142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Early Adoption of Hand Hygiene Prevention Interventions in US Emergency Departments: A Qualitative Study

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Leslie Mandel, PhD, MA, MSM , Department of Nursing, Science and Health Professions, Regis College, Weston, MA
Corine Sinette, MA, MPH , Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
Eileen Carter, BSN, RN, PhDc , School of Nursing, Columbia University, New York, NY
Jeremiah Schuur, MD, MHS , Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA
Emergency Departments (ED) often function as the gateway to patient care before hospital admission. High throughput, crowding, built environment and variable patient conditions make EDs ideal settings for transmission of healthcare-associated infections (HAIs.) Hand hygiene (HH) to avert pathogen transmission is critical to HAI prevention efforts. Still, few US EDs address HAI prevention through comprehensive HH programs, and little is known about high performing HH programs in EDs.

We conducted a qualitative study of HH improvement programs in U.S. EDs enrolling high-performers, defined as those with active HH improvement projects, regular HH data collection, and sustained HH compliance of 80% or better. Sampling was informed by: results of a prior nationwide survey of EDs reporting HAI prevention activities (N=400 with 56% participating in HH programs), outreach to national Infection-prevention and ED associations, and snowball sampling.

Eighty-five interviews and 23 focus groups were conducted with administrators and front-line staff (N=~200) from 9 US EDs (56% urban, 44% suburban) selected to identify specific strategies and challenges to HH interventions. With even geographic distribution, sites were 2/3 adult, 1/3 pediatric EDs, and 40% in safety-net hospitals. ED size varied with (55%) serving >50,000 patients annually and the remainder equally divided between moderate-small EDs. More than half described efforts to address other HAIs. Data were thematically coded with NVIVO9.

EDs can successfully adopt, implement, and sustain HH prevention programs with systematic oversight via covert/overt observation, transparent data dissemination, real-time feedback, and project champion involvement. Challenges include physical space/design, message over-saturation and inconsistent staff compliance. Local adaptations can be made to accommodate concerns. Techniques of high-performing EDs offer a model for others. Facilitating broader ED adoption of HH programs will be discussed.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Planning of health education strategies, interventions, and programs

Learning Objectives:
Explain the need to target emergency departments in efforts to reduce Healthcare-Acquired Infections. Describe the use of qualitative methods to capture details of healthcare-acquired infection prevention practices in U.S. Emergency Departments, focusing on hand hygiene Identify and compare strategies and challenges to implementation and sustainability of Hand Hygiene Initiatives among early adopters in U.S. Emergency Departments Discuss opportunities to utilize best practices to facilitate broader adoption of comprehensive Hand Hygiene programs in US Emergency Departments Demonstrate ways in which healthcare administrators and infection-prevention professionals can use qualitative methods to explore organizational factors and address quality improvement issues pertaining to healthcare-acquired infections.

Keyword(s): Emergency Medical Services, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have an extensive background with designing, conducting, analyzing, and teaching qualitative research. I am an experienced researcher and evaluator of health and public health programs. I am a co-investigator on the study being presented. I was an active participant in both the qualitative data collection and analysis phases of the project described in the abstract. Finally, I am a long-standing APHA member and have previously reviewed abstracts and presented data at APHA annual meetings.
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.