ECCMID19: Hand hygiene compliance is low in ICUs, new study suggests

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Research presented at the 29th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID; 13–16 April, Amsterdam, the Netherlands) has suggested healthcare workers on intensive care units (ICUs) are regularly missing opportunities to clean their hands during patient care, despite its importance for infection prevention and control.

Hand hygiene is one of the most effective methods for preventing the spread of bacteria and pathogens; however, few studies of hand hygiene compliance have evaluated the order in which healthcare workers perform patient care tasks and whether this order affects hand hygiene.

This study analyzed data from the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, assessing when healthcare workers carried out hand hygiene in their sequences of care and identifying factors associated with hygiene compliance.

The researchers linked consecutive tasks performed by individual healthcare workers into care sequences to identify ‘task transitions’ – two consecutive patient care tasks and the intervening hand hygiene opportunities.

Overall, 3246 hours of observation were recorded in 18 ICUs across the USA. Results suggested that general hand hygiene compliance was poor, with healthcare workers moving from dirtier to cleaner tasks during two-thirds of the transitions recorded, and from cleaner to dirtier in the remaining third. Proper hand hygiene was performed in half of instances when moving from dirtier to cleaner tasks, and approximately 43% of instances of moving from cleaner to dirtier tasks.

The team also reported that physicians were 50% more likely to move from dirtier to cleaner tasks, compared with nurses. In addition, hand hygiene was less likely when gloves were worn, with healthcare workers more likely to move from dirtier to cleaner tasks.

These are observational studies, and the authors note that behaviour could have been influenced by observation, however, this suggests a low compliance of hand hygiene in ICUs.

Loreen Herdwaldt (Carver College of Medicine, IA, USA) concluded: “Our findings indicate that healthcare workers may inadvertently increase patients’ risks for healthcare-associated infection by the direction in which they do tasks. We need to identify interventions that will help healthcare workers organise their work in a way that decreases this risk and also reduces their workloads.”

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Source: Chang NC, Reisinger H, Schweizer M et al. Hand hygiene and the sequence of patient care. Presented at ECCMID (13–16 April, Amsterdam, the Netherlands). Presentation P2648 (Abstract 2680).

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