Low compliance with alcohol gel compared with chlorhexidine for hand hygiene in ICU patients: results of an alcohol gel implementation program

Abstract

Although the introduction of alcohol based products have increased compliance with hand hygiene in intensive care units (ICU), no comparative studies with other products in the same unit and in the same period have been conducted. We performed a two-month-observational prospective study comparing three units in an adult ICU, according to hand hygiene practices (chlorhexidine alone-unit A, both chlorhexidine and alcohol gel-unit B, and alcohol gel alone-unit C, respectively). Opportunities for hand hygiene were considered according to an institutional guideline. Patients were randomly allocated in the 3 units and data on hand hygiene compliance was collected without the knowledge of the health care staff. TISS score (used for measuring patient complexity) was similar between the three different units. Overall compliance with hand hygiene was 46.7% (659/1410). Compliance was significantly higher after patient care in unit A when compared to units B and C. On the other hand, compliance was significantly higher only between units A (32.1%) and C (23.1%) before patient care (p=0.02). Higher compliance rates were observed for general opportunities for hand hygiene (patient bathing, vital sign controls, etc), while very low compliance rates were observed for opportunities related to skin and gastroenteral care. One of the reasons for not using alcohol gel according to health care workers was the necessity for water contact (35.3%, 12/20). Although the use of alcohol based products is now the standard practice for hand hygiene the abrupt abolition of hand hygiene with traditional products may not be recommended for specific services.

Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross sectional study

“…Hand hygiene is the most important means of preventing HAI [19]. Over the years, immense efforts have been made at improving HH compliance worldwide.…”

Use of a Patient Hand Hygiene Protocol to Reduce Hospital-Acquired Infections and Improve Nurses’ Hand Washing

“…The ICU staff's hand-washing compliance rate before the study was consistent with rates in published reports and supported the low compliance rates reported for an ICU setting. 1,[25][26][27] During the study, HCWs' hand-washing compliance was greater than the compliance rates in published reports for an ICU. 1,25,26 Nurses' hand-washing compliance when entering the patient's room increased from 35% to 66% during the study period, a marked improvement, The protocol appears to have shifted nurses' focus from self-protection to protection of patients.…”

Impact of Replacing Powdered Gloves With Powder-free Gloves on Hand-hygiene Compliance Among Healthcare Workers of an Intensive Care Unit: a Quasi-experimental Study

“…In the United States (US), it was estimated that 4.5 to 5.7 million dollars are spent yearly for treatment of HAI, with an average of two million cases, resulting in 80 thousand deaths a year (2) . In 2015, in the US, 12,299 patients were surveyed in 199 hospitals. Of those, 394 patients presented at least one episode of HAI (3.2%; 95% Con dence Interval [95% CI]: 2.9 to 3.5%) (3) .…”