Highlights
- •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.
Background
Monitoring results showing poor hand hygiene compliance in a major, busy emergency
department prompted a quality improvement initiative to improve hand hygiene compliance.
Purpose
To identify, remove, and reduce barriers to hand hygiene compliance in an emergency
department.
Methods
A barrier identification tool was used to identify key barriers and opportunities
associated with hand hygiene compliance. Hand hygiene imperatives were developed and
agreed on with clinicians, and a framework for monitoring and improving hand hygiene
compliance was developed.
Results
Barriers to compliance were ambiguity about when to clean hands, the pace and urgency
of work in some areas of the department, which left little time for hand hygiene and
environmental and operational issues. Sore hands were a problem for some staff.
Expectations of compliance were agreed on with staff, and changes were made to remove
barriers. A monitoring tool was designed to monitor progress. Gradual improvement
occurred in all areas, except in emergency situations, which require further improvement
work.
Conclusions
The context of care and barriers to compliance should be reflected in hand hygiene
expectations and monitoring. In the emergency department, the requirement to deliver
urgent live-saving care can supersede conventional hand hygiene expectations.
Key Words
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Article info
Publication history
Published online: December 18, 2017
Footnotes
Funding/support: No additional resources utilised.
Conflicts of interest: None.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
