Non-Compliance with Hand Hygiene Standards among Nurses in Windhoek, Namibia

AS THE 2009 INFLUENZA A(H1N1) virus expands its reach, health officials continue to stress the importance of hand washing as the first line of defense in prevention. Particularly in health care settings, hand antisepsis has long been recognized as a key factor in minimizing the spread of pathogenic microorganisms and limiting health care–associated infections. Yet getting health care workers, including physicians and nurses, to wash their hands remains a problem. In response, new patient safety programs from the Joint Commission and the World Health Organization (WHO) are placing their initial focus on improving compliance with hand hygiene standards. On September 10, the Joint Commission launched its Center for Transforming Healthcare, which seeks to identify effective quality and safety practices that can be implemented at a broad range of institutions, said Mark R. Chassin, MD, MPH, Joint Commission president. Its first target: hand cleanliness. “We conducted a little poll giving institutions about 35 of the nastiest quality problems they now face and asked them to identify for themselves what their top problems were,” Chassin said. “The problem receiving the most votes was hand hygiene.” The Joint Commission’s program comes a few months after the May 5 launch by the WHO of the First Global Patient Safety Challenge, which is intended to spur worldwide commitment by policy makers, health care workers, and patients to make cleanliness in the health care setting a top priority. Its first charge is to achieve consensus on the most effective strategies for improving hand hygiene in health care. The WHO has also published a guide to implementing its health hygiene strategies (http: //whqlibdoc.who.int/publications/2009 /9789241597906_eng.pdf). To date, 5752 hospitals in 122 counties have signed on to the challenge. The evidence for hand hygiene is compelling. According to the Joint Commission, an estimated 1 in 136 patients in the United States (2 million cases annually) become seriously ill from hospital-acquired infections, resulting in annual direct medical costs of up to $45 billion; prevention programs could cut those costs by up to $31.5 billion. And while the evidence is limited, studies suggest a higher burden of health care–associated infections in developing countries, with the WHO citing 1-day prevalence surveys of single hospitals in Albania, Morocco, and Tunisia that found such infections in almost 1 in 5 patients. While it seems obvious that health care workers should be practicing optimal hand hygiene, a variety of factors work against this, said Kathy B. Kirkland, MD, an associate professor of medicine, infectious disease, and international health at Dartmouth Medical School in Lebanon, NH. “One problem is that failure to clean hands is not proximally related enough to the infection acquired by a patient to create its own feedback loop—so there is a disconnect,” Kirkland said. “No one knows whose hand hygiene event failure is associated with a specific patient infection, so it is difficult to make that accountability link as easily as if you touched patients and they broke out with boils.” Beyond the disconnect, there are other obstacles faced by health care workers in their efforts to achieve optimal hand hygiene. The Joint Commission listed such barriers as ineffective placement of dispensers or sinks, insufficient or nonexistent education and just-in-time coaching, a safety culture that fails to stress hand hygiene at all levels, the awkwardness of cleaning hands when carrying items, the interference of gloves with the process of cleaning, a misperception that wearing gloves eliminates the need for hand hygiene, forgetfulness, and distractions. Further, compliance data are often not collected or reported accurately or frequently. But health care workers should know they are susceptible to carrying around infectious organisms, and that cleaning hands is effective in minimizing the risk of infecting others. Studies have shown that 80% of hospital staff who dressed wounds infected with methicillin-resistant Staphylococcus aureus (MRSA) carried the organism on their

ObjectivesTo understand the key attributes in designing effective interventions for improving healthcare workers’ (HCWs’) hand hygiene compliance and HCWs’ preference for these attributes.DesignA discrete choice experiment (DCE) was conducted with...

