Tuesday, March 26, 2013

Hand Hygiene- Missed Opportunities

I recently attended an excellent lecture titled "Hand Hygiene: Thinking Outside the Box" by Dr. Michael Edmond.  One message in the lecture is that hand hygiene opportunities are nearly innumerable during the course of patient care at the bedside. 

Why? Even after hand hygiene, re-contamination of the hands is common by touching the inanimate environment (bedside table, stethoscope, reflex hammer, pen, computer keyboard, bedside monitor, IV pole etc) at the point of care. 

Here is an article in the Journal of Hospital Infection on common hand hygiene (missed) opportunities.

Fifty-eight 90 min sessions of unobtrusive observation were made in open bays and isolation rooms.  Hand-hygiene audits were conducted using the World Health Organization ‘five moments for hand hygiene’ observational tool.

In critical care, the majority of activity occurred within the bed space. The bedside computer and equipment trolley were the surfaces most commonly touched, often immediately after patient contact. In the general ward, movement between bed spaces was more common and observed hand hygiene ranged from 25% to 33%. Regardless of ward type, observed hand-hygiene compliance when touching the patient immediately on entering an isolation room was less than 30%.

Contamination of the hands after direct contact with the inanimate environment is perceived as low risk. Hand hygiene must be meticulous at the point of care, even after touching the inanimate environment.

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