A hospital has just installed automated dispensers for alcohol-based hand rub. E

ID: 3204076 • Letter: A

Question

A hospital has just installed automated dispensers for alcohol-based hand rub. Each dispenser records how many times it is used. The general surgery unit has 10 patients and the beds are almost always full. Last month, the counts revealed that the dispensers are used 480 times per day on average. So the nurses now know that on their unit, hands are cleaned about 2 times per patient per hour.

The nurses on the unit aren’t sure whether this is good or bad. They want to know how many times hand hygiene should be performed for each patient each hour (i.e., how many opportunities there are). They also want to know if the number of opportunities varies much from patient to patient – they assume it does. They hire nursing students to sit with patients and observe how many opportunities for hand hygiene occur. Forty-two patients agree to be observed. The students observe every interaction that occurs between any healthcare worker and the patient. Using a paper form, they record every opportunity for hand hygiene, whether the healthcare workers did or didn’t clean their hands, and which dispenser was used. The data are entered into an Excel spreadsheet called Hand_Hygiene_1.

Using Excel and the dataset Hand_Hygiene_1, complete the following questions. Answer the questions with the corresponding number.

1. How severely ill was participant A027 on admission compared to other participants?

2. Create a new variable called Hand Hygiene Opportunities per Hour. What is the minimum and maximum number of hand hygiene opportunities per hour?

3. What is the median (IQR) number of hand hygiene opportunities per patient per hour?

HAND HYGIENE 1 DATASET INFORMATION:

