Hesitation and error: Does product placement in an emergency department influence hand hygiene performance?

BACKGROUND: Existing research has consistently demonstrated poor compliance by health care workers with hand hygiene standards. This study examined the extent to which incorrect hand hygiene occurred as a result of the inability to easily distinguish between different hand hygiene solutions placed at washbasins. METHODS: A direct observational method was used using ceiling-mounted, motion-activated video camera surveillance in a tertiary referral emergency department in Australia. Data from a 24-hour period on day 10 of the recordings were collected into the Hand Hygiene-Technique Observation Tool based on Feldman's criteria as modified by Larson and Lusk. RESULTS: A total of 459 episodes of hand hygiene were recorded by 6 video cameras in the 24-hour period. The observed overall rate of error in this study was 6.2% (27 episodes). In addition an overall rate of hesitation was 5.8% (26 episodes). There was no statistically significant difference in error rates with the 2 hand washbasin configurations. CONCLUSION: The amelioration of causes of error and hesitation by standardization of the appearance and relative positioning of hand hygiene solutions at washbasins may translate in to improved hand hygiene behaviors. Placement of moisturizer at the washbasin may not be essential.

Surveillance of healthcare-acquired infections in Queensland, Australia: data and lessons from the first 5 years.

OBJECTIVE: To present healthcare-acquired infection surveillance data for 2001-2005 in Queensland, Australia. DESIGN: Observational prospective cohort study. SETTING: Twenty-three public hospitals in Queensland. METHODS: We used computer-assisted surveillance to identify episodes of surgical site infection (SSI) in surgical patients. The risk-adjusted incidence of SSI was calculated by means of a risk-adjustment score modified from that of the US National Nosocomial Infections Surveillance System, and the incidence of inpatient bloodstream infection (BSI) was adjusted for risk on the basis of hospital level (level 1, tertiary referral center; level 2, large general hospital; level 3, small general hospital). Funnel and Bayesian shrinkage plots were used for between-hospital comparisons. PATIENTS: A total of 49,804 surgical patients and 4,663 patients who experienced healthcare-associated BSI. RESULTS: The overall cumulative incidence of in-hospital SSI ranged from 0.28% (95% confidence interval [CI], 0%-1.54%) for radical mastectomies to 6.15% (95% CI, 3.22%-10.50%) for femoropopliteal bypass procedures. The incidence of inpatient BSI was 0.80, 0.28, and 0.22 episodes per 1,000 occupied bed-days in level 1, 2, and 3 hospitals, respectively. Staphylococcus aureus was the most commonly isolated microorganism for SSI and BSI. Funnel and shrinkage plots showed at least 1 hospital with a signal indicating a possible higher-than-expected rate of S. aureus-associated BSI. CONCLUSIONS: Comparisons between hospitals should be viewed with caution because of imperfect risk adjustment. It is our view that the data should be used to improve healthcare-acquired infection control practices using evidence-based systems rather than to judge institutions.