Study reports that hand-hygiene compliance at outpatient clinics needs improvement

Despite having policies in place to prevent infections, staff observed at several outpatient care facilities in one state failed to follow hand-hygiene policies 37 percent of the time, a rate still higher than for all health care workers.

Researchers from the University of New Mexico and the New Mexico Health Department conducted a cross-sectional study of 15 outpatient facilities in the same state. Medical students assessed hand-hygiene practices of physicians and other clinical staff during the summer of 2014.

Medical student interviews with outpatient facility staff indicated that 93 percent of policies recommended by the Centers for Disease Control and Prevention (CDC) were in place across the 15 New Mexico facilities in the study.

Students observed 63 percent compliance with recommended hand-hygiene practices and 66 percent compliance with safe-injection practices. In 37 percent of hand-hygiene observations, workers failed to comply with hand-washing policies.

“Although not 100 percent, hand hygiene rates in our outpatient facilities surpass average hand-washing rates overall,” says James Cheek, M.D., MPH, a lead author of the study who teaches in the public health program at the University of New Mexico School of Medicine.

The average hand-washing rates for all U.S. health care workers is generally below 50 percent, according to a 2006 report by the Institute for Healthcare Improvement called “How-to Guide: Improving Hand Hygiene.” Research by other national organizations has put the compliance rate at 40 percent and lower.

The outpatient facility findings were reported in the April issue of the American Journal of Infection Control, the publication of the Association for Professionals in Infection Control and Epidemiology.

Medical students assessed prevention policies at each facility using an outpatient infection prevention checklist developed by the CDC. 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 practice.

Of the 163 injection-safety observations, 66 percent of the preparations complied with all of the recommended steps. During the 330 hand-hygiene observations, students reported that proper cleaning supplies were always available.