidemiol. 2011; 32: 1120-1123
- Is handwashing teachable?: failure to improve handwashing behavior in an urban emergency department.Acad Emerg Med. 1996; 3: 360-365
- Assessing the sustainability of hand hygiene adherence prior to patient contact in the emergency department: a 1-year postintervention evaluation.Am J Infect Control. 2011; 39: 14-18
- Impact of wearable alcohol gel dispensers on hand hygiene in an emergency department.Acad Emerg Med. 2008; 15: 393-396
- Marked variability in adherence to hand hygiene: a 5-unit observational study in Tuscany.Am J Infect Control. 2009; 37: 306-310
- Respiratory hygiene in emergency departments: compliance, beliefs and perceptions.Am J Infect Control. 2013; 41: 14-18
- Working in an overcrowded accident and emergency department: nurses' narratives.Aust J Adv Nurs. 2007; 25: 21-27
- Variables influencing worker compliance with universal precautions in the emergency.Am J Infect Control. 1994; 22: 138-148
- Variables influencing worker compliance with universal precautions in the emergency department.Am J Infect Control. 1994; 22: 138-148
- Hand hygiene among physicians: performance, beliefs, and perceptions.Ann Intern Med. 2004; 141: 1-8
- The impact of overcrowding on the bacterial contamination of blood cultures in the ED.Am J Emerg Med. 2012; 30: 839-845
- Influence of role models and hospital design on the hand hygiene of health-care workers.Emerg Infect Dis. 2003; 9: 217-223
- Marketing hand hygiene in hospitals—a case study.J Hosp Infect. 2002; 50: 42-47
- The World Health Organization hand hygiene observation method.Am J Infect Control. 2009; 37: 827-834
- Collecting the data but missing the point: validity of hand hygiene audit data.J Hosp Infect. 2015; 90: 156-162
- A practical tool to identify and eliminate barriers to evidence-based guideline compliance.Jt Comm J Qual Patient Saf. 2009; 35: 526-532
- An intervention to decrease catheter-related bloodstream infections in the ICU.N Engl J Med. 2006; 355 (Erratum in: N Engl J Med 2007;356:2660): 2725-2732
- Surgical specimen identification errors: a new measure of quality in surgical care.Surgery. 2007; 141: 450-455
- Implementing standardized operating room briefings and debriefings at a large regional medical center.Jt Comm J Qual Patient Saf. 2009; 35: 391-397
- My five moments for hand hygiene”: a user-centred design approach to understand, train, monitor and report hand hygiene.J Hosp Infect. 2007; 67: 9-21
- A systematic review of hand hygiene strategies: a behavioural approach.Implement Sci. 2012; 7: 92
- Ambiguity and ambivalence: senior managers' accounts of organizational change in a restructured government department.J Organ Change Manag. 2008; 21: 686-700
- Engaging for success, enhancing performance through employee engagement: a report to government.Department of Business, Innovation & Skills, London, UK2009
- Normalisation process theory: a new paradigm to analyse and interpret strategies to prevent and control healthcare-associated infection.J Hosp Infect. 2016; 94: 373-380
- An alternative methodology for interpretation and reporting of hand hygiene compliance data.Am J Infect Control. 2012; 40: 332-335
- Strategies for sustaining a quality improvement collaborative and its patient safety gains.Int J Qual Health Care. 2012; 24: 380-390
- Bacterial contaminationof unused, disposable non-sterile gloves on a hospital orthopaedic ward.Aus Med J. 2013; 6: 331-338
- Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time?—a randomized controlled trial.Am J Infect Control. 2013; 41: 994-996
- Self-protection as a driver for hand hygiene among healthcare workers.Infect Control Hosp Epidemiol. 2009; 30: 578-580
- Attitudes and beliefs about hand hygiene among paediatric residents: a qualitative study.BMJ Open. 2012; 2: e002188
- Interventions to improve hand hygiene compliance in patient care (second update).Cochrane Database Syst Rev. 2017; (CD005186)
- Measuring the cost of quality measurement: a missing link in quality strategy.JAMA. 2017; 318: 1219-1220
- The Hawthorne and avoidance effects in hand hygiene practice and research: methodological reconsideration.J Hosp Infect. 2017; 95: 169-174
- Can it work? Does it work? Is it worth it?: the testing of healthcare interventions is evolving.BMJ. 1999; 319: 652-653
Funding/support: No additional resources utilised.
Conflicts of interest: None.