Hand Washing Frequency in an Emergency Department

Michelle R. Meengs, Beverly K. Giles, Carey D. Chisholm, William H. Cordell, David R. Nelson

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Study objective: Previous studies, conducted mainly in ICUs, have shown low compliance with hand-washing recommendations, with failure rates approaching 60%. Hand washing in the emergency department has not been studied. We examined the frequency and duration of hand washing in one ED and the effects of three variables: level of training, type of patient contact (clean, dirty, or gloved), and years of staff clinical experience. Design: Observational. Setting: ED of an 1,100-bed tertiary referral, central city, private teaching hospital. Participants: Emergency nurses, faculty, and resident physicians. Participants were informed that their activities were being monitored but were unaware of the exact nature of the study. Interventions: An observer recorded the number of patient contacts and activities for each participant during three-hour observation periods. Activities were categorized as either clean or dirty according to a scale devised by Fulkerson. The use of gloves was noted and hand-washing technique and duration were recorded. A hand-washing break in technique was defined as failure to wash hands after a patient contact and before proceeding to another patient or activity. Results: Eleven faculty, 11 resident physicians, and 13 emergency nurses were observed. Of 409 total contacts, 272 were clean, 46 were dirty, and 91 were gloved. Hand washing occurred after 32.3% of total contacts (SD, 2.31%). Nurses washed after 58.2% of 146 contacts (SD, 4.1%), residents after 18.6% of 129 contacts (SD, 3.4%), and faculty after 17.2% of 134 contacts (SD, 3.3%). Nurses had a significantly higher hand washing frequency than either faculty (P < .0001) or resident physicians (P < .0001). Hand washes occurred after 28.4% of 272 clean contacts (SD, 2.34%), which was significantly less (P < .0001) than 50.0% of 46 dirty contacts (SD, 7.4%) and 64.8% of 91 gloved contacts (SD, 5.0%). The number of years of clinical experience was not significantly related to hand-washing frequency (P = .82). Soap and water were used in 126 of the hand washes, and an alcohol preparation was used in the remaining six. The average duration of soap-and-water hand washes was 9.5 seconds. Conclusion: Compliance with hand washing recommendations was low in this ED. Nurses washed their hands significantly more often than either staff physicians or resident physicians, but the average hand-washing duration was less than recommended for all groups. Poor compliance in the ED may be due to the large number of patient contacts, simultaneous management of multiple patients, high illness acuity, and severe time constraints. Strategies for improving compliance with this fundamental method of infection control need to be explored because simple educational interventions have been unsuccessful in other health care settings. [Meengs MR, Giles BK, Chisholm CD, Cordell WH, Nelson DR: Hand-washing frequency in an emergency department. Ann Emerg Med June 1994;23:1307-1312.].

Original languageEnglish (US)
Pages (from-to)1307-1312
Number of pages6
JournalAnnals of Emergency Medicine
Volume23
Issue number6
DOIs
StatePublished - 1994
Externally publishedYes

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Hand Disinfection
Hospital Emergency Service
Hand
Nurses
Physicians
Soaps
Emergencies
Private Hospitals
Urbanization
Water
Infection Control
Teaching Hospitals
Referral and Consultation
Alcohols
Observation

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Meengs, M. R., Giles, B. K., Chisholm, C. D., Cordell, W. H., & Nelson, D. R. (1994). Hand Washing Frequency in an Emergency Department. Annals of Emergency Medicine, 23(6), 1307-1312. https://doi.org/10.1016/S0196-0644(94)70357-4

Hand Washing Frequency in an Emergency Department. / Meengs, Michelle R.; Giles, Beverly K.; Chisholm, Carey D.; Cordell, William H.; Nelson, David R.

In: Annals of Emergency Medicine, Vol. 23, No. 6, 1994, p. 1307-1312.

