Hand Hygiene Compliance Rates Research Articles

Effects of the Implementation of Intelligent Technology for Hand Hygiene in Hospitals: Systematic Review and Meta-analysis.

The World Health Organization recommends regular hand hygiene monitoring and feedback to improve hand hygiene behaviors and health care-associated infection rates. Intelligent technologies for hand hygiene are increasingly being developed as alternative or supplemental monitoring approaches. However, there is insufficient evidence regarding the effect of this type of intervention, with conflicting results in the literature. We conduct a systematic review and meta-analysis to evaluate the effects of using intelligent technology for hand hygiene in hospitals. We searched 7 databases from inception to December 31, 2022. Two reviewers independently and blindly selected studies, extracted data, and assessed the risk of bias. A meta-analysis was performed using the RevMan 5.3 and STATA 15.1 software. Sensitivity and subgroup analyses were also conducted. Overall certainty of evidence was appraised using the Grading of Recommendations Assessment, Development, and Evaluation approach. The systematic review protocol was registered. The 36 studies comprised 2 randomized controlled trials and 34 quasi-experimental studies. The included intelligent technologies involved 5 functions: performance reminders，electronic counting and remote monitoring，data processing，feedback，and education. Compared with usual care, the intelligent technology intervention for hand hygiene improved health care workers' hand hygiene compliance (risk ratio 1.56, 95% CI 1.47-1.66; P<.001), reduced health care-associated infection rates (risk ratio 0.25, 95% CI 0.19-0.33; P<.001), and was not associated with multidrug-resistant organism detection rates (risk ratio 0.53, 95% CI 0.27-1.04; P=.07). Three covariates, including publication year, study design, and intervention, were not factors of hand hygiene compliance or hospital-acquired infection rates analyzed by meta-regression. Sensitivity analysis showed stable results except for the pooled outcome of multidrug-resistant organism detection rates. The caliber of 3 pieces of evidence suggested a dearth of high-caliber research. Intelligent technologies for hand hygiene play an integral role in hospital. However, low quality of evidence and important heterogeneity were observed. Larger clinical trials are required to evaluate the impact of intelligent technology on multidrug-resistant organism detection rates and other clinical outcomes.

SG-APSIC1171: A new approach of hand hygiene observation with focus on healthcare worker (HCW) category

Objectives: The past hand hygiene (HH) compliance rate has indicated the low number of opportunities for some healthcare workers (HCWs) because the infection control liaison officer (ICLO) tended to capture opportunities from nurses who were available, despite the proportional allocation of opportunities per HCW type based on the World Health Organization (WHO) HH methodology. Therefore, HH compliance rates may not have accurately represented the specific HCW type, which may have affected the overall HH compliance rate. We sought to determine an accurate baseline of HH compliance rate with consistent number of opportunities across all HCW categories. Methods: HH auditors were ICLOs trained in HH observation by the infection control nurse (ICN) according to the WHO “My Five Moments of Hand Hygiene.” HH observations were conducted bimonthly with assigned areas focusing only on 1 HCW category for each session: nursing, medical, clinical support services, or environmental services. A briefing session was given on the day of observation, with the goal of collecting 20 opportunities per area with HCW focus during their peak activities. Direct feedback and positive reinforcement were given to HCWs after observations were completed. Results: A survey of 96 ICLOs indicated that observations based on HCW focus allowed them to capture more HH opportunities and concentrate on their observations. The new approach showed a significant increase in number of opportunities across all HCW categories that was more representative. We also successfully determined a new baseline for all HCW categories, with further breakdown of HCW type. Conclusions: A new methodology of HH observation with a focus on HCW category has resulted in more HH opportunities across all HCW categories and improved representation of the HH compliance rate.

