857 - Contact Precautions as a Barrier to Hand Hygiene: PDSA to Improve Compliance with Gloved Hand Hygiene

Background: Full compliance with personal protective equipment (PPE) is challenging, with multiple barriers noted: adherence to appropriate PPE, lack of knowledge of appropriate PPE, added time to workflow, and appropriate donning/doffing techniques of PPE to avoid self-contamination. Recent studies note that nurses tend to batch care to achieve more while in the room. A hand hygiene technology system alerted MRICU nurses to difficulties performing WHO’s Five Moments of hand hygiene (HH) when in contact precaution PPE.

Methods: We implemented the ‘Plan-Do-Study-Act’ (PDSA) framework to address the MRICU team concerns.  Six nurses were directly observed while providing bedside care to understand nursing workflow and barriers to HH while in contact precautions.

Results: : All 6 nurses performed hand hygiene prior to entering the room and at the time of exiting the room. Once donning contact precautions, they had variable but low compliance with any additional HH opportunities. The average missed opportunities per encounter was 5.2 (range: 2-11). Moments that would require hand washing or sanitizer if nurse were not gloved were not met with changing gloves. An average of 9.8 tasks were achieved in each room (range: 3-18). On average, each visit was 16 (range: 4-30 minutes) minutes long.

Conclusion: There is significant opportunity for improved HH while in PPE. Nurses may be more aware of the “Five moments” when not wearing gloves in contact precaution rooms, but lose the trigger once the gloves are on in the contact precaution rooms. An education campaign to improve hand sanitizer usage with gloves is the next step in this PDSA. More prominent placement of glove boxes in the rooms will also serve as a trigger to remind nurses to change gloves after certain tasks. Limitations of this PDSA cycle include Hawthorne effect of the nurses knowing they were observed and potentially changing their workflow. We also only observed morning workflow; nurses on different shifts may have different workflow.