Analysis of compliance of hand hygiene in an intensive care unit

Abstract

Hand hygiene of health care workers (HCW) is the most important, the easiest and the cheapest measure for prevention of nosocomial infections. Hand disinfection is more effective, faster and less harmful for the skin then all other techniques for hand hygiene. In the intensive care unit (ICU) at the Department of Infectious Diseases, University Hospital Ljubljana, in the last years alcoholic hand disinfection became a standard procedure when the hands are not visibly soiled. In the study we evaluated the compliance of hand hygiene, especially we were interested in factors positively or negatively influencing hand hygiene. We observed HCW in during routine care and rounds in the ICU during 2 months. The compliance for hand hygiene was related to transmission of methicillinresistant Staphylococcus aureus (MRSA) between patients in the ICU. Opportunities for hand hygiene were defined according to the guidelines of the Center for Disease Control and Prevention (CDC) (1). 531 opportunities for hand hygiene were documented. In 75 % opportunities HCW performed a hand hygiene procedure: hand disinfection was used in 97 % with a mean duration of 7 seconds; whereas hand washing was used in 3 % and required a mean of 11 seconds. Compliance was higher after removing gloves (85 %), after direct patient contact (89 %) and after contact with patient body fluids (100 %) than between care of clean and dirty body areas (21 %) and before manipulating vascular and urinary catheters (25 %) (p < 0.05). After implementing additional infection control measures, compliance significantly increased from 72 % to 82 % (p < 0.05). This correlated with decrease in incidence of MRSA transmission from 11 % to 2 % (p = 0.003) in the same period. Hand hygiene was better when 0.4 to 0.6 nurses per patient were present (69 %) or more than 0.6 nurses per patient (73 %), whereas less than 0.4 nurses per patient was associated with lower compliance (62 %). Compliance did not significantly differ among age groups, gender, and profession: nurses (72 %), physicians (86 %), and other personnel (60 %). The overall compliance for hand hygiene in HCW was good (75 %). Hand disinfection was performed in 97 % and hand washing in only 3 %. Increase in compliance with hand hygiene (from 72 % to 82 %) was achieved due to additional motivation of HCW to use hand disinfection and correlated with a significant decrease in MRSA transmission in the ICU.