Video observation of hand hygiene practices during routine companion animal appointments and the effect of a poster intervention on hand hygiene compliance

Abstract

Background: Hand hygiene is considered one of the most important infection control measures in human healthcare settings, but there is little information available regarding hand hygiene frequency and technique used in veterinary clinics. The objectives of this study were to describe hand hygiene practices associated with routine appointments in companion animal clinics in Ontario, and the effectiveness of a poster campaign to improve hand hygiene compliance.

Results: Observation of hand hygiene practices was performed in 51 clinics for approximately 3 weeks each using 2 small wireless surveillance cameras: one in an exam room, and one in the most likely location for hand hygiene to be performed outside the exam room following an appointment. Data from 38 clinics were included in the final analysis, including 449 individuals, 1139 appointments before and after the poster intervention, and 10894 hand hygiene opportunities. Overall hand hygiene compliance was 14% (1473/10894), while before and after patient contact compliance was 3% (123/4377) and 26% (1145/4377), respectively. Soap and water was used for 87% (1182/1353) of observed hand hygiene attempts with a mean contact time of 4 s (median 2 s, range 1-49 s), while alcohol-based hand rub (ABHR) was used for 7% (98/1353) of attempts with a mean contact time of 8 s (median 7 s, range 1-30 s). The presence of the posters had no significant effect on compliance, although some staff reported that they felt the posters did increase their personal awareness of the need to perform hand hygiene, and the posters had some effect on product contact times.

Conclusions: Overall hand hygiene compliance in veterinary clinics in this study was low, and contact time with hand hygiene products was frequently below current recommendations. Use of ABHR was low despite its advantages over hand washing and availability in the majority of clinics. The poster campaign had a limited effect on its own, but could still be used as a component of a multimodal hand hygiene campaign. Improving the infection control culture in veterinary medicine would facilitate future campaigns and studies in this area, as well as overall patient and staff safety.

Figure 1

Hand hygiene opportunities and attempts observed during 2278 companion animal veterinary appointments. See Table  1 for list of procedures considered “clean” vs “dirty”. These data are presented in more detail in tabular format in Additional file 7.

Figure 2

Probabilities of hand hygiene compliance as per the final logistic regression model (n = 10894). Interactions indicate the effect of the variables listed on the y-axis (e.g. role: veterinarian, technician, other role) differed according to the interaction variable (e.g. room: backroom vs exam room).

Figure 3

Median hand hygiene product contact times as per the final linear regression model (n = 1330). Interactions indicate the effect of the variables listed on the y-axis (e.g. role: veterinarian, technician, other role) differed according to the interaction variable (e.g. presence of AHBR: no AHBR in clinic vs AHBR in clinic).

Figure 4

Self-perceived impacts¹ of a hand hygiene poster intervention on individual hand hygiene awareness and practices.¹Impact ranked on a scale of 1 (not at all) to 7 (very much). HH awareness = Posters increased awareness of need to perform hand hygiene and/or infection control in general (n = 270). HH frequency = Posters increased how often hand hygiene was performed (n = 271). HH technique = Posters increased how hand hygiene was performed (e.g. more thorough washing/rubbing) (n = 271).