Hospital-acquired Infections (HAI) represent an important cause of
morbidity and mortality in Intensive care units, particularly in the
pediatric age group. HAIs increase the length of stay, and are
associated with substantial risk of mortality [1]. Good hand hygiene
reduces HAI rates and cross-transmission of antimicrobial-resistant
pathogens [2]. Healthcare workers’ hands become progressively colonized
with potential pathogens during patient care [3,4]. Several HAI
outbreaks have been associated with contaminated healthcare workers’
hands [5-7]. The present study was undertaken to assess the hand-hygiene
compliance of healthcare workers in the pediatric intensive care unit
(PICU) of All India Institute of Medical Sciences, New Delhi, India.
Ethical clearance was obtained from the Institutional Ethics Committee.
Hand hygiene observation sessions were conducted over
a period of 11 months (13 February 2012-13 January 2013) by a single
observer. These sessions lasted for 10 minutes each, and were randomly
done, either during morning hours (9:30 am -12:30 pm) or in the
afternoon (2:30 pm-5:30 pm). The PICU personnel were unaware of these
observations. The hand hygiene followed by the healthcare workers was
observed during ‘opportunities’ defined by WHO as ‘5 moments of hand
hygiene’ i.e. before touching a patient, before clean/aseptic procedure,
after body fluid exposure risk, after touching a patient, and after
touching a patients surrounding. The actions (hand washing or
alcohol-based hand-rub) taken during these opportunities were noted and
compliance was calculated by dividing number of actions with number of
opportunities. The following formula: Compliance (%) =
Actions/Opportunities × 100. Compliance was further categorized
according to the professional category of the healthcare worker (Nurses
and Doctors) and the timing (reflecting workload) of the sessions (Table
I).
TABLE I Hand Hygiene Compliance of Health-care Workers (N=100)
Personnel |
Compliance |
|
Morning slot |
Afternoon slot |
Overall |
Nurses |
78.8% |
82.3% |
80.7% |
Doctors |
80.6% |
84.6% |
82.4% |
Total |
79.2% |
82.9% |
80.9% |
We conducted 100 hand hygiene observation sessions.
The overall hand hygiene compliance was 80.9%. Compliance to hand
hygiene during afternoon was higher compared to morning hours (82.9%
vs.79.2%). This possibly reflects the effect of peak workload during
the morning shift (impending clinical rounds, new admissions etc.) on
hand hygiene practices.
In a previous study done in our PICU, the important
reasons for poor compliance to infection control practices included high
workload, lack of knowledge, role models /rewards, and intuitional
guidelines [8]. Limitations of our study include lack of time-trend
analysis after feedback to healthcare workers, insufficient information
on the accuracy of hand washing/rub technique, and the "opportunities"
which were missed. Verbal feedback, hand hygiene education through
posters/demonstration of hand washing technique, was given to the PICU
staff at regular intervals.
We conclude that hand hygiene observation sessions
conducted for as few as 10 minutes can help understand the gaps in
practices followed by healthcare workers, thereby paving way for
effective future hand hygiene protocols.
Contributors: ST: concept and design, Planning
and execution of study in the PICU, draft revision and final approval;
RL, BD and AK: concept and design, planning of study, draft revision and
final approval.
Funding; None; Competing interest: None
stated.
References
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http://apps.who.int/medicinedocs/documents/s16320e/s16320e.pdf.
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