SG-APSIC1105: The effectiveness of the infection control interventions in decreasing multidrug-resistant organism transmission in the Department of Neonatology of Hung Vuong Hospital

Objectives: Infection control and prevention (IPC) is one of the most important factors in decreasing multidrug-resistant organism (MRDO) transmission. We evaluated the effectiveness of the IPC program in reducing the spread of MDROs at the Department of Neonatology of Hung Vuong Hospital. Methods: This research was conducted from April 2020 to September 2020 in the neonatology department in 3 phases: (1) We determined the compliance rate of hand hygiene and high-touch surfaces cleaning (via camera monitoring). (2) We conducted the following interventions: We developed specific cleaning protocols for the neonatology department. We provided training regarding MRDO transmission control and prevention for healthcare workers. We implemented a counseling program for active screening and isolation for hospitalized children; added isolation rooms for children with MRDO asymptomatic infections. And we improved feedback efficiency through an online group between the infection control and prevention team and the department of neonatology. (3) We re-evaluated compliance with hand hygiene practices and cleaning of high-touch surfaces, then we compared the rates of positive MRDO cultures before and after these interventions. Results: Before the interventions, 453 hand hygiene observations were recorded and 322 high-touch-surface cleaning observations were recorded. The hand hygiene compliance rate improved significantly from 33.2% to 85.5% (PR, 11.9; 95% CI, 7.4–19.3; P&lt; .01). The high-touch-surface cleaning rate increased from 82.4% to 93.5% (PR, 3.1, 95% CI, 1.5–6.4; P &lt; .01). The rate of high-touch surfaces being cleaned with proper technique increased from 38.5% to 87.9% (PR, 11.6; 95% CI, 6.3–21.3; P &lt; .01). In total, 103 swab samples were positive for MRDOs by culture before and after the intervention. The rate of positive MRDO cultures decreased from 80.8% to 64.7% (P = .017). Conclusions: Enhancing hand hygiene and high-touch-surface cleaning compliance helped reduce MRDO transmission in the Department Neonatology of Hung Vuong Hospital.

Steady amelioration of institutional hand hygiene behavior among health care personnel after 12-year consistent intervention

Institutional hand hygiene (HH) behavior is difficult to monitor and improve consistently, especially over long periods. This study aimed to investigate the long-term effects of HH promotion activities. We launched the HH promotion team in 2010 and conducted interventions including goal setting, observation and feedback, education, reward incentives, and accountability. Optimal HH compliance rates were calculated based on adherence to all 6-step HH technique and appropriate time recommended by the World Health Organization. HH and optimal HH compliance were calculated over 12 years. Poisson regression analysis was used to determine the trend in HH compliance according to year. In 2010, HH and optimal HH compliance were 59.7% and 15.6%, respectively. HH compliance increased by 83.9% in 2013 and remained over 75%. HH compliance increased significantly, with a relative risk (RR) of 1.014 (95% CI 1.002-1.025, P=.018). Optimal HH compliance increased by 67.8% in 2013 and remained over 60%, except in 2016 (58.8%) and 2019 (59.8%). Optimal HH compliance increased with RR 1.033 (95% CI 0.991-1.076, P=.123). HH and optimal HH compliance increased significantly over the 12 years when subgroup analysis was performed by job category. HH promotion team activities improved and maintained optimal HH compliance among HCWs.

SG-APSIC1165: Hand hygiene feedback card—Providing real-time feedback to improve hand hygiene compliance

Objectives: Hand hygiene is widely recognized as the most effective practice for preventing healthcare-associated infections. Despite ongoing interventions and strategies implemented by the infection control committee, the compliance with and consistency in the hand hygiene practice remains a challenge. At times, staff are unaware when they are noncompliant with hand hygiene; therefore, a more robust strategic approach is needed. One such strategy is customized audit with real-time feedback. A literature review highlighted the effectiveness of audit coupled with specific feedback. This approach was also supported by several guidelines and regulatory bodies that recognized the importance of audit and feedback in hand hygiene improvement efforts. For example, the World Health Organization (WHO) has emphasized 5 core components of improving hand hygiene. One of these components is evaluation and feedback. We sought to provide feedback to healthcare personnel when they do not show compliance with the Five Moments of Hand Hygiene. We aimed to achieve &gt;95% hand hygiene compliance among healthcare staff. Methods: Information on the use of the hand hygiene feedback card was provided to the auditors. The hand hygiene feedback card procedure began in all the wards in May 2020. This process first started with orientation of the auditors regarding the hand hygiene feedback card, followed by auditing hand hygiene practice. Staff who did not comply with hand hygiene procedures were given real-time feedback via a card that specified the missed hand hygiene movement. Results: Overall hand hygiene compliance among healthcare staff increased by 6% after the hand hygiene feedback card procedure was implemented. Conclusions: Overall, the hand hygiene feedback card was effective in improving hand hygiene. Through this quality improvement project, significant and sustained gains in hand hygiene compliance rates of &gt;95% can be achieved.

