The effect of hand hygiene audit in COVID intensive care units in a tertiary care hospital in South India

Abstract

Background: In the era of COVID-19 pandemic, there is an upsurge of healthcare-associated infections (HAI) in COVID intensive care units (ICUs), which can be reduced by following proper hand hygiene (HH) practice. Performing HH auditing in COVID ICU and providing timely feedback to the stake holders is crucial to reduce HAIs. Methods: From November 2020-April 2021, HH audit was conducted in COVID ICUs. HH complete adherence rate (HHCAR), HH partial adherence rate (HHPAR) and HH total adherence rate (HHTAR) were analyzed. Profession-specific HHTAR and moment-specific HHTAR (for each WHO moment) were also calculated. Results: HHCAR, HHPAR and HHTAR were found as 30.8%, 34.5% and 65.3% respectively. There was a significant increase in the monthly HHTAR from 26.7% to 68.4% (P < .001). The profession-specific HHAR was found to be highest among doctors (67.5%) and nurses (66.4%). As the HHTAR increases there is a significant decrease in device associated infection (DAI) rate from 24.7 to 11.5 per 1,000 device days. Conclusions: Auditing HH and providing timely feedback significantly improved HH compliance. The need of the hour is to regularly conduct HH audit in COVID locations of all healthcare facilities to reduce HAI rate among the COVID-19 infected patients in ICUs.

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis

“…26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 The list of excluded studies and reasons for exclusion are shown in Figure 1 . Among the ten included studies, six studies were carried out in China 26 , 27 , 28 , 29 , 32 , 33 , one in America 30 , one in Germany 31 , one in Italy 34 and one in India 35 , including three cross-sectional surveys 27 , 28 , 32 , six before-after studies 29 , 30 , 31 , 33 , 34 , 35 , and one randomized controlled trial (RCT) study. 26 All the studies were conducted between December, 2019 and April, 2021, and the HHC rates ranged from 46% to 100% ( Table 1 ).…”

“…Five studies were performed in designated COVID-19 hospitals or wards. 26 , 28 , 32 , 33 , 35 Most of the studies (6/10) took the hospital as the whole unit to conduct the overall study. 29 , 30 , 31 , 32 , 33 , 34 Among all the healthcare providers included, 64 (48.85%) worked in ICU, accounting for the vast majority, followed by 46 (35.11%) in surgery and 21 (16.03%) in internal medicine.…”

“…A total of 1891664 HH actions and 3591681 HH opportunities were observed in ten studies. For the observation method of HHC, the researchers adopted the secret observation method (three groups) 26 , 29 , 32 , open observation method (six groups) 26 , 27 , 31 , 33 , 34 , 35 , mixed secret and open observation method (one group) 28 , and automated monitoring system (one group) 30 separately. Six studies reported the HHC rate of different occupations 26 , 29 , 30 , 33 , 34 , 35 , six studies reported the HHC rate at different WHO five HH opportunities 26 , 29 , 30 , 31 , 33 , 35 , and all ten studies reported different observation methods of HH 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ( Table 2 ).…”

“…More than two subgroups were observed in five studies 26 , 30 , 31 , 33 , 35 , and finally 16 subgroups were included in the meta-analysis. The overall compliance rate of HH was 74% ( I 2 =100%, P <0.0001; 95% CI: 68%–79%).…”

“…Since the only 5 retrieved literatures reported the HHC comparison before and after the pandemic, the comparison data before COVID-19 were referred from the HHC regarded meta-analysis studies published from January 1, 2015 to December 31, 2019. 27 , 29 , 33 , 34 , 35 …”