Objectives. To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care. Design. A systematic review of studies published before January 1, 2009, on observed or self‐reported compliance rates. Methods. Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed. Results. We included 96 empirical studies, the majority ( \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont...

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0195941700028927

Systematic Review of Studies on Compliance with Hand Hygiene Guidelines in Hospital Care

National bodies and guidelines should be less suggestive and more directive

In Europe about 7% of patients in hospital develop healthcare associated infections.1 The associated financial burden of these infections for the United Kingdom is estimated to be £1-11bn (€1.1-12.6bn; $1.6-18bn). 2 3 Current policies aim for, perhaps unrealistically, 100% prevention.

The British Medical Association recently published guidelines on how to tackle healthcare associated infections, and set priorities for action.4 The most important changes in the guidelines are the shift from policies dealing with micro-organisms (especially meticillin resistant Staphylococcus aureus and Clostridium difficile ) to policies aimed at reducing rates of healthcare associated infections (such as surgical site infections, ventilator associated pneumonia, and urinary tract infections) and changing behaviour. 

How the suggested interventions are understood and implemented by health professionals is critical in determining whether they will be successful. Although interventions to improve patients’ safety may seem simple (see box) it is non-compliance with the interventions that is the problem.

The guidelines stress …

Healthcare associated infections

Objective. To understand the behavioral determinants of hand hygiene in our hospital. Design. Qualitative study based on 17 focus groups. Setting. Mount Sinai Hospital, an acute care tertiary hospital affiliated with the University of Toronto. Participants. We recruited 153 healthcare workers (HCWs) representing all major patient care job categories. Methods. Focus group discussions were transcribed verbatim. Thematic analysis was independently conducted by 3 investigators. Results. Participants reported that the realities of their workload (eg, urgent care and interruptions) make complete adherence to hand hygiene impossible. The guidelines were described as overly conservative, and participants expressed that their judgement is adequate to determine when to perform hand hygiene. Discussions revealed gaps in knowledge among participants; most participants expressed interest in more information and education. Participants reported self‐protection as the primary reason for the performance of hand hygiene, ...

Focus Group Study of Hand Hygiene Practice among Healthcare Workers in a Teaching Hospital in Toronto, Canada

Hand hygiene (HH) is the single most important factor in the prevention of health care-acquired infections. The 3 most frequently reported methods of measuring HH compliance are: (1) direct observation, (2) self-reporting by health care workers (HCWs), and (3) indirect calculation based on HH product usage. This article presents the results of a 12-month multicenter collaboration assessing HH compliance rates at US health care facilities by measuring product usage and providing feedback about HH compliance. Our results show that HH compliance at baseline was 26% for intensive care units (ICUs) and 36% for non-ICUs. After 12 months of measuring product usage and providing feedback, compliance increased to 37% for ICUs and 51% for non-ICUs. (ICU, P = .0119; non-ICU, P < .001). HH compliance in the United States can increase when monitoring is combined with feedback. However, HH still occurs at or below 50% compli- ance for both ICUs and non-ICUs.

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Hand Hygiene Compliance Rates in the United States—A One-Year Multicenter Collaboration Using Product/Volume Usage Measurement and Feedback

tively, reduced the number of nosocomial infections from 089 to 085; reducing the ratio to 1 and 1, respectively, further reduced the number of nosocomial infections to 032 Increases in handwashing rates by 0%, 10%, and 20% for high-risk visits yielded reductions in nosocomial infections similar to those yielded by increases in handwashing rates for all visits (089, 036, and 024, respectively) Screening all patients for MRSA at admission reduced the transmission rate to 081 per 1,000 patient-days from 137 if no patients were screened CONCLUSION: Within the ranges of parameters studied, the most effective strategies for reducing the rate of MRSA transmission were increasing the handwashing rates for visits involving contact with skin or bodily fluid and screening patients for MRSA at admission (Infect Control Hosp Epidemiol 2005;26:607615)

Modeling transmission of methicillin-resistant Staphylococcus aureus among patients admitted to a hospital.

Objective:To obtain accurate data regarding the handwashing behavior and patterns of visits to patients by healthcare workers (HCWs).Methods:All visits by HCWs to selected patient rooms were recorded for 3 days and 2 nights. Additionally, 5 nurses were observed for 1 day each and 2 nurses were observed for 1 night each. Nurses were observed for their entire shifts and all of their activities were recorded.Setting:A general medical ward in a tertiary-care hospital.Participants:Convenience samples of HCWs and patients.Results:Patients were visited every 25 minutes on average. Monitoring rooms and observing nurses resulted in similar rates of patient visits. The highest level of risk was contact with body fluids in 11% of visits and skin in 40% of visits. The overall rate of handwashing was 46%; however, the rate was higher for visits involving contact with body fluids (81%) and skin (61%). Nurses returned immediately to the same patient 45% of the time. The rate of handwashing was higher for the last of a series of visits to a patient's room (53% vs 30%, P < .0001).Conclusions:Nurses adjusted their handwashing rates in accordance with the risk level of each visit. Monitoring patient rooms and observing nurses yielded similar estimates of patient visits and proportions of visits involving contact with skin or body fluids. Education programs about hand hygiene may be more effective if patterns of care and levels of risk are incorporated into recommendations.

Andy Simor

Papers

Patterns of handwashing behavior and visits to patients on a general medical ward of healthcare workers.