- Email: [email protected]
Hand hygiene compliance among health care workers in pediatric oncology ward of a tertiary care hospital: A cross sectional observational study
Indian Journal of Medical Specialities 8 (2017) 197–199
Contents lists available at ScienceDirect
Indian Journal of Medical Specialities journal homepage: www.elsevier.com/locate/injms
Original research article
Hand hygiene compliance among health care workers in pediatric oncology ward of a tertiary care hospital: A cross sectional observational study Bineeta Kashyapa,* , Kavita Guptab , Sunil Gomberc , Neha Guptaa , Abhilasha Bhardwaja , NP Singha , Ashwani Kumara a
Department of Microbiology, UCMS & GTB Hospital, Delhi, India Department of Microbiology, Dharamshila Cancer Hospital, Delhi, India c Department of Pediatrics, UCMS & GTB Hospital, Delhi, India b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 15 September 2017 Received in revised form 2 November 2017 Accepted 5 November 2017 Available online 6 November 2017
Background: Hand hygiene compliance was incorporated in the Global Patient Safety Challenge initiative by WHO with the goal of reducing the burden of Health care Associated Infections (HAIs), however, compliance rates among healthcare workers remain low. Methods: All possible opportunities for Hand Hygiene were recorded for 15 days in a cross sectional study among healthcare workers in a 10-bedded Pediatric Oncology Ward. The observations were noted for all five moments of Hand hygiene by WHO. Each moment was counted as one opportunity. Results: Hand Hygiene compliance rates of 53.4%, 42.5% and 32.6% were observed for nurses, doctors and other HCWs respectively. 100% and 26.4% compliance rates were observed for moments 3 and 5 respectively. Nurses had the best compliance in all five moments of hand hygiene. Conclusions: Infection trends can vary with hand hygiene indicators. Hand hygiene monitoring is the key intervention in prevention of spread of multi-drug resistant organisms in health care settings. © 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.
Keywords: Hand hygiene Compliance Monitoring Healthcare workers Moments
1. Introduction In the 1840s, the effectiveness of hand hygiene was demonstrated by Semmelweis as hand hygiene practices significantly reduced maternal deaths in patients suffering from puerperal fever [1]. Even after several decades later, the hand hygiene message of Semmelweis is not translated consistently into clinical practices and compliance of health-care workers towards hand hygiene practices is unacceptably very low regardless of advances in infection control measures [2,3]. To reduce the healthcareassociated infections across the world, a campaign was launched in 2005 by WHO as Global Patient Safety Challenge: ‘Clean Care is Safer Care’ [4]. Many consensus guidelines were subsequently published on hand hygiene practices in healthcare systems [5,6]. Nevertheless, hand hygiene is the simplest but most effective measure when practiced meticulously can prevent nosocomial infections. The microorganism are usually transmitted via health
* Corresponding author. E-mail address: [email protected] (B. Kashyap).
personnel‘s hands. Routine hand hygiene practices removes the transient flora, colonizing the superficial layers of the skin. These organisms residing in transient flora of health care worker’s hands are most frequently associated with health care associated infections [7]. The burden of infectious diseases is still very high especially in developing countries. Compliance to recommended hand-washing practices remains unacceptably low in most of the health care facilities, it rarely exceeds more than 40 per cent of situations where hand hygiene is indicated [8,9]. Hospital acquired infections have been acknowledged as a grave problem for more than a century ago, it badly affects the quality of patient care provided in health care facilities. Hand hygiene and patient isolation are the two essential principles that have been recognized as most effective methods of reducing hospital-acquired infections There is paucity of published data for Hand hygiene surveillance in developing countries like India especially in government hospital, keeping this in mind the study was conducted in pediatric oncology ward among all health care workers to assess the exact compliance rate of hand hygiene in the pediatric oncology ward. The real aim of the study was to stress on the hand hygiene practices in our hospital.
https://doi.org/10.1016/j.injms.2017.11.001 0976-2884/© 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.
