Outpatient Clinic Staff Often Fail to Follow Hand Hygiene Recommendations

Overdoses Related to Heroin Tripled in Three-Year Period
Overdoses Related to Heroin Tripled in Three-Year Period
Staff did not follow any hand hygiene recommendations 37% of the time, or use safe injection practices 33% of the time.

Staff at outpatient care facilities failed to follow any recommendations for hand hygiene 37% of the time, according to data published in the American Journal of Infection Control.

Infection outbreaks in outpatient settings can be caused by lapses in infection prevention procedures. To investigate the overall infection prevention status in outpatient environments, researchers from the University of New Mexico and the New Mexico Health Department designed a cross-sectional study, in which medical students assessed infection prevention policies.

The study was conducted at 15 outpatient sites in New Mexico in 2014 during a medical student outpatient rotation. The medical students evaluated prevention policies using a standardized infection prevention checklist that was developed by the Centers for Disease Control and Prevention (CDC).

The checklist assessed administrative policies, education and training, reporting procedures, personal protection, hand hygiene, injection safety, and processing of reusable instruments and devices.

The students also conducted 163 injection procedure and 330 hand hygiene observations.

“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,” the authors of the study concluded. “The project findings identify areas for public health patient safety policy and prevention efforts.”

The recommended policies and practices for hand hygiene were present in 92.8% of the staff interviews across all 15 facilities. When the researchers observed the injection procedures, they found that the medication vial rubber septums were disinfected with alcohol 78.4% of the time before piercing (95% confidence interval [CI]: 71.1%-84.7%).

After the hand hygiene observations, the researchers noted that alcohol-based hand-rub was used in 33.9% of observations (95% CI: 28%-39.1%), soap and water was used 29.1% of the time (95% CI: 24.2%-34.0%), and in 37.0% of observations there was no use of hand hygiene (95% CI: 31.8%-42.2%).

Deborah Thompson, MD, MSPH, from the New Mexico Department of Health and one of the authors of the study, noted that health care providers should utilize the CDC’s One and Only Campaign, a public health initiative to eliminate unsafe medical injections.

“Outpatient healthcare providers should take action utilizing the CDC and One and Only Campaign infection prevention resources to ensure their practices are meeting the minimum expectations for safe care,” Dr Thompson told Infectious Disease Advisor. “This should be done both through review of policies and procedures, as well as by direct observation of hand hygiene and safe injection practices.”

Dr Thompson also highlighted the benefits of collaboration between public health, academic medicine, and community healthcare providers. “This project raised awareness of expectations for safe care in outpatient settings among medical students and community healthcare providers, while also providing a meaningful assessment of infection prevention policies and practices that could be used by the clinics themselves for quality improvement and used to target areas for public health interventions,” she stated.


1. Thompson D, Bowdey L, Brett M, Creek J. Using medical student observers of infection prevention hand hygiene, and injection safety in outpatient settings: A cross-sectional survey. Am J Infect Control. 2016; doi: 10.1016/j.ajic.2015.11.029.