Hand hygiene is as simple as the ABCs—always, be, careful, caring and compliant

Abstract

Background: Health-care professionals (HCPs) who work in the operating room (OR) or post anaesthesia care unit (PACU) have a greater opportunity to cross-contaminate patients due to high workloads and frequent patient contact events. The prevalence of health-care-associated infections is a major health concern and patient contact in the OR and PACU can be a contributing factor, due to microbial contamination. The research published on maintaining the sterility of the OR is abundant, but less attention has been focused on patient contact by ’non-scrubbed’ HCPs in OR and PACU. Methods: An observational study was conducted on the hand hygiene compliance of ‘non-scrubbed’ HCPs working in the OR and PACU of the King Fahad Hospital, King Abdulaziz Medical City, a quaternary health-care facility in Saudi Arabia. The participants in the study were surgeons, anaesthetists, circulating and PACU nurses, with surreptitious observations being performed by two trained OR and PACU nurses. ’Sterile’ scrubbed HCPs were excluded. The observation timeframe was from January to December 2013 and the hand hygiene compliance components that were observed were the World Health Organisation ‘5 moments’ of hand hygiene ( Figure 1 ). Results: The study included 2300 opportunities (observations) for hand hygiene compliance and HCP observed 2000 nurses, 100 surgeons and 100 anaesthetists. Hand hygiene compliance in the King Abdulaziz Medical City OR and PACU was highest among nurses (> 90%) and lowest among physicians: surgeons (< 70%), followed by anaesthetists (< 50%). Conclusion: Adherence to hand hygiene guidelines by King Abdulaziz Medical City OR and PACU nurses was acceptably higher than anaesthetists and surgeons, noting that the organisational hand hygiene compliance target is 100%. However, the low compliance to hand hygiene guidelines by doctors potentially exposes patients to microbial transmission and harm and therefore validates a theory-practice-ethics gap.