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Fewer than half of health care workers effectively wash hands
Hand hygiene measures improved after intervention but fell back to less than 40% compliance in Canadian study.
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Education seemed to have a temporary beneficial effect in hand hygiene measures for physicians and nurses at two hospitals in Quebec.
After finding health care workers’ compliance with hand washing regressed without intervention, researchers suggest continued strategies to remind health care workers to wash hands between patients to prevent multi-resistant pathogen transmission.
Two studies were conducted by Sophie Michaud, MD, MPH, a professor at the University of Sherbrooke School of Medicine in Quebec, and colleagues.
In the first study, the researchers used observational data to examine compliance rates. In the second study, the researchers tested transient flora on hands, pagers and stethoscopes of doctors and residents at the same hospital.
Hand washing rates fluctuate
To evaluate compliance in hand hygiene measures among health care workers, medical students recorded direct observation of compliance rates before and after an intervention. Observations were made at two hospitals — Hospital Fleurimont in 2002 and 2003 and Hotel-Dieu in 2004 and 2005 — and then at both hospitals in 2006. Hand washing opportunities were categorized by hospital ward, type of personnel, isolation precautions and type of care procedure. Hand washing and alcoholic gel use methods, including friction time, were also recorded.
Researchers observed a total 5,590 hand hygiene opportunities were observed over a five-year period. Of those, 774 were associated with caregivers of patients under isolation precautions, whereas the remaining 4,816 were associated with caregivers of non-isolated patients.
Compliance rates were identical at both hospitals in 2006 and data were combined. In 2006, hand hygiene measure rates for health care professionals working with patients under isolation were 73% and 35% for non-isolation patients. For health care workers treating patients under isolation, compliance rates rose from 68% in 2002 to 82% in 2003 and remained between 70% and 72% thereafter. For health care workers with patients not under isolation, hand hygiene measure compliance was 32% in 2002, 38% in 2003 (after an intervention) and 46% in 2005 (after an intervention). Without a new promotional activity, compliance rates decreased to 35% (P=.002). The decline in compliance was from 43% to 31% among nurses (P<.0001) and from 57% to 45% among physicians (P=.03).
In 2006, compliance rates of less than 40% were noted for non-isolated patients in two-thirds of wards at the hospital of the University of Sherbrooke. Mean friction time was 4.3 seconds when washing hands, and 12% of health care workers used paper towels to close faucets.
In another study, researchers cultured 104 hands, 105 pagers and 81 stethoscopes among 104 health care workers from samples taken while they were working at two hospitals. Overall, 37.5% of cultures contained Staphylococcus aureus, Enterobacteriaceae or non-fermenting gram negatives, including Pseudomonas and Acinetobacter. No methicillin-resistant S. aureus, vancomycin-resistant enterococci or Clostridium difficile were found.
For more information:
- Michaud S, Cardin-Langlois E, Gaudreau J, et al. Compliance of health care workers to hand hygiene measures at the Centre Hospitalier Universitaire de Sherbrooke: Where are we after five years of efforts? Abstract #194. Poster presented at: The 17th Annual Scientific Sessions of the Society for Healthcare Epidemiology of America; April 14-17, 2007; Baltimore.
- Michaud S, Leblanc L, Zabinksi M. Getting doctors’ hands clean: An interactive activity. Abstract #199. Poster presented at: The 17th Annual Scientific Sessions of the Society for Healthcare Epidemiology of America; April 14-17, 2007; Baltimore.