title: Improving hand hygiene compliance in the emergency department: getting to the point.
abstract: BACKGROUND
  The emergency department (ED) represents an environment with a high density of invasive, and thus, infection-prone procedures. The two primary goals of this study were (1) to define the number of hand-rubs needed for an individual patient care at the ED and (2) to optimize hand hygiene (HH) compliance without increasing workload.
  
  
  METHODS
  Prospective tri-phase (6-week observation phases interrupted by two 6-week interventions) before after study to determine opportunities for and compliance with HH (WHO definition). Standard operating procedures (SOPs) were optimized for invasive procedures during two predefined intervention periods (phases I and II) to improve workflow practices and thus compliance with HH.
  
  
  RESULTS
  378 patient cases were evaluated with 5674 opportunities for hand rubs (HR) and 1664 HR performed. Compliance significantly increased from 21% (545/2603) to 29% (467/1607), and finally 45% (652/1464; all p<0.001) in phases 1, 2, and 3, respectively. The number of HR needed for one patient care significantly decreased from 22 to 13 for the non-surgical and from 13 to 7 for the surgical patients (both p<0.001) due to improved workflow practices after implementing SOPs. In parallel, the number of HR performed increased from 3 to 5 for non-surgical (p<0.001) and from 2 to 3 for surgical patients (p=0.317). Avoidable opportunities as well as glove usage instead of HR significantly decreased by 70% and 73%, respectively.
  
  
  CONCLUSIONS
  Our study provides the first detailed data on HH in an ED setting. Importantly, HH compliance improved significantly without increasing workload.
authors.affiliation: Department of Infection Control and Infectious Diseases, RWTH Aachen University Hospital, Aachen, Germany. sscheithauer@ukaachen.de
authors.forename: Simone
authors.initials: S
authors.lastname: Scheithauer
authors.forename: Vanessa
authors.initials: V
authors.lastname: Kamerseder
authors.forename: Peter
authors.initials: P
authors.lastname: Petersen
authors.forename: Jörg Christian
authors.initials: JC
authors.lastname: Brokmann
authors.forename: Luis-Alberto
authors.initials: LA
authors.lastname: Lopez-Gonzalez
authors.forename: Carsten
authors.initials: C
authors.lastname: Mach
authors.forename: Roland
authors.initials: R
authors.lastname: Schulze-Röbbecke
authors.forename: Sebastian W
authors.initials: SW
authors.lastname: Lemmen
mesh_terms: D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000706:statistics & numerical data*; D015438:Health Behavior; D006282:Health Personnel; D006801:Humans; D005791:Patient Care / Q000706:statistics & numerical data; D011446:Prospective Studies
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