Hand hygiene compliance falls off significantly toward end of a 12-hour shift, particularly if shift was intense.J Appl Psychol. 2014 Nov 3; [Epub ahead of print].
The impact of time at work and time off from work on rule compliance: the case of hand hygiene in health care.
Dai H, Milkman KL, Hofmann DA, Staats BR. J Appl Psychol. 2014 Nov 3; [Epub ahead of print].
This large observational study demonstrated that hand hygiene compliance rates decrease over the course of a normal work shift. During the first hour of work, average compliance rates were approximately 43%. This dropped to 35% for the last hour of a 12-hour shift. In addition, more intense work shifts were associated with even bigger hand hygiene compliance drop-offs. The authors extrapolate these results to estimate that this compliance decrement could produce an additional 600,000 infections per year in the United States, resulting in up to 35,000 unnecessary deaths and $12.5 billion in excess costs. More time off between shifts led to better compliance rates during a subsequent shift. In this sample, 65% of the caregivers were nurses, and only 4% were physicians. Longer nursing shifts have previously been linked to other patient safety hazards. A prior AHRQ WebM&M commentary discussed challenges related to nursing staffing.
Preventing Central Line–Associated Bloodstream Infections: a Global Challenge, a Global Perspective.
The Joint Commission. Oakbrook Terrace, IL: Joint Commission Resources; May 2012.
Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series.
Kirkland KB, Homa KA, Lasky RA, Ptak JA, Taylor EA, Splaine ME. BMJ Qual Saf. 2012;21:1019-1026.
Eliminating Catheter-Associated Urinary Tract Infections.
Chicago, IL: Health Research & Educational Trust; July 2013.
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Reducing methicillin-resistant Staphylococcus aureus (MRSA) infections.
Griffin FA. Jt Comm J Qual Patient Saf. 2007;33:726-731.