Implementation of a quality improvement project using the patient as the observer to improve hand hygiene compliance in ambulatory care practices

Abstract

Background: Monitoring hand hygiene compliance in the ambulatory setting remains a challenge because a healthcare trained observer loses line of sight once the examination room door closes. This quality improvement project focused on the implementation of a hand hygiene compliance improvement programme that is amenable to the routines and work flows of the ambulatory setting.

Methods: After a review of the literature, nursing leadership and infection prevention implemented the 'patient as the observer' hand hygiene programme across 32 ambulatory practices.

Results: Patients completed 281,000 observations with an overall compliance rate of ≥90%. The average overall compliance rate by role was 91% for providers, 89% for nurses, and 91% for medical assistants/technicians/others. A 92% compliance average was noted 'before caring for you' and 89% 'after caring for you' for providers, 90% and 87% for nurses, and 92% and 89% for medical assistants/technicians/others.

Discussion: This study demonstrated that the implementation of a hand hygiene compliance improvement programme using the patient as the observer can be adopted successfully in the ambulatory setting.

Conclusion: Hand hygiene compliance can be monitored effectively in the ambulatory setting with the involvement of the patient as the observer.

Keywords: Ambulatory hand hygiene compliance; Hand hygiene practices; Patient as the observer method.