Hand hygiene is important in minimizing the risk of transmission of disease. At Sunnybrook Health Sciences Centre, we observe 4 moments for hand hygiene as outlined in the Ontario Just Clean Your Hands initiative in inpatient settings, achieving an overall hospital target of 87%. However, it is not well studied in ambulatory care settings. In an ambulatory care setting such as the Sunnybrook Academic Family Health Team, our auditors observed before and after contact with the patient (moments 1 and 4), and demonstrated a combined compliance of 95%. However direct observation of moment 2 (before aseptic procedures) and moment 3 (after body fluid exposure risk) was difficult due to availability and cost of trained auditors, physical layout restrictions, and respecting patient confidentiality. Ambulatory care presents a unique challenge in auditing all 4 moments of hand hygiene due to many reasons. We used a quality improvement lens to assess the feasibility of engaging patients as observers to investigate whether all 4 moments of hand hygiene could be assessed whether we were meeting our targets for hand hygiene compliance rates in an ambulatory care setting. This QI study was conducted over a three year time frame and consisted of 1691 hand hygiene opportunities observed by patients. The QI study demonstrated an overall hand hygiene compliance rate of 94-97% for all four moments of hand hygiene, maintaining the target of an overall compliance at 95%. Limitations to this study included the Hawthorne effect, convenience sampling and the use of volunteer resources. The results of this study suggest that involving the patient as the observer is a feasible and beneficial way to monitor hand hygiene compliance in an ambulatory care setting.
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