Handwashing gets skipped a third of the time in outpatient healthcare

Researchers from the University of New Mexico and the New Mexico Health Department conducted a cross-sectional study of 15 geographically-dispersed outpatient facilities in which medical students assessed infection prevention policies and practices during the summer of 2014. Medical student interviews with outpatient facility staff indicated that 93 percent of recommended policies were in place across the 15 facilities. However, when the students observed behaviors, they noted only 63 percent compliance with recommended hand hygiene practices and 66 percent compliance with safe injection practices. In 37 percent of hand hygiene observations, no hand hygiene was performed.

"Despite high levels of report of hand hygiene education and observed supply availability, observations of hand hygiene and aseptic injection technique showed lack of similarly high behavior compliance," the study authors commented. "This project highlights the importance of assessing both the report of recommended infection prevention policies and practices, as well as behavior compliance through observational audits. This is critical because there have been outbreaks and infection transmission to patients reported in outpatient settings due to these types of infection prevention breaches, including transmission of hepatitis B and C."

Medical students assessed prevention policies using an outpatient infection prevention checklist developed by the Centers for Disease Control and Prevention (CDC) that included 14 topic areas including administrative policies, education and training, occupational health, environment cleaning, hand hygiene, and injection safety. In addition to assessing policies via the checklist, the students evaluated injection safety and hand hygiene practices through direct observations. Each student was asked to observe 10 injections and 20 hand hygiene opportunities at their assigned outpatient practice.

Of the 163 injection safety observations, only 66 percent of the preparations complied with all of the recommended infection prevention steps, which included performing hand hygiene, disinfecting the rubber septum, using a new needle and syringe, properly discarding single-dose vials, and dating multi-dose vials upon opening. During the 330 hand hygiene observations, students reported that hand hygiene supplies were available 100 percent of the time.

"These findings highlight the need for ongoing quality improvement initiatives regarding infection prevention policies and practices in outpatient settings," conclude the authors.