The Institute for Healthcare Improvement in its How-to Guide: Improving Hand Hygiene recommends a multidimensional approach (e.g., introduction of alcohol-based handrub, and educational and behavioral initiatives) to improve compliance with hand hygiene guidelines in healthcare settings.38 The science supporting a multidimensional approach to hand hygiene is sufficiently established to be considered the standard and consist of four components (Table 5).1,3,5,6
|1. HCP demonstrate knowledge||Predicated on educational exposure, HCP understand the rationale for hand hygiene:|
|2. HCP demonstrate competence||Predicated on exposure to live demonstrations, video-presentations, and/or fluorescent dye-based training methods, HCP perform appropriate hand hygiene:|
|3. Institution enables staff||Predicated on institutional commitment to good hand hygiene practices:|
|4. Institution verifies competency of HCP and provides feed back||Predicated on an established program to monitor that hand hygiene is performed and gloves are used appropriately by HCP as recommended by the CDC:|
A novel strategy of video surveillance of hand hygiene coupled with real-time compliance feedback has been reported.39 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 HCP. Sensors in the doorways identified when an individual entered/exited. Video auditors observed HCP performing hand hygiene upon entering and exiting a room and assigned a pass or fail grade.
Hand hygiene was measured during a 16-week period without feedback and a 91-week period with feedback. During the 16-week pre-feedback period, hand hygiene rates were less than 10%. In the first 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 HAI-data were not presented, this approach to improve compliance merits consideration.
The Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care published by the CDC in 2016 includes an Infection Prevention Checklist for Dental Settings: Basic Expectations for Safe Care.6 Section I.5 of the checklist relates to institutional hand hygiene policies and practices, while Section II.1 is an evaluation tool to monitor the compliance of oral HCP with hand hygiene practices that fulfill expectations for dental healthcare settings (Box A).
|Institutional Compliance with Policies and Practices and Direct-Observation-based Hand Hygiene-related Competency of Oral HCP|
Name of oral HCP evaluated
Name of observer
Date of observation
|Elements to be assessed||Compliance/Competency||Notes/areas for improvement|
|Supplies necessary for adherence to hand hygiene for routine dental procedures (e.g., soap, water, paper towels, alcohol-based hand rub) are readily accessible to oral HCP||□ Y □ N|
|If surgical procedures* are performed, appropriate supplies are available for surgical hand antisepsis (e.g., antimicrobial soap, alcohol-based hand scrub with persistent activity)||□ Y □ N|
|Oral HCP are trained regarding appropriate indications for hand hygiene including handwashing, hand antisepsis, and surgical hand antisepsis#||□ Y □ N|
|Appropriate hand hygiene# is performed correctly when hands are visibly soiled||□ Y □ N|
|Appropriate hand hygiene# is performed correctly after barehanded touching of instruments, equipment, materials and other objects likely to be contaminated by blood, saliva, or respiratory secretions||□ Y □ N|
|Appropriate hand hygiene# is performed correctly before and after treating each patient||□ Y □ N|
|Appropriate hand hygiene# is performed correctly before putting on gloves||□ Y □ N|
|Appropriate hand hygiene# is performed correctly immediately after removing gloves||□ Y □ N|
|Surgical hand antisepsis is performed correctly before putting on sterile surgeon’s gloves for all surgical procedures*||□ Y □ N|