Observation of Hand Hygiene Practices in Home Health Care |
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| Authors: | Margaret V. McDonald Carlin Brickner David Russell Dawn Dowding Elaine L. Larson Marygrace Trifilio Irene Y. Bick Sridevi Sridharan Jiyoun Song Victoria Adams Kyungmi Woo Jingjing Shang |
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| Affiliation: | 1. Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA;2. Department of Sociology, Appalachian State University, Boone, NC, USA;3. Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK;4. Columbia University School of Nursing, New York, NY, USA;5. Quality Care Management, Visiting Nurse Service of New York, New York, NY, USA |
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| Abstract: | ObjectiveTo describe nurse hand hygiene practices in the home health care (HHC) setting, nurse adherence to hand hygiene guidelines, and factors associated with hand hygiene opportunities during home care visits.DesignObservational study of nurse hand hygiene practices.Settingand Participants: Licensed practical/vocational and registered nurses were observed in the homes of patients being served by a large nonprofit HHC agency.MethodsTwo researchers observed 400 home care visits conducted by 50 nurses. The World Health Organization's “5 Moments for Hand Hygiene” validated observation tool was used to record opportunities and actual practices of hand hygiene, with 3 additional opportunities specific to the HHC setting. Patient assessment data available in the agency electronic health record and a nurse demographic questionnaire were also collected to describe patients and nurse participants.ResultsA total of 2014 opportunities were observed. On arrival in the home was the most frequent opportunity (n = 384), the least frequent was after touching a patient's surroundings (n = 43). The average hand hygiene adherence rate was 45.6% after adjusting for clustering at the nurse level. Adherence was highest after contact with body fluid (65.1%) and lowest after touching a patient (29.5%). The number of hand hygiene opportunities was higher when patients being served were at increased risk of an infection-related emergency department visit or hospitalization and when the home environment was observed to be “dirty.” No nurse or patient demographic characteristics were associated with the rate of nurse hand hygiene adherence.Conclusions and ImplicationsHand hygiene adherence in HHC is suboptimal, with rates mirroring those reported in hospital and outpatient settings. The connection between poor hand hygiene and infection transmission has been well studied, and it has received widespread attention with the outbreak of SARS-CoV-2. Agencies can use results found in this study to better inform quality improvement initiatives. |
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| Keywords: | Infection control hand hygiene home care services home health nursing |
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