SG-APSIC1055: Hand hygiene challenges among the ancillary team during the COVID-19 pandemic

Objectives: Ancillary staff members perform operational support functions and play an active role in enhancing the patient care experience. Infection prevention practices among ancillary staff play a critical role in preventing transmission of microorganisms, which ensures the safety of patients. Low hand hygiene compliance was found among porters in a cross-institutional hand hygiene audit in 2021. A quality improvement team was formed to improve hand hygiene compliance, especially during the COVID-19 pandemic. Methods: A focus-group discussion and survey were conducted to understand hand hygiene knowledge and challenges among porters. Using the findings, the team initiated Glo–germ education tools, pocket alcohol hand-rub agents, pocket moisturizer, poster display, and a toolbox messaging system via conversion of group roll call to satellite-area roll call. Respective satellite teams were sent hand hygiene reminders, and prompt corrective action was taken following noncompliance events. Analytic comparisons of pre- and postsurvey data were performed using the χ2 test, and P &lt; .05 was regarded as statistically significant. Results: In total, 572 ancillary staff participated in the survey. Knowledge of hand hygiene practices improved significantly following the interventions, as shown in the comparison of pre- and postintervention results: knowledge of the hand hygiene steps (P &lt; .001), knowledge of the duration of hand rub (P &lt; .001), and knowledge of duration of handwashing (P &lt; .001). Also, 295 staff members (97.68%) stated that implementation measures increased their awareness of the importance of hand hygiene. Moreover, the hand hygiene compliance rate improved from 77.8% to 100%. There were no significant differences related to sex (P = .089), age group (P = .355), years of working (P = .359), education level (P = .268), or difficulty in reading English (P = .906). Conclusions: Evaluating staff hand hygiene knowledge and understanding the challenges faced among porters helped toward the development of appropriate interventions and assurance of success in project.

SG-APSIC1064: The role of infection control activities on healthcare-associated infections during 2017-2021 at intensive care units in Cho Ray Hospital

Objectives: Healthcare-associated infections (HAIs) are one of the greatest challenges and concerns in Vietnam and around the world. Many studies have shown that HAIs may result in an increase in hospital length of stay, antibiotic use, multidrug-resistant organism (MDROs) infections, treatment costs, and mortality. Therefore, in the past 5 years, the Department of Infection Control of Cho Ray Hospital has carried out many infection and prevention control (IPC) activities to reduce the rates of HAI and MDRO infection. We evaluated IPC activities and results achieved in these efforts at Cho Ray Hospital during 2017–2021. Methods: We described the implemented IPC activities and retrospectively collected data from HAIs surveillance reports during 2017–2021 for 3 intensive care units (ICUs): ICU-B, ICU-D, and the NICU. Results: In the past 5 years, we implemented synchronous IPC activities, including promoting hand hygiene training and surveillance, environmental cleaning surveillance, carrying out improvement projects such as a ventilator-associated pneumonia (VAP) prevention bundle, an MDRO prevention bundle, and an environmental cleaning quality improvement project. Many positive results were achieved, although a slight increase in the HAI incidence occurred in 2021 due to the COVID-19 pandemic. Overall, the hand hygiene compliance rate increased from 49.7% to 83.8%. The rate of HAIs per 1,000 patient days decreased steadily from 5.4 to 2.4. The VAP rate fell from 30.5 to 17.2 per 1,000 patient days, and the central-line–associated bloodstream infection (CLABSI) rate decreased gradually from 5.4 to 2.4 per 1,000 patient days. The catheter-associated urinary tract infection (CAUTI) rate decreased from 2.9 to 0.9 per 1,000 patient days, and the MDRO infection rate decreased significantly from 32.7 to 11.3 per 1,000 patient days. Conclusions: The synchronous implementation of HAI prevention bundles promoting hand hygiene and environmental cleaning achieved significant effects in the efforts to decrease HAIs and MDROs in the ICUs of Cho Ray Hospital.

