By now, one would think that all health care workers know the importance of washing their hands, yet a recent study found that staff at outpatient care facilities fail to follow recommendations for hand hygiene 37% of the time, and for safe injection practices 33% of the time, even after having policies in place about these infection control issues (Am J Infect Control 2016;44:374-380).
Researchers from the University of New Mexico and the New Mexico Department of Health conducted a cross-sectional study of 15 geographically dispersed outpatient facilities in which medical students assessed infection prevention policies and practices during the summer of 2014. Medical student interviews with outpatient facility staff indicated that 93% of recommended policies were in place across the 15 facilities.
However, when the students observed behaviors, they noted only 63% compliance with recommended hand hygiene practices and 66% compliance with safe injection practices. In 37% of hand hygiene observations, no hand hygiene was performed.
“Despite high levels of report of hand hygiene education and observed supply availability, observations of hand hygiene and aseptic injection technique showed lack of similarly high behavior compliance,” the researchers wrote.
“This project highlights the importance of assessing both the report of recommended infection prevention policies and practices, as well as behavior compliance through observational audits.”
Medical students assessed prevention policies using an outpatient infection prevention checklist developed by the Centers for Disease Control and Prevention that included 14 topic areas, including administrative policies, education and training, occupational health, environment cleaning, hand hygiene and injection safety. In addition to assessing policies via the checklist, the students evaluated injection safety and hand hygiene practices through direct observations. Each student was asked to observe 10 injections and 20 hand hygiene opportunities at their assigned outpatient practice.
Of the 163 injection safety observations, only 66% of the preparations complied with all of the recommended infection prevention steps, which included performing hand hygiene, disinfecting the rubber septum, using a new needle and syringe, properly discarding single-dose vials and dating multidose vials upon opening. During the 330 hand hygiene observations, students reported that hand hygiene supplies were available 100% of the time.
“These findings highlight the need for ongoing quality improvement initiatives regarding infection prevention policies and practices in outpatient settings,” the researchers concluded.