Abstract
BackgroundStandard hygiene precautions are an effective way of controlling healthcare-associated infections. Nevertheless, compliance with hand hygiene (HH) guidelines among healthcare workers (HCWs) is often poor, and evidence regarding appropriate use of gloves and gowns is limited and not encouraging. In this study, we evaluated the ability over time of a multimodal intervention to improve HCWs compliance with standard hygiene precautions.MethodsTrend analysis of direct observations of compliance with HH guidelines and proper glove or gown use was conducted in the medical/surgical intensive care unit (ICU) of Umberto I Teaching Hospital of Sapienza University of Rome. The study consisted of two phases: a six-month baseline phase and a 12-month post-intervention phase. The multimodal intervention was based on the World Health Organization strategy and included education and training of HCWs, together with performance feedback.ResultsA total of 12,853 observations were collected from November 2016 to April 2018. Overall compliance significantly improved from 41.9% at baseline to 62.1% (p < 0.001) after the intervention and this improvement was sustained over the following trimesters. Despite variability across job categories and over the study period, a similar trend was observed for most investigations. The main determinants of compliance were job category (with nurses having the highest compliance rates), being a member of ICU staff and whether delivering routine, as opposed to emergency, care. HH compliance was modified by glove use; unnecessary gloving negatively affected HH behaviour while appropriate gloving positively influenced it.ConclusionsThe multimodal intervention resulted in a significant improvement in compliance with standard hygiene precautions. However, regular educational reinforcement and feedback is essential to maintain a high and uniform level of compliance.
Highlights
Adherence to standard hygiene precautions leads to a reduction in infection rates healthcare-associated infections (HAIs) [1, 2], representing the most effective way of preventing cross-transmission of microorganisms [3, 4]
The training consisted of a two-hour session that included a lecture and an open discussion of the contents of the World Health Organization (WHO) Hand Hygiene Technical Reference Manual (21) and it was conducted by the resident physicians of the Department of Public Health and Infectious Diseases of Sapienza University of Rome
Observations of compliance with proper glove use accounted for 30.8% of the total observations, whereas only 7.7% were of gown use [Additional file 1: Table S1]
Summary
Adherence to standard hygiene precautions leads to a reduction in infection rates healthcare-associated infections (HAIs) [1, 2], representing the most effective way of preventing cross-transmission of microorganisms [3, 4]. The World Health Organization (WHO) has develop an evidence-based guideline; key for systematic adherence to standard hygiene precautions is education and training of all HCWs, coupled with staff evaluation and performance feedback [4, 10,11,12]. Direct observation is recommended as the gold standard for monitoring HCW compliance [13] Successful, such WHO strategy has proved that adherence to good practice varies according to the country, local setting, habit, culture and availability of resources [14]. Compliance with hand hygiene (HH) guidelines among healthcare workers (HCWs) is often poor, and evidence regarding appropriate use of gloves and gowns is limited and not encouraging. We evaluated the ability over time of a multimodal intervention to improve HCWs compliance with standard hygiene precautions
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