198
B. Kashyap et al. / Indian Journal of Medical Specialities 8 (2017) 197–199
2. Material & methods A cross sectional observational study was conducted in the pediatric oncology ward (consisting of 10 beds) of Guru Teg Bahadur Hospital. The study was done in the month of August’2016 among all health care workers including doctors, nurses and health care workers working in that time period. A pretested close ended validated questionnaire was conducted before the analysis. All possible opportunities for hand hygiene in the ward were recorded for a period of 15 days. The observations were noted for all five moments of Hand hygiene by WHO. Each moment counted as 1 opportunity. 2.1. WHO five moments of hand hygiene 1 – Before touching a patient, 2 – Before clean/Aseptic procedure, 3 – After body fluid exposure, 4 – After touching a patient, 5 – After touching patient surroundings. A total of 308 opportunities were noted among doctors, nurses and other health care workers. Hand Hygiene compliance rate was calculated by dividing the no. of preformed actions by number of opportunities as per WHO guidelines. Compliance (%) = performed actions/opportunities 100 3. Results Out of the total 308 opportunities, nurses comprised of the highest number 202 (65.5%) followed by doctors 54 (17.5%) and other health care workers 52 (16.8%). Compliance rate for nurses was 53.4% while 42.5% and 32.6% compliance rate was observed in doctors and other health care workers respectively. Table 1 describes the distribution of opportunities with compliance rate in each group whereas frequency of distribution of all five moment of hand hygiene varies and have been shown in Table 2. Overall compliance rate in each five moments of hand hygiene shown in Table 2. Highest compliance rate was observed in moment 3 (100%) followed by moment 2(82%) whereas least compliance rate was seen in moment 5 (26.4%). Compliance rate among nurses was better compared to doctors and other health care workers in all five moments of hand hygiene. 4. Discussion Hand hygiene remains a “corner stone” for prevention of health care associated infections. It remains as the most indispensable measure to prevent any health care associated infections [10]. Despite the significance of hand hygiene, it is not correctly and consistently followed in any health care facility. The overall compliance rate in our study is 48% percent based on the WHO’s “My Five Moments for Hand Hygiene” and compliance definition of WHO. However our study demonstrated higher compliance rate than reported by WHO (38.7%) [5] in the past but a much lower compliance have been published by WHO recently in 2013 (51.0%) [6]. Recently a study done in India have demonstrated compliance rate as high as 78% [11]. In most health care institutions, adherence to recommended hand-washing practices remains unacceptably
low, rarely exceeds above 40% [8]. As per the goal of infection control the hand hygiene compliance rate must be above 70%. The reason for lower compliance observed in our hospital, may be due to lack of knowledge among newly recruited health care personnel, who have not yet attended the training for hand hygiene at their previous hospitals, limited number of sinks and resources for hand hygiene such as soap and hand rub are the major contributors. Most of the health care worker believes that wearing of gloves substitutes hand hygiene and can reduce the high number of opportunities for hand hygiene per hour of patient care. Highest compliance rate was seen among nurses was 53.4% while doctors and other health care workers had 42.5% and 32.6% compliance rate respectively. However, Nurses demonstrated higher compliance rate among all health care providers but much higher adherence rate (63%) was observed in a study done in India [11] other studies also demonstrated comparatively higher prevalence among nursing staffs [8,12,13]. Among all the WHO five moments of hand hygiene maximum adherence/compliance (100%) was observed for moment 3- After body fluid exposure. However the number of opportunities being very less so it will be wrong to derive any conclusion from this in true sense. Nevertheless, it is noticed that all the health care workers were very careful after body fluid exposure and they perceive it as an important measure for self-protection. Moment 3 was closely followed by moment 2 with 82% compliance rate and the goal of infection control (hand hygiene compliance must be above 70%) was achieved in this moment both by nurses and doctors. This may be attributed to the awareness about the risk of hospital acquired infections that can be transmitted during any invasive procedure. Poor compliance rate was observed for moment 1(before touching a patient) and moment 4 (after touching a patient) while worst compliance rate was seen for moment 5 (after touching patient surroundings) other studies have also reported poor performance for moment 5 across all health care workers [11]. In our study doctors behaved worst both for moment 4 & 5. There is no standard protocol to monitor compliance to hand hygiene. Most of the studies conducted in past have included direct observation as a method to assess hand hygiene compliance [14– 16] and has also been recommended by WHO. Direct observation method provides qualitative as well as quantitative information about why and when failures occur [5]. In a developing country like India, due to non availability of technologies like electronic machines to monitor compliance, direct observation method remains as a gold standard. The questionnaire round was conducted before the study period as a part of regular feedback training. Any feedback for their performance was not given during the study period as awareness of healthcare worker just before study may affect health care workers behavior ultimately direct observation results may be affected (Hawthorne effect) [17]. There were certain limitations in our study like we were not able to monitor them continuously, the data was collected for 30 min period twice a day for 15 days that probably provides information about a very low percentage of all hand hygiene opportunities. Hand hygiene practices reflect attitudes, behavior and beliefs of health care personnel. Several factors can affect the performance of hand hygiene like health care worker related factors clinical factors
Table 1 Distribution of opportunities with compliance rate in each group of Healthcare workers (HCW) under study.