Healthcare-associated infections (HAIs) are a global challenge in modern healthcare. One of the most accessible and effective strategies for preventing HAIs is regular hand hygiene by healthcare personnel. Despite its apparent simplicity, maintaining a high level of compliance with hand hygiene standards among healthcare workers remains an extremely difficult task, requiring new approaches and solutions. The key to understanding this issue may lie in the maturity of organizational culture – specifically, one of its components: safety culture. In healthcare, safety culture refers to an organizational environment where the prevention of errors and the minimization of risks to patients are prioritized. It encompasses shared values, attitudes, and behavior patterns aimed at ensuring safe care delivery. According to current perspectives, the level of safety culture can be assessed using specialized survey tools. This opens up the possibility of exploring how the sociocultural aspects of healthcare work contribute to the emergence of adverse events, errors, and other critical challenges in modern medicine. The aim of this study is to assess the relationship between safety culture indicators and healthcare workers’ adherence to hand hygiene practices. Methods. A retrospective observational study was conducted at the multidisciplinary clinic JSC «Medicina» in Moscow from 2014 to 2020. Annual safety culture assessments were carried out using the SOPS Hospital Survey 1.0. Hand hygiene compliance was evaluated based on a multi-level monitoring system developed in accordance with the Joint Commission International (JCI) International Patient Safety Goals (IPSG 5). Results. The strongest correlations were identified between hand hygiene adherence and the following components of safety culture: “staffing”, “supervisor/manager expectations and actions promoting patient safety”, “management support for patient safety”, “communication openness”, and the “overall perception of patient safety”. Conclusions. The findings confirm that an organization’s safety culture significantly influences healthcare workers’ adherence to hand hygiene protocols. Strengthening safety culture fosters a deeper understanding of the importance of hand hygiene as a means of protecting patients. Therefore, enhancing the level of safety culture is a necessary condition for improving hand hygiene compliance in healthcare facilities. The results of this study may be of interest to a broad audience concerned with patient safety in healthcare.

Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose threats to global health. Effective hand hygiene is essential for preventing HAIs and the spread of AMR in healthcare. We aimed to highlight the recent progress and future directions in hand hygiene and alcohol-based handrub (ABHR) use in the healthcare setting. In September 2023, 42 experts in infection prevention and control (IPC) convened at the 3rd International Conference on Prevention and Infection Control (ICPIC) ABHR Taskforce in Geneva, Switzerland. The purpose of this meeting was to provide a synthesis of recent evidence and formulate a research agenda on four critical areas for the implementation of effective hand hygiene practices: (1) ABHR formulations and hand rubbing techniques, (2) low-resource settings and local production of ABHR, (3) hand hygiene monitoring and technological innovations, and (4) hand hygiene standards and guidelines.

Qualitative interview study exploring frontline managers’ contributions to hand hygiene standards and audit: Local knowledge can inform practice

Effects of implementation of healthcare associated infection surveillance and interventional measures in the neonatal intensive care unit: Small steps matter

BackgroundStandard precautions (SPs) including hand hygiene are considered fundamental protective measures to manage health care-associated infections (HCAIs) and to reduce occupational health hazards. The purpose of this research was to examine the effectiveness of an infection control link nurse (ICLN) program on compliance with SPs and hand hygiene among nurses.MethodsA quasi-experimental study with a pretest-post-test design was conducted with participating of 154 clinical nurses who worked in different wards of a tertiary referral teaching hospital in Iran. The intervention group (n = 77) had 16 infection control link nurses nominated. The control group (n = 77) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of compliance with standard precautions and hand hygiene compliance was performed via the Compliance with Standard Precautions Scale (CSPS) and the World Health Organization observational hand hygiene form. Two independent sample t-tests were used to examine differences between Compliance with Standard Precautions and hand hygiene Compliance among nurses in intervention and control group. Multiple linear regression analysis was used to assess the effect size.ResultsAfter developing and implementing the infection control link nurse program, no statistically significant improvement was found in the Compliance with Standard Precautions (β = 5.18; 95% CI= -0.3–10.65, p = 0.064). An improvement in hand hygiene compliance was observed among nurses in the intervention group that improved statistically significant from 18.80% before the program to 37.32% 6 months after the program (β = 20.82; 95% CI 16.40–25.25, p < 0.001).ConclusionsGiven the continuing level of interest that exists in improving health care workers’ hand hygiene practices, the findings of this study provide significant practical implications for hospitals seeking to improve compliance with hand hygiene among nurses, showing the effectiveness of using infection control link nurse program. Further research is needed to assess effectiveness of using infection control link nurse program to improve compliance with standard precautions.

