Elsevier

Journal of Patient Safety & Infection Control

Volume 3, Issue 3, September–December 2015, Pages 130-133
Journal of Patient Safety & Infection Control

Original Article
Promotion of Successful Hand Hygiene practices in the Intensive Care Units of a Tertiary Care Hospital

https://doi.org/10.1016/j.jpsic.2015.11.004Get rights and content

Abstract

Background

Control of nosocomial infections is a major health concern in a hospital setting and hand hygiene is considered as the most important tool in nosocomial infection control.

Methods

This prospective study about the practice of hand washing by 106 HCWs (Health Care Workers) working in Intensive Care Unit (ICU) before and after patient contact in a tertiary care hospital was conducted to find out the hand washing compliance rate in ICU of GB Pant Institute of Postgraduate Medical Education and Research and the factors associated with noncompliance and to find out the impact of a task-orientated hand hygiene education and intervention program.

Results

462 opportunities of hand hygiene were observed in the ICUs over 30 h. Adherence was found to be 52%. A positive intention to comply with hand hygiene was found among 94% of the respondents. Most respondents (78.2%) believed that they could improve compliance with hand hygiene on their own. Intervention included education on hand hygiene indications and technique, hand hygiene performance feedback, and discussion of the previous assessment of HCWs’ beliefs toward hand hygiene. After intensive promotion of hand hygiene, observation sessions were performed on 98 nursing staff, which provided 425 opportunities of hand hygiene, and hand hygiene adherence was increased to 63% as an impact of measures taken.

Conclusions

The study revealed that hand hygiene compliance can be effectively increased among HCWs by regular reminders and surveys. Training programs on hand hygiene should be systematically planned, regularly conducted, and evaluated for staff nurses so as to keep them motivated.

Introduction

Control of nosocomial infections is a major health concern in a hospital setting. Colonization of healthcare workers’ (HCWs’) hands with Staphylococcus aureus has been described to range between 10.5% and 78.3%.1, 2 Similarly, colonization rates with Gram-negative bacteria ranged from 21% to 86.1%, the highest rate being found in the intensive care unit (ICU) setting.3 Hand hygiene is considered as the most important tool of infection control in the hospital setting. However, HCWs’ adherence to recommended hand hygiene practices is unacceptably low. Hand hygiene promotion requires a complex approach which should consider personal factors affecting health workers’ attitudes. It is also important to know the hand hygiene compliance in one's facility, and to select and implement effective interventions accordingly. The current study was carried out to find the hand washing compliance rate of HCWs in the ICU of our hospital and the factors associated with noncompliance, and to educate and sensitize the HCW for hand hygiene practices. A series of hand hygiene education was carried out, and the impact of a task-orientated hand hygiene education and intervention program was estimated.

Section snippets

Material And Methods

This prospective study was conducted over a period of six months in the ICUs of the GB Pant Institute of Postgraduate Medical Education and Research, which is a tertiary care hospital. One hundred and six nursing staff posted in postoperative ward of the hospital were included in the study. The study was carried out in 3 phases. Phase 1 consisted of the evaluation of HCW's knowledge, beliefs, and perceptions toward hand hygiene using questionnaire issued by WHO and observation sessions.

Results

Of the 110 questionnaires distributed to the nurses, 106 were returned and included in the analysis. 76% were staff nurses and 24% were nursing sisters. The staff nurse had experience of 0–5 years and nursing sisters had work experience of 6 years and more. 92 (86.8%) of the respondents believed that the main route of cross-transmission of potentially harmful germs between the patients occurred through hands of HCWs. There was no significant difference of hand hygiene behavior and knowledge

Discussion

Healthcare-acquired infections (HAIs) are almost completely preventable, yet HAIs are responsible for a number of deaths. In addition to mortality, HAIs put a huge burden on hospitals. Most commonly used method to check hand hygiene compliance is by direct observation. According to the World Health Organization (WHO) guidelines, the observation is the “gold standard” for measuring hand hygiene adherence.4 It is the only way to directly measure the HCWs’ adherence to hand hygiene guidelines.4

Conflicts of interest

The authors have none to declare.

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