Nurses Doctors Other Health Care Workers Total
Performed actions
Opportunities
Compliance rate (%)
108 23 17 148
202 54 52 308
53.4 42.5 32.6 48.0
B. Kashyap et al. / Indian Journal of Medical Specialities 8 (2017) 197–199
199
Table 2 Hand hygiene compliance rate (%) in each group of Health care workers for five moments of Hand Hygiene by WHO. Compliance rate (%) in WHO 5 moments of hand hygiene Moment 1 (Before touching Moment 2 (Before clean/aseptic Moment 3 (After body fluid Moment 4 (After touching Moment 5 (After touching patient a patient) procedure) exposure) a patient) surroundings) n = 83 n = 50 n = 05 n = 83 n = 87 Nurses Doctors Other HCW Total
31/58 (53.4) 9/17 (52.9) 3/8 (37.5)
33/39 (84.6) 8/11 (72.7) 0
3/3 (100) 0 2/2 (100)
29/58 (50) 4/17 (23.5) 3/8 (37.5)
12/44 (27.2) 2/9 (22.2) 9/34 (26.4)
43/83 (51.8)
41/50 (82)
5/5 (100)
36/83 (43.3)
23/87 (26.4)
and environmental/institutional factors [18]. Poor compliance of hand hygiene may be attributed to lack of knowledge, workload pressure. An induction course should be conducted monthly for all new recruits in the hospital where microbiologist will train them. Educational sessions should focus on benefits of hand hygiene, ideal duration and steps of hand hygiene and the extent of reduction of hospital acquired infections by hand hygiene. There should be posters at strategic locations to educate and aware all health care workers about the significance of hand hygiene. There should be sufficient supply of alcohol-based hand rubs in the hospital premises and it should be placed bedside so that it can be utilized as and when required. Since 2008, every year on 15th of October Global Hand washing Day has been celebrated to motivate and mobilize people around the world towards hand washing. Multimodal strategies have been shown to be more successful in improving rates of adherence with hand hygiene among health care workers rather than single interventions [19]. Although we have progressed so far and have developed many evidence based guidelines for infection control, it still remains difficult to implement them especially in developing countries. Hand hygiene practices are vital by which we can reduce the cross contamination of multi-drug resistant organisms (MDROs) as treatment of patients infected with these MDROs is challenging and it overburdens our health care system. Lack of basic health care facilities, surveillance networks and enough resources like to build sinks at places where required are major deterrents. The use of WHO recommended alcohol based hand rubs is a practical solution to conquer all these constraints, because it can be distributed individually to a health care worker and they can carry it with them and can use when required [20]. Therefore, by increasing the emphasis on infection control measures, regular training and continuous monitoring are important steps to prevent any nosocomial infection. Conflict of interest None. Source of funding None.
