Major article
Quantification of anesthesia providers' hand hygiene in a busy metropolitan operating room: What would Semmelweis think?

https://doi.org/10.1016/j.ajic.2011.10.008Get rights and content

Background

Hand hygiene (HH) is poor in the health care environment representing a major public health concern. HH compliance is poorly studied in anesthesia providers who contribute extensively to nosocomial infection. The rate of HH opportunities and compliance by these providers was studied using embedded, clandestine observers. We aimed to quantify HH behaviors and taxonomize failures.

Methods

Following intensive training, 5 observers masquerading as nursing staff in an academic center, observed the HH of anesthesia providers over a 4-week period throughout the perioperative period using a World Health Organization tool. HH opportunities and HH failures were recorded and categorized using a qualitative content analysis.

Results

Nearly 8,000 HH opportunities were observed. HH opportunities averaged 34 to 41/hour and peaked several times at 54/hour. Aggregate failure rate was 82% with a range of 64% to 93% by provider group.

Conclusion

HH was very poor among anesthesia providers. The task density of anesthesia care may conspire with an intrinsic HH failure rate to create great opportunity for horizontal and vertical vectors for nosocomial infection. Our observations have led to aggressive educational and ergonomic interventions at our facility. Given the task density of anesthesia care, and the observed failure rates, novel approaches to HH should be investigated.

Section snippets

Methods

Following institutional approval by the Committee for Protection of Human Subjects at Virginia Commonwealth University Medical Center, 5 observers trained to use a WHO HH observation form and assessment inventory and masquerading as surgical nurses undergoing routine employee orientation to the operating room (OR), were randomly placed in various perioperative areas over the course of a 4-week period. The observers were savvy about the OR milieu (all were RNs not employed by the institution)

Results

Over the course of the 4-week period, 7,976 HH opportunities among the anesthesia providers actively engaged in clinical practice were observed, recorded, and electronically archived. Likewise, missed opportunities for HH were observed, recorded, and electronically archived.

  • The overall failure of HH ranged from 64% to 93% by provider group with a mean aggregate failure rate of 82%.

  • Depending on the phase of the procedure (induction, maintenance, emergence), we found indications occurring for HH

Discussion

Other researchers in multiple disciplines have demonstrated a significant failure rate in HH among health care workers using observational approaches that are likely to significantly influence provider behavior. The current study is unique in that it quantified the HH behaviors of anesthesia providers in a busy operating room in a large, metropolitan medical center using observers who were embedded in the operating room with easy visual access of the anesthesia providers throughout the

References (18)

There are more references available in the full text version of this article.

Cited by (65)

  • Challenges in reducing the risk of infection when accessing vascular catheters

    2021, Journal of Hospital Infection
    Citation Excerpt :

    Intraoperative contamination of providers’ hands has been linked to OLS contamination and postoperative infections [21,24,27]. A high number of anaesthesia care tasks require hand hygiene; however, low compliance rates have been documented, ranging from 2.9% to 18% [28,56,57]. Microbial contamination of syringes used for anaesthesia can occur during preparation or during clinical use [58].

View all citing articles on Scopus

Conflicts of interest: None to report.

View full text