The Effect of Alcohol Dispenser Visibility on Hand Hygiene Compliance in Intensive Care Units Open Access
Kassner, Holly (Fall 2018)
Abstract
Our study analyzed whether intensive care units (ICUs) rooms with hand hygiene (HH) dispensers with higher visibility on entry and exit will have higher levels of HH compliance than those with lower visibility. Additionally we tested whether individual feedback or immediate voice feedback systems would increase HH compliance relative to HH dispenser visibility. The study population was comprised of healthcare workers (HCWs) (n=276) working in hospital ICUs (n=5) between October and December 2017 with a total of 68 individual rooms and 204,085 observations. HH was measured using Bluetooth sensors on dispensers and HCW badges and worked on proximity for entry and exit. The rooms were ranked based on the visibility of their dispensers on room entry and exit and then grouped into high, medium, and low ranks at near-tertiles. The overall compliance level without interventions was 39.17%, with low visibility ranked rooms at 35.55%, medium visibility ranked rooms at 45.04%, and high visibility ranked rooms at 32.34%. After controlling for shift, HCW type, isolation precautions, and intervention interaction using multivariate analysis, rooms with low scores of visibility were more likely to have lower odds of compliance (adjusted odds ratio OR 0.81, 95% CI (0.79, 0.83)) than rooms with high visibility (aOR 0.72, 95% CI (0.70, 0.74)). The referent group of medium ranked rooms was still the highest of the three tiers of ranks in comparison. HCWs had 1.41 (95% CI (1.39, 1.44)) times higher adjusted odds of performing HH after receiving immediate voice feedback and 1.19 (95% CI (1.17, 1.21)) higher adjusted odds with individual feedback compared with no intervention. Interaction odds ratios between the different interventions and room visibility indicated that rooms with high visibility benefited more from individual feedback (aOR 1.44 95% CI (1.39, 1.49)) than rooms with low visibility (aOR 1.19 95% CI (1.16, 1.23)), whereas there was no difference in effect by voice feedback. Our findings suggest that interventions such as individualized records of compliance and immediate voice feedback increase the level of HH compliance in ICU units even if visibility levels of the dispensers remain poor.
Table of Contents
Background — 1
Methods — 5
Results — 9
Discussion — 13
Strengths and Limitations — 16
Future Directions — 17
References — 19
Tables
Table 1. Total Number of Rooms of Each Room Visibility Rank, Mean Level of Compliance, and Total Hand Hygiene (HH) Compliance and Total Observations per Room Visibility Rank for All Phases of Study by Healthcare Workers at Emory University Hospital Midtown in 5 Intensive Care Units (ICU) in Atlanta, Georgia, United States, 2017 — 23
Table 2. Level of Hand Hygiene (HH) Compliance and Total Number of Observations by Room Score Level, Healthcare Worker (HCW) Status, Unit, Shift, Isolation Status, and Feedback Intervention by Healthcare Workers of Emory University Hospital Midtown in 5 Intensive Care Units (ICU) in Atlanta, Georgia, United States, 2017— 24
Table 3. Level of Hand Hygiene (HH) Compliance by Room Visibility Rank and Intervention— 25
Table 4. Estimated Unadjusted Odds Ratio (OR) and Adjusted Odds Ratio (aOR) for the Association Between Room Visibility Rank of Hand Hygiene (HH) Dispensers on HH Compliance for Healthcare Worker Status (HCW), Feedback Intervention, Isolation Precautions, and Shift by Healthcare Workers of Emory University Hospital Midtown in 5 Intensive Care Units (ICU) in Atlanta, Georgia, United States, 2017— 26
Figures and Figure Legends
Figure 1–Graph of Mean Compliance by Room Visibility Rank — 27
Figure 2–Variability of Room Visibility Rank Scores for Unit 11 ICU With 12 Rooms —28
Figure 3–Variability of Room Visibility Rank Scores for Unit PICU With 12 Rooms — 28
Figure 4–Variability of Room Visibility Rank Scores for Unit 31 ICU With 12 Rooms — 29
Figure 5–Variability of Room Visibility Rank Scores for Unit 41 ICU With 12 Rooms — 29
Figure 6–Variability of Room Visibility Rank Scores for Unit 71 ICU With 20 Rooms —30
Appendices
Appendix A – Hand Hygiene Visibility Survey — 31
Appendix B – ICU Maps with Room Visibility Rank Scores — 47
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