Ensuring the use of Best Practices for Hand Hygiene in an Athletic Training Healthcare System

Document Type

Poster

Abstract

Context: While hand hygiene is an expectation in healthcare, adherence to best-practice guidelines by the Centers for Disease Control (CDC) and World Health Organization (WHO) related to the specifics of the handwashing process is a long-standing concern, heightened by the COVID-19 pandemic. Inconsistencies in handwashing practices in a local healthcare system were identified as a quality problem. Improving ATs’ adherence to handwashing guidelines would facilitate a safer medical facility for patients by reducing the spread of unwanted pathogens. The purpose of this quality improvement (QI) project was to increase athletic trainers’ (ATs) handwashing adherence to 5 key CDC/WHO best-practice recommendations by 15% over a 6-week time period in a local athletic training healthcare system. Methods: The QI project took place in a Division-I University with 350 student-athletes cared for by 10 athletic trainers, who work across 2 athletic training clinics. We used the Model for Improvement which included generating a Fishbone diagram and process map to identify areas contributing to handwashing inconsistencies (ie, lack of awareness of best-practices, short-cuts for handwashing duration) and to identify opportunities for improvement. The week prior to the start of interventions, a baseline assessment of self-reported handwashing practices was made by all participating ATs to reflect how well they perceive they adhere to 5 key CDC/WHO recommendations: 20-second washing duration, appropriate soap usage, all surface/crease/nail coverage, full rinsing, and full drying. AT ratings for these 5 questions were completed on an online form and reported on a scale of 0 (not done) to 100 (done exceptionally well). Three Plan-Do-Study-Act (PDSA) cycles were run, 2 cycles with interventions (2-weeks each) and 1 cycle without intervention (1-week). PDSA cycle 1 targeted improving awareness of handwashing best-practices through posting an informative flier of the CDC/WHO handwashing guidelines near handwashing stations. PDSA cycle 2 targeted improving adherence to the 20-second handwashing recommendation through placement of timers next to handwashing stations. PDSA cycle 3 removed handwashing resources. Athletic trainers self-reported their adherence to the 5 handwashing best-practices 2 times per week using the online form during all PDSA cycles. Data were calculated for mean percent adherence for each of the 5 best-practice recommendations at each assessment time point and percent relative improvement from the first (baseline) to last (PDSA cycle 3) assessment time points, calculated as ([end-PDSA3%-baseline%]/baseline%)*100. Data are presented as: baseline%, end-PDSA1%, end-PDSA2%, end-PDSA3%; relative improvement%. Results: 7 of 10 (70.0%) ATs (age=29.4±6.7 years; years AT experience=6.9±6.3) participated in all 6 weeks of the project. Adherence with handwashing best-practices increased across all self-reported variables over all PDSA cycles, including 20 second washing duration (baseline: 55.9%, end-PDSA1: 78.4%, end-PDSA2: 91.8%; end-PDSA3: 94.0%; relative improvement=68.2%) using an appropriate amount of soap (baseline: 79.3%, end-PDSA1: 89.4%, end-PDSA2: 94.9%, end-PDSA3: 96.9%; relative improvement=22.2%), thoroughness of hand-washing (baseline: 70.9%, end-PDSA1: 85.6%, end-PDSA2: 92.9%, end-PDSA3: 95.9%; relative improvement=35.3%), fully rinsing (baseline: 86.7%, end-PDSA1: 89.6%, end-PDSA2: 93.6%, end-PDSA3: 96.3%; relative improvement=11.1%), and fully drying (baseline: 75.8%, end-PDSA1: 88.2%, end-PDSA2: 96.0%, end-PDSA3: 97.3%; relative improvement=28.4%). Changes from baseline to PDSA cycle 3 and relative improvement exceeded the 15% goal for all handwashing best-practices, except for fully rinsing (9.6% and 11.1%, respectively). Conclusions: This 6-week QI initiative successfully increased self-reported adherence to CDC/WHO handwashing best-practice recommendations in a local healthcare system, with over 94% adherence across recommendations at the end of the project. The largest improvement (38.1%) was noticed with adherence to the 20-second washing duration recommendation which is meaningful given that it is often shortened in practice. Using signage and support aids, such as a timer, to increase awareness were effective strategies for improving attention to handwashing best-practices that might be useful in other athletic healthcare systems.

Publication Date

Fall 2022

Comments

Poster presented at ATSU-ASHS DAT Fall - 2022. This is a Kubify based presentation hosted at https://api.ltb.io/show/ABQRN It includes a video presentation, references, a PowerPoint presentation, and summary poster.

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