An Interventional Hand Hygiene Study at an Oncology Center. Dr. Denise M. Korniewicz RN, FAAN Professor & Senior Associate Dean Jeanne Hinton Siegel PhD, ARNP Assistant Professor Research Project Director
Purpose of Study The purpose of this descriptive hand hygiene study was two fold: To establish the feasibility of the a new hand held sanitizer spray over a twelve week period and to determine if introduction of a new hand hygiene product would improve hand hygiene compliance.
Review of Literature Improved adherence to hand hygiene (hand washing and alcohol based products) Has been shown to terminate outbreaks in healthcare facilities, to reduce transmission of antimicrobial resistant organisms, and reduce overall infection rates Center for Disease Control, (2006)
Review of Literature When Health Care Workers (HCWs) hands are visibly soiled, soap and water should be used to clean hands. The use of gloves does not eliminate the requirement for hand hygiene. Good hand hygiene does not eliminate the need for gloves. Hand hygiene should be used before and after each patient just as gloves should be changed before and after each patient. Center for Disease Control, (2006)
Review of Literature Alcohol based products act quickly to significantly reduce the number of microorganisms on the skin and cause less skin irritation. Alcohol based hand products take less time than traditional hand washing. It is estimated that in an eight-hour shift a nurse in the ICU will save one hour of time. Center for Disease Control, (2006)
Review of Literature Cost Comparisons Alcohol based rubs were found to cost $750 per 1000 patient days but were found to be less costly due to shorter application time than hand washing. Cimiotti, J.P, Stone, P.W., & Larson, E.L. (2004)
Methods A quasi- experimental pretest posttest design was used to evaluate the affect of a newly developed hand sanitizer on hand hygiene compliance when introduced on inpatient and outpatient units of a south Florida hospital. HCWs were asked to use the hand sanitizer spray in place of or in addition to the products currently available on their units. Self report questionnaires were used to establish feasibility. Direct observation of was used to establish HCWs hand hygiene compliance. A multivariate analysis was performed to determine factors associated with poor compliance to hand hygiene.
Demographics Feasibility Observation Infection Control Inventory Scale Methods Instrumentation
Included Self Reported: HCW category Gender Age Ethnicity Unit Assignment Demographics Hand hygiene product currently used Number of years in Health Care Number of hours worked every two weeks Average number of times hands are washed/cleaned in a work day Estimate of number of pairs of gloves used in an average work day
Product Description A hand held alcohol based spray sanitizer with belt clip or lanyard for easy access.
Feasibility Questionnaire A 20 item self report survey instrument designed to investigate the participants perception about a hand sanitizer spray. Variables investigated: Convenience Feel of product on hands Perception of effectiveness
Observation Data Guidelines Directly observed data on hand hygiene practices including: Procedure from beginning to end HCW use of hand sanitizer spray during procedure Interrater reliability 92% Observed Hand hygiene practices Procedures observed (checklist) Risk of exposure
Infection Control Inventory Scale (ICIS) Infection Control Inventory Scale is a valid and reliable measure of HCW hand washing attitudes, gloving practices, and skin integrity associated with infection control practices (Cronbach s alpha =.79)
Data Collection Stage 1: Observation 2 weeks Stage 2: Introduction of hand spray 12 weeks Stage 3: Data Analysis Ongoing Stage 4: Review of findings Present to participants Summer 2006
Using SPSS 14.0 Methods Data Analysis Frequencies/ Descriptive used to determine Frequency/ Percentages/ Means with Standard Deviations Crosstabs with Chi Square used to determine differences across groups
