American Journal of Infection Control 41 (2013) 1114-5
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Adherence to hand hygiene in high-risk units of a tertiary care hospital in India Manisha Biswal MD a, *, Neena Vir Singh MSc b, Rupinder Kaur MSc b, Tissamol Sebastian MSc b, Rinzin Dolkar MSc b, Suma B. Appananavar MD a, Gagandeep Singh MD a, Neelam Taneja MD a a b
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Key Words: Hand hygiene Compliance Prerequisites ICUs India
To improve the compliance to hand hygiene in our health care workers, 3 hand hygiene awareness weeks have been conducted over the past one-and-a-half years in our hospital. This observational audit conducted from October 2011 to March 2012 was planned to assess the impact of the above awareness drives. Although overall compliance increased significantly in 7 intensive care units from 23.1% to 41.2% (P < .0001), several deficiencies were noticed both in technique used as well as during specific opportunities of hand hygiene. Copyright Ó 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Among standard precautions recommended to reduce health care-associated infections, hand hygiene (HH) is the single most important measure to reduce nosocomial infections.1 To increase compliance to HH in our hospital, 3 HH awareness drives were organized by the Infection Control Team between May 2010 and April 2011. Extensive activities including continuing medical educations, educative interactive sessions, orientation classes, posters for display, and direct team supervision of practical training were included in these drives. The aim of this study was to determine the impact of these sessions on the HH compliance in health care workers (HCWs). The study was cleared by the institute Ethics Committee. Three infection control nurses, trained in observation and recoding of HH activities, conducted this 5-month prospective audit from October 2011 to March 2012. A total of 7 intensive care units (ICUs) was included; main ICU, pediatric ICU, transplant ICU, neonatal ICU, neurosurgery ICU, cardiology ICU, and cardiothoracic and vascular surgery ICU. Each nurse spent an hour each day observing and recording compliance of all health care staff and patient attendants in the ICU in which she was posted. HH opportunities included before and after patient care, before an invasive procedure, when hands were visibly soiled with blood or body fluids of patients, and before and after removing gloves.2 One patient was chosen by a draw of lots, and all HH opportunities
* Address correspondence to Manisha Biswal, MD, Assistant Professor, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India. E-mail address: [email protected] (M. Biswal). Conflicts of interest: None to report.
related to that patient were recorded by the observer. In each ICU, the total number of opportunities for 1 hour for a period of 4 or 5 days was recorded for this study. To minimize the Hawthorne effect, the participants did not know that they were being observed for HH compliance. Both washing hands with soap and water and rubbing hands with alcohol products was counted as HH performed. The total number of opportunities and actual HH performed was recorded by the observer.3 Compliance was expressed as percentage (observed HH/total opportunities for HH). For comparison of compliance in different ICUs, 1-way analysis of variance with post hoc Bonferroni correction was used for statistical analysis; and, for comparison of compliance before and after any opportunity, c2 test was used for statistical analysis. A P value of < .05 was considered as statistically significant and that of < .001 highly significant. A total of 822 opportunities was observed comprising various moments of HH. There were significant variations among the ICUs both in the prerequisites of HH (Fig 1) (P < .05) and the actual observed compliance (Table 1). Compliance prior to wearing gloves varied between 20% and 85.7%. HH performed prior to touching the central venous catheter (39.3%) was significantly more than after touching it (21.5%) (P < .05). On the other hand, the HH performed prior to touching the urinary catheter (17.5%) was significantly less than after touching it (45%) (P < .0001). Although not significant, the HCWs performed HH more after suctioning of endotracheal secretions (57.3%) compared with before (56.9%) (P ¼ .97). We wanted to assess the impact of a HH training program started in our hospital in this study. We found that, in spite of the generally high availability of soap and/or alcohol hand rub at each bedside, the HH compliance was only 41.2% (95% confidence
0196-6553/$36.00 - Copyright Ó 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2013.05.026
M. Biswal et al. / American Journal of Infection Control 41 (2013) 1114-5
1115
Fig 1. Compliance with prerequisites of hand hygiene in different ICUs. *P < .05.
