title: Rate of healthcare worker-patient interaction and hand hygiene opportunities in an acute care setting.
abstract: OBJECTIVE
  Identify factors affecting the rate of hand hygiene opportunities in an acute care hospital.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors: Laura
authors: L
authors: Goodliffe
authors: Kelsey
authors: K
authors: Ragan
authors: Michael
authors: M
authors: Larocque
authors: Emily
authors: E
authors: Borgundvaag
authors: Sophia
authors: S
authors: Khan
authors: Christine
authors: C
authors: Moore
authors: Liz
authors: L
authors: McCreight
authors: Brenda L
authors: BL
authors: Coleman
authors: Allison J
authors: AJ
authors: McGeer
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D063373:Hand Hygiene / Q000706:statistics & numerical data*; D006797:Housekeeping, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D009740:Nursing Staff / Q000706:statistics & numerical data; D010564:Personnel, Hospital / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D011446:Prospective Studies