Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-13T19:58:30.220Z Has data issue: false hasContentIssue false

Patterns of Handwashing Behavior and Visits to Patients on a General Medical Ward of Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Janet Raboud*
Affiliation:
Department of Public Health Sciences, University of Toronto and the University Health Network, Toronto, Ontario, Canada
Refik Saskin
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Kurt Wong
Affiliation:
Faculty of Science, University of Toronto, Toronto, Ontario, Canada
Christine Moore
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Grace Parucha
Affiliation:
Department of Nursing, Mount Sinai Hospital, Toronto, Ontario, Canada
Jocelyn Bennett
Affiliation:
Department of Nursing, Mount Sinai Hospital, Toronto, Ontario, Canada
Karen Green
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
Don Low
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Mark Loeb
Affiliation:
McMaster University, Hamilton, Ontario, Canada
Andy Simor
Affiliation:
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Allison McGeer
Affiliation:
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
*
Prosserman Center for Health Research, Room 5-244, 60 Murray St., Toronto, Ontario M5G 1X5, Canada

Abstract

Objective:

To obtain accurate data regarding the handwashing behavior and patterns of visits to patients by healthcare workers (HCWs).

Methods:

All visits by HCWs to selected patient rooms were recorded for 3 days and 2 nights. Additionally, 5 nurses were observed for 1 day each and 2 nurses were observed for 1 night each. Nurses were observed for their entire shifts and all of their activities were recorded.

Setting:

A general medical ward in a tertiary-care hospital.

Participants:

Convenience samples of HCWs and patients.

Results:

Patients were visited every 25 minutes on average. Monitoring rooms and observing nurses resulted in similar rates of patient visits. The highest level of risk was contact with body fluids in 11% of visits and skin in 40% of visits. The overall rate of handwashing was 46%; however, the rate was higher for visits involving contact with body fluids (81%) and skin (61%). Nurses returned immediately to the same patient 45% of the time. The rate of handwashing was higher for the last of a series of visits to a patient's room (53% vs 30%, P < .0001).

Conclusions:

Nurses adjusted their handwashing rates in accordance with the risk level of each visit. Monitoring patient rooms and observing nurses yielded similar estimates of patient visits and proportions of visits involving contact with skin or body fluids. Education programs about hand hygiene may be more effective if patterns of care and levels of risk are incorporated into recommendations.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Harbarth, S, Rutschmann, O, Sudre, P, Pittet, D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998;158:182189.Google Scholar
2.Kim, T, Oh, PI, Simor, AE. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol 2001;22:99104.Google Scholar
3.Bryce, EA, Kerschbaumer, V. The cost of doing business: managing MRSA and VRE. Presented at the 4th Decennial International Conference on Nosocomial and Healthcare Associated Infections; March 59, 2000; Atlanta, GA.Google Scholar
4.Crow, S. Asepsis: back to the basics. Urol Nurs 1998;18:4246.Google Scholar
5.Widmer, AF. Replace hand washing with the use of a waterless alcohol hand rub? Clin Infect Dis 2000;31:136143.Google Scholar
6.Bischoff, WE, Reynolds, TM, Sessler, CN, Edmond, MB, Wenzel, RP. Handwashing compliance by health care workers: the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000;160:10171021.Google Scholar
7.Pittet, D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000;21:381386.Google Scholar
8.McGuckin, M, Waterman, R, Porten, L, et al. Patient education model for increasing handwashing compliance. Am J Infect Control 1999;27:309314.Google Scholar
9.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;17:330339.Google Scholar
10.Voss, A, Widmer, AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205208.Google Scholar
11.Dubbert, PM, Dolce, J, Richter, W, Miller, M, Chapman, SW. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191193.Google Scholar
12.Larson, E, McGeer, A, Quraishi, A, Krenzischek, D, Parsons, BJ, Holdford, J. Effect of an automated sink on handwashing practices and attitudes in high-risk units. Infect Control Hosp Epidemiol 1990;11:191193.Google Scholar
13.Austin, DJ, Anderson, RM. Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models. Philos Trans R Soc Land B Biol Sci 1999;354:721738.Google Scholar
14.Austin, DJ, Bonten, MJM, Weinstein, RA, Slaughter, S, Anderson, RM. Vancomycin-resistant enterococci in intensive care hospital settings: transmission dynamics, persistence, and the impact of infection control programs. Proc Natl Acad Sci USA 1999;96:69086913.Google Scholar
15.Sebille, V, Chevret, S, Valleron, AJ. Modeling the spread of resistant nosocomial pathogens in an intensive care unit. Infect Control Hosp Epidemiol 1997;18:8183.Google Scholar
16.Zeger, SL, Liang, KY. Longitudinal data analysis of discrete and continuous outcomes. Biometrics 1986;42:121130.Google Scholar