Increasing Hand Hygiene Performance in Health Care Workers with Electronic Real-time Prompting
Year: 2019
Type: dissertation
Study design: Clinical Trial
Abstract: Poor hand hygiene (HH) by health care professionals is a major cause of healthcare-acquired infections. Improving HH compliance among staff is the most effective way to reduce healthcare acquired infections. This thesis evaluates the ability of an electronic monitoring system with real-time prompting capability, to improve HH behaviours, its ability to capture high resolution audit data, and presents alternate system deployment strategies. To investigate HH behaviours, 120,441 dispenser activations on a nursing unit were counted before, during, and after installation of the system. The effect of changing the prompt duration on HH performance was determined by a randomized control trial including 90,776 HH opportunities from 185 participants on three nursing units. Sustainability of performance and participation was observed on four nursing units including observations from 419 participants over a year. Results showed that real-time prompts of 20 seconds’ duration nearly doubled HH activity and caused HH to occur sooner after entering a patient room. These improvements were sustainable over a year. Analysis of HH audit capabilities was conducted on data collected on a musculoskeletal rehabilitation unit over 12 weeks. Results showed that continuous collection of HH data that included temporal, spatial, and personnel details provided information on actual HH practices, whereas direct observation or dispenser activation counts showed only aggregate trends. Aggregate performance at patient and soiled utility rooms were both 67%, although individual compliance varied greatly. The number of HH events that occurred inside patient rooms increased with longer visits, whereas HH performance at patient room exit decreased. Eighty-three percent of missed HH opportunities occurred as part of a series of missed events, not in isolation. The system was deployed two more times on the unit at six month intervals. There was a significant increase in aggregate dispenser use with every deployment and a decrease over several weeks following each withdrawal. Intermittent deployment of the system counteracted potential declines in participation rates sometimes seen with continuous system use.
Source: TSpace (University of Toronto)
Author: Steven Pong
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Toronto Rehabilitation Institute
OpenAlex ID: W3010769550