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Currently submitted to: JMIR Nursing

Date Submitted: Mar 18, 2020
Open Peer Review Period: Mar 18, 2020 - May 13, 2020
(currently open for review)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Mixed-Methods Approach to Assess Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting

  • Hammad Akram; 
  • Alison Andrews-Paul; 
  • Rachel Washburn; 



Hand hygiene and low-level disinfection (LLD) of equipment behaviors among hospital staff are some of the leading cost-effective methods in reducing hospital-acquired infections (HAI) among patients


To examine hygiene and low-level disinfection practices in a central Texas hospital and exploring pertaining gaps, perceptions, and challenges


Data were collected using multipronged mixed-methods approaches 1) observation of hand hygiene and LLD practices (12 & 8 units during morning & evening shifts respectively 2) usability/placement of hand sanitizer dispensers 3) semi-structured interviews 4) follow-up email survey.


6 units (50%) in the morning and 2 (25%) during evening shifts had ≥0.80 hand hygiene compliance. Aggregated LLD compliance during the morning was 0.54 and evening 0.33. overall, the odds of non-compliant hand hygiene behavior were 1.4 times higher among staff who worked during night shifts compared to day shifts; however, this relationship was not statistically significant (P=0.456). All units (except one) had similar hand sanitizer dispenser usability characteristics. In the qualitative part, some identified challenges were: “shortage of time while seeing patients”, “some time staff forgets”, “concern about drying hands”, “behavior is difficult or require reminders”, “there may be issues with resources or access to supplies to perform these behaviors”. Staff also stated that “a process that is considered effective is the Stop the Line program”, and “behavior is easy and automatic”.


Hand hygiene and LLD compliance is dependent on several personal and non-personal factors. The issues such as time constraints, peer pressure, work culture, available resources, understanding of guidelines could be connected with the staff behavior. The information collected through the present study can be used to reexamine similar or related issues at a larger scale. Clinical Trial: NA


Please cite as:

Akram H, Andrews-Paul A, Washburn R

Mixed-Methods Approach to Assess Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting

JMIR Preprints. 18/03/2020:18788

DOI: 10.2196/preprints.18788


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