Developing a design-based concept to improve hand hygiene in the neonatal intensive care unit

BackgroundHand hygiene (HH) is the most critical measure in the prevention of nosocomial infections in the neonatal intensive care unit (NICU). Improving and sustaining adequate HH compliance rates, however, remains a significant challenge. Using a behavioral change framework and nudge theory, we developed a design-based concept aimed at facilitating and stimulating HH behavior.MethodsConcept development was initiated by selecting a theoretical framework after which contextual field studies aimed at discovering causes for poor compliance were conducted. Potential solutions were brainstormed upon during focus group sessions. Low-fidelity prototypes were tested regarding feasibility, usability, and acceptability. A final concept was crafted drawing from findings from each design phase.ResultsComplying with recommended HH guidelines is unrealistic and infeasible due to frequent competing (clinical) priorities requiring HH. The concept “Island-based nursing,” where a patient room is divided into two geographical areas, namely, the island and general zone, was created. HH must be performed upon entering and exiting the island zone, and after exposure to any surface within the general zone. Reminding of HH is prompted by illuminated demarcation of the island zone, serving as the concept’s nudge.ConclusionsIsland zone demarcation facilitates and economizes HH indications in an innovative and intuitive manner.ImpactAlthough hand hygiene (HH) is the single most important element in the prevention of nosocomial infections in neonates, improving and sustaining adequate HH compliance rates remains a significant challenge.Complying with recommended HH guidelines was found to be unrealistic and infeasible due to the significant amount of time required for HH in a setting with a high workload and many competing (clinical) priorities.The concept of “Island-based nursing,” under which the primary HH indication is upon entering and exiting the island zone, facilitates and economizes HH indications in an innovative and user-friendly manner.

Opinions of Healthcare Professionals on Hand Hygiene Use and Evaluation of Hand Hygiene Compliance Rates

Objective: The aim of this study was to determine the hand hygiene habits, beliefs, and practice levels of healthcare workers. Materials and Methods: A total of 238 healthcare workers were included in this cross-sectional survey study. The first part of the questionnaire included sociodemographic data and questions about hand hygiene habits, while the second part included questions from the Hand Hygiene Belief Scale (HHBS) and Hand Hygiene Practice Inventory (HHPI). Results: Results: The mean age of the participants was 33.16±8.54 years and 147 (61.8%) of them were male. The majority of the participants were nurses/health officers (n=92, 36.8%). The rate of those who had previously participated in in-service training was 58.4%. The mean HHBS score was 79.79 and the mean HHPI score was 60.08. The mean HHBS score was higher in women than in men (p=0.003). In terms of occupational groups, the mean HHBS score of physicians (p=0.024) and the mean HHPI score of nurses/health officers (p=0.006) were higher. It was determined that the mean HHPI score of the employees working in internal clinics was higher than those working in surgical clinics (p=0.044), while there was no significant difference in terms of the mean HHBS score. The mean HHPI was higher in participants who received in-service training on hand hygiene (p=0.004). Participants who spent &lt;15 seconds on average while washing their hands had a lower mean HHPI than participants who spent a longer time washing their hands (p=0.003). Conclusion: In the study, it was found that the belief in hand hygiene was high and the practice was generally adopted. The fact that employees especially in surgical departments paid less attention to hand hygiene practice was an important problem. Increasing the frequency of in-service pieces of training to increase compliance with hand hygiene and eliminating the preventive factors will be extremely beneficial for reducing nosocomial infections.

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit.

Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was 'basic' (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to 'intermediate' level (262). There was no change in the neonatal unit HA-BSI rate. Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.

Increased Frequency of Hand Hygiene and Other Infection Prevention Practices Correlates with Reduced Surgical Wound Infection Rates in Spinal Surgery during the COVID-19 Pandemic.

