Staff at outpatient care facilities may need to brush up on hygiene basics, as a new study found a failure to follow recommendations for hand hygiene in 37 percent of observations.

The study, appearing in the American Journal of Infection Control, also found safe injection practices were neglected one-third of the time.

Researchers from the New Mexico Department of Health and the University of New Mexico assessed infection prevention policies and practices at 15 outpatient sites across the state in 2014 during a medical student outpatient rotation. A standardized infection prevention checklist was completed via staff interview; observations of injection safety practices and hand hygiene behavior were conducted.

Medical student interviews with outpatient facility staff indicated that 93 percent of recommended policies were in place across the 15 facilities. However, when the students observed behaviors, they noted only 63 percent compliance with recommended hand hygiene practices and 66 percent compliance with safe injection practices. In 37 percent of hand hygiene observations, no hand hygiene was performed.

“Despite high levels of report of hand hygiene education and observed supply availability, which would promote hand hygiene adherence, as well as report of requirements for injections to be prepared aseptically, observations of hand hygiene and aseptic injection technique showed lack of similarly high behavior compliance,” wrote Deborah Thompson, MD, MSPH, of the New Mexico Department of Health in Santa Fe, and colleagues.

Medical students assessed prevention policies using an outpatient infection prevention checklist developed by the Centers for Disease Control and Prevention (CDC) that included 14 topic areas including administrative policies, education and training, occupational health, environment cleaning, hand hygiene, and injection safety. In addition to assessing policies via the checklist, the students evaluated injection safety and hand hygiene practices through direct observations.

Of the 163 injection safety observations, only 66 percent of the preparations complied with all of the recommended infection prevention steps, which included performing hand hygiene, disinfecting the rubber septum, using a new needle and syringe, properly discarding single-dose vials, and dating multi-dose vials upon opening. During the 330 hand hygiene observations, students reported that hand hygiene supplies were 100 percent available yet there was no use of hand hygiene 37 percent of the time.

“The study was able to highlight the importance of assessing both the report of recommended infection prevention policies and practices as well as behavior compliance through observational audits” wrote Thompson and colleagues.