195287 Hand hygiene in nursing homes: A study of knowledge, attitudes, practices, and barriers

Monday, November 9, 2009: 2:30 PM

Muhammad Salman Ashraf, MD , Internal Medicine/ Geriatrics, North Shore-LIJ Health System, New Hyde Park, NY
Syed Wasif Hussain, MD , Department of Internal Medicine/ Geriatrics, Mayo Clinic, Rochester, MN
Nimit Agarwal, MD , Department of Internal Medicine/ Geriatrics, Loyola University Medical Center, Maywood, IL
Mercedes Rivera, MD , Department of Internal Medicine, Akron General Medical Center, Akron, OH
Sadaf Ashraf, MD , Department of Internal Medicine, St. Barnabas Hospital, Bronx, NY
Erica George-Saintilus, MD , Destin Health Care and Rehabilitation Center, Fort Walton Beach, FL
Sheda Heidarian, MD , Indus Medical Associate, Rancho Mirage, CA
Gabriel EL-Kass, MD , Department of Internal Medicine/ Geriatrics, North Shore-LIJ Health System, New Hyde Park, NY
Roshan Hussain, MPH, MBA , Suite 220B, Krasnoff Quality Management Institute, Great Neck, NY
Nimmy Mathew, MA , Krasnoff Quality Management Institute, Great Neck, NY
Renee Pekmezaris, PhD , North-Shore LIJ Health System, New Hyde Park, NY
Charles Cal, RN, MS, MBA , Krasnoff Quality Management Institute, Great Neck, NY
Barbara T. Edwards, MD , Infectious Diseases, Long Island Jewish Medical Center, New Hyde Park, NY
Betina Louis, MD , 270-05 76th Ave, Long Island Jewish Medical Center, New Hyde Park, NY
Gloria Alano, MD , 270-05 76th Ave, Long Island Jewish Medical Center, New Hyde Park, NY
Gisele Wolf-Klein, MD , Lorber Center for Advancement of Medical Education, New Hyde Park, NY
  
Background:

The rise of multi-resistant organisms has made nursing homes an obvious, but poorly recognized, battleground for sanitation. This multi-center study aims to analyze knowledge, attitudes, and practices, as well as barriers to effective hand hygiene.

Methods: Using CDC guidelines, a 52-question survey was developed and implemented to determine nursing home employees' knowledge, attitudes, and self-reported practices, as well as barriers to hand washing. Respondents were classified into three categories (nurses, certified nursing assistants [CNAs], and other professionals). Significant differences among groups were explored using chi-square and analysis of variance.

Results: There were 1,036 participants (31.1% nurses, 34.7% CNAs and 33.6% other professionals) from 15 nursing homes across 6 states. Only 31.2% reached top percentile (>89%) in the 19 knowledge questions section. With regards to the 7 attitude questions, all groups were similar, with 86.4% reporting that the CDC guidelines on hand hygiene were indeed relevant to nursing homes. However there were significant differences among the groups for hand hygiene practices. For example, nurses (61.7%) and CNAs (55.8%) were more likely to always wash their hands with soap when visibly dirty than others (44.9%) (p<.001). Interestingly, other professionals were less likely to receive periodic education by infection control than nurses and CNAs (69.2%, 79.0% and 80.8%, respectively, p<.001). They were also less likely to receive feedback than nurses and CNAs (16.9%, 33.7% and 44.1%, p<.001).

With regards to barriers, 85.1% reported at least one obstacle in implementing hand hygiene. Half (59.4%) reported not washing hands when they just went into patient's room to talk, 22.1 % when they wore gloves, 28.3% when the patient needed immediate medical attention, and 13.8% when patients didn't have serious medical problems. In addition, 33.7% recognized forgetting to wash hands when busy and many blamed absence of alcohol-based product (28.1%), soaps and towels (15.9%) or sinks nearby (16.9%). Overall, the groups were different in identifying barriers (p <.001). Nurses were more likely than CNAs to omit washing hands if they “just” spoke to patients (69.4% v. 46.0%, p<.001), to report lack of alcohol-based rub nearby (28.5% v. 14.0%, p<.001) and to forget washing hands when busy (33.2% v. 21.5%, p<.005).

Conclusions: These data demonstrate the positive attitude of health care professionals towards hand hygiene guidelines. However, practices vary significantly across job category. Quality improvement efforts geared toward hand hygiene education and minimizing identified barriers must be implemented to improve practices in long term care facilities.

Learning Objectives:
1. Recognize the impact of individual perceptions, professional education and practical limitations of health care settings on hand hygiene behavior. 2. Compare the knowledge, attitudes and self reported practices of Nursing Home Employees with regards to the CDC guidelines for Hand Hygiene. 3. Identify different barriers to hand hygiene in nursing homes that if minimized may lead to better practices. 4. Demonstrate the difference in perception of barriers to hand hygiene among various groups of employees. 5. Assess whether there is an association between infection control teams effort of providing education or personal feedback and self reported hand hygiene practices. 6. Discuss the importance of identifying the deficiencies in knowledge and self perceived barriers to hand hygiene in different group of employees as a significant initial step in quality improvement efforts.

Keywords: Nursing Homes, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principle investigator of this multi-center study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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