Hand Hygiene Compliance in the ICU: A Systematic Review

Abstract

Objectives: To synthesize the literature describing compliance with WHO hand hygiene (HH) guidelines in Intensive Care Units (ICUs), to evaluate the quality of extant research, and to examine differences in compliance rates across geographical regions, ICU types, and healthcare worker groups, observation methods, and Moments (indications) of HH. Data sources: Electronic searches were conducted in August 2018 using Medline, CINAHL, PsycInfo, Embase, and Web of Science. Reference lists of included studies and related review articles were also screened. Study selection: English-language, peer-reviewed studies measuring HH compliance by healthcare workers in an ICU setting using direct observation guided by the WHO's 'Five Moments of Hand Hygiene', published since 2009, were included. Data extraction: Information was extracted on study location, research design, type of ICU, healthcare workers, measurement procedures, and compliance rates. Data synthesis: Sixty-one studies were included. Most were conducted in high-income countries (60.7%) and in adult ICUs (85.2%). Mean HH compliance was 59.6%. Compliance rates appeared to differ by geographic region (high-income countries 64.5%, low-income countries 9.1%), type of ICU (neonatal 67.0%, pediatric 41.2%, adult 58.2%), and type of healthcare worker (nursing staff 43.4%, physicians 32.6%, other staff 53.8%). Conclusions: Mean HH compliance appears notably lower than international targets. The data collated may offer useful benchmarks for those evaluating, and seeking to improve, hand hygiene compliance in ICUs internationally.

Trends in Health Care–Associated Infection Prevention Practices in US Veterans Affairs Hospitals From 2005 to 2017

“…Despite the high reported use of practices to prevent C difficile infection and CLABSI, actual compliance with many practices (eg, hand washing) was likely lower. 15 Although increases over time were observed for most CAUTI prevention practices, the proportion of hospitals reporting regular use of CAUTI prevention practices was lower compared with the reported use of other HAI prevention practices. This lag may be associated with the relative lack of importance placed on CAUTI by hospital leadership.…”

“Seconds save lives—clean your hands”: the 5 May 2021 World Health Organization SAVE LIVES: Clean Your Hands campaign

“…Although effective infection prevention and control (IPC) programmes in health care facilities should meet WHO minimum requirements [1], the 2020 global WASH report revealed that one in three facilities do not have adequate hand hygiene stations at the point of care [2]. A recent systematic review showed that hand hygiene compliance is only around 9% during care of critically ill patients in lowincome countries [3]; such shocking data, in conjunction with the ongoing COVID-19 pandemic, highlight the urgent need for additional efforts to strengthen global compliance and champion best practices. Although vaccines are starting to be delivered, hand hygiene and appropriate use of personal protective equipment remain crucial for safe care of both COVID-19 and non-COVID-19 patients.…”

The importance of infection prevention and control in chronic wound care

“…Ennek ellenére a betegek ellátását végző dolgozók kézhigiénés együttműködési készsége alacsony, 50% alatti, melynek oka leggyakrabban a prevenciós ismeretek, az intézményi elkötelezettség és a vezetői példamutatás hiánya (17)(18)(19)(20). Figyelembe véve a fentebb leírtakat, indokolt, hogy a kézhigiénés tevékenységeket az egészségügyi és a szociális intézmények dolgozói is ismerjék és alkalmazzák a krónikus bőrsebek ellátása során is.…”