Comparison of national and subnational guidelines for hand hygiene

Abstract

Hand hygiene promotion is considered as the cornerstone for healthcare-associated infection prevention. Over the past years, hand hygiene guidelines have been developed by different agencies at international, national and subnational levels. A comparison of these documents could help in understanding recommendations in different parts of the world and the methods used for their development. Guidelines were identified through search engines, electronic libraries, and personal contacts, and their content was analysed using an adapted version of a tool from the European DG XII-funded HARMONY project. Twenty-two guidelines were retrieved and 21 were evaluated. Documents varied in scope, approach, content and terminology. Some were primarily advisory directives, whereas others focused on the technical issues of why, when, and how to perform hand hygiene. The extent to which evidence was collected and assessed varied considerably and details were provided only in very few. Grading systems and definitions to indicate the strength of evidence and recommendations also differed. The intended outcome was to improve hand hygiene practices in healthcare, thus leading to a reduction of healthcare-associated infections and/or antimicrobial resistance. Although overall agreement on indications and procedures was noted, the range and depth of recommendations on best practices and implementation varied. Essential aspects such as compliance measurement and audits to assess guideline effectiveness were neglected in most documents. In conclusion, there is a need for a more consistent approach leading to recommendations based on a thorough evaluation of evidence and applicable worldwide. Aspects related to implementation and impact monitoring deserve greater attention.

Impact of observing hand hygiene in practice and research: a methodological reconsideration

“…Most cross-infection takes place via the hands of health workers 1, 2 and it is agreed that cleansing hands can break the chain of infection, thus reducing rates of HCAI 1 . The importance of hand hygiene is recognised internationally 3,4 and guidelines developed by the World Health Organization (WHO) in 2009 5 are credited with exerting considerable impact on hand hygiene policy and practice globally 6 . The WHO 5 emphasises the importance of regular monitoring to assess health workers' hand hygiene performance.…”

Higieninė-Epidemiologinė Intervencinių Procedūrų Sauga Slaugos Praktikoje

“…Slaugos paslaugų higieninis-epidemiologinis saugumas priklauso nuo rankų taršos rodiklio, intervencijų, slaugos procedūrų skaičiaus ir skyriaus profilio. Personalo chalatų, rankų kolonizacija patogeniniais mikroorganizmais gali būti ne tik iš užkrės-tų žaizdų, bet taip pat nuo dažnai kolonizuotos nepažeistos paciento odos [25,26]. Palyginti nedaug duomenų yra apie saugias procedūras, pacientų sveikatos priežiūros veiklos rū-šis, personalo darbo drabužius, papuošalus, rankų higieną [27][28][29].…”

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

“…587 However, such education requires regular updating [638][639][640] to promote the adoption of, and continued adherence to, evidence-based improvements, 641,642 and monitoring systems are necessary to audit compliance. 595,596,[643][644][645] Although existing studies highlight success in limiting HCAIs 48,181 through hand hygiene 195,639,[646][647][648] and wider reaching educational programmes, [649][650][651][652][653] a high level of non-compliance with basic infection control measures persists among health-care professionals. 654 Indeed, junior medical and nursing staff copy the aberrant behaviour of their superiors, [655][656][657] which results in the entrenchment of non-compliance across successive generations.…”

“…352 This most basic of practices, therefore, constitutes a cognitive and behavioural ensemble that demands little by way of organised competencies. 595,626 However, in order to be effective, hand hygiene must be enacted as a conscious activity. 630 But its broader social utility positions this practice as routine and somewhat mindless 696 and habitual, 697 which limits the individual's reflexive monitoring and appraisal of the practice.…”