Who Goes in and Out of the Hospital Patient Room?

Abstract

BACKGROUND: The objective of this study was to determine what percentage of entries and exits (E/E) in and out of the patient room should be attributed to healthcare workers (HCWs) in a wide variety of hospital units. This is a critical question for hospitals considering an automated monitoring system (AMS) to measure hand hygiene performance (HHP) as a complement to data from visual observation. HCWs often implicate others and do not perceive a need to change their HH behavior because they are convinced that visitors, patients, and others are responsible for very low HHP data.

METHODS: Events (defined as patient room E/E) were observed and recorded by nurses not employed by the hospital. Observations were made in US and Canadian hospital units including emergency, ICU, medical surgical, oncology, and pediatrics. Observers classified events by: HCWs (e.g., nursing staff, aides, doctors, EVS, etc.), patients plus visitors, and other (e.g., clergy, hospice workers). Logistic regression was used to determine who was responsible for the most E/E events by category of individuals.

RESULTS: Observers recorded a total of 14,876 E/E events in 29 units of 16 hospitals with units varying in size from 10 to 41 beds. 84.3% of all E/E were attributed to HCWs; 15.0% were from patients plus visitors and 0.7% from others. The odds are 6 to 1 that an E/E into a patient room is by a HCW (P < .0005). Pediatric units had the lowest percentage of HCWs E/E (76.7% total)

CONCLUSIONS: This study demonstrates HCWs account for the greatest proportion of hospitalized patient room E/E. Further, the data show that others share a very small percentage of room E/E countering the argument that those individuals are responsible for the low unit HHP measured by AMS. This study demonstrates that other categories of individuals are not a deterrent to increasing unit-level HHP.