Improving Hand Hygiene Compliance By Incorporating It Into the Verification Process in the Operating Room

摘要

Background: Universal compliance with hand hygiene is fundamental to reduce infections, patient mortality, and health care costs. Since compliance is known to be poor, we implemented and evaluated two interventions to improve compliance in the operating room setting.Objective: We aimed to determine the compliance of hand washing in our operating room before and after implementing two process-improvement interventions. Our hypothesis was that these interventions would change the behaviors and ultimately increase the compliance among operating room personnel in using the alcohol-based hand sanitizers while entering and exiting the operating rooms.Methods: We randomly observed 1000 encounters of operating room personnel using the alcohol-based hand sanitizers while both entering and exiting the operating rooms in a university tertiary care center. Two distinct interventions to promote hand hygiene were implemented. Intervention A: displaying signs in strategic areas throughout the operating rooms. Intervention B: including hand hygiene in the time-out/verification process. Interventions were separated by 5 months.Results: We found that: A) the baseline compliance rate of utilizing the alcohol-based hand foam prior to any intervention was 7.6%; B) after Intervention A, the compliance rate increased to 11.2% (p=0.0511) and decreased to 10.4% after 5 months; C) after Intervention B, the compliance rate significantly increased to 70.8% (p<0.0001).Conclusions: The results of our study clearly show that the compliance rate of utilizing the alcohol-based hand sanitizers was poor and that interventions with clearly accountable results changed the behaviors and ultimately increased the compliance among operating room personnel. We conclude that incorporating hand hygiene into the time-out process is an effective process improvement intervention that boosts compliance of hand hygiene. This process improvement intervention may help reduce perioperative infection rates, mortality, and overall healthcare expenditures. Introduction Our largest organ system, the human skin, is composed of four distinct layers, each having its own physiologic purpose and function. The outermost layer, the stratum corneum, is composed of a tough horny layer of keratin that serves as the primary barrier against water and heat loss, pathogens, and other foreign bodies from entering our system. However, as much as this layer is designed to protect its host it also provides a reservoir rich in bacterial flora that can promote pathogen cross-contamination between healthcare workers and patients.The prevention of cross contamination with hand hygiene has been known since the mid-1800s. Its significance, however, was not universally appreciated until 1843 when Oliver Wendell Holmes recognized the role of transmission of contagions on the hands of physicians in the spread of puerperal fever.1 In addition, Joseph Lister identified the importance of antisepsis with carbolic or phenic acid in the practice of surgery2 Furthermore, the actual impact of hand hygiene on infection rates was indeed first demonstrated in 1847 by Ignaz Semmelweis when he remarkably demonstrated the effectiveness of hand hygiene in reducing postpartum maternal mortality from a high of 18.97% to about 3%.3Today, healthcare workers are generally complacent about following hand hygiene practices. As few as 5% of health care workers comply with the fundamentals of hand hygiene practices.4 In fact, in an observational study, Pittet et al. showed that physicians in a teaching hospital were less compliant with hand washing than other healthcare workers.5 Furthermore, Pittet et al. found that the average compliance rate with hand washing was only 48%.5 This lack of hand hygiene has been shown to contribute to the risk of infection.6 Furthermore, central line-associated blood stream infections have been linked with prolonged length of hospital stay, increased morbidity and mortality, and increased healthcare