Hand hygiene practices after brief encounters with patients: An important opportunity for prevention

OBJECTIVE. To identify characteristics of encounters between healthcare workers ( HCWs) and patients that correlated with hand hygiene adherence among HCWs. DESIGN. Observational study. SETTING. Intensive care unit in a Veterans Affairs hospital. PARTICIPANTS. HCWs. RESULTS. There were 767 patient encounters observed ( 48.6% involved nurses, 20.6% involved physicians, and 30.8% involved other HCWs); 39.8% of encounters involved patients placed under contact precautions. HCW contact with either the patient or surfaces in the patient's environment occurred during all encounters; direct patient contact occurred during 439 encounters ( 57.4%), and contact with environmental surfaces occurred during 710 encounters ( 92.6%). The median duration of encounters was 2 minutes ( range, ! 1 to 51 minutes); 33.6% of encounters lasted 1 minute or less, with no significant occupation- associated differences in the median duration of encounters. Adherence with hand hygiene practices was correlated with the duration of the encounter, with overall adherences of 30.0% after encounters of <= 1 minute, 43.4% after encounters of 11 to <= 2 minutes, 51.1% after encounters of >3 to <= 5 minutes, and 64.9% after encounters of >5 minutes (P<.001 by the chi(2) for trend). In multivariate analyses, longer encounter duration, contact precautions status, patient contact, and nursing occupation were independently associated with adherence to hand hygiene recommendations. CONCLUSIONS. In this study, adherence to hand hygiene practices was lowest after brief patient encounters ( ie, <2 minutes). Brief encounters accounted for a substantial proportion of all observed encounters, and opportunities for hand contamination occurred during all brief encounters. Therefore, improving adherence after brief encounters may have an important overall impact on the transmission of healthcare- associated pathogens and may deserve special emphasis in the design of programs to promote adherence to hand hygiene practices.