Feasibility of direct observation and consumption method for hand hygiene compliance in an intensive care unit of a Tertiary Care Hospital

Abstract

Background: Emerging pandemics, rampant multidrug resistance, and diversity of healthcare-associated infections entail hand hygiene (HH) compliance, surveillance, and documentation as the cornerstone of infection control practices. Methods: HH adherence rates (HHARs) were determined by the WHO's “Direct Observation” technique and compared with the “Indirect Hand-Rub Consumption” method, in the main intensive care unit of a tertiary care hospital over a period of 15 days, encompassing 3000 HH opportunities. HHARs were also compared over the study duration and among doctors and nurses. Results: The overall HHAR estimated by direct observation as per the WHO criteria was 28.5% and by “indirect hand-rub consumption” method was 12.12%. Healthcare workers adhered maximally to the WHO HH moment 3 (64.6%) followed by 5 (31.6%), 4 (27%), and 2 (27%). Conclusion: The direct observation technique for monitoring HH, though conventionally deemed as the gold standard, mandates skilled personnel and devoted time which may deter daily surveillance in resource-limited settings. The time constraints in addition to the observation biases often confound or may even push HH surveillance to the backburners. The indirect “hand-rub consumption” technique, on the other hand, might prove to be an attractive alternative in resource-limited settings, which, in addition to providing an overall glimpse of existing HH culture, is also devoid of observation biases.