Prolonged length of stay is associated with reduced hand hygiene compliance in the emergency department: A single centre retrospective study

Emerg Med Australas. 2022 Oct 2. doi: 10.1111/1742-6723.14097. Online ahead of print.


Objective: To examine whether patient flow factors in the ED such as prolonged length of stay are associated with hand hygiene (HH) compliance.

Methods: We conducted a retrospective study at an urban district hospital utilising available data from January 2018 to December 2021. Compliance to the World Health Organization five moments of HH expressed as percentage of total moments observed were collated every 2 months. Patient flow measures including proportion of patients referred or discharged within 4 h (LOS4), proportion of patients with ED length of stay >24 h (LOS24) and total number of patient presentations, were obtained for each 2-month periods. The association between these patient flow measures and HH compliance was examined using Pearson's correlation (P < 0.05).

Results: The results showed a moderate and significant association between rates of HH compliance and LOS24 (r = -0.48, P = 0.025). That is, lower proportion of patients with ED length of stay >24 h was associated with improved HH compliance. There was no significant correlation between HH compliance and LOS4 (r = 0.38, P = 0.085) or total number of ED presentations (r = -0.30, P = 0.17).

Conclusions: The findings show that prolonged ED length of stay may explain, at least partly, lower rates of HH compliance. Improvements in ED HH compliance should also include strategies that enhance patient flow.

Keywords: access block; emergency medicine; hand hygiene; patient flow.