title: Improving hand hygiene compliance in the anesthesia working room work area: More than just more hand rubs.
abstract: BACKGROUND
  The anesthesia working area represents an environment with a high density of invasive and, thus, infection-prone procedures. The 2 primary goals of this study were (1) to perform a precise analysis of anesthesia-related hand hygiene (HH) procedures and (2) to optimize HH compliance.
  
  
  METHODS
  We conducted a prospective, triphase before/after study to determine opportunities for and compliance with hand disinfection (World Health Organization definition) in an anesthesia working area. Standard operating procedures were optimized for invasive procedures during 2 predefined intervention periods to improve work flow practices.
  
  
  RESULTS
  Seven hundred fifty anesthesia procedures were evaluated with 12,142 indications for HH. Compliance significantly increased from 10% (465/4,636) to 30% (1,202/4,029) and finally to 55% (1,881/3,477; all P < .001) in phases I, II, and III, respectively. We identified a significant increase in the number of hand rubs performed during 1 anesthesia procedure (2 to 8, respectively; P < .001) in parallel with a significant decrease in number of opportunities needing a hand rub (24 to 14, respectively; P < .0001) because of improved work flow practices. Notably, the greatest improvement was seen before aseptic tasks (8% to 55%, respectively).
  
  
  CONCLUSIONS
  Our study provides the first detailed data on anesthesia-related and indication-specific HH. Importantly, HH compliance improved significantly without a noticeable increasing workload.
authors.affiliation: Department of Infection Control and Infectious Diseases, RWTH Aachen University Hospital, Aachen, Germany. Electronic address: sscheithauer@ukaachen.de.
authors.forename: Simone
authors.initials: S
authors.lastname: Scheithauer
authors.forename: Anna
authors.initials: A
authors.lastname: Rosarius
authors.forename: Steffen
authors.initials: S
authors.lastname: Rex
authors.forename: Peter
authors.initials: P
authors.lastname: Post
authors.forename: Hans
authors.initials: H
authors.lastname: Heisel
authors.forename: Vedranka
authors.initials: V
authors.lastname: Krizanovic
authors.forename: Roland
authors.initials: R
authors.lastname: Schulze-Röbbecke
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.forename: Sebastian W
authors.initials: SW
authors.lastname: Lemmen
mesh_terms: D000758:Anesthesia / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence / Q000458:organization & administration*; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D011446:Prospective Studies
keywords: Cross-transmission; Infection control; Operating theatre; Quality management; Surveillance