Hand-hygiene compliance by hospital staff and incidence of health-care-associated infections, Finland

Abstract

Objective To determine changes in hand-hygiene compliance after the introduction of direct observation of hand-hygiene practice for doctors and nurses, and evaluate the relationship between the changes and the incidence of health-care-associated infections. Methods We conducted an internal audit survey in a tertiary-care hospital in Finland from 2013 to 2018. Infection-control link nurses observed hand-hygiene practices based on the World Health Organization’s strategy for hand hygiene. We calculated hand-hygiene compliance as the number of observations where necessary hand-hygiene was practised divided by the total number of observations where hand hygiene was needed. We determined the incidence of health-care-associated infections using a semi-automated electronic incidence surveillance programme. We calculated the Pearson correlation coefficient ( r ) to evaluate the relationship between the incidence of health-care-associated infections and compliance with hand hygiene. Findings The link nurses made 52 115 hand-hygiene observations between 2013 and 2018. Annual hand-hygiene compliance increased significantly from 76.4% (2762/3617) in 2013 to 88.5% (9034/10 211) in 2018 ( P < 0.0001). Over the same time, the number of health-care-associated infections decreased from 2012 to 1831, and their incidence per 1000 patient-days fell from 14.0 to 11.7 ( P < 0.0001). We found a weak but statistically significant negative correlation between the monthly incidence of health-care-associated infections and hand-hygiene compliance (r = −0.48; P < 0.001). Conclusion The compliance of doctors and nurses with hand-hygiene practices improved with direct observation and feedback, and this change was associated with a decrease in the incidence of health-care-associated infections. Further studies are needed to evaluate the contribution of hand hygiene to reducing health-care-associated infections.

Effects of a 4-year intervention on hand hygiene compliance and incidence of healthcare associated infections: a longitudinal study

“…We found an increase in HH compliance by 5 moments across all healthcare workers and unit types with implementation of multimodal HH interventions, similar to findings of previous reports [15,18,19]. Comparing other moments and healthcare workers, HH compliance was generally lower for before touching a patient and after contact with patient surroundings, while compliance was lower among interns and cleaners.…”

Why Clinical Nurses Couldn’t Adhere to Standard Precautions Adequately Despite their High Adherence Intention? A Quantile Regression Approach

“…Among the SP sub-strategies, although hand hygiene is a basic practice of infection control, the adherence to hand hygiene was the lowest (below 70 points) of all SP strategies. Most previous studies have also reported similar results regarding low compliance with hand hygiene [10,23]. Moreover, in the case of no observers such as in video surveillance, hand hygiene adherence was more worse [24].…”

“…Hence, real hand hygiene adherence might be extremely low because results that excluded the observer's effect would be more realistic. Poor hand hygiene was revealed to be a risk factor for HAIs [10,18,25]. Therefore, an investigation of the barriers hindering the adherence of nurses' hand hygiene and effective strategies to improve adherence is needed.…”

“…SPs include the eight strategies of 1) hand hygiene, 2) the use of personal protective equipment (PPE), 3) cough etiquette, 4) isolation precaution, 5) environmental infection control including disinfection and sterilization, 6) handle textiles and laundry carefully, 7) safe infection practices, 8) healthcare worker safety [9]. Adequate adherence to SPs is a major strategy for preventing HAIs between patients and healthcare workers and can reduce infection exposure for patients as well as healthcare providers [7,10]. Hence, SPs are the simplest and most important way to reduce the risk of microbial transmission in healthcare settings.…”

Synergistic Effect of Combination Interventions for Methicillin-Resistant Staphylococcus aureus Transmission Control in Nursing Homes: A Computation Modelling Evaluation with Heterogeneous Contact Mixing

“…Results in intervention effectiveness among these three clinical studies are inconclusive. Prior research in MRSA control in hospital settings suggests that hand hygiene compliance is crucial in reducing healthcare associated infections [21]. The results from our simulation also demonstrated that different level of hand hygiene compliance results in different levels of long term MRSA prevalence reduction.…”