Advertisement

Hand Hygiene Compliance at a Canadian provincial cancer centre – the complementary roles of nurse auditor-driven and patient auditor-driven audit processes and impact upon practice in ambulatory cancer care

Published:October 20, 2020DOI:https://doi.org/10.1016/j.ajic.2020.10.012

      Highlights

      • In the setting of an ambulatory care provincial Canadian cancer centre independent nurse hand hygiene compliance (HHC) auditors provide complementary compliance information to a patient-driven audit process.
      • Overall, patient-driven HHC rates have increased with time and by discipline in most cases.
      • Our patient population indicated the high priority it set on HHC; however, there remained reluctance for patients to remind their care providers to engage in HHC.

      Background

      We examined the patterns of hand hygiene compliance (HHC) among health care providers (HCP) as observed by trained nurse and patient auditors over time in an ambulatory care Canadian provincial cancer agency.

      Methods

      Nurse and volunteer patient auditors completed separate standardized forms documenting hand-cleansing opportunities during clinic visits. HHC rates were compared over time by HCP group and by specialty teams. Observations from 10 calendar quarters were analyzed from April 2015 to September 2019.

      Results

      Nurse audit HHC rates ranged from 84% to 96%, encompassing 7,213 opportunities with no significant time-dependent trends by linear regression (R2 = 2.3E-005, P = .9895). The patient audit HHC rates ranged from 57% to 82%, encompassing 23,402 opportunities, were lower overall compared to the nurse audit (73.6% vs 89.2%, respectively, P < .0001), but displayed an increasing trend (R2 = 0.5374, P = .0159) over the same 10 time periods. The relative risk ratio for the differences decreased over time (R2 = .5101, P = .0203). Patients acknowledged the importance of HHC and the audit process, but were reticent to remind HCP to comply.