Due to the COVID-19 pandemic outbreak, many changes were done in the hospital practice, and new guidelines were issued in order to contain the infection spread. One of the most common measures is represented by a correct and frequent hand washing. Recently, an association between increased adherence to hand hygiene (HH) protocols and reduction in hospital infections was documented however no studies about the surgical wound infection rate were reported in the Literature. The present study represents a multicentric retrospective epidemiological study. The HH compliance rate was recorded through direct observations by trained nurses, 24 h a day. The primary outcome was HH compliance rate. The association of HH with spinal surgical wound infections was the secondary outcome. We reported a compliance to HH practices during the pandemic period of 85.2% compared with 57% observed during 2019. Our analysis showed an overall surgical wound infection reduction of 66.6% during the hospital stay in the pandemic period. Hand hygiene has always been considered one of the most effective, reproducible and low-cost weapons to deal with hospital infections. The good health habits acquired during the COVID-19 pandemic should be maintained even after the virus is eradicated.

Compliance with a novel hand hygiene protocol tailored to non-sterile healthcare workers in the operating theatre

Observing hand hygiene compliance (HHC) among non-sterile healthcare workers (HCWs) in the operating theatre (OT) is challenging as there are no tailored protocols or observation tools. To develop and test a hand hygiene protocol tailored to non-sterile HCWs in the OT. In this prospective observational study, nine hospitals in the Rotterdam-Rijnmond region provided input on a draft protocol on hand hygiene in the OT, resulting in a new consensus protocol for the region. An observation tool based on the protocol was developed and tested. HHC rates with 95% confidence intervals (CI) were calculated by type of hospital and type of HCW. The protocol has three sections: (1) written general hand hygiene rules; (2) written hand hygiene rules specific for anaesthesia and surgery; and (3) visual representation of the OT, divided into four hand hygiene areas. Hand hygiene should be applied when changing area. Average HHC of 48.0% (95% CI 45.2-61.2%) was observed in OTs across all hospitals. HHC was highest in the two specialized hospitals (64.0%, 95% CI 30.6-89.8%; 76.7%, 95% CI 62.8-84.5%) and lowest in the academic teaching hospital (23.1%, 95% CI 0.0-45.8%). In terms of type of HCW, HHC was lowest among anaesthesiologists (31.6%, 95% CI 19.2-62.4%) and highest among OT assistants (57.4%, 95% CI 50.1-78.2%). This uniform way of observing HHC in the OT enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, HHC in the OT was below 50%; this needs to be addressed, particularly in teaching hospitals and among physicians.

Application Effect of Transparent Supervision Based on Informatization in Prevention and Control of Carbapenem-Resistant Klebsiella pneumoniae Nosocomial Infection.

To explore the effect of transparent supervision model on the prevention and control of carbapenem-resistant Klebsiella pneumoniae (CRKP) nosocomial infection and the value of the autoregressive integrated moving average (ARIMA) model in predicting the incidence of CRKP infection. A total of 46,873 inpatients from Jiawang District People's Hospital of Xuzhou between January 2019 and December 2019 (prior to COVID-19 prevention and control) were selected as the preintervention group and 45,217 inpatients from January 2020 to December 2020 (after the COVID-19 prevention and control) as the postintervention group. We performed transparent supervision on CRKP patients detected by the real-time monitoring system for nosocomial infection. Incidence and detection rate of CRKP, utilization rate of special grade hydrocarbon enzyme alkene antibiotics, hand hygiene compliance rate, qualified rate of ATP tests on surface of environmental objects, and execution rate of CRKP core prevention and control were compared between the two groups. Transparent supervision of CRKP-infected patients was conducted daily from January to December 2020, which resulted in the following: (a) the infection rate of CRKP decreased in a fluctuating manner, and the actual value of hydrocarbon alkene use rate was basically the same as the predicted value with an overall decreasing trend; (b) after the intervention, hand hygiene compliance rate increased from 53.30% to 70.24% (P < 0.001) and the ATP qualified rate increased from 53.77% to 92.24% (P < 0.001); (c) the fitted value of the ARIMA model was in good agreement with the actual value. The incidence of CRKP infection and the utilization rate of carbene antibiotics were also in good agreement with the predicted value. The average relative errors were 11% and 10.78%. During the COVID-19 outbreak in 2020, the ARIMA model effectively fit and predicted the CRKP infection rate, thereby providing scientific guidance for the prevention and control of CRKP infection. In addition, the transparent supervision intervention model improved the hand hygiene compliance and environmental hygiene qualification rates of medical staff, effectively reducing CRKP cross-infection in the hospital.

