Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 27, 2021
Date Accepted: Nov 17, 2021
A New Performance Metric to Estimate the Risk of Exposure to Infection in a Healthcare Setting: Descriptive Study
ABSTRACT
Background:
Despite several measures to monitor and improve hand hygiene (HH) in healthcare settings, healthcare-acquired infections (HAIs) remain prevalent. The measures used to calculate HH performance are not able to fully benefit from the high-resolution data collected using electronic monitoring systems.
Objective:
This study proposes a novel parameter, Patient Exposure Risk (PER) that quantifies the HAI exposure risk of individual patient by considering temporal and spatial features of healthcare workers’ HH adherence.
Methods:
PER is calculated as a function of the number of consecutive missed HH opportunities, the number of unique rooms visited by the healthcare professionals (HCPs), and the time duration that the HCP spends inside and outside the patient’s room without performing HH. The PER is compared to the Entrance Compliance Rate (ECR) defined as the ratio of the number of HH actions performed at a room entrance to the total number of entrances to the room. The compliance rate is conventionally used to measure HH performance. The ECR and the PER are analyzed using the data collected from an inpatient nursing unit for 12 weeks.
Results:
Analysis of the data collected from 59 nurses at a musculoskeletal rehabilitation unit at KITE-Toronto Rehabilitation Institute showed that there is no strong linear relation between the ECR and PER (r=0.7, P<.001). Since the ECR is calculated based on the number of missed HH actions upon room entrance, this parameter is already included in PER. Therefore, there might be scenarios that these two parameters are correlated, however; in several cases the ECR contrasted with the reported PER. Generally, the patients in the rooms with significantly high ECR can be potentially exposed to a considerable risk of infection. In contrast, small ECRs do not necessarily result in high PER. The results clearly explained the important role of the factors incorporated in PER for quantifying the risk of infection for the patients.
Conclusions:
PER provides a more reliable estimation of the risk of developing HAIs compared to ECR by considering both the temporal and spatial aspects of HH records.
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