Hand Hygiene and Face Touching in Family Medicine Offices
Hand Hygiene and Face Touching in Family Medicine Offices
The CARInG Network is a regional primary care PBRN with 21 member practices. All practices were invited, and 7 chose to participate in this study. This study was approved by the University of Cincinnati Institutional Review Board.
Within each practice, each clinician (physician and nurse practitioner) and staff member who had contact with patients as part of their job (front office, medical assistants [MAs]), nurses, behavioral counselors, supervisors) could elect to participate in the study. To limit the likelihood that participants would change behaviors during the observation period, participants were told only that the study's purpose was to "describe family physicians' and staff's observed behaviors during their routine medical office work that might impact infection." Hand hygiene and touching the T-zone were never specifically mentioned to the participants.
Observations. Each participant was observed for a 2-hour period while performing their usual duties. During that time, the observer noted how many times the participant touched their eyes, nose, and/or mouth with their hands. In addition, each time the participant cleansed their hands, observers noted details about each component of an "ideal" cleansing. For alcohol-based cleanser this entailed rubbing the hands together until the product covered all surfaces of the hands and waiting for product to dry completely. For hand washing, this entailed (1) wetting hands, (2) covering all surfaces of hands with soap/water, (3) rubbing the hands together for a minimum of 10 seconds, (4) drying hands with a disposable towel, and (5) using the towel to turn off the water or using an automatic faucet. Observers followed participants into the examination rooms with patients, but if the observers were asked not to follow a participant to an activity, the observer noted that pause and added additional time to the observation period. Three observers were trained by the study investigators (NCE, WS) and they practiced in a nonparticipating office until their observations of the key components described above were identical.
Surveys. After all observations were completed in an office, clinicians and staff completed a 2-page survey about personal behaviors and recommendations given to patients to prevent URTIs. Questions for the survey were taken from both the medical literature as well as common activities in family medicine practice. There were 12 activities and recommendations presented to participants, 8 of which have been recommended by the Centers for Disease Control and Prevention (CDC) or are supported by the literature. A draft survey was pilot tested with staff and clinicians who were not involved in the study and was revised for clarity.
The observation and the survey data were analyzed using SPSS software versions 19 and 20 (IBM, Chicago, IL). Touching the T-zone and quality of hand cleansing was determined for each participant, and we used t tests and one-way analyses of variance to compare results by professional role and practice experience. We defined a subset of clinicians and staff who demonstrated less T-zone touching and better hand hygiene; these participants touched their T-zone less than the median number of touches for the entire group and rubbed their hands 10 seconds or more each time they washed with soap or used an alcohol-based cleanser correctly every time. χ Tests were used to assess differences in personal and recommended URTI prevention activities by observed behaviors. Because of the large number of individual survey items analyzed, we adjusted the P value for significance to .002 using Bonferroni's correction.
Methods
The CARInG Network is a regional primary care PBRN with 21 member practices. All practices were invited, and 7 chose to participate in this study. This study was approved by the University of Cincinnati Institutional Review Board.
Participants
Within each practice, each clinician (physician and nurse practitioner) and staff member who had contact with patients as part of their job (front office, medical assistants [MAs]), nurses, behavioral counselors, supervisors) could elect to participate in the study. To limit the likelihood that participants would change behaviors during the observation period, participants were told only that the study's purpose was to "describe family physicians' and staff's observed behaviors during their routine medical office work that might impact infection." Hand hygiene and touching the T-zone were never specifically mentioned to the participants.
Data Collection
Observations. Each participant was observed for a 2-hour period while performing their usual duties. During that time, the observer noted how many times the participant touched their eyes, nose, and/or mouth with their hands. In addition, each time the participant cleansed their hands, observers noted details about each component of an "ideal" cleansing. For alcohol-based cleanser this entailed rubbing the hands together until the product covered all surfaces of the hands and waiting for product to dry completely. For hand washing, this entailed (1) wetting hands, (2) covering all surfaces of hands with soap/water, (3) rubbing the hands together for a minimum of 10 seconds, (4) drying hands with a disposable towel, and (5) using the towel to turn off the water or using an automatic faucet. Observers followed participants into the examination rooms with patients, but if the observers were asked not to follow a participant to an activity, the observer noted that pause and added additional time to the observation period. Three observers were trained by the study investigators (NCE, WS) and they practiced in a nonparticipating office until their observations of the key components described above were identical.
Surveys. After all observations were completed in an office, clinicians and staff completed a 2-page survey about personal behaviors and recommendations given to patients to prevent URTIs. Questions for the survey were taken from both the medical literature as well as common activities in family medicine practice. There were 12 activities and recommendations presented to participants, 8 of which have been recommended by the Centers for Disease Control and Prevention (CDC) or are supported by the literature. A draft survey was pilot tested with staff and clinicians who were not involved in the study and was revised for clarity.
Data Analysis
The observation and the survey data were analyzed using SPSS software versions 19 and 20 (IBM, Chicago, IL). Touching the T-zone and quality of hand cleansing was determined for each participant, and we used t tests and one-way analyses of variance to compare results by professional role and practice experience. We defined a subset of clinicians and staff who demonstrated less T-zone touching and better hand hygiene; these participants touched their T-zone less than the median number of touches for the entire group and rubbed their hands 10 seconds or more each time they washed with soap or used an alcohol-based cleanser correctly every time. χ Tests were used to assess differences in personal and recommended URTI prevention activities by observed behaviors. Because of the large number of individual survey items analyzed, we adjusted the P value for significance to .002 using Bonferroni's correction.
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