Valerie Ness In the patient zone: healthcare staffs perceptions of the 5 th 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 WHOs 5 moments for hand hygiene Compliance less for 5th moment Research aim & questions Aim: To evaluate healthcare staffs perceptions of the WHO hand hygiene moment 5 relative to compliance with this moment Questions: 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 staffs perceptions of moment 5? 4. Do healthcare staffs perceptions of moment 5 vary across the

professional group? 5. Is there an association between healthcare staffs 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 Data Collection observation tool Clinical Area Participant number * Gr Event N/M/ AHP/ ANC-O 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 Patient zone Shared Locker Bed rail Bed/Trolley/Chair Door handle Curtains Bed linen

Bed table Equipment: please specify Other: please specify Final action Next moment Use alcohol rub Wash hands No hand hygiene 1 2 3 4 5 N/M/ AHP/ ANC-O N/M/ AHP/ANC-O N/M/ AHP/ ANC-O N/M/

AHP/ ANC-O Self-report questionnaire Could you answer the following questions in relation to: In the prevention of infection, the 5th moment for hand hygiene (after touching the patients surroundings) is Clearly defined [ ] [ ] [ ] [ ] [ ] Not clearly defined Unachievable [ ] [ ] [ ]

[ ] [ ] Achievable Essential [ ] [ ] [ ] [ ] [ ] Not essential Too time consuming [ ] [ ]

[ ] [ ] [ ] Not too time consuming Encouraged [ ] [ ] [ ] [ ] [ ] Not encouraged Not valuable [ ] [ ]

[ ] [ ] [ ] Valuable Not repetitive [ ] [ ] [ ] [ ] [ ] Repetitive Not widely known [ ]

[ ] [ ] [ ] [ ] Widely known Data analysis SPSS Mostly nonparametric tests 1st stage: - distributions and frequencies 2nd stage: - Chi-squared tests/Fishers 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 3=5.3, 1p=0.2) Significant differences in relation to compliance with

Moment 5 across the health boards (3 (2) =10.3, 1p=0.006) Results healthcare staffs perceptions of the 5th moment Overall positive 77% essential 71% clearly defined 70% encouraged 69% achievable 65% widely known 56% not too timeconsuming Only negative 60% repetitive Results Group differences in healthcare staffs views Significant difference between medical staff and ancillary staff, where medical staff felt it was less essential and less encouraged than ancillary staff Professional Statistic Defined Achievable

Essential group Medical staff Ancillary/ Time Encouraged Valuable Repetitive consuming Widely known mean 0.92 0.79

0.81 0.52 0.42 0.90 0.85 mean 1.22 1.25 1.56 0.82 1.18 1.45 -1.07

1.07 0.1 0.02 <0.001** 0.2 <0.001** 0.005 0.03 0.3 other t-test min.2p 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?

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