Table 2. Results: Demographics HCW Demographics Variable Frequency (%) n=47 Gender Male 8 (17%) Female 39 (83%) Mean ± SD Age 44.46 ± 9.5 years Ethnicity African American Asian Hispanic Caucasian Other Unit Inpatient Outpatient Hours Worked Part time Full Time Years in Health Care 19(40%) 13(28%) 8(17%) 3(7%) 3(7%) 30 (64%) 17 (36%) 5 (11%) 39 (83%) 16.5 ± 9.9 years
Results: Participant Demographics Variable Frequencies (%) n=45 Comments Hand Washings per 12º Shift (self reported) 5-30 31-60 > 61 Pairs of gloves used per 12º shift (self reported) 1-20 >21 20 (44.4) 13 (28.9) 11 (24.4) 24 (53.3) 21 (46.7) *CDC HCWs used 4 prs. Of gloves per hour. Korniewicz et al. (2002)
Number of HCWs Results: Convenience of Use HCWs: Convenience of Use 40 35 30 25 20 15 10 5 0 83% 95% 17% 5% 1 2 Group Convenient to Use Not Convenient to Use
Numbers of HCWs Reporting Results: Product Perception HCW Perception of Product: "Feel on Hands" 35 30 25 20 15 70% 64% Positive Responses Negative Responses 10 5 30% 36% 0 1 2 Group
Results: HCWs Reaction to Hand Sanitizer Spray HCWs Overall Reaction to Using Hand Spray Negative 19% Positive 81%
Results: Observed Product Preferences HCW Hand Hygiene Preferences Observed Pre and Post Procedures Hand Sanitizer 45/244 18% 44% 38% Hand Sanitizer Spray 93/244 Hand Washing 106/244
HCW percent responses Feasibility of hand held sanitizer spray by data collection periods:time 1 (weeks 1-4), Time 2( weeks 5-8), & Time 3 (weeks 9-12). 1.2 1 0.8 0.6 0.4 Time 1 Time 2 Time 3 0.2 0 Freq. hand spray use Clear instructions Feel on hands Overall reaction to spray Interest to continue use
Percent od Observations Results: Hand Hygiene Compliance Percent of HCW Compliance to Hand Hygiene during pre & post Precedure Observaations at 2, 4, & 8 weeks 90 80 70 60 50 40 30 20 10 0 Pre intervention wks 1-4 wks 5-8 Pre Procedure Post Precedure
Percentage of noncompliance Results: Percentage of Non compliance Percent of Observed HCW noncompliance control vs experimental by pre & post procedure 35 30 25 20 15 10 5 0 Control experimental pre procedure noncompliance post procedure noncompliance Group
Number of Observations Results: Observations HCW Non-compliance to Hand Hygiene during Observation by Control, Group 1, and Group 2 Pre/post procedure 50 40 30 20 10 0 43/140 39/140 33/101 19/101 17/75 15/75 1 2 3 Group Number Pre procedure post Procedure Consistently during the study, pre and post procedure hand hygiene compliance results demonstrated a significant difference (p<.001). Compliance was significantly less pre procedure (34-57%) than post procedure (63-81%).
% Compliant 90 80 70 60 50 40 30 20 10 0 pre-procedure compliance postprocedure compliance high risk exposure low risk exposure low risk exposure high risk exposure Observed hand hygiene compliance pre and post procedure stratified by blood borne pathogen risk.
Discussion HCW had no experience with research and observation, a Hawthorne effect occurred. Introduction of the Hand Sanitizer Spray as an alternate produced no negative effects. HCW s demonstrated a preference for hand washing and hand sanitizer spray over the available hand sanitizer.
Discussion In spite of 3 hand sanitizer products 20-22% of the HCW observed did not use a hand hygiene product. HCW positive perception of the hand held sanitizer spray was consistent through the research study. Hand hygiene compliance diminished over time during the study with the lowest level at the end of the study. The significant difference in pre and post procedure hand hygiene remained consistent.
Recommendations and Future Research Questions Clinical Journal of Oncology Nursing Investigate other interventions that may influence hand hygiene compliance
Thank you
References Center for Disease Control. (2006) Hand Hygiene Guidelines. Retrieved 06/04/06 from www.cdc.gov/od/oc/media/pressrel/fs21025.htm