A novel approach to auditing the compliance of hand hygiene and staff behaviour change
Robyn Ann Donnellan A B , Jackie Ludher A and Michael Brydon AA Sydney Children’s Hospital, High Street, Randwick, 2031 NSW, Australia.
B Corresponding author. Email: Robyn.Donnellan@ncahs.health.nsw.gov.au
Healthcare Infection 16(2) 55-60 https://doi.org/10.1071/HI09015
Submitted: 11 May 2009 Accepted: 16 May 2011 Published: 23 June 2011
Abstract
The objective of hand hygiene auditing is to gather information to identify opportunities for improving compliance, and ultimately the safety and quality of patient care. An Australian tertiary children’s hospital has demonstrated high levels of hand hygiene compliance using traditional auditing practices. This compliance was achieved using a multidisciplinary, peer-based approach that effectively relays information back to the health professionals using education, feedback of audit data and active intervention by the auditor. This study also demonstrates that the audit tools commonly used in many Australian facilities may lack the sophistication to adequately assess strategies that are known to improve hand hygiene, namely the duration of the hand hygiene and the selection of the appropriate solution. Future audit practice should include an accurate measure of the time taken to undertake hand hygiene relevant to the practice setting, as well as the clinician’s choice of solution.
References
[1] Boyce J, Pittet D. ‘MMWR Recommendations and Reports. Guideline for hand hygiene in health care setting.’ October 25, 2002, vol. 51. RR-16; 1–44.[2] Schedule 1 of the Health Practitioner Regulation (New South Wales).
[3] Larson E. A casual link between Hand washing and risk of infection. Examination of the evidence. Infect Control Hosp Epidemiol 1988; 9 28–36.
| A casual link between Hand washing and risk of infection. Examination of the evidence.Crossref | GoogleScholarGoogle Scholar | 19722934PubMed |
[4] Laustsen S, Lund E, Biddy B, Kristensen B, Thulstrup A, Moller J. Effect of correctly using alcohol-based hand rub in a clinical setting. Infect Control Hosp Epidemiol 2008; 29 954–6.
| Effect of correctly using alcohol-based hand rub in a clinical setting.Crossref | GoogleScholarGoogle Scholar | 18754741PubMed |
[5] Won S-P, Chou H-C, Hsieh W-S, Chen C-Y, Huang S-M, Tsou K-I, et al Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004; 25 742–6.
| Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit.Crossref | GoogleScholarGoogle Scholar | 15484798PubMed |
[6] Dharan S, Hugonnet S, Sax H, Pittet D. Comparison of waterless hand antisepsis agents at short application times: raising the flag of concern. Infect Control Hosp Epidemiol 2003; 24 160–4.
| Comparison of waterless hand antisepsis agents at short application times: raising the flag of concern.Crossref | GoogleScholarGoogle Scholar | 12683505PubMed |
[7] Widmer A, Dangel M. Alcohol-based handrub: evaluation of technique and microbiological efficacy with international infection control professional. Infect Control Hosp Epidemiol 2004; 25 207–9.
| Alcohol-based handrub: evaluation of technique and microbiological efficacy with international infection control professional.Crossref | GoogleScholarGoogle Scholar | 15061411PubMed |
[8] McDonald LC. Hand hygiene in the new millennium: drawing the distinction between efficacy and effectiveness. Infect Control Hosp Epidemiol 2003; 24 157–9.
| Hand hygiene in the new millennium: drawing the distinction between efficacy and effectiveness.Crossref | GoogleScholarGoogle Scholar | 12683504PubMed |
[9] Galway R, Harrod ME, Crisp J, Donnellan R, Hardy J, Harvey A, Maurice L, Petty S, Senner A. Central venous access and handwashing: variability in policies and practices. Paediatric Nursing 2003; 15 14–8.
| 14705353PubMed |
[10] Gillespie E, Kotsanas D, Wilson J, Buist M, Stuart R. Hand Profiling: a novel tool used to demonstrate hand hygiene technique. Health Infect 2009; 14 153–7.
| Hand Profiling: a novel tool used to demonstrate hand hygiene technique.Crossref | GoogleScholarGoogle Scholar |
[11] Erol K, Ptak J, Smith R, Taylor E, Kirkland T. Variability in the Hawthorne Effect with regard to hand hygiene performance in high- and low performing inpatient care units. Infect Control Hosp Epidemiol 2009; 30 222–5.
| 19199530PubMed |
[12] Sydney Children’s Hospital Hand Hygiene and Hand Care Policy .
[13] Tavolacci M, Marini H, Vanheste S, Merle V, Coulon A, Micaud G, et al A voluntary ingestion of alcohol based handrub. J Hosp Infect 2007; 66 86–7.
| A voluntary ingestion of alcohol based handrub.Crossref | GoogleScholarGoogle Scholar | 17350719PubMed |
[14] Archer J, Wood D, Tizzard Z, Jones A, Darson P. Alcohol handrubs hygiene and Hazard. BMJ 2007; 335 1154–5.
| Alcohol handrubs hygiene and Hazard.Crossref | GoogleScholarGoogle Scholar | 18048543PubMed |
[15] NHS National Patient Safety Agency (NPSA) Summary of review of NRLS data for incidents related to alcohol handrub. July 2008. More information available at http://www.npsa.nhs.uk/patientsafety/patient-safety-incident-data/quarterly-data- reports/
[16] Hirschmann H, Fux L, Podusel J, Schindler K, Kundi M, Rotter M, et al The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications. J Hosp Infect 2001; 49 199–203.
| The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MnntVyrtA%3D%3D&md5=659290ebea84a5531d28a425fe201ebfCAS | 11716637PubMed |
[17] Grundemann B, Larson E. Antisepsis in current practice. Disinfection sterilisation and antisepsis in health care. Rutala W (editor). Association for Professionals in Infection Control and Epidemiology, Inc. Washington DC, USA and Polyscience Publications Inc., Champlain, NY. USA 1997: pp. 183–195.
[18] Dixon N, Review of Ethics Issues related to Clinical Audit and Quality Improvement Activities. Healthcare Quality Quest LTD. Healthcare Quality Improvement Partnership: pp. 21–41.