Nai-Chung Chang1,2,3, Michael Jones4, Heather Schacht Reisinger5,6, Marin L Schweizer5,6, Elizabeth Chrischilles1, Margaret Chorazy1, W Charles Huskins7, Loreen Herwaldt1,5. 1. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa. 2. Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah. 3. Veterans' Affairs Salt Lake City Health Care System, Salt Lake City, Utah. 4. Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa. 5. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. 6. Iowa City VA Health Care System, Iowa City, Iowa. 7. Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Abstract
OBJECTIVE: To determine whether the order in which healthcare workers perform patient care tasks affects hand hygiene compliance. DESIGN: For this retrospective analysis of data collected during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, we linked consecutive tasks healthcare workers performed into care sequences and identified task transitions: 2 consecutive task sequences and the intervening hand hygiene opportunity. We compared hand hygiene compliance rates and used multiple logistic regression to determine the adjusted odds for healthcare workers (HCWs) transitioning in a direction that increased or decreased the risk to patients if healthcare workers did not perform hand hygiene before the task and for HCWs contaminating their hands. SETTING: The study was conducted in 17 adult surgical, medical, and medical-surgical intensive care units. PARTICIPANTS: HCWs in the STAR*ICU study units. RESULTS: HCWs moved from cleaner to dirtier tasks during 5,303 transitions (34.7%) and from dirtier to cleaner tasks during 10,000 transitions (65.4%). Physicians (odds ratio [OR]: 1.50; P < .0001) and other HCWs (OR, 2.15; P < .0001) were more likely than nurses to move from dirtier to cleaner tasks. Glove use was associated with moving from dirtier to cleaner tasks (OR, 1.22; P < .0001). Hand hygiene compliance was lower when HCWs transitioned from dirtier to cleaner tasks than when they transitioned in the opposite direction (adjusted OR, 0.93; P < .0001). CONCLUSIONS: HCWs did not organize patient care tasks in a manner that decreased risk to patients, and they were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks than the reverse. These practices could increase the risk of transmission or infection.
OBJECTIVE: To determine whether the order in which healthcare workers perform patient care tasks affects hand hygiene compliance. DESIGN: For this retrospective analysis of data collected during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, we linked consecutive tasks healthcare workers performed into care sequences and identified task transitions: 2 consecutive task sequences and the intervening hand hygiene opportunity. We compared hand hygiene compliance rates and used multiple logistic regression to determine the adjusted odds for healthcare workers (HCWs) transitioning in a direction that increased or decreased the risk to patients if healthcare workers did not perform hand hygiene before the task and for HCWs contaminating their hands. SETTING: The study was conducted in 17 adult surgical, medical, and medical-surgical intensive care units. PARTICIPANTS: HCWs in the STAR*ICU study units. RESULTS: HCWs moved from cleaner to dirtier tasks during 5,303 transitions (34.7%) and from dirtier to cleaner tasks during 10,000 transitions (65.4%). Physicians (odds ratio [OR]: 1.50; P < .0001) and other HCWs (OR, 2.15; P < .0001) were more likely than nurses to move from dirtier to cleaner tasks. Glove use was associated with moving from dirtier to cleaner tasks (OR, 1.22; P < .0001). Hand hygiene compliance was lower when HCWs transitioned from dirtier to cleaner tasks than when they transitioned in the opposite direction (adjusted OR, 0.93; P < .0001). CONCLUSIONS: HCWs did not organize patient care tasks in a manner that decreased risk to patients, and they were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks than the reverse. These practices could increase the risk of transmission or infection.