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      Hand Hygiene Compliance in the Intensive Care Units of a Tertiary Care Hospital

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          Abstract

          Context:

          Hand hygiene (HH) is the most important measure to prevent hospital-acquired infections but the compliance is still low.

          Aims:

          To assess the compliance, identify factors influencing compliance and to study the knowledge, attitude and perceptions associated with HH among health care workers (HCW).

          Settings and Design:

          Cross-sectional study conducted in 42 bedded Medical (Pulmonary, Medicine and Stroke) intensive care units (ICU) of a tertiary care hospital.

          Materials and Methods:

          HCWs (doctors and nurses) were observed during routine patient care by observers posted in each ICU and their HH compliance was noted. Thereafter, questionnaire regarding knowledge, perception and attitudes toward HH was filled by each HCW.

          Statistical Analysis:

          Percentages and χ 2 test.

          Results:

          The overall compliance was 43.2% (394/911 opportunities). It was 68.9% (31/45) in the intensivists, 56.3% (18/32) in attending physicians, 40.0% (28/70) in the postgraduate residents and 41.3% (301/728) in the nurses. Compliance was inversely related to activity index. Compliance for high, medium and low risk of cross-transmission was 38.8% (67/170), 43.8% (175/401) and 44.7% (152/340), respectively.

          Conclusions:

          Compliance of the study group is affected by the activity index (number of opportunities they come across per hour) and professional status. The HCWs listed less knowledge, lack of motivation, increased workload as some of the factors influencing HH.

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          Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.

          D Pittet, S Hugonnet, S Harbarth … (2000)
          Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel. We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant. We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001). The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
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            Hand hygiene among physicians: performance, beliefs, and perceptions.

            Didier Pittet, Anne Simon, Stéphane Hugonnet … (2004)
            Physician adherence to hand hygiene remains low in most hospitals. To identify risk factors for nonadherence and assess beliefs and perceptions associated with hand hygiene among physicians. Cross-sectional survey of physician practices, beliefs, and attitudes toward hand hygiene. Large university hospital. 163 physicians. Individual observation of physician hand hygiene practices during routine patient care with documentation of relevant risk factors; self-report questionnaire to measure beliefs and perceptions. Logistic regression identified variables independently associated with adherence. Adherence averaged 57% and varied markedly across medical specialties. In multivariate analysis, adherence was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution. Conversely, high workload, activities associated with a high risk for cross-transmission, and certain technical medical specialties (surgery, anesthesiology, emergency medicine, and intensive care medicine) were risk factors for nonadherence. Direct observation of physicians may have influenced both adherence to hand hygiene and responses to the self-report questionnaire. Generalizability of study results requires additional testing in other health care settings and physician populations. Physician adherence to hand hygiene is associated with work and system constraints, as well as knowledge and cognitive factors. At the individual level, strengthening a positive attitude toward hand hygiene and reinforcing the conviction that each individual can influence the group behavior may improve adherence among physicians. Physicians who work in technical specialties should also be targeted for improvement.
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              Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America.

              Didier Pittet, Kylie J. Boyce, … (2002)
              The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
              Article 0 comments Cited 115 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Community Med
                Journal ID (publisher-id): IJCM
                Title: Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine
                Publisher: Medknow Publications (India )
                ISSN (Print): 0970-0218
                ISSN (Electronic): 1998-3581
                Publication date (Print): Jul-Sep 2011
                Volume: 36
                Issue: 3
                Pages: 217-221
                Affiliations
                [1]Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
                [1 ]Department of Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
                [2 ]Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
                [3 ]Department of Pulmonary Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
                Author notes
                Address for correspondence: Dr. Sarit Sharma, Department of Community Medicine, DMC and Hospital, Old Campus, Civil Lines, Ludhiana - 141 001, Punjab, India. E-mail: sarit_sharma@ 123456yahoo.com
                Article
                Publisher ID: IJCM-36-217
                DOI: 10.4103/0970-0218.86524
                PMC ID: 3214448
                PubMed ID: 22090677
                SO-VID: 17f40c35-13f3-4a8d-89df-9c5ddd94bb14
                Copyright © Copyright: © Indian Journal of Community Medicine
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 03 May 2010
                Date accepted : 24 August 2011
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Public health
                Keywords: hospital acquired infections,hand hygiene,intensive care unit,compliance,health care workers
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: hospital acquired infections, hand hygiene, intensive care unit, compliance, health care workers

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