Valerie Ness
In the patient zone: healthcare staff’s perceptions of the 5th 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
• WHO’s “5 moments
for hand hygiene”
• Compliance less for 5th
moment
Research aim & questions
Aim:
To evaluate healthcare staff’s 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 staff’s perceptions of moment 5?
4. Do healthcare staff’s perceptions of moment 5 vary across the
professional group?
5. Is there an association between healthcare staff’s 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
N/M/
AHP/ ANC-O
Participant number * Gr
Event
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
Shared
‘Patient zone’
Locker
Bed rail
Bed/Trolley/Chair
Door handle
Curtains
Bed linen
Bed table
Equipment: please specify
Other: please specify
Final action
Use alcohol rub
Wash hands
No hand hygiene
Next moment
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 patient’s surroundings) is…”
Clearly defined
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Not clearly defined
Unachievable
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Achievable
Essential
[ ]
[ ]
[ ]
[ ]
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Not essential
Too time consuming
[ ]
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Not too time consuming
Encouraged
[ ]
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Not encouraged
Not valuable
[ ]
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Valuable
Not repetitive
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Repetitive
Not widely known
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Widely known
Data analysis
• SPSS
• Mostly nonparametric tests
• 1st stage:
- distributions and frequencies
• 2nd stage:
- Chi-squared tests/Fisher’s 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 χ²3=5.3, 1p=0.2)
• Significant differences in relation to compliance with
Moment 5 across the health boards (χ²3 (2) =10.3,
1p=0.006)
Results – healthcare staff’s 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
staff’s 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?