Rate Of Healthcare Worker-Patient Interaction And Hand Hygiene Opportunities In An Acute Care Setting

Objective.Identify factors affecting the rate of hand hygiene opportunities in an acute care hospital.Design.Prospective observational study.Setting.Medical and surgical in-patient units, medical-surgical intensive care unit (MSICU), neonatal intensive care unit (NICU), and emergency department (ED) of an academic acute care hospital from May to August, 2012.Participants.Healthcare workers.Methods.One-hour patient-based observations measured patient interactions and hand hygiene opportunities as defined by the Four Moments for Hand Hygiene. Rates of patient interactions and hand hygiene opportunities per patient-hour were calculated, examining variation by room type, healthcare worker type, and time of day.Results.During 257 hours of observation, 948 healthcare worker--patient interactions and 1,605 hand hygiene opportunities were identified. Moments 1, 2, 3, and 4 comprised 42%, 10%, 9%, and 39% of hand hygiene opportunities. Nurses contributed 77% of opportunities, physicians contributed 8%, other healthcare workers contributed 11%, and housekeeping contributed 4%. The mean rate of hand hygiene opportunities per patient-hour was 4.2 for surgical units, 4.5 for medical units, 5.2 for ED, 10.4 for NICU, and 13.2 for MSICU (P < .001). In non-ICU settings, rates of hand hygiene opportunities decreased over the course of the day. Patients with transmission-based precautions had approximately half as many interactions (rate ratio [RR], 0.55 [95% confidence interval (CI), 0.37--0.80]) and hand hygiene opportunities per hour (RR, 0.47 [95% CI, 0.29--0.77]) as did patients without precautions.Conclusions.Measuring hand hygiene opportunities across clinical settings lays the groundwork for product use--based hand hygiene measurement. Additional work is needed to assess factors affecting rates in other hospitals and health care settings.