Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital

Abstract

Aim:We are using multimodal technique to improve hand hygiene (HH) compliance among all health care staff for the past 1-year. This cross-sectional observational study was conducted in the surgical ICU to assess adherence to HH among nurses and allied healthcare workers, at the end of the training year.Materials and Methods:This was a cross-sectional observational study using direct observation technique. A single observer collected all HH data. During this analysis, 1500 HH opportunities were observed. HH compliance was tested for all 5 moments as per WHO guidelines.Results:Overall compliance as per WHO Guidelines was 78%. Nurses had an adherence rate of 63%; allied staff adherence was 86.5%. Compliance was 93% after patient contact versus 63% before patient contact. Nurses'compliance before aseptic procedures was lowest at 39%. 92% staff was aware of the facts viz. Diseases prevented by hand washing, ideal duration of HH, reduction of health care associated infections, etc.Conclusion:After 1-year of aggressive multimodal intervention in improving HH compliance, we have an overall compliance of 78%. It implies that sustained performance and compliance to HH can be ensured by ongoing training. Direct observation remains a widely used, easily reproducible method for monitoring compliance.

Hand hygiene: nurses’ adherence after training

“…In addition, the same study pointed out that several professionals worked below standard conditions during the observation periods. This reality was also reported in another study, which noted that the unavailability of materials in the work area, the high workload, and the shortage of nurses were barriers to professionals' adherence (8) . Teker et al (9) listed multiple factors with the potential to influence these indicators, such as lack of training and experience; lack of feedback on inadequate performance; working in highly complex care units; inadequate staffing; lack of role models in the team; inadequate use of gloves; lack of knowledge about the importance of the procedure; inadequate time management; planning of care without accounting for the time necessary for hand hygiene; lack of motivation at individual and institutional levels; lack of priority of hand hygiene at the institutional level; lack of performance rewards or sanctions; and lack of institutional guidelines.…”

“…However, one of the studies reported that, despite the higher levels of training, only 43% of nurses and 18% of health technicians had washed their hands during the observation period, which may suggest that the knowledge about a certain procedure does not, in itself, translate into best practices (6) . On the other hand, in a study that compared nurses and allied healthcare workers, the adherence to hand hygiene was of 63% among nurses and 86.5% among allied healthcare workers (8) . Contrary to these results, one of the analyzed studies (10) found that adherence was higher among nurses (50%) than among doctors (45%) and other health professionals (38.4%).…”

“…Three of the included studies have explored the reasons that compromise professionals' adherence and the quality of the procedure (6,(8)(9) . "Lack of time" (41.4%) and "skin irritation" (6.3%) were some of the reasons mentioned in one study (6) .…”

“…Some authors (8) have analyzed the hand hygiene procedure ("five moments" for hand hygiene (5) ). According to these studies, after the training program, adherence was higher in steps 3 and 4 (self-protection) (8)(9) and lower after aseptic procedures (8) and after touching patient surroundings (10) . Similarly, the authors of another study observed that only 47% of the professionals washed their hands before touching the patient and that 70% washed their hands after touching the patient (6) .…”

Hand hygiene: A self reported practice among health care workers in tertiary health institutions in Plateau State, Nige

“…Other studies have found sex of the respondents, duration of practice, water supply, availability of disposable hand towels, patient load and proximity of hand washing facility as potent determinants of hand hygiene practice. [3,10,[12][13][14][15] …”