The impact of the International Nosocomial Infection Control Consortium (INICC) multicenter, multidimensional hand hygiene approach in two cities of India

Abstract

The fundamental tool for preventing and controlling healthcare-acquired infections is hand hygiene (HH). Nonetheless, adherence to HH guidelines is often low. Our goal was to assess the effect of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach (IMHHA) in three intensive care units of three INICC member hospitals in two cities of India and to analyze the predictors of compliance with HH. From August 2004 to July 2011, we carried out an observational, prospective, interventional study to evaluate the implementation of the IMHHA, which included the following elements: (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance and (6) performance feedback. The practices of health care workers were monitored during randomly selected 30-min periods. We observed 3612 opportunities for HH. Overall adherence to HH increased from 36.9% to 82% (95% CI 79.3-84.5; P=0.0001). Multivariate analysis indicated that certain variables were significantly associated with poor HH adherence: nurses vs. physicians (70.5% vs. 74%; 95% CI 0.62-0.96; P=0.018), ancillary staff vs. physicians (43.6% vs. 74.0%; 95% CI 0.48-0.72; P<0.001), ancillary staff vs. nurses (43.6% vs. 70.5%; 95% CI 0.51-0.75; P<0.001) and private vs. academic hospitals (74.2% vs. 66.3%; 95% CI 0.83-0.97; P<0.001). It is worth noticing that in India, the HH compliance of physicians is higher than in nurses. Adherence to HH was significantly increased by implementing the IMHHA. Programs targeted at improving HH are warranted to identify predictors of poor compliance.

A twenty-four-hour observational study of hand hygiene compliance among health-care workers in Debre Berhan referral hospital, Ethiopia

“…In low-income and middle-income countries, HH compliance was averaged 22·4% before multimodal intervention [ 11 ]. Hand hygiene compliance was much lower in the present study compared to post- multimodal intervention studies from India (82%) [ 15 ], Kuwait (61.4%) [ 25 ], and Colombia (77%) [ 26 ]. The possible reason for low compliance in our study might be due to the WHO’s multimodal HH improvement strategy which was not implemented.…”

Predictors of hand hygiene practice among Saudi nursing students: A cross-sectional self-reported study

“…An example is the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach (IMHHA), which includes administrative support, availability of supplies, education and training, reminders, process surveillance, and performance feedback. Previous studies have reported significant improvement in adherence to hand hygiene with the implementation of the IMHHA in ICUs in various countries [17][18][19][20][21][22][23].…”

Infrastructure and Organization of Adult Intensive Care Units in Resource-Limited Settings

“…A prospective observational study involving 99 ICUs in 19 resource-limited countries demonstrated a significant 23.1% overall increase in hand hygiene compliance after implementation of a multidimensional hand hygiene program involving administrative support, supply availability, education and training, workplace reminders, process surveillance, and performance feedback [84]. These findings have been replicated in geographically diverse locations including India [85], China [86], and Mexico [87]. A prospective study in six Colombian ICUs demonstrated a significant reduction (12.7% annually during the 4-year study period) in central line-associated bloodstream infections after introduction of a targeted hand hygiene program that included installation of alcohol-based hand rub dispensers adjacent to each ICU bed and regular feedback to healthcare workers [88].…”