References [1] Pittet D, Boyce JM. Hand hygiene and patient care: pursuing the Semmelweis legacy. Lancet Infect Dis 2001;1(0):9–20. [2] Jarvis WR. Handwashing—the Semmelweis lesson forgotten. Lancet 1994;344:1311–2. [3] Larson EL. CIC 1992-1993, 1994 APIC Guidelines Committee: APIC guideline for hand washing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–69. [4] Pittet D, Donaldson L. Clean Care is Safer Care: a worldwide priority. Lancet 2005;366:1246–7. [5] WHO Guidelines on Hand Hygiene in Health Care, 2009. 2014. Sep 11th, Available from: http://www.whqlibdoc.who.int/publications/2009/ 9789241597906_eng.pdf. [6] Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis 2013;13:843– 51. [7] Boyce JM, Pittet D. 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. Morb Mortal Wkly Rep 2002;51:1–44. [8] Trampuz A, Widmer AF. Hand hygiene: a frequently missed lifesaving opportunity during patient care. Mayo Clin Proc 2004;79:109–16. [9] Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital: infection control program. Ann Intern Med 1999;130:126– 30. [10] Song X, Stockwell D, Floyd T, Short BL, Singh N. Improving hand hygiene compliance in health care workers: strategies and impact on patient outcomes. Am J Infect Control 2013;41(10):101–5. [11] Chavali S, Menon V, Shukla U. Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian J Crit Care Med 2014;18 (10):689–93. [12] Stewardson A, Pittet D. Quicker, easier, and cheaper. The promise of automated hand hygiene monitoring? Infect Control Hosp Epidemiol 2011;32:1029–31. [13] Marra AR, Moura Jr. DF, Paes AT, dos Santos OF, Edmond MB. Measuring rates of hand hygiene adherence in the intensive care setting: a comparative study of direct observation, product usage, and electronic counting devices. Infect Control Hosp Epidemiol 2010;31:796–801. [14] Randle J, Arthur A, Vaughan N. Twenty-four-hour observational study of hospital hand hygiene compliance. J Hosp Infect 2010;76:252–5. [15] Mathai E, Allegranzi B, Kilpatrick C, Pittet D. Prevention and control of health care-associated infections through improved hand hygiene. Indian J Med Microbiol 2010;28:100–6. [16] Rupp ME, Fitzgerald T, Puumala S, Anderson JR, Craig R, Iwen PC, et al. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol 2008;29:8–15. [17] Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirkland KB. Variability in the Hawthorne effect with regard to hand hygiene performance in high- and lowperforming inpatient care units. Infect Control Hosp Epidemiol 2009;30:222– 5. [18] Mathur P. Hand hygiene: back to the basics of infection control. Indian J Med Res 2011;134:611–20. [19] Magiorakos AP, Suetens C, Boyd L, Costa C. National hand hygiene campaigns in Europe, 2000–2009. Euro Survell 2009;14:ii–19191. [20] Pittet D, Allegranzi B, Storr J, Bagheri Nejad S, Dziekan G, Leotsakos A. Infection control as a major World Health Organization priority for developing countries. J Hosp Infect 2008;68:285–92.
Contents lists available at ScienceDirect
Indian Journal of Medical Specialities journal homepage: www.elsevier.com/locate/injms
Original research article
Hand hygiene compliance among health care workers in pediatric oncology ward of a tertiary care hospital: A cross sectional observational study Bineeta Kashyapa,* , Kavita Guptab , Sunil Gomberc , Neha Guptaa , Abhilasha Bhardwaja , NP Singha , Ashwani Kumara a
Department of Microbiology, UCMS & GTB Hospital, Delhi, India Department of Microbiology, Dharamshila Cancer Hospital, Delhi, India c Department of Pediatrics, UCMS & GTB Hospital, Delhi, India b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 15 September 2017 Received in revised form 2 November 2017 Accepted 5 November 2017 Available online 6 November 2017
Background: Hand hygiene compliance was incorporated in the Global Patient Safety Challenge initiative by WHO with the goal of reducing the burden of Health care Associated Infections (HAIs), however, compliance rates among healthcare workers remain low. Methods: All possible opportunities for Hand Hygiene were recorded for 15 days in a cross sectional study among healthcare workers in a 10-bedded Pediatric Oncology Ward. The observations were noted for all five moments of Hand hygiene by WHO. Each moment was counted as one opportunity. Results: Hand Hygiene compliance rates of 53.4%, 42.5% and 32.6% were observed for nurses, doctors and other HCWs respectively. 100% and 26.4% compliance rates were observed for moments 3 and 5 respectively. Nurses had the best compliance in all five moments of hand hygiene. Conclusions: Infection trends can vary with hand hygiene indicators. Hand hygiene monitoring is the key intervention in prevention of spread of multi-drug resistant organisms in health care settings. © 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.
