Valerie Ness

In the patient zone: healthcare staff’s perceptions of the 5th moment

Funded by the Scottish Infection Research Network (SIRN)

Project management group: Robin Creelman, Lesley Price, Lisa Ritchie, Jackie McIntyre, Donald Bunyan, Jon Godwin, Stefan Morton and Jacqui Reilly

Background

• Hand hygiene – one of the most effective measures in reducing & preventing avoidable illness

• WHO’s “5 moments for hand hygiene”

• Compliance less for 5th moment

Research aim & questionsAim: To evaluate healthcare staff’s perceptions of the WHO hand hygiene moment 5 relative to compliance with this momentQuestions:1. Do healthcare staff comply with moment 5 in practice?2. Does compliance with moment 5 vary between professional

groups or in different contexts?3. What are healthcare staff’s perceptions of moment 5?4. Do healthcare staff’s perceptions of moment 5 vary across the

professional group?5. Is there an association between healthcare staff’s hand

hygiene behaviour and their perceptions of moment 5?

Mixed method design

• Focus groups• Development of self-report questionnaire• Purposive sample of healthcare staff from 3

Scottish Health Boards• Non-participant observation• Completion of self-report questionnaire

Clinical Area

  N/M/AHP/ ANC-O

N/M/AHP/ ANC-O

N/M/AHP/ANC-O

N/M/AHP/ ANC-O

N/M/AHP/ ANC-O

Participant number * Gr          

Event Talking to patients          

  Drug round          

  Ward round          

  Catering          

  Toileting          

  Transferring          

  Cleaning          

  Observations          

  Documentation          

  Other: please specify 

         

Setting Bed/Trolley/Chair          

  Bathroom          

  Dayroom          

  Treatment room          

  Sluice          

  Other: please specify 

         

Room Single          

  Shared          

‘Patient zone’ Locker          

  Bed rail          

  Bed/Trolley/Chair          

  Door handle          

  Curtains          

  Bed linen          

  Bed table          

  Equipment: please specify          

  Other: please specify 

         

Final action Use alcohol rub          

  Wash hands          

  No hand hygiene          

Next moment 1          

  2          

  3          

  4          

  5          

Data Collection – observation tool

Self-report questionnaireCould you answer the following questions in relation to:

“In the prevention of infection, the 5th moment for hand hygiene (after touching the patient’s surroundings) is…”

Clearly defined

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Not clearly defined

Unachievable

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Achievable

Essential

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Not essential

Too time consuming

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Not too time consuming

Encouraged

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Not encouraged

Not valuable

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Valuable

Not repetitive

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Repetitive

Not widely known

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Widely known

Data analysis

• SPSS• Mostly nonparametric tests • 1st stage: - distributions and frequencies• 2nd stage:

- Chi-squared tests/Fisher’s Exact test - Mann-Whitney U test/Krustal-Wallis/t-tests

Results

• 410/484 returned questionnaires (response rate 84%)• 404 could be matched to observation data• 93% either washed their hands, used alcohol gel or did

both at Moment 5• No significant differences across professionals regarding

compliance with Moment 5 (Heterogeneity χ²3=5.3, 1p=0.2)

• Significant differences in relation to compliance with Moment 5 across the health boards (χ²3 (2) =10.3, 1p=0.006)

Results – healthcare staff’s perceptions of the 5th moment

Overall positive• 77% essential• 71% clearly defined• 70% encouraged• 69% achievable• 65% widely known• 56% not too time-

consuming

Only negative• 60% repetitive

Results – Group differences in healthcare staff’s views

Significant difference between medical staff and ancillary staff, where medical staff felt it was “less essential” and “less encouraged” than ancillary staff

Professional

group

Statistic Defined Achievable Essential Time

consuming

Encouraged Valuable Repetitive Widely

known

Medical staff

mean 0.92 0.79 0.81 0.52 0.42 0.90   0.85

Ancillary/

other

mean 1.22 1.25 1.56 0.82 1.18 1.45 -1.07 1.07

t-test min.2p

  0.1 0.02 <0.001** 0.2 <0.001** 0.005 0.03 0.3

Results - relationship between staff perceptions & hand hygiene practice

Only significant variable was “widely known” –those who performed hand hygiene scored “widely known” higher than those who did not (p=<0.001)

Discussion

• 93% compliance with Moment 5 is still less than the 96% national compliance level for all hand hygiene opportunities

• Differences between health boards• Staff perceptions about being widely known• No significant differences in health professionals

compliance but differences in perceptions (encouraged, essential)

• Repetitive

Conclusion

• Although staff are positive about the 5th Moment & compliance is high, it is not optimum

• Increased staff awareness & understanding of Moment 5 may enhance compliance

Thank you. Any questions?