Prolonged length of stay is associated with reduced hand hygiene compliance in the emergency department: A single centre retrospective study.

To examine whether patient flow factors in the ED such as prolonged length of stay are associated with hand hygiene (HH) compliance. We conducted a retrospective study at an urban district hospital utilising available data from January 2018 to December 2021. Compliance to the World Health Organization five moments of HH expressed as percentage of total moments observed were collated every 2 months. Patient flow measures including proportion of patients referred or discharged within 4h (LOS4), proportion of patients with ED length of stay >24 h (LOS24) and total number of patient presentations, were obtained for each 2-month periods. The association between these patient flow measures and HH compliance was examined using Pearson's correlation (P < 0.05). The results showed a moderate and significant association between rates of HH compliance and LOS24 (r=-0.48, P=0.025). That is, lower proportion of patients with ED length of stay >24 h was associated with improved HH compliance. There was no significant correlation between HH compliance and LOS4 (r=0.38, P=0.085) or total number of ED presentations (r= -0.30, P=0.17). The findings show that prolonged ED length of stay may explain, at least partly, lower rates of HH compliance. Improvements in ED HH compliance should also include strategies that enhance patient flow.

Reducing Carbapenem-Resistant Enterobacteriaceae Using the Targeted Solution Tool: A Quality Improvement Project.

Carbapenem-resistant Enterobacteriaceae (CRE) is a worldwide urgent health problem. Hand hygiene (HH) is an effective intervention to reduce the spread of CRE. In 2017, an increase in the rate of health care-associated (HA) CRE colonization was observed in a large multiorgan transplant center in Italy. This study aimed to reduce the HA-CRE colonization rates by improving HH compliance. A pre-/post-intervention project was conducted from November 2017 through December 2020. The DMAIC (Define, Measure, Analyze, Improve, and Control) framework was used to implement the HH Targeted Solution Tool (TST). Hand hygiene compliance increased from 49% to 76.9% after the Improve phase ( P = .0001), and to 81.9% after the second Control phase ( P = .0001). The rate of HA-CRE decreased from 24.9% to 5.6% ( P = .0001). Using the DMAIC framework to implement the TST can result in significant improvements in HH compliance and HA-CRE colonization rates.

Compliance of Nurses with Hand Hygiene Guidelines in Tripoli University Hospital, 2019

Abstract Background Health care-associated infections (HAIs) result in high morbidity, decreased personal satisfaction, and mortality. Implementing infection prevention and control strategies such as hand hygiene (HH) promotion is critical to reduce the risk of the HAI and protect patients. Aims This study aimed to determine the compliance rate of HH among nurses in Tripoli University Hospital (TUH, previously known as Tripoli Medical Center). Method A cross-sectional study was conducted in different departments at TUH, starting from May 1st to October 31st, 2019. An observational checklist based on the “five moments for hand hygiene” of World Health Organization (WHO) was used. There were 271 nurses who interacted with 1,213 patients, a total of 3,452 HH episodes, and 6,065 cases of HH that were collected in this study, and data were statistically analyzed. Results The overall HH compliance rate was 56.9%. Most of the nurses (86%) preferred to use HH after contact with individual patients and 71.6% after contact with patients' environment. There was, however, low percentage of HH prior to patient contact (35.1%). The compliance rate was higher among nurses of the age group of less than 20 years (60.8%), non-Libyan (60.7%), and those who received formal training (60.5%). Conclusion In general, the HH compliance rate was low among nurses working in TUH. Education is an important factor that impacts the practice of HH pre- and postpatient contact. Wider studies that include assessment of pre- and posteducation courses should be conducted in the future.

