135 Patients' and Healthcare Workers' Perception of Hand Hygiene Practices

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Caroline Soyemi, RN , Loyola University School of Nursing, Maywood, IL
Jorge P. Parada, MD, MPH , Loyola University Medical Center, Maywood, IL
Kenneth Soyemi, MD, MPH , John H Stroger Hospital, Chicago, IL
Gigi Marinakos-Trulis , Loyola University Medical Center, Maywood, IL
Alexander Tomich, RN, MSM , Loyola University School of Nursing, Maywwod, IL
Bridget Gaughan, RN , Loyola University School of Nursing, Maywwod, IL
Pua Herminia, RN , Loyola University School of Nursing, Maywwod, IL
Ida Androwich, RN, PhD , Loyola University School of Nursing, Maywwod, IL
Background: Hand hygiene is the single most important method of reducing hospital associated infection. Historically, hand hygiene compliance rates among healthcare workers (HCWs) have been low.

Objective: To examine the perception of hand hygiene compliance as observed and reported by HCWs and patients responding to a survey at a tertiary medical center and its ambulatory care centers.

Methods: A single center cross-sectional survey questionnaire was completed by HCWs (July 2010) and patients (June to August 2010). Respondents were asked to categorize hand hygiene practices using a five point Likert scale. Responses were grouped into 2 categories: compliant and noncompliant. Association was tested with Chi square test or Fischer’s exact test as appropriate. The strength of association was measured with odds ratio (OR) and 95% confidence intervals (95% CIs).

Results: Of the 4,033 respondents, 3,622 (90%) were patients and 411 (10%) were HCWs. 3,293 of 3,622 (91%) patients agreed that HCWs practiced hand hygiene during patient care encounters compared to 380 of 411 (92%) of HCWs (P =0.3).

Of the 411 HCW respondents, 257 (63%) were nurses, 48 (12%) were physicians, 50 (12%) were technicians, and 56 (13%) were classified as other. Amongst HCWs, 123 (30%) worked in ambulatory care,  211 (51%) worked in hospital in non-ICU settings, and 77 (19%) were ICU personnel. Amongst patient respondents, 2,721 (75%) received care in ambulatory care settings, 829 (23%) were non-ICU inpatients, and 72 (2%) were ICU patients.

Both HCWs and patients reported hand hygiene was highest in ICU settings (95% and 99%, respectively). Inpatient hand hygiene was perceived as superior to that in ambulatory care settings by HCWs (94% versus 89%), but no difference was reported by patients (91% in both settings). Adjusting for point of care (outpatient versus inpatient) and intensity of care (ICU versus non-ICU) there was no significant difference in perception of hand hygiene compliance.

Bivariate categorical analysis of hand hygiene compliance by staff type showed that 46 (98%) physicians (OR=2.0, 95% CI 0.5-8.6); 242 (94%) nurses (OR=1.9, 95% CI 0.9-3.9); 44 (88%) technicians (OR=0.5, 95% CI 0.2-1.4); and 48 (86%) other staff (OR=0.4, 95% CI 0.2-1.0) agreed that coworkers practiced hand hygiene.

Conclusions: These results show that there is no significant difference in perceptions among HCWs and patients regarding hand hygiene compliance. Although technicians and other HCW staff reported lower hand hygiene, overall, HCWs and patients had a high degree of concordance in their responses. Point of care, intensity of care, type of HCW, and provider versus receiver of care status did not significantly modify hand hygiene perceptions. More than 91% of all respondents agreed that hand hygiene was performed by HCWs.