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WHO 'My five moments for hand hygiene' in anaesthesia induction: a video-based analysis reveals novel system challenges and design opportunities


Schmutz, Jan B; Grande, Bastian; Sax, Hugo (2023). WHO 'My five moments for hand hygiene' in anaesthesia induction: a video-based analysis reveals novel system challenges and design opportunities. Journal of Hospital Infection, 135:163-170.

Abstract

BACKGROUND: Anaesthesia induction is a fast-paced, complex activity that involves a high density of hand-to-surface exposures. Hand hygiene (HH) adherence has been reported to be low, which bears the potential for unnoticed pathogen transmission between consecutive patients.

AIM: To study the fit of the World Health Organization's (WHO) five moments of HH concept to the anaesthesia induction workflow.

METHODS: Video recordings of 59 anaesthesia inductions were analysed according to the WHO HH observation method considering each hand-to-surface exposure of every involved anaesthesia provider. Binary logistic regression was used to determine risk factors for non-adherence, i.e. professional category, gender, task role, gloves, holding of objects, team size and HH moment. Additionally, half of all videos were recoded for quantitative and qualitative analysis of provider self-touching.

FINDINGS: Overall, 2240 HH opportunities were met by 105 HH actions (4.7%). The drug administrator role (odds ratio (OR): 2.2), the senior physician status (OR: 2.1), donning (OR: 2.6) and doffing (OR: 3.6) of gloves were associated with higher HH adherence. Notably, 47.2% of all HH opportunities were caused by self-touching behaviour. Provider clothes, face, and patient skin were the most frequently touched surfaces.

CONCLUSION: The high density of hand-to-surface exposures, a high cognitive load, prolonged glove use, carried mobile objects, self-touching, and personal behaviour patterns were potential causes for non-adherence. A purpose-designed HH concept based on these results, involving the introduction of designated objects and provider clothes to the patient zone, could improve HH adherence and microbiological safety.

Abstract

BACKGROUND: Anaesthesia induction is a fast-paced, complex activity that involves a high density of hand-to-surface exposures. Hand hygiene (HH) adherence has been reported to be low, which bears the potential for unnoticed pathogen transmission between consecutive patients.

AIM: To study the fit of the World Health Organization's (WHO) five moments of HH concept to the anaesthesia induction workflow.

METHODS: Video recordings of 59 anaesthesia inductions were analysed according to the WHO HH observation method considering each hand-to-surface exposure of every involved anaesthesia provider. Binary logistic regression was used to determine risk factors for non-adherence, i.e. professional category, gender, task role, gloves, holding of objects, team size and HH moment. Additionally, half of all videos were recoded for quantitative and qualitative analysis of provider self-touching.

FINDINGS: Overall, 2240 HH opportunities were met by 105 HH actions (4.7%). The drug administrator role (odds ratio (OR): 2.2), the senior physician status (OR: 2.1), donning (OR: 2.6) and doffing (OR: 3.6) of gloves were associated with higher HH adherence. Notably, 47.2% of all HH opportunities were caused by self-touching behaviour. Provider clothes, face, and patient skin were the most frequently touched surfaces.

CONCLUSION: The high density of hand-to-surface exposures, a high cognitive load, prolonged glove use, carried mobile objects, self-touching, and personal behaviour patterns were potential causes for non-adherence. A purpose-designed HH concept based on these results, involving the introduction of designated objects and provider clothes to the patient zone, could improve HH adherence and microbiological safety.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:06 Faculty of Arts > Institute of Psychology
04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
Dewey Decimal Classification:150 Psychology
Scopus Subject Areas:Health Sciences > Microbiology (medical)
Health Sciences > Infectious Diseases
Language:Italian
Date:1 May 2023
Deposited On:10 May 2023 08:33
Last Modified:29 Jun 2024 01:36
Publisher:Elsevier
ISSN:0195-6701
OA Status:Hybrid
Publisher DOI:https://doi.org/10.1016/j.jhin.2023.03.002
PubMed ID:36907335
Project Information:
  • : FunderSNSF
  • : Grant ID177695
  • : Project TitleDon’t Crack Under Pressure: Team Reflexivity as a Means to Enhance Team Functioning and Performance in Extreme Situations
  • : FunderSNSF
  • : Grant ID203374
  • : Project TitleTeamwork Under Pressure: Effective Team Processes During Extreme Events
  • Content: Published Version
  • Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)