title: Using medical student observers of infection prevention, hand hygiene, and injection safety in outpatient settings: A cross-sectional survey.
abstract: BACKGROUND
  Health care-associated infection outbreaks have occurred in outpatient settings due to lapses in infection prevention. However, little is known about the overall infection prevention status in outpatient environments.
  
  
  METHODS
  A cross-sectional design was employed to assess infection prevention policies and practices at 15 outpatient sites across New Mexico in 2014 during a medical student outpatient rotation. A standardized infection prevention checklist was completed via staff interview; observations of injection safety practices and hand hygiene behavior were conducted. Aggregate data were analyzed using Excel (Microsoft, Redmond, WA) and Stata (version 12.1, Stata Corp, College Station, TX) statistical software.
  
  
  RESULTS
  Medical practice staff interviews reported a mean of 92.8% (median, 96.7%; range, 75.0%-98.9%) presence of recommended policies and practices. One hundred sixty-three injection safety observations were performed that revealed medication vial rubber septums were disinfected with alcohol 78.4% (95% confidence interval [CI], 71.1%-84.7%) of the time before piercing. Three hundred thirty hand hygiene observations revealed 33.9% (95% CI, 28.8%-39.1%) use of alcohol-based handrub, 29.1% (95% CI, 24.2%-34.0%) use of soap and water, and 37.0% (95% CI, 31.8%-42.4%) use of no hand hygiene.
  
  
  CONCLUSIONS
  These findings support the need for ongoing infection prevention quality improvement initiatives in outpatient settings and underscore the importance of assessing both self-report and observed behavior of infection prevention compliance.
authors.affiliation: New Mexico Department of Health, Santa Fe, NM. Electronic address: dlt3@cornell.edu.
authors.forename: Deborah
authors.initials: D
authors.lastname: Thompson
authors.affiliation: New Mexico Department of Health, Santa Fe, NM.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bowdey
authors.affiliation: University of New Mexico Hospital, Albuquerque, NM.
authors.forename: Meghan
authors.initials: M
authors.lastname: Brett
authors.affiliation: Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
authors.forename: James
authors.initials: J
authors.lastname: Cheek
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000379:methods*; D006302:Health Services Research; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007267:Injections / Q000379:methods*; D008297:Male; D009516:New Mexico; D013337:Students, Medical; D055815:Young Adult
keywords: Health care-associated infections; Policies; Practices; Quality improvement