      Conclusions

      The nurse audit measuring HCP HHC before entering and after exiting patient examination rooms showed persistently high compliance over time whereas the patient-driven audit measuring HHC within the examination room increased over time suggesting a training effect upon practice. These measures appeared complementary.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Larson EL
        APIC guideline for handwashing and hand antisepsis in health care settings.
        Am J Infect Control. 1995; 23: 251-269
        • Pittet D
        • Dharan S
        • Touveneau S
        • Sauvan V
        • Perneger TV
        Bacterial contamination of the hands of hospital staff during routine patient care.
        Arch Intern Med. 1999; 159: 821-826
        • Conly JM
        • Hill S
        • Ross J
        • Lertzman J
        • Louie TJ
        Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates.
        Am J Infect Control. 1989; 17: 330-339
        • Allegranzi B
        • Pittet D
        Role of hand hygiene in healthcare-associated infection prevention.
        J Hosp Infect. 2009; 73: 305-315
        • Talbot TR
        • Johnson JG
        • Fergus C
        • et al.
        Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives.
        Infect Control Hosp Epidemiol. 2013; 34: 1129-1136
        • Jarvis WR
        Handwashing–the Semmelweis lesson forgotten?.
        Lancet. 1994; 344: 1311-1312
        • Pittet D
        • Mourouga P
        • Perneger TV
        Compliance with handwashing in a teaching hospital. Infection Control Program.
        Ann Intern Med. 1999; 130: 126-130
        • Erasmus V
        • Daha TJ
        • Brug H
        • et al.
        Systematic review of studies on compliance with hand hygiene guidelines in hospital care.
        Infect Control Hosp Epidemiol. 2010; 31: 283-294
        • Sax H
        • Allegranzi B
        • Chraiti MN
        • Boyce J
        • Larson E
        • Pittet D
        The World Health Organization hand hygiene observation method.
        Am J Infect Control. 2009; 37: 827-834
        • Walker JL
        • Sistrunk WW
        • Higginbotham MA
        • et al.
        Hospital hand hygiene compliance improves with increased monitoring and immediate feedback.
        Am J Infect Control. 2014; 42: 1074-1078
        • Kovacs-Litman A
        • Wong K
        • Shojania KG
        • Callery S
        • Vearncombe M
        • Leis JA
        Do physicians clean their hands? Insights from a covert observational study.
        J Hosp Med. 2016; 11: 862-864
        • Gould DJ
        • Drey NS
        • Creedon S
        Routine hand hygiene audit by direct observation: has nemesis arrived?.
        J Hosp Infect. 2011; 77: 290-293
        • Jeanes A
        • Coen PG
        • Gould DJ
        • Drey NS
        Validity of hand hygiene compliance measurement by observation: A systematic review.
        Am J Infect Control. 2019; 47: 313-322
        • Bow EJ
        • Bourrier V
        • Trudel J
        • Kostiuk N
        • McLeod JM
        Patient-driven hand hygiene audit process at a regional cancer center.
        Am J Infect Control. 2018; 46: 97-99
        • Bittle MJ
        • LaMarche S
        Engaging the patient as observer to promote hand hygiene compliance in ambulatory care.
        Jt Comm J Qual Patient Saf. 2009; 35: 519-525
        • Le-Abuyen S
        • Ng J
        • Kim S
        • et al.
        Patient-as-observer approach: an alternative method for hand hygiene auditing in an ambulatory care setting.
        Am J Infect Control. 2014; 42: 439-442
        • Desai C
        • Rezmovitz J
        • Manson J
        • Callery S
        • Vearncombe M
        Engaging patients as observers in monitoring hand hygiene compliance in ambulatory care.
        Can J Infect Control. 2017; 32: 150-153
        • Pittet D
        • Allegranzi B
        • Boyce J
        • World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of E
        The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations.
        Infect Control Hosp Epidemiol. 2009; 30: 611-622
        • Kohli E
        • Ptak J
        • Smith R
        • Taylor E
        • Talbot EA
        • Kirkland KB
        Variability in the Hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units.
        Infect Control Hosp Epidemiol. 2009; 30: 222-225
        • El-Saed A
        • Noushad S
        • Tannous E
        • et al.
        Quantifying the Hawthorne effect using overt and covert observation of hand hygiene at a tertiary care hospital in Saudi Arabia.
        Am J Infect Control. 2018; 46: 930-935
        • McLaws ML
        • Kwok YLA
        Hand hygiene compliance rates: Fact or fiction?.
        Am J Infect Control. 2018; 46: 876-880
        • Eckmanns T
        • Bessert J
        • Behnke M
        • Gastmeier P
        • Ruden H
        Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect.
        Infect Control Hosp Epidemiol. 2006; 27: 931-934
        • Pan SC
        • Tien KL
        • Hung IC
        • et al.
        Compliance of health care workers with hand hygiene practices: independent advantages of overt and covert observers.
        PLoS One. 2013; 8: e53746
        • Thompson D
        • Bowdey L
        • Brett M
        • Cheek J
        Using medical student observers of infection prevention, hand hygiene, and injection safety in outpatient settings: A cross-sectional survey.
        Am J Infect Control. 2016; 44: 374-380
        • Arntz PR
        • Hopman J
        • Nillesen M
        • et al.
        Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department.
        Am J Infect Control. 2016; 44: 1203-1207
        • Pittet D
        • Panesar SS
        • Wilson K
        • et al.
        Involving the patient to ask about hospital hand hygiene: a National Patient Safety Agency feasibility study.
        J Hosp Infect. 2011; 77: 299-303
        • McGuckin M
        • Govednik J
        Patient empowerment and hand hygiene, 1997-2012.
        J Hosp Infect. 2013; 84: 191-199
        • McGuckin M
        • Storr J
        • Longtin Y
        • Allegranzi B
        • Pittet D
        Patient empowerment and multimodal hand hygiene promotion: a win-win strategy.
        Am J Med Qual. 2011; 26: 10-17