Accepted for/Published in: JMIR Nursing
Date Submitted: Mar 18, 2020
Open Peer Review Period: Mar 18, 2020 - Apr 12, 2020
Date Accepted: Apr 18, 2020
(closed for review but you can still tweet)
Assessing Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting: Mixed-Methods Approach
ABSTRACT
Background:
Hand hygiene and low-level disinfection of equipment behaviors among hospital staff are some of the leading cost-effective methods in reducing hospital-acquired infections (HAI) among patients
Objective:
To examine hygiene and low-level disinfection of equipment practices in a central Texas hospital and exploring pertaining gaps, perceptions, and challenges
Methods:
Data were collected using multi-pronged mixed-methods approaches 1) observation of hand hygiene and low-level disinfection practices (12 & 8 units during morning & evening shifts respectively 2) usability/placement of hand sanitizer dispensers 3) semi-structured interviews 4) follow-up email survey.
Results:
222 (shifts: 156 morning, 66 evening) staff members were observed. Out of 526 hand hygiene and 33 low-level disinfection opportunities, 410 (~78%) and 17 (~51%) times compliance were observed respectively. 6 units (50%) in the morning and 2 (25%) during evening shifts had ≥0.80 hand hygiene compliance. Aggregated low-level disinfection compliance during the morning was 0.54 and evening 0.33. Overall, the odds of non-compliant hand hygiene behavior were 1.4 times higher among staff who worked during night shifts compared to day shifts; however, this relationship was not statistically significant (CI=0.86-2.18, P=.18). The non-compliant behavior had highest odds among unit B staff during evening; however, this relationship was not statistically significant as well (OR=5.3, CI=0.84-32.9, P=.07) All units (except one) had similar hand sanitizer dispenser usability characteristics. In the qualitative part, some identified challenges were: “shortage of time while seeing patients”, “some time staff forgets”, “concern about drying hands”, “behavior is difficult or require reminders”, “there may be issues with resources or access to supplies to perform these behaviors”. Staff also stated that “a process that is considered effective is the Stop the Line program”, and “behavior is easy and automatic”.
Conclusions:
Hand hygiene and low-level disinfection compliance is dependent on several personal and non-personal factors. The issues such as time constraints, peer pressure, work culture, available resources, understanding of guidelines could be connected with the staff behavior. The information collected through the present study can be used to reexamine similar or related issues at a larger scale.
Citation
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