Objective: The use of personal protective equipment and hand hygiene are often the most recommended line of defense against coronavirus disease-19 (COVID-19). The purpose of this study is to determine the magnitude of compliance and associated factors of personal protective equipment (PPE) utilization and hand hygiene practice among healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia.Methods: A hospital-based cross-sectional study was conducted among 489 healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia from June 15 to July 30, 2021. Proportional sample size allocation to each selected hospital followed by simple random sampling techniques were used to select the study participants using human resource records from each hospital. A pre-tested and structured self-administered questionnaire with WHO's standardized hand hygiene and PPE utilization observational checklist were used to collect data. Bivariate and multivariable analyses with 95% CI and p-value < 0.05 were employed to identify the associated factors of personal protective equipment utilization.Results: About 32 and 22.3% of healthcare workers were compliant with personal protective equipment utilization and hand hygiene practice, respectively. Feedback for safety (AOR = 2.05; 95% CI: 1.26–3.35), training on COVID-19 prevention (AOR = 3.43; 95% CI: 2.01–5.86), and perception to infection risk (AOR = 1.98; 95% CI: 1.18–3.33) were significant factors of good compliance with personal protective equipment utilization.Conclusion: The magnitude of good compliance with personal protective equipment utilization and hand hygiene was low. Interventions to promote personal protective equipment utilization and hand hygiene should focus on feedback for safety, training on COVID-19 prevention, and perception of infection risk.

Background: Healthcare-associated infections are major causes of morbidity and mortality associated with clinical, diagnostic, and therapeutic procedures in healthcare organizations. Enhancement of hand hygiene practices among healthcare workers is responsible for decreasing 30 to 50% of healthcare-associated infections. However, previous studies have indicated inadequate adherence to hand hygiene procedures in healthcare institutions. Therefore, increasing knowledge, attitude, and practices of hand hygiene among nursing students who participate in caring for patients is essential to improve the quality of care and patient safety. Objectives: This study aimed to examine knowledge, attitude, the practice of hand hygiene, and their associations among nursing students at Can Tho University of Medicine and Pharmacy. Materials and methods: A descriptive correlational study was conducted with 104 nursing students as study participants. Knowledge and attitude were examined by using a self-structured questionnaire, while practice was evaluated by observation based on the hand hygiene checklist of the Vietnamese Ministry of Health. Results: The findings showed that 44.2% and 66.3% of participants had good knowledge and positive hand hygiene attitudes, respectively. Poor adherence of 5 moments of hand hygiene and 6 steps of the hand hygiene procedure were revealed. Half of the respondents showed low to moderate compliance with the hand hygiene procedure. There were significant associations between knowledge, attitude, and hand hygiene practices among nursing students. Conclusion: among nursing students, poor knowledge, attitude, and hand hygiene practices were reported. The study findings supported previous literature and found that respondents emphasized the importance of training programs and hand hygiene monitoring in improving hand hygiene practices.

Background Poor hand hygiene (HH) among health care workers (HCWs) in low-resource healthcare settings has continued to increase the spread of infectious diseases, including COVID-19. The present study aimed to assess the knowledge, attitude, adherence, and barriers to HH practices among HCWs during the COVID-19 pandemic in Nigeria. Methods The study was an online cross-sectional survey using a tailored questionnaire distributed through chain referral sampling among southern Nigerian HCWs during the first wave of the COVID-19 pandemic (February to August 2020). The primary outcomes were knowledge, attitude, adherence to HH guidelines, and the barriers limiting compliance with the guidelines. Data were analysed using percentage, frequency, mean, standard deviation, one-way ANOVA, and multiple linear regression. The study timeline was from 15 April to 31 July 2020. Results Four hundred and fifty-four HCWs (236 males and 218 females) participated in the study. The participants had a moderate knowledge of standard HH protocol (mean ± SD) 62.45 ± 10.82%, positive attitude 84.34 ± 11.32%, and high adherence to the standard guidelines 81.21 ± 9.49%. There was no significant difference in knowledge, attitude, and adherence across the healthcare professions. Increasing age (β = 0.186, p &lt; 0.003) and knowledge (β = 0.229, p &lt; 0.001), and decreasing negligence (β = − 0.178, p = 0.004), and forgetfulness (β = − 0.159, p = 0.012) were the significant predictors of effective HH practices. Conclusion Nigerian HCWs had moderate knowledge, a positive attitude, and adhered to the standard HH practices during the COVID-19 pandemic. However, the major barriers were institutional-based factors such as the inadequate supply of HH items, competing job demands, emergencies, increased workload, and personal characteristics such as age, poor knowledge, negligence, and forgetfulness. We recommend that hospital management provide their staff with adequate HH materials and continued infectious disease training.

