Coming clean on hand hygiene

Introduction: Hand hygiene is universally recognized as one of the most effective ways to reduce the cross-transmission of hospital acquired infections. Successful strategies to improve hand hygiene compliance require a baseline knowledge of hand hygiene practices. Methodology: A direct observational method was used to collect data about hand hygiene practices amongst medical doctors by a group of trained medical students during their clinical assignments. To prevent any bias during the observation, the purpose of the study was not disclosed to the doctors; they only knew that they were being observed for infection control practices. A structured data collection sheet was used to direct the observations. Data on hand hygiene practices was collected during routine clinical work over a number of weeks. Observers recorded the professional grade of physician observed, speciality, location, activity performed, method used, and facilities available. Results: A total of 898 observations were recorded. Overall compliance before and after doctor-patient contact was 22.7% and 33.5% respectively. Within specialties, hand hygiene practices were lowest in obstetrics and gynaecology and highest in specialized surgical units. Poorest compliance was evident in house officers before patient contact, while the most compliant was the registrar group, following examination. Alcohol hand rub was the preferred method in the wards whilst hand washing was mainly utilised in the outpatient setting. Conclusion: Hand hygiene amongst doctors in St Luke's Hospital is low and could be a factor in the high MRSA endemicity.peer-reviewe

Compliance of Healthcare Workers with Hand Hygiene Practices in the Northeast of Iran: an Overt Observation

Hand hygiene (HH) is one of the most effective methods to prevent transmission and spread of microorganisms from one patient to another, also, it used to reduce the spread of pathogens in clinical settings and to help control outbreaks but compliance is usually poor. The purpose of this study was to analyze the compliance of hand hygiene and affecting factors among healthcare workers (HCWs) of northeast hospitals in Iran. This study was conducted based on observation method for the compliance of hand hygiene according to the World Health Organization (WHO) guidelines. HCWs were observed during routine patient care in different shifts, also the technique of hand hygiene was assessed through hand washing with alcohol-based disinfectant. Data were collected during 1 year, from June 2014 to July 2015 by the infection control teams in the northeast hospital of Iran. By direct observation, we evaluated a total of 92518 hand hygiene opportunities from 29 hospitals in the northeast of Iran during 1 year, with overall compliance rates in these hospitals were 43.42%. Compliance rates differed by role: nurses43%, doctors 19 % and other health workers 29%. In this observational study, we identified that adherence to hand hygiene practice and use of alcohol-based disinfectant was very low in this hospitals, so effective intervention programs to promote adherence to hand hygiene and use of disinfectants could be effective to increase compliance

Interventions to improve hand hygiene compliance in patient care

Background Health care‐associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. Objectives To assess the short‐ and long‐term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care‐associated infection. Search methods We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. Selection criteria We included randomised trials, non‐randomised trials, controlled before‐after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol‐based hand rub (ABHR), or both. Data collection and analysis Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta‐analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. Main results This review includes 26 studies: 14 randomised trials, two non‐randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long‐term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention. Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes. Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low. Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence). Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence. Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence. Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence. Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. Authors' conclusions With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context

Interventions to improve hand hygiene compliance in patient care

Four studies met the criteria for the review: two from the original review and two from the update. Two studies evaluated simple education initiatives, one using a randomized clinical trial design and the other a controlled before and after design. Both measured hand hygiene compliance by direct observation. The other two studies were both interrupted times series studies. One study presented three separate interventions within the same paper: simple substitutions of product and two multifaceted campaigns, one of which included involving practitioners in making decisions about choice of hand hygiene products and the components of the hand hygiene program. The other study also presented two separate multifaceted campaigns, one of which involved application of social marketing theory. In these two studies follow-up data collection continued beyond 12 months, and a proxy measure of hand hygiene compliance (product use) was recorded. Microbiological data were recorded in one study. Hand hygiene compliance increased for one of the studies where it was measured by direct observation, but the results from the other study were not conclusive. Product use increased in the two studies in which it was reported, with inconsistent results reported for one initiative. MRSA incidence decreased in the one study reporting microbiological data

Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward

Hand hygiene is generally considered to be the most important measure that can be applied to prevent the spread of healthcare-associated infection (HAI). Continuous emphasis on this intervention has lead to the widespread opinion that HAI rates can be greatly reduced by increased hand hygiene compliance alone. However, this assumes that the effectiveness of hand hygiene is not constrained by other factors and that improved compliance in excess of a given level, in itself, will result in a commensurate reduction in the incidence of HAI. However, several researchers have found the law of diminishing returns to apply to hand hygiene, with the greatest benefits occurring in the first 20% or so of compliance, and others have demonstrated that poor cohorting of nursing staff profoundly influences the effectiveness of hand hygiene measures. Collectively, these findings raise intriguing questions about the extent to which increasing compliance alone can further reduce rates of HAI. In order to investigate these issues further, we constructed a deterministic Ross-Macdonald model and applied it to a hypothetical general medical ward. In this model the transmission of staphylococcal infection was assumed to occur after contact with the transiently colonized hands of HCWs, who, in turn, acquire contamination only by touching colonized patients. The aim of the study was to evaluate the impact of imperfect hand cleansing on the transmission of staphylococcal infection and to identify, whether there is a limit, above which further hand hygiene compliance is unlikely to be of benefit. The model demonstrated that if transmission is solely via the hands of HCWs, it should, under most circumstances, be possible to prevent outbreaks of staphylococcal infection from occurring at a hand cleansing frequencies <50%, even with imperfect hand hygiene. The analysis also indicated that the relationship between hand cleansing efficacy and frequency is not linear - as efficacy decreases, so the hand cleansing frequency required to ensure R0<1 increases disproportionately. Although our study confirmed hand hygiene to be an effective control measure, it demonstrated that the law of diminishing returns applies, with the greatest benefit derived from the first 20% or so of compliance. Indeed, our analysis suggests that there is little benefit to be accrued from very high levels of hand cleansing and that in most situations compliance >40% should be enough to prevent outbreaks of staphylococcal infection occurring, if transmission is solely via the hands of HCWs. Furthermore we identified a non-linear relationship between hand cleansing efficacy and frequency, suggesting that it is important to maximise the efficacy of the hand cleansing process

Improving Hand Hygiene Compliance among Health Education Students of Ambrose Alli University, Ekpoma, Edo State, Nigeria

This study assessed improving hand hygiene compliance among health education students of Ambrose Alli University, Ekpoma, Edo State, Nigeria. Three research questions and one hypothesis guided the study. This study is a descriptive survey design. 200 education students of which all was Health Education in Ambrose Alli University, Ekpoma, Edo State was sampled out of the entire 4,987 population Faculty of Education students through a simple random technique. A questionnaire titled: Improving Hand Hygiene Compliance (IHHC) was used. Data collected were analyzed. The findings revealed that there was high level of compliance to hand hygiene among students Health Education students had positive attitude and knowledge on hand hygiene compliance and there was no significant difference on the attitude and knowledge of male and female Health Education students hand hygiene compliance. Based on the findings of the study, the following recommendations were made improved hand hygiene practice needs a multifaceted approach involving both individual and facility factors. This should include improved training programs and ongoing staff development. Most importantly, patients should be empowered to monitor those employed in their care. Poor or insufficient access to hand hygiene facilities also need to be addressed