title: Environmental factors and their association with emergency department hand hygiene compliance: an observational study.
abstract: OBJECTIVE
  Hand hygiene is effective in preventing healthcare-associated infections. Environmental conditions in the emergency department (ED), including crowding and the use of non-traditional patient care areas (ie, hallways), may pose barriers to hand hygiene compliance. We examined the relationship between these environmental conditions and proper hand hygiene.
  
  
  METHODS
  This was a single-site, observational study. From October 2013 to January 2014, trained observers recorded hand hygiene compliance among staff in the ED according to the World Health Organization 'My 5 Moments for Hand Hygiene'. Multivariable logistic regression was used to analyse the relationship between environmental conditions and hand hygiene compliance, while controlling for important covariates (eg, hand hygiene indication, glove use, shift, etc).
  
  
  RESULTS
  A total of 1673 hand hygiene opportunities were observed. In multivariable analyses, hand hygiene compliance was significantly lower when the ED was at its highest level of crowding than when the ED was not crowded and lower among hallway care areas than semiprivate care areas (OR=0.39, 95% CI 0.28 to 0.55; OR=0.73, 95% CI 0.55 to 0.97).
  
  
  CONCLUSIONS
  Unique environmental conditions pose barriers to hand hygiene compliance in the ED setting and should be considered by ED hand hygiene improvement efforts. Further study is needed to evaluate the impact of these environmental conditions on actual rates of infection transmission.
authors.affiliation: Columbia University School of Nursing, New York, New York, USA.
authors.forename: Eileen J
authors.initials: EJ
authors.lastname: Carter
authors.affiliation: Columbia University Medical Center, New York, New York, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Wyer
authors.affiliation: Columbia University Medical Center, New York, New York, USA.
authors.forename: James
authors.initials: J
authors.lastname: Giglio
authors.affiliation: Columbia University School of Nursing, New York, New York, USA Columbia University Mailman School of Public Health, New York, New York, USA.
authors.forename: Haomiao
authors.initials: H
authors.lastname: Jia
authors.affiliation: NewYork-Presbyterian Hospital, New York, New York, USA.
authors.forename: Germaine
authors.initials: G
authors.lastname: Nelson
authors.affiliation: NewYork-Presbyterian Hospital, New York, New York, USA.
authors.forename: Vepuka E
authors.initials: VE
authors.lastname: Kauari
authors.affiliation: Columbia University School of Nursing, New York, New York, USA Columbia University Mailman School of Public Health, New York, New York, USA.
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
mesh_terms: D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D003441:Crowding; D004636:Emergency Service, Hospital / Q000592:standards*; D004777:Environment; D005260:Female; D006235:Hand Disinfection / Q000592:standards / Q000639:trends; D063373:Hand Hygiene / Q000592:standards* / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010348:Patient Care Team / Q000458:organization & administration*
keywords: Compliance; Emergency department; Infection control