Enhancing hand hygiene compliance in healthcare environmental services staff: a systematic approach to indicator...

The aim was to develop a comprehensive system of hand hygiene (HH) indicators for environmental services (EVS) staff in medical institutions, thereby providing clear guidelines on the appropriate moments for EVS staff to perform HH, offering monitoring and feedback metrics for their HH practices, and utilizing the collected monitoring data to evaluate the effectiveness of these practices and serve as a basis for implementing improvement measures.

We conducted non-participant observations to document the workflows of EVS staff across 38 clinical departments within a single tertiary hospital in China, creating a textual corpus. Utilizing the Latent Dirichlet Allocation (LDA) modeling, we identified thematic work tasks for EVS staff in medical settings. We analyzed HH protocols based on standard operating procedures for each task and synthesized these with literature insights to derive HH guidelines for EVS staff. The Delphi method was employed to refine these guidelines and establish their relative importance through hierarchical analysis.

Our research identified and labeled twelve themes of janitorial tasks. Through a meticulous examination and extraction process based on detailed standard operating procedures for each task, we delineated seven HH moments for EVS staff: before handling clean items, before cleaning or disinfection, before donning personal protective equipment (PPE), before doffing PPE, after cleaning or disinfection, after touching highly contaminated surfaces or items, and after doffing PPE. Following two rounds of Delphi consultation, experts reached a consensus and five indicators were retained based on importance, feasibility, and coefficient of variation. The final HH indicators for healthcare EVS staff, ranked by importance, included: after touching highly contaminated surfaces or items, before handling clean items, after cleaning or disinfection, before cleaning or disinfection, and after doffing PPE.

The formulation of HH indicators for cleaning personnel not only clarifies when and under what circumstances HH should be performed but also fosters further advancements in HH management for EVS staff.