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Sterilization & Infection Prevention
Perioperative Hand Hygiene PDSA Cycle Diagram
Assess for impact
with each cycle
of intervention
for HHC.
Act
Compile monthly
compliance rate
and provide
feedback through
dashboards and
staff meetings.
Plan
Trained Independent
Auditors to monitor
Hand Hygiene
Compliance (HHC)
using WHO 5 moments
of Hand
Hygiene.
emphasized, ensuring buy-in from
all team members.
* Visual cues
» Strategically placed reminders,
such as posters and emojis, near
hand sanitizer stations, were introduced
»
" Intimidating " visual aids were replaced
with non-threatening symbols
based on staff feedback.
* Accessibility
» Additional hand sanitizer stations
were installed in high-traffic areas
Study
Do
Introduce a series
of interventions,
one per cycle but
cumulatively. Collect
weekly compliance data
and assess for impact of
interventions.
» Sanitizers were positioned at eye
level to encourage usage and reduce
workflow interruptions.
expose staff to blood, bodily fluids, or
other contaminants. In the OR, such
exposure can occur during tasks like
suctioning, assisting with Foley catheter
insertion, or disposing of biohazard
materials. This moment is especially
relevant for circulating nurses and OR
assistants, who are often responsible
for handling instruments or waste materials
that could be contaminated. Noncompliance
at this juncture increases
the risk of spreading contaminants to
other surfaces or team members.
❹ After exiting the OR
Hand hygiene after exiting the OR helps
perioperative personnel ensure they do
not carry contaminants into other areas
of the hospital. For example, when a circulating
nurse steps out to retrieve supplies
or provide updates to family members,
they must sanitize their hands to
prevent cross-contamination.
❺ After contact with patient
surroundings
Hand hygiene is still needed even when
there is no direct patient contact. This
moment applies to touching inanimate
objects in the patient's vicinity, such
26
OR Manager | Mar/Apr 2025
as surgical tables, equipment, or door
handles. In the OR, this often involves
interactions with monitoring devices,
IV pumps, or non-sterile surgical instruments.
While this step is well-defined
in other healthcare settings, its application
in the OR has been less straightforward
due to the complex workflows
and the constant presence of inanimate
objects.
During the initial phase of this HHC
project, the above five moments were
clarified and reinforced to ensure all
non-scrubbed personnel understood
their importance. Then through education,
visual cues, and increased sanitizer
accessibility, compliance at each
of the five moments significantly improved.
In
a nutshell, the multipronged strategy
entailed:
* Education
» Training sessions highlighted the
importance of HHC and the risks
associated with non-compliance
» The WHO's Five Moments were
clarified and adapted to the OR
» Role-specific responsibilities were
Methodology, results
Using the Plan-Do-Study-Act (PDSA)
framework, the project systematically
evaluated interventions over six
months. The inclusion criteria focused
on all non-scrubbed personnel in the
OR suite, ensuring data validity while
excluding vendors and students.
Key steps included:
* Pre-intervention phase. Baseline
compliance data were collected for
2 months, revealing low adherence
rates among non-scrubbed personnel.
* Intervention cycles. A new intervention
per month was introduced over
3 months:
» Month 1-Installation of additional
sanitizer stations
» Month 2-Education sessions for
all non-scrubbed personnel
» Month 3-Introduction of visual
cues alongside continued education.
*
Data collection and analysis. Trained
auditors recorded compliance using
an adapted WHO monitoring tool
(sidebar, Perioperative hand hygiene
monitoring tool). Observations covered
all five hand hygiene moments.
Data were analyzed biweekly using
SAS software. Compliance rates
were calculated as percentages and
assessed using Chi-square tests
and logistic regression models.
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