ID Address Phone Adm Date Disch Date LOS (days) Age Height (cm) Weight (kg) BMI Primary Diagnosis Severity of illness on admission Analgesic Doses Hours Observed Opportunities Door Dispenser Bedside Dispenser Sink Dispenser Personal Dispenser Missed A032 East York (763) 343-0910 8-01-16 8-09-16 8 73 172 50 16.90102758 crohns 116 15 27 140 73 40 7 0 20 A002 City (623) 985-8361 7-05-16 7-12-16 7 66 168 50 17.7154195 ulcerative colitis 97 14 18 73 25 30 0 0 18 A013 East York (584) 788-8610 7-14-16 7-30-16 16 58 172 52 17.57706869 ulcerative colitis 111 34 36 177 104 27 4 3 39 A014 East York (798) 397-4533 7-15-16 7-31-16 16 62 172 52 17.57706869 IBD 58 38 8 41 33 5 0 0 3 A042 City (905) 685-2885 8-04-16 8-09-16 5 29 193 52 13.96010631 small bowel obstruction 46 12 10 61 43 10 0 2 6 A023 City (408) 837-4889 7-25-16 7-31-16 6 60 175 54 17.63265306 IBD 66 4 17 162 100 26 2 0 34 A021 Etobicoke (362) 658-5258 7-22-16 7-28-16 6 36 188 54 15.27840652 ulcerative colitis 45 12 6 51 30 2 1 5 13 A007 Etobicoke (384) 050-7442 7-08-16 7-12-16 4 59 185 54 15.7779401 ulcerative colitis 55 61 48 217 142 40 3 2 30 A024 East York (886) 306-3818 7-26-16 7-31-16 5 78 183 56 16.72190869 abdominal mass 47 19 35 171 97 40 7 1 26 A035 Etobicoke (522) 967-1809 8-01-16 8-05-16 4 71 162 57 21.71925011 ulcerative colitis 32 44 33 116 64 32 1 0 19 A016 East York (556) 587-0106 7-18-16 7-23-16 5 58 180 59 18.20987654 pancreatitis 100 30 18 139 89 19 1 3 27 A019 City (737) 445-7323 7-19-16 7-25-16 6 74 181 61 18.61970025 pancreatitis 19 2 26 110 55 18 4 0 33 A033 North York (660) 756-0039 8-01-16 8-06-16 5 20 164 62 23.05175491 abdominal mass 43 28 30 135 70 44 0 1 20 A010 City (692) 915-9003 7-11-16 7-15-16 4 45 197 66 17.0063645 ulcerative colitis 83 23 7 66 43 7 1 0 15 A004 East York (801) 728-9089 7-07-16 7-12-16 5 43 187 68 19.44579485 abdominal mass 115 0 2 11 8 0 0 0 3 A005 City (515) 352-2203 7-08-16 7-23-16 15 51 196 68 17.70095793 crohns 112 34 10 111 52 29 0 0 30 A022 North York (389) 966-7503 7-25-16 7-30-16 5 78 160 71 27.734375 crohns 41 17 16 90 77 5 0 0 8 A020 East York (630) 964-2392 7-22-16 7-27-16 5 31 189 73 20.436158 abdominal mass 24 34 16 82 35 17 0 0 30 A028 East York (612) 841-8819 7-28-16 8-02-16 5 21 188 74 20.9370756 abdominal mass 67 31 30 135 85 19 7 0 24 A027 City (549) 001-4877 7-27-16 8-02-16 6 26 181 75 22.89307408 pancreatitis 69 23 31 146 88 32 1 0 25 A006 City (814) 588-2964 7-08-16 7-23-16 15 33 187 76 21.73353542 abdominal mass 93 19 22 98 56 15 0 0 27 A001 East York (576) 182-4884 7-05-16 7-23-16 18 39 190 76 21.05263158 ulcerative colitis 111 41 18 117 64 34 4 0 15 A011 Etobicoke (853) 525-2174 7-12-16 7-23-16 11 64 163 76 28.60476495 crohns 115 61 10 80 30 24 1 2 23 A017 Etobicoke (401) 837-4726 7-18-16 7-24-16 6 18 155 76 31.63371488 crohns 58 59 22 171 129 2 1 0 39 A003 City (658) 933-4373 7-06-16 7-09-16 3 68 163 78 29.35752192 small bowel obstruction 28 14 13 82 27 15 0 12 28 A031 City (576) 936-4032 7-29-16 8-16-16 18 92 186 79 22.83500983 IBD 51 40 26 125 76 26 1 0 22 A012 North York (413) 339-7313 7-14-16 7-25-16 11 32 161 81 31.24879441 crohns 111 12 16 131 46 13 1 47 24 A036 City (449) 316-9959 8-02-16 8-07-16 5 51 178 82 25.88057064 abdominal mass 97 17 24 99 61 19 0 0 19 A034 East York (640) 911-7004 8-01-16 8-07-16 6 73 186 87 25.14741589 small bowel obstruction 50 36 25 121 67 30 3 2 19 A030 City (756) 440-0406 7-28-16 8-03-16 6 21 182 91 27.47252747 pancreatitis 13 14 32 108 79 5 0 2 22 A026 North York (434) 632-9611 7-27-16 8-01-16 5 79 182 91 27.47252747 IBD 16 15 32 149 91 30 3 0 25 A038 Etobicoke (377) 808-8702 8-03-16 8-08-16 5 55 166 94 34.11235303 small bowel obstruction 17 25 16 89 55 12 3 2 17 A029 City (307) 162-3079 7-28-16 8-02-16 5 36 153 95 40.58268187 ulcerative colitis 44 19 25 125 82 13 5 1 24 A015 City (887) 291-1935 7-18-16 7-22-16 4 28 180 96 29.62962963 ulcerative colitis 94 8 20 101 64 23 0 0 14 A009 City (595) 637-1062 7-11-16 7-15-16 4 75 158 97 38.85595257 ulcerative colitis 66 16 14 112 52 18 0 15 27 A041 Etobicoke (319) 835-4318 8-04-16 8-09-16 5 57 151 100 43.85772554 ulcerative colitis 54 34 16 65 46 11 0 1 7 A040 City (720) 466-2738 8-03-16 8-08-16 5 42 154 121 51.02040816 pancreatitis 33 5 19 69 49 12 0 0 8 A018 City (385) 633-2667 7-18-16 7-24-16 6 38 183 135 40.31174415 IBD 119 75 16 118 69 14 8 0 27 A008 East York (878) 808-2594 7-11-16 7-14-16 3 84 195 136 35.76594346 ulcerative colitis 23 2 19 70 47 4 1 0 18 A037 City (636) 112-7784 8-02-16 8-08-16 6 48 172 140 47.32287723 small bowel obstruction 35 16 21 95 58 13 4 1 19 A025 City (541) 715-8776 7-27-16 7-31-16 4 56 192 144 39.0625 ulcerative colitis 109 14 42 171 94 44 5 2 26 A039 City (804) 802-1085 8-03-16 8-07-16 4 80 200 155 38.75 ulcerative colitis 64 12 15 80 52 12 1 0 15

Explanation / Answer

participant A027 =69 Severity of illness on admission

Total Severity of illness on admission=2747

participant A027 Severity of illness on admission = (69/2747)*100=2.51%

Participant A027 Severity of illness on admission is 2.51% of other participant.

Hand hygine per hour= Opportunities/Hours observed

Hours Observed

Opportunities

Hand hygine/hr

A032

140

A002

A013

177

A014

A042

A023

162

A021

A007

217

A024

171

A035

116

A016

139

A019

110

A033

135

A010

A004

A005

111

A022

A020

A028

135

A027

146

Minimum number of hand hygiene opportunities per hour= 3

Maximum number of hand hygiene opportunities per hour= 11

median (IQR) number of hand hygiene opportunities per patient per hour =

(5+4+5+5+6+10+9+5+5+4+8+4+5+10+6+11+6+5+5+5+5+7+8+8+6+5+8+4+5+3+5+6+5+5+8+4+4+7+4+5+4+5) /42

=5.80=6

Median (IQR) number of hand hygiene opportunities per patient per hour is 6