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Validation and implementation of group electronic hand hygiene monitoring across twenty-four critical care units

Published online by Cambridge University Press:  25 June 2021

Jerome A. Leis Open the ORCID record for Jerome A. Leis [Opens in a new window] ,
Maryam Obaidallah ,
Victoria Williams ,
Matthew P Muller ,
Jeff E. Powis ,
Jennie Johnstone ,
Susy Hota ,
Kevin Katz ,
Michael Payne  and
Lucas Castellani
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Jerome A. Leis*
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Sunnybrook Research Institute, Toronto, Ontario, Canada
Maryam Obaidallah
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Victoria Williams
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Matthew P Muller
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada St Michael’s Hospital, Toronto, Ontario, Canada
Jeff E. Powis
Affiliation:
Michael Garron Hospital, Toronto, Ontario, Canada
Jennie Johnstone
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Sinai Health, Toronto, Ontario, Canada
Susy Hota
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada University Health Network, Toronto, Ontario, Canada
Kevin Katz
Affiliation:
North York General Hospital, Toronto, Ontario, Canada
Michael Payne
Affiliation:
London Health Science Centre, London, Ontario, Canada
Lucas Castellani
Affiliation:
The Sault Area Hospital, Sault Ste. Marie, Ontario, Canada
Mark Downing
Affiliation:
St Joseph’s Health Centre, Toronto, Ontario, Canada
Dominik Mertz
Affiliation:
Hamilton Health Sciences Centre and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Daniel R. Ricciuto
Affiliation:
Peterborough Regional Health Centre, Peterborough, Ontario, Canada Lakeridge Health, Oshawa, Ontario, Canada
Alex Kiss
Affiliation:
Sunnybrook Research Institute, Toronto, Ontario, Canada
Brian H. Cuthbertson
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
*
Author for correspondence: Jerome A. Leis, Email: [email protected]
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Abstract

Objectives:

An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units.

Design:

Multicenter, observational study (10 hospitals) followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada.

Methods:

Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS.

Results:

During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P < .0001).

Conclusions:

Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 7 , July 2022 , pp. 834 - 839
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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