Despite policies in place to prevent infections, a study article published in the April 2016 edition of the American Journal of Infection Control (AJIC) reveals that staff at outpatient care facilities fail to follow recommendations for hand hygiene 37% of the time, and for safe injection practices 33% of the time.

Researchers from the University of New Mexico and the New Mexico Health Department conducted a cross-sectional study of 15 geographically-dispersed outpatient facilities in which medical students assessed infection prevention policies and practices during the summer of 2014. Medical student interviews with outpatient facility staff indicated that 93% of recommended policies were in place across the 15 facilities. However, when the students observed staff behavior, they noted only 63% compliance with recommended hand hygiene practices and 66% compliance with safe injection practices. In other words, in 37% of hand hygiene observations, no hand hygiene was performed.

The study authors observed that despite high levels of reported hand hygiene education and complete availability of hand hygiene supplies, healthcare workers consistently failed to follow proper handwashing and aseptic injection technique. “This project highlights the importance of assessing both the report of recommended infection prevention policies and practices, as well as behavior compliance through observational audits, which is critical because there have been outbreaks and infection transmission to patients reported in outpatient settings due to these types of infection prevention breaches, including transmission of hepatitis B and C,” the authors noted in their article.

For the study, medical students assessed prevention policies using an outpatient infection prevention checklist developed by the Centers for Disease Control and Prevention (CDC) that included 14 topic areas including administrative policies, education and training, occupational health, environment cleaning, hand hygiene, and injection safety. In addition to assessing policies via the checklist, the students evaluated injection safety and hand hygiene practices through direct observations.

Of the 163 injection safety observations, only 66% of the preparations complied with all of the recommended infection prevention steps, which included performing hand hygiene, disinfecting the rubber septum, using a new needle and syringe, properly discarding single-dose vials, and dating multi-dose vials upon opening. For additional information on the hand hygiene study, see the published article on the AJIC website.

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