Hand Hygiene in the Intensive Care Unit: Knowledge, Compliance and Factors Influencing Nursing Adherence, a Descriptive Study

Background: Nosocomial infections are particularly common among hospitalized patients who undergo resuscitation compared with other types of care. Hand hygiene remains the simplest and most effective measure to prevent and control the risk of infection. Objective: The main objectives are to evaluate hand hygiene compliance among nursing staff in the different intensive care units and to identify the factors influencing the adherence of nursing staff to the practice. Methods: It was a quantitative descriptive study using a questionnaire and an observation grid with all the nursing staff working in all the intensive care units of our university hospital. Results: The study showed a hand contamination rate of (80%), a hand hygiene compliance rate of (21.3%), it also showed the different factors explaining non-adherence, these are not necessarily related to training, nor to the availability of material resources but related to hidden reasons, non-apparent factors, which are often more important. (Workload and work environment) Conclusion: This study examined hand hygiene in the ICU setting, obtained data on overall compliance, which remains poor, and the various factors influencing nurses' adherence to the practice.

Hand Hygiene Compliance Rates in 9 Pediatric Intensive Care Units Across Europe: Results from the Reducing Antimicrobial use and Nosocomial Infections in Kids Network.

A unified surveillance mechanism for hand hygiene and hospital-acquired infections for pediatric wards is lacking in Europe. We managed to setup such a mechanism in 9 pediatric intensive care units in 7 European countries, using World Health Organization's definitions and common methodology which allows for benchmarking among units and countries. Median hand hygiene compliance was found high 82.3% (interquartile range 71.6-94.5%), but gaps in practices were identified.

Differences in observed and self-reported compliance with ‘Five Moments for Hand Hygiene’ as a function of the empathy of healthcare workers

Hand hygiene at critical time-points (as established by the World Health Organization's model 'Five Moments for Hand Hygiene') remains the leading measure for minimizing the risk of healthcare-associated infections. While many interventions have been tested to improve hand hygiene compliance (HHC) of healthcare workers (HCWs), little is known about the relationship between HHC and empathy of HCWs. To investigate the relationship between moment-specific HHC rates and empathy of HCWs at both individual and ward levels. HHC data were collected via observation and self-report, and empathy levels were measured using an established questionnaire. The survey was conducted on 38 wards of three tertiary care hospitals in Germany. Observation data were obtained via in-house observations conducted ≤8 months before or after the survey. Evidence for the expected correlation between empathy of HCWs and moment-specific HHC was found for both observed HHC (Moment 1: r=0.483, P=0.031; Moment 2: r=588, P=0.006) and self-reported HHC (Moment 1: r=0.093, P=0.092; Moment 2: r=0.145, P=0.008). In analyses of variance, the critical interaction effect between empathy (i.e. lower vs higher empathy) and designated time-point of hand hygiene (i.e. before vs after reference task) was also significant. Empathy of HCWs should be considered as an important factor in explaining differences between moment-specific HHC rates. In consequence, empathy comes into focus not only as a crucial factor for high-quality patient care, but also as an important contributor to improving HHC.

Hand Hygiene Compliance during COVID-19 Pandemic among Neonatal Nurses in a Federal University Teaching Hospital in Nigeria

Introduction: Compliance with Hand hygiene (HH) has been considered as a simple and the most efficient strategy to reduce hospital-acquired infections (HAIs). Compliance with this practice is not often assessed in Nigeria and thus posed a significant risk to the quality of care and patient safety and especially in this era of the COVID-19 pandemic. The study aimed to assess neonatal nurses’ compliance to “my five moments for HH”. Method: A cross-sectional observational study was carried out in a Nigerian federal hospital, using an adapted version of a standardized observational WHO tool of ‘’my five moments of HH’’. A Chi-square test was employed to examine the relationship of HH compliance across units, shifts, and “my five moments for HH” opportunities. Results: The observer recorded 425 HH opportunities and the total HH compliance rate was (62.8%). There was no association between the units, working shifts, and nurses’ HH compliance. Compliance to HH was dependent on the five moments of HH (p &lt; 0.000), better compliance was seen after body fluid exposure (100%), followed by after newborn contact (86.3%), and after contact with newborn surroundings (63.4%), while compliance before newborn contact (28.5%), and before an aseptic procedure (9.1%) were poor. Conclusion: The findings of this study showed a significant gap with the HH compliance among neonatal nurses, suggesting multiple opportunities for neonatal infections despite the current awareness of HH in the Covid-19 pandemic. Hence, there is a need to intensify infection control practices in Nigeria, especially on HH practice.