BackgroundLack of hand hygiene (HH) amongst healthcare workers (HCWs) contributes to healthcare associated infections and the spread of multidrug-resistant organisms. We assessed HCW HH knowledge, attitudes, and compliance using WHO tools and applied the Systems Engineering Initiative for Patient Safety (SEIPS) model in interviews to help guide and increase sustainability of HH interventions.MethodsWe conducted a cross-sectional study at Jimma University Medical Center (JUMC) in Jimma, Ethiopia. We assessed HCW’s HH knowledge and attitudes using questionnaires adapted from WHO resources via systematic sampling. Observations of HH practices at WHO’s 5 Moments of HH were conducted by non-identified, trained observers via systematic sampling. 22 semi-structured interviews were conducted via convenience sampling with HCWs using an interview guide based on the SEIPS model.ResultsWe observed 1,386 HH moments and found a compliance rate of 9.38%, with compliance highest after contact with patient surroundings (27.92%) compared to the other four HH moments (1.77 - 9.57%). Of 251 survey participants, 13.6% had prior HH training and 69.9% reported routine HH compliance. The average knowledge score was 61.4%, with no significant difference between participants that identified as trained vs untrained (p=0.41). 68% of interview participants stated they were unaware of JUMC’s Infection Prevention and Control (IPC) team and are more likely to perform HH if a patient appears infectious. Interview participants cited multiple barriers to HH (table 1).Table 1ConclusionBaseline HH compliance and knowledge were low despite perceived compliance and regardless of prior HH training. Relatively higher compliance after patient contact may be due to perceptions of patient infectiousness. Utilizing the SEIPS model as an adjunct to WHO HH guidelines has provided actionable items upon which the JUMC IPC team can focus to improve HH practices: providing a sustainable supply of alcohol hand rub, ongoing HH education targeting knowledge deficits, and enhanced IPC presence and HH monitoring.DisclosuresMeredith Kavalier, MD, University of Wisconsin-Madison Global Health Institute (Grant/Research Support)

Innovative technologies for hand hygiene monitoring are urgently needed in the fight against COVID-19

Use of an Electronic Survey Instrument to Determine Barriers to Certification in Infection Control

Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of multidisciplinary hand hygiene improvement programs. Observational surveys conducted by trained personnel are currently considered the "gold standard" method for establishing compliance rates, but they are time-consuming and have a number of shortcomings. Monitoring hand hygiene product consumption is less time-consuming and can provide useful information regarding the frequency of hand hygiene that can be used to give caregivers feedback. Electronic counting devices placed in hand hygiene product dispensers provide detailed information about hand hygiene frequency over time, by unit and during interventions. Electronic hand hygiene monitoring systems that utilize wireless systems to monitor room entry and exit of healthcare workers and their use of hand hygiene product dispensers can provide individual and unit-based data on compliance with the most common hand hygiene indications. Some systems include badges (tags) that can provide healthcare workers with real-time reminders to clean their hands upon entering and exiting patient rooms. Preliminary studies suggest that use of electronic monitoring systems is associated with increased hand hygiene compliance rates and that such systems may be acceptable to care givers. Although there are many questions remaining about the practicality, accuracy, cost, and long-term impact of electronic monitoring systems on compliance rates, they appear to have considerable promise for improving our efforts to monitor and improve hand hygiene practices among healthcare workers.

Hesitation and error: Does product placement in an emergency department influence hand hygiene performance?