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Hand Hygiene: Infection Control/Exposure Control Issues for Oral Healthcare Workers

Géza T. Terézhalmy, DDS, MA; Michaell A. Huber, DDS

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The Institute for Healthcare Improvement in its How-to Guide:  Improving Hand Hygiene recommends a multidimensional approach (i.e., introduction of alcohol-based hand rub, and educational and behavioral initiatives) to improve compliance with hand hygiene guidelines in healthcare settings.41  The science supporting a multidimensional hand hygiene program (glove use is included in this strategy because proper glove use is inextricably linked to effective hand hygiene) is sufficiently established to be considered a standard and consist of four components (Table 5).  While these four components of best practices individually improve hand hygiene compliance, when applied together they are substantially more effective.

Table 5. Multidimensional approach to improve compliance with hand hygiene guidelines

Recently, a novel strategy of video surveillance of hand hygiene coupled with real-time compliance feedback has been reported.42  The study was conducted in a 17-bed intensive care unit.  Cameras were placed with views of every sink and hand sanitizer dispenser to record hand hygiene of HCW.  Sensors in the doorways identified when an individual entered/exited.  When video auditors observed a HCW performing hand hygiene upon entering/exiting, they assigned a pass; if not, a fail was assigned.

Hand hygiene was measured during a 16-week period without feedback and a 91-week period with feedback.  During a 16-week pre-feedback period, hand hygiene rates were less than 10%.  In the 16-week post-feedback period compliance improved to 81.6% and, subsequently, was maintained through 75 weeks at 87.9%.  While quality of hand hygiene and healthcare-associated infection data were not presented, this approach for improving to improve compliance merits consideration.

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