Keywords: Hand hygiene Compliance Monitoring Healthcare workers Moments
1. Introduction In the 1840s, the effectiveness of hand hygiene was demonstrated by Semmelweis as hand hygiene practices significantly reduced maternal deaths in patients suffering from puerperal fever [1]. Even after several decades later, the hand hygiene message of Semmelweis is not translated consistently into clinical practices and compliance of health-care workers towards hand hygiene practices is unacceptably very low regardless of advances in infection control measures [2,3]. To reduce the healthcareassociated infections across the world, a campaign was launched in 2005 by WHO as Global Patient Safety Challenge: ‘Clean Care is Safer Care’ [4]. Many consensus guidelines were subsequently published on hand hygiene practices in healthcare systems [5,6]. Nevertheless, hand hygiene is the simplest but most effective measure when practiced meticulously can prevent nosocomial infections. The microorganism are usually transmitted via health
* Corresponding author. E-mail address: [email protected] (B. Kashyap).
personnel‘s hands. Routine hand hygiene practices removes the transient flora, colonizing the superficial layers of the skin. These organisms residing in transient flora of health care worker’s hands are most frequently associated with health care associated infections [7]. The burden of infectious diseases is still very high especially in developing countries. Compliance to recommended hand-washing practices remains unacceptably low in most of the health care facilities, it rarely exceeds more than 40 per cent of situations where hand hygiene is indicated [8,9]. Hospital acquired infections have been acknowledged as a grave problem for more than a century ago, it badly affects the quality of patient care provided in health care facilities. Hand hygiene and patient isolation are the two essential principles that have been recognized as most effective methods of reducing hospital-acquired infections There is paucity of published data for Hand hygiene surveillance in developing countries like India especially in government hospital, keeping this in mind the study was conducted in pediatric oncology ward among all health care workers to assess the exact compliance rate of hand hygiene in the pediatric oncology ward. The real aim of the study was to stress on the hand hygiene practices in our hospital.
https://doi.org/10.1016/j.injms.2017.11.001 0976-2884/© 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Indian Journal of Medical Specialities.
198
B. Kashyap et al. / Indian Journal of Medical Specialities 8 (2017) 197–199
2. Material & methods A cross sectional observational study was conducted in the pediatric oncology ward (consisting of 10 beds) of Guru Teg Bahadur Hospital. The study was done in the month of August’2016 among all health care workers including doctors, nurses and health care workers working in that time period. A pretested close ended validated questionnaire was conducted before the analysis. All possible opportunities for hand hygiene in the ward were recorded for a period of 15 days. The observations were noted for all five moments of Hand hygiene by WHO. Each moment counted as 1 opportunity. 2.1. WHO five moments of hand hygiene 1 – Before touching a patient, 2 – Before clean/Aseptic procedure, 3 – After body fluid exposure, 4 – After touching a patient, 5 – After touching patient surroundings. A total of 308 opportunities were noted among doctors, nurses and other health care workers. Hand Hygiene compliance rate was calculated by dividing the no. of preformed actions by number of opportunities as per WHO guidelines. Compliance (%) = performed actions/opportunities 100 3. Results Out of the total 308 opportunities, nurses comprised of the highest number 202 (65.5%) followed by doctors 54 (17.5%) and other health care workers 52 (16.8%). Compliance rate for nurses was 53.4% while 42.5% and 32.6% compliance rate was observed in doctors and other health care workers respectively. Table 1 describes the distribution of opportunities with compliance rate in each group whereas frequency of distribution of all five moment of hand hygiene varies and have been shown in Table 2. Overall compliance rate in each five moments of hand hygiene shown in Table 2. Highest compliance rate was observed in moment 3 (100%) followed by moment 2(82%) whereas least compliance rate was seen in moment 5 (26.4%). Compliance rate among nurses was better compared to doctors and other health care workers in all five moments of hand hygiene. 4. Discussion Hand hygiene remains a “corner stone” for prevention of health care associated infections. It remains as the most indispensable measure to prevent any health care associated infections [10]. Despite the significance of hand hygiene, it is not correctly and consistently followed in any health care facility. The overall compliance rate in our study is 48% percent based on the WHO’s “My Five Moments for Hand Hygiene” and compliance definition of WHO. However our study demonstrated higher compliance rate than reported by WHO (38.7%) [5] in the past but a much lower compliance have been published by WHO recently in 2013 (51.0%) [6]. Recently a study done in India have demonstrated compliance rate as high as 78% [11]. In most health care institutions, adherence to recommended hand-washing practices remains unacceptably