Table 1 Hand hygiene compliance before and after hand hygiene awareness campaigns in 5 ICUs of the hospital Compliance expressed in % (observed hand hygiene/total opportunities for hand hygiene)
Intensive care unit (ICU) Cardiology ICU Cardiovascular and thoracic ICU Main (open mixed medical-surgical) ICU Neurosurgery ICU Neonatal ICU Pediatric ICU Transplant ICU Total
Pre-HH awareness campaign
Post-HH awareness campaign
P value
21.8 (34/156) 19.0 (31/163)
41.2 (80/195) 30.4 (38/125)
.0001 .0267
9.3 (17/183)
37.1 (52/140)
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Adherence to hand hygiene in high-risk units of a tertiary care hospital in India Manisha Biswal MD a, *, Neena Vir Singh MSc b, Rupinder Kaur MSc b, Tissamol Sebastian MSc b, Rinzin Dolkar MSc b, Suma B. Appananavar MD a, Gagandeep Singh MD a, Neelam Taneja MD a a b
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Key Words: Hand hygiene Compliance Prerequisites ICUs India
To improve the compliance to hand hygiene in our health care workers, 3 hand hygiene awareness weeks have been conducted over the past one-and-a-half years in our hospital. This observational audit conducted from October 2011 to March 2012 was planned to assess the impact of the above awareness drives. Although overall compliance increased significantly in 7 intensive care units from 23.1% to 41.2% (P < .0001), several deficiencies were noticed both in technique used as well as during specific opportunities of hand hygiene. Copyright Ó 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Among standard precautions recommended to reduce health care-associated infections, hand hygiene (HH) is the single most important measure to reduce nosocomial infections.1 To increase compliance to HH in our hospital, 3 HH awareness drives were organized by the Infection Control Team between May 2010 and April 2011. Extensive activities including continuing medical educations, educative interactive sessions, orientation classes, posters for display, and direct team supervision of practical training were included in these drives. The aim of this study was to determine the impact of these sessions on the HH compliance in health care workers (HCWs). The study was cleared by the institute Ethics Committee. Three infection control nurses, trained in observation and recoding of HH activities, conducted this 5-month prospective audit from October 2011 to March 2012. A total of 7 intensive care units (ICUs) was included; main ICU, pediatric ICU, transplant ICU, neonatal ICU, neurosurgery ICU, cardiology ICU, and cardiothoracic and vascular surgery ICU. Each nurse spent an hour each day observing and recording compliance of all health care staff and patient attendants in the ICU in which she was posted. HH opportunities included before and after patient care, before an invasive procedure, when hands were visibly soiled with blood or body fluids of patients, and before and after removing gloves.2 One patient was chosen by a draw of lots, and all HH opportunities
* Address correspondence to Manisha Biswal, MD, Assistant Professor, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India. E-mail address: [email protected] (M. Biswal). Conflicts of interest: None to report.
related to that patient were recorded by the observer. In each ICU, the total number of opportunities for 1 hour for a period of 4 or 5 days was recorded for this study. To minimize the Hawthorne effect, the participants did not know that they were being observed for HH compliance. Both washing hands with soap and water and rubbing hands with alcohol products was counted as HH performed. The total number of opportunities and actual HH performed was recorded by the observer.3 Compliance was expressed as percentage (observed HH/total opportunities for HH). For comparison of compliance in different ICUs, 1-way analysis of variance with post hoc Bonferroni correction was used for statistical analysis; and, for comparison of compliance before and after any opportunity, c2 test was used for statistical analysis. A P value of < .05 was considered as statistically significant and that of < .001 highly significant. A total of 822 opportunities was observed comprising various moments of HH. There were significant variations among the ICUs both in the prerequisites of HH (Fig 1) (P < .05) and the actual observed compliance (Table 1). Compliance prior to wearing gloves varied between 20% and 85.7%. HH performed prior to touching the central venous catheter (39.3%) was significantly more than after touching it (21.5%) (P < .05). On the other hand, the HH performed prior to touching the urinary catheter (17.5%) was significantly less than after touching it (45%) (P < .0001). Although not significant, the HCWs performed HH more after suctioning of endotracheal secretions (57.3%) compared with before (56.9%) (P ¼ .97). We wanted to assess the impact of a HH training program started in our hospital in this study. We found that, in spite of the generally high availability of soap and/or alcohol hand rub at each bedside, the HH compliance was only 41.2% (95% confidence
0196-6553/$36.00 - Copyright Ó 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2013.05.026
M. Biswal et al. / American Journal of Infection Control 41 (2013) 1114-5
1115
Fig 1. Compliance with prerequisites of hand hygiene in different ICUs. *P < .05.
Table 1 Hand hygiene compliance before and after hand hygiene awareness campaigns in 5 ICUs of the hospital Compliance expressed in % (observed hand hygiene/total opportunities for hand hygiene)
Intensive care unit (ICU) Cardiology ICU Cardiovascular and thoracic ICU Main (open mixed medical-surgical) ICU Neurosurgery ICU Neonatal ICU Pediatric ICU Transplant ICU Total
Pre-HH awareness campaign
Post-HH awareness campaign
P value
21.8 (34/156) 19.0 (31/163)
41.2 (80/195) 30.4 (38/125)
.0001 .0267
9.3 (17/183)
37.1 (52/140)