Research output: Contribution to journalArticle

Meengs, MR, Giles, BK, Chisholm, CD, Cordell, WH & Nelson, DR 1994, 'Hand Washing Frequency in an Emergency Department', Annals of Emergency Medicine, vol. 23, no. 6, pp. 1307-1312. https://doi.org/10.1016/S0196-0644(94)70357-4
Meengs MR, Giles BK, Chisholm CD, Cordell WH, Nelson DR. Hand Washing Frequency in an Emergency Department. Annals of Emergency Medicine. 1994;23(6):1307-1312. https://doi.org/10.1016/S0196-0644(94)70357-4
Meengs, Michelle R. ; Giles, Beverly K. ; Chisholm, Carey D. ; Cordell, William H. ; Nelson, David R. / Hand Washing Frequency in an Emergency Department. In: Annals of Emergency Medicine. 1994 ; Vol. 23, No. 6. pp. 1307-1312.
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abstract = "Study objective: Previous studies, conducted mainly in ICUs, have shown low compliance with hand-washing recommendations, with failure rates approaching 60{\%}. Hand washing in the emergency department has not been studied. We examined the frequency and duration of hand washing in one ED and the effects of three variables: level of training, type of patient contact (clean, dirty, or gloved), and years of staff clinical experience. Design: Observational. Setting: ED of an 1,100-bed tertiary referral, central city, private teaching hospital. Participants: Emergency nurses, faculty, and resident physicians. Participants were informed that their activities were being monitored but were unaware of the exact nature of the study. Interventions: An observer recorded the number of patient contacts and activities for each participant during three-hour observation periods. Activities were categorized as either clean or dirty according to a scale devised by Fulkerson. The use of gloves was noted and hand-washing technique and duration were recorded. A hand-washing break in technique was defined as failure to wash hands after a patient contact and before proceeding to another patient or activity. Results: Eleven faculty, 11 resident physicians, and 13 emergency nurses were observed. Of 409 total contacts, 272 were clean, 46 were dirty, and 91 were gloved. Hand washing occurred after 32.3{\%} of total contacts (SD, 2.31{\%}). Nurses washed after 58.2{\%} of 146 contacts (SD, 4.1{\%}), residents after 18.6{\%} of 129 contacts (SD, 3.4{\%}), and faculty after 17.2{\%} of 134 contacts (SD, 3.3{\%}). Nurses had a significantly higher hand washing frequency than either faculty (P < .0001) or resident physicians (P < .0001). Hand washes occurred after 28.4{\%} of 272 clean contacts (SD, 2.34{\%}), which was significantly less (P < .0001) than 50.0{\%} of 46 dirty contacts (SD, 7.4{\%}) and 64.8{\%} of 91 gloved contacts (SD, 5.0{\%}). The number of years of clinical experience was not significantly related to hand-washing frequency (P = .82). Soap and water were used in 126 of the hand washes, and an alcohol preparation was used in the remaining six. The average duration of soap-and-water hand washes was 9.5 seconds. Conclusion: Compliance with hand washing recommendations was low in this ED. Nurses washed their hands significantly more often than either staff physicians or resident physicians, but the average hand-washing duration was less than recommended for all groups. Poor compliance in the ED may be due to the large number of patient contacts, simultaneous management of multiple patients, high illness acuity, and severe time constraints. Strategies for improving compliance with this fundamental method of infection control need to be explored because simple educational interventions have been unsuccessful in other health care settings. [Meengs MR, Giles BK, Chisholm CD, Cordell WH, Nelson DR: Hand-washing frequency in an emergency department. Ann Emerg Med June 1994;23:1307-1312.].",
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N2 - Study objective: Previous studies, conducted mainly in ICUs, have shown low compliance with hand-washing recommendations, with failure rates approaching 60%. Hand washing in the emergency department has not been studied. We examined the frequency and duration of hand washing in one ED and the effects of three variables: level of training, type of patient contact (clean, dirty, or gloved), and years of staff clinical experience. Design: Observational. Setting: ED of an 1,100-bed tertiary referral, central city, private teaching hospital. Participants: Emergency nurses, faculty, and resident physicians. Participants were informed that their activities were being monitored but were unaware of the exact nature of the study. Interventions: An observer recorded the number of patient contacts and activities for each participant during three-hour observation periods. Activities were categorized as either clean or dirty according to a scale devised by Fulkerson. The use of gloves was noted and hand-washing technique and duration were recorded. A hand-washing break in technique was defined as failure to wash hands after a patient contact and before proceeding to another patient or activity. Results: Eleven faculty, 11 resident physicians, and 13 emergency nurses were observed. Of 409 total contacts, 272 were clean, 46 were dirty, and 91 were gloved. Hand washing occurred after 32.3% of total contacts (SD, 2.31%). Nurses washed after 58.2% of 146 contacts (SD, 4.1%), residents after 18.6% of 129 contacts (SD, 3.4%), and faculty after 17.2% of 134 contacts (SD, 3.3%). Nurses had a significantly higher hand washing frequency than either faculty (P < .0001) or resident physicians (P < .0001). Hand washes occurred after 28.4% of 272 clean contacts (SD, 2.34%), which was significantly less (P < .0001) than 50.0% of 46 dirty contacts (SD, 7.4%) and 64.8% of 91 gloved contacts (SD, 5.0%). The number of years of clinical experience was not significantly related to hand-washing frequency (P = .82). Soap and water were used in 126 of the hand washes, and an alcohol preparation was used in the remaining six. The average duration of soap-and-water hand washes was 9.5 seconds. Conclusion: Compliance with hand washing recommendations was low in this ED. Nurses washed their hands significantly more often than either staff physicians or resident physicians, but the average hand-washing duration was less than recommended for all groups. Poor compliance in the ED may be due to the large number of patient contacts, simultaneous management of multiple patients, high illness acuity, and severe time constraints. Strategies for improving compliance with this fundamental method of infection control need to be explored because simple educational interventions have been unsuccessful in other health care settings. [Meengs MR, Giles BK, Chisholm CD, Cordell WH, Nelson DR: Hand-washing frequency in an emergency department. Ann Emerg Med June 1994;23:1307-1312.].

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