low, rarely exceeds above 40% [8]. As per the goal of infection control the hand hygiene compliance rate must be above 70%. The reason for lower compliance observed in our hospital, may be due to lack of knowledge among newly recruited health care personnel, who have not yet attended the training for hand hygiene at their previous hospitals, limited number of sinks and resources for hand hygiene such as soap and hand rub are the major contributors. Most of the health care worker believes that wearing of gloves substitutes hand hygiene and can reduce the high number of opportunities for hand hygiene per hour of patient care. Highest compliance rate was seen among nurses was 53.4% while doctors and other health care workers had 42.5% and 32.6% compliance rate respectively. However, Nurses demonstrated higher compliance rate among all health care providers but much higher adherence rate (63%) was observed in a study done in India [11] other studies also demonstrated comparatively higher prevalence among nursing staffs [8,12,13]. Among all the WHO five moments of hand hygiene maximum adherence/compliance (100%) was observed for moment 3- After body fluid exposure. However the number of opportunities being very less so it will be wrong to derive any conclusion from this in true sense. Nevertheless, it is noticed that all the health care workers were very careful after body fluid exposure and they perceive it as an important measure for self-protection. Moment 3 was closely followed by moment 2 with 82% compliance rate and the goal of infection control (hand hygiene compliance must be above 70%) was achieved in this moment both by nurses and doctors. This may be attributed to the awareness about the risk of hospital acquired infections that can be transmitted during any invasive procedure. Poor compliance rate was observed for moment 1(before touching a patient) and moment 4 (after touching a patient) while worst compliance rate was seen for moment 5 (after touching patient surroundings) other studies have also reported poor performance for moment 5 across all health care workers [11]. In our study doctors behaved worst both for moment 4 & 5. There is no standard protocol to monitor compliance to hand hygiene. Most of the studies conducted in past have included direct observation as a method to assess hand hygiene compliance [14– 16] and has also been recommended by WHO. Direct observation method provides qualitative as well as quantitative information about why and when failures occur [5]. In a developing country like India, due to non availability of technologies like electronic machines to monitor compliance, direct observation method remains as a gold standard. The questionnaire round was conducted before the study period as a part of regular feedback training. Any feedback for their performance was not given during the study period as awareness of healthcare worker just before study may affect health care workers behavior ultimately direct observation results may be affected (Hawthorne effect) [17]. There were certain limitations in our study like we were not able to monitor them continuously, the data was collected for 30 min period twice a day for 15 days that probably provides information about a very low percentage of all hand hygiene opportunities. Hand hygiene practices reflect attitudes, behavior and beliefs of health care personnel. Several factors can affect the performance of hand hygiene like health care worker related factors clinical factors
Table 1 Distribution of opportunities with compliance rate in each group of Healthcare workers (HCW) under study.
Nurses Doctors Other Health Care Workers Total
Performed actions
Opportunities
Compliance rate (%)
108 23 17 148
202 54 52 308
53.4 42.5 32.6 48.0
B. Kashyap et al. / Indian Journal of Medical Specialities 8 (2017) 197–199
199
Table 2 Hand hygiene compliance rate (%) in each group of Health care workers for five moments of Hand Hygiene by WHO. Compliance rate (%) in WHO 5 moments of hand hygiene Moment 1 (Before touching Moment 2 (Before clean/aseptic Moment 3 (After body fluid Moment 4 (After touching Moment 5 (After touching patient a patient) procedure) exposure) a patient) surroundings) n = 83 n = 50 n = 05 n = 83 n = 87 Nurses Doctors Other HCW Total
31/58 (53.4) 9/17 (52.9) 3/8 (37.5)
33/39 (84.6) 8/11 (72.7) 0
3/3 (100) 0 2/2 (100)
29/58 (50) 4/17 (23.5) 3/8 (37.5)
12/44 (27.2) 2/9 (22.2) 9/34 (26.4)
43/83 (51.8)
41/50 (82)
5/5 (100)
36/83 (43.3)
23/87 (26.4)
and environmental/institutional factors [18]. Poor compliance of hand hygiene may be attributed to lack of knowledge, workload pressure. An induction course should be conducted monthly for all new recruits in the hospital where microbiologist will train them. Educational sessions should focus on benefits of hand hygiene, ideal duration and steps of hand hygiene and the extent of reduction of hospital acquired infections by hand hygiene. There should be posters at strategic locations to educate and aware all health care workers about the significance of hand hygiene. There should be sufficient supply of alcohol-based hand rubs in the hospital premises and it should be placed bedside so that it can be utilized as and when required. Since 2008, every year on 15th of October Global Hand washing Day has been celebrated to motivate and mobilize people around the world towards hand washing. Multimodal strategies have been shown to be more successful in improving rates of adherence with hand hygiene among health care workers rather than single interventions [19]. Although we have progressed so far and have developed many evidence based guidelines for infection control, it still remains difficult to implement them especially in developing countries. Hand hygiene practices are vital by which we can reduce the cross contamination of multi-drug resistant organisms (MDROs) as treatment of patients infected with these MDROs is challenging and it overburdens our health care system. Lack of basic health care facilities, surveillance networks and enough resources like to build sinks at places where required are major deterrents. The use of WHO recommended alcohol based hand rubs is a practical solution to conquer all these constraints, because it can be distributed individually to a health care worker and they can carry it with them and can use when required [20]. Therefore, by increasing the emphasis on infection control measures, regular training and continuous monitoring are important steps to prevent any nosocomial infection. Conflict of interest None. Source of funding None.
