A study comparing hand hygiene compliance before and after migration to a new hospital facility.

Abstract

Healthcare-associated infections can be minimised by hand hygiene (HH) practices, however many studies performed in the US and European hospitals have shown that HH compliance rarely exceeds 50% (Larson 1995, Gould 1994, Watanakunakorn 1998, Pittet et al1999). (HH) remains one of the most cost effective interventions in healthcare yet compliance continues to elude many hospitals. This suggests the need to understand perceptions and analyze reasons for non-conformity The main purpose of this research was to study HH compliance before and after a hospital migration exercise to one were they have suddenly been improved to a considerable degree. A structured questionnaire was first disseminated in the study wards to determine concepts of staff towards HH. 150 questionnaires (response rate 85%) were returned; 51% of respondents were nurses and 23% doctors. Doctors placed reduced emphasis on HH importance, were likely to have attended less educational HH events after their graduation and were more unwilling to be corrected after a missed HH opportunity. All HCWs admitted to lower HH frequency before as opposed to after patient or environmental contact. Suggestions for improvement focused mainly on education and facilities with audit and feedback amongst the least mentioned. An educational HH campaign was undertaken in 2 of the 4 study wards, after migration. The observations were undertaken in four different departments and consisted of three phases (pre-migration, post-migration and post campaign). The observations showed that in spite the substantial increase of HH stations at the new hospital, HH compliance remained very low and there was no statistically significant increase in compliance. However, the study revealed that awareness campaigns together with the strong presence of Infection Control Personnel and the continuous feedback on infection rates did result in increasing HH compliance in the study wards, as opposed to controls. Efforts to improve HH face numerous socio-cultural challenges and primarily self-protection concepts not only between countries but also amongst different professions. Local HH campaigns must take into account such nuances if there are to succeed. Thus this research study recommends that the results should be published and distributed across the hospital without referring to individual wards. Each head of ward will receive their own results and will be able to compare with other wards. Moreover, the local infection control team could consider the introduction of infection control link nurses and hand hygiene champions could be a way of disseminating information informally among ward based staff.