1518Hand Hygiene for Patients: an Initiative to Study and Promote Hand Hygiene Practice for Hospitalized Patients

Conclusions Objective References Methods Pre-Intervention: A survey was designed to assess if patients were provided with HH education and HH opportunities by HCWs. Patients were surveyed by a nurse project leader for 1 month to obtain baseline data ( approx. 30 patients/unit). Intervention: HCWs were in-serviced on the value and benefit of patient HH by a nurse leader using materials developed by Nursing Education and Infection Control. HCWs then provided HH education to all new patients along with • Alcohol wipes (Sani Hands®), a 69.5% alcohol hand sanitizing product placed at the bedside • Daily reminders, assisted opportunities and encouragement for HH for patients • A card on all Dietary meal trays for HH reminder prior to eating. Post-intervention: Following a 1 month learning and implementation period, surveys from each unit were collected (1:3 ratio preand post-intervention) over the following 4 months for assessment. 1. Ardizzone,LL, et al, Am J Infection Control (2013)41 :487-91 2. Burnett, E, Am J Infection Control (2009) 37(8):638-42 3. Banfield, KR and Kerr, KG, J Hosp Infection (2005)61(3): 183-88 4. Ward, D, Nursing Standard (2003)17(35)39:42 Infection Prevention & Control Department Patient Hand Hygiene QI Team Nurses Environmental Services Department and Dietary Services Acknowledgements Results Patient HH increased significantly in the postintervention period (Table 1). The largest percentage improvements occurred in providing: • Verbal or written education to the patient (88.2%) • Encouragement to perform HH before touching dressings or incisions (131.2%) • HH before and after having visitors (74.2%) • After returning from testing or a procedure (73.7%) A review of HAIs on the units showed that hospital acquired C. difficile infections decreased during the study period (14 preand 9 post-intervention). No reduction in other HAIs was noted Introduction A QI project was developed and approved for use on four inpatient units to provide patients with education on the importance of HH while in the hospital, and a tool (pre-packaged alcohol sanitizer) at the bedside to improve patient HH practice. Hand hygiene (HH) practice in hospitalized patients has not been widely studied. Patient HH may affect the acquisition of hospital acquired infections (HAIs). Acuity and mobility status of patients may be obstacles to HH. A preliminary survey of patients showed: • HH education was provided to patients only 20% of the time. • Opportunities for HH before meals and after toileting occurred ˂ 50% of the time. Survey Questions l Age, gender and room location of each patient collected; no other identifiers 1.) How important on a scale of 1 to 5 do you think hand hygiene / hand washing is in the prevention of infection? Circle : 1 2 3 4 5 2.) Did your nurse talk to you about or provide you with information on the importance of your hand hygiene during your hospital stay? Y/N 3.) Were you offered an opportunity to clean your hands today by your healthcare provider? Y/N 4.) What method (soap and water or alcohol product) of hand hygiene was offered? Soap and Water Alcohol Sanitizer NA 5.) Were you were satisfied with the hand hygiene method? Y/N NA 6.) Were you encouraged to perform hand hygiene before specific times • prior to eating a meal Y/N • after using the toilet or bedpan Y/N • before or after meeting your visitors Y/N • before touching your dressings or your incision Y/N • after returning to room from testing or procedures in other areas Y/N 7.) How many times can you recall having washed /sanitized your hands today? 8.) Can you think of any way that we can increase your opportunity to wash your hands? Table 1 Patient HH Survey Results Pre-intervention (N=97) Post-intervention (N=291) Percentage Change Chi-Square p-value Verbal or written education provided by the HCW 33/96 (34%) 188/291 (64%) 88.20% <0.0001 Opportunity for HH provided 55/92 (60%) 251/291 (86%) 43.30% <0.0001 Encouragement for HH: Prior to meals 51/92 (55%) 201/277 (72.5%) 31.80% 0.002 After toileting 66/94 (70%) 236/287 (82%) 17.10% 0.013 Before or after having visitors 21/87 (24% ) 106/253 (41.8%) 74.20% 0.003 Before touching dressings or incisions 15/73 (20.5%) 92/194 (47.4%) 131.20% <0.0001 After returning from testing or procedure 18/76 (23.6%) 88/214 (41%) 73.70% 0.007 1518 Table 1. Patient HH Survey Questions Pre-intervention (N=97) Post-intervention (N=291) Percentage Change Chi-Square p-value Verbal or written education provided 33/96 (34%) 188/291 (64%) 88.20% <0.0001 Opportunity for HH provided 55/92 (60%) 251/291 (86%) 43.30% <0.0001 Encouragement for HH: Prior to meals 51/92 (55%) 201/277 (72.5%) 31.80% 0.002 After toileting 66/94 (70%) 236/287 (82%) 17.10% 0.013 Before or after having visitors 21/87 (24% ) 106/253 (41.8%) 74.20% 0.003 Before touching dressings or incisions 15/73 (20.5%) 92/194 (47.4%) 131.20% <0.0001 After returning from testing or procedure 18/76 (23.6%) 88/214 (41%) 73.70% 0.007 Background: Hand hygiene (HH) practice in hospitalized patients has not been widely studied. Patient HH (PHH) may affect the acquisition of hospital acquired infections (HAIs) by direct contact transmission. The healthcare worker (HCW) is the primary resource for PHH assistance and education. The acuity and mobility status of patients may be obstacles to HH. Preliminary surveys at our hospital showed HH education was provided 20% of the time and HH opportunities before meals and after toileting occurred ˂ 50% of the time. A PHH study was implemented on 4 patient units to provide education coupled with pre-packaged alcohol wipes (AWs) at the bedside to improve PHH practice. Methods: Patients were surveyed over a 1 month period concerning their HH practices for baseline data. HCWs were then in-serviced on the value of PHH and requested to educate all new patients. AWs (Sani Hands® 69.5% alcohol) were made available. Daily reminders and assisted opportunities for HH were encouraged. Dietary provided a reminder on meal trays for HH prior to eating. After implementation, follow-up surveys were collected for a 4 month period. Percent improvement was analyzed by Chi-square test. HAIs were followed preand post-intervention. Results: PHH increased significantly post-intervention (see Table 1). C. difficile infections (CDIs) decreased (14 preand 9 post-intervention) with no reduction noted in other HAIs during the study. Conclusion: PHH practice can be improved by providing education, the opportunity to clean hands with AWs and encouragement. Incidence of CDI may be influenced by improved PHH practice.