Observation of Hand Hygiene Practices in Home Health Care.
Margaret V McDonald, Carlin Brickner, David Russell and 9 others
PMID 32943340WHAT IT FOUND
Home health nurses performed hand hygiene during 45.6% of observed opportunities.
Adherence was lowest after touching patients and highest after removing gloves with body fluid contact. Dirty homes and higher infection risk were linked to more chances, not better hand hygiene.
Key findings
01Across 400 visits, adjusted hand hygiene adherence was 45.6%.
02Adherence was 65.1% after removing gloves when the procedure included body fluid contact and 29.5% after touching a patient.
03Dirty environment and higher predicted infection risk were associated with more hand hygiene opportunities, but not with higher adjusted adherence.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single agency and 50 volunteer nurses, so results may not apply to other home health settings. Nurses knew infection control was being studied, though not that hand hygiene was the specific focus, so practice may have been better than usual. The study measured hand hygiene opportunities and adherence, not infections or patient outcomes. Eight patients lacked clinical record data, so infection-risk values were imputed for those cases. Associations with dirty homes and infection risk do not show those conditions caused more opportunities or that more opportunities were needed. Adherence estimates had wide confidence intervals and nurse-to-nurse variability, especially for arrival and leaving moments.
Declared interests
The supplied text does not report author disclosures or funding; the publication types note research support from the U.S. government, Public Health Service.
The easy way to misread this
Do not read the 45.6% adherence rate as proof that home health nursing caused infections or that hand hygiene training would reduce them. The study counted observed opportunities and adherence, not infection outcomes.