References [1] Pittet D, Boyce JM. Hand hygiene and patient care: pursuing the Semmelweis legacy. Lancet Infect Dis 2001;1(0):9–20. [2] Jarvis WR. Handwashing—the Semmelweis lesson forgotten. Lancet 1994;344:1311–2. [3] Larson EL. CIC 1992-1993, 1994 APIC Guidelines Committee: APIC guideline for hand washing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–69. [4] Pittet D, Donaldson L. Clean Care is Safer Care: a worldwide priority. Lancet 2005;366:1246–7. [5] WHO Guidelines on Hand Hygiene in Health Care, 2009. 2014. Sep 11th, Available from: http://www.whqlibdoc.who.int/publications/2009/ 9789241597906_eng.pdf. [6] Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis 2013;13:843– 51. [7] Boyce JM, Pittet D. 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. Morb Mortal Wkly Rep 2002;51:1–44. [8] Trampuz A, Widmer AF. Hand hygiene: a frequently missed lifesaving opportunity during patient care. Mayo Clin Proc 2004;79:109–16. [9] Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital: infection control program. Ann Intern Med 1999;130:126– 30. [10] Song X, Stockwell D, Floyd T, Short BL, Singh N. Improving hand hygiene compliance in health care workers: strategies and impact on patient outcomes. Am J Infect Control 2013;41(10):101–5. [11] Chavali S, Menon V, Shukla U. Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian J Crit Care Med 2014;18 (10):689–93. [12] Stewardson A, Pittet D. Quicker, easier, and cheaper. The promise of automated hand hygiene monitoring? Infect Control Hosp Epidemiol 2011;32:1029–31. [13] Marra AR, Moura Jr. DF, Paes AT, dos Santos OF, Edmond MB. Measuring rates of hand hygiene adherence in the intensive care setting: a comparative study of direct observation, product usage, and electronic counting devices. Infect Control Hosp Epidemiol 2010;31:796–801. [14] Randle J, Arthur A, Vaughan N. Twenty-four-hour observational study of hospital hand hygiene compliance. J Hosp Infect 2010;76:252–5. [15] Mathai E, Allegranzi B, Kilpatrick C, Pittet D. Prevention and control of health care-associated infections through improved hand hygiene. Indian J Med Microbiol 2010;28:100–6. [16] Rupp ME, Fitzgerald T, Puumala S, Anderson JR, Craig R, Iwen PC, et al. Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol 2008;29:8–15. [17] Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirkland KB. Variability in the Hawthorne effect with regard to hand hygiene performance in high- and lowperforming inpatient care units. Infect Control Hosp Epidemiol 2009;30:222– 5. [18] Mathur P. Hand hygiene: back to the basics of infection control. Indian J Med Res 2011;134:611–20. [19] Magiorakos AP, Suetens C, Boyd L, Costa C. National hand hygiene campaigns in Europe, 2000–2009. Euro Survell 2009;14:ii–19191. [20] Pittet D, Allegranzi B, Storr J, Bagheri Nejad S, Dziekan G, Leotsakos A. Infection control as a major World Health Organization priority for developing countries. J Hosp Infect 2008;68:285–92.