Nav: Home

Study finds low hand hygiene compliance on ICUs

April 14, 2019

Healthcare workers on intensive care units (ICUs) are regularly missing opportunities to clean their hands during the care of patients, despite its critical importance for infection control, according to new research being presented at this year's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (13-16 April).

Worryingly, the authors say, hand hygiene compliance was lowest when moving from dirtier to cleaner patient care tasks than from cleaner to dirtier tasks, further increasing the risk of infection.

Interventions to improve hand hygiene compliance should teach healthcare workers to move from cleaner to dirtier tasks to minimise risks to patients, researchers say.

Despite concerted efforts to tackle the prevalence of healthcare associated infections, they are still one of the most common complications of hospital care, affecting around 30% of patients in ICUs in high-income countries [1]. These infections are associated with a substantial amount of ill health and death as well as considerable health service costs.

Hand hygiene is critical to preventing health care-associated infections, which kill about 100,000 people a year in the USA and cost about US$33 billion to treat.

According to the US CDC, roughly 1 in every 25 patients acquires a health care-associated infection during their hospital care, adding up to about 722,000 infections a year. Of these, 75,000 patients die of their infections.

Good hand hygiene is the most effective way of stopping the spread of bacteria and viruses. Few studies of hand hygiene compliance have evaluated the order in which healthcare workers perform patient care tasks, or whether the order in which they do these tasks affects hand hygiene compliance.

To provide more evidence, Professor Loreen Herwaldt from Roy J. and Lucille A. Carver College of Medicine, Iowa City, USA and colleagues analysed data from the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study [2]. They assessed when healthcare workers did hand hygiene during their sequences of care, and identified factors associated with hand hygiene compliance as defined by the CDC/HICPAC Guideline for Hand Hygiene in Health-Care Settings [3].

Researchers linked consecutive tasks that individual healthcare workers performed into care sequences to identify "task transitions"--defined as two consecutive patient care tasks, such as touching a patient's intact skin followed by handling the patient's body fluids, and the intervening hand hygiene opportunities.

In total, 3246 hours of observation were recorded between December 2005 and August 2006 in ICUs in 18 centres across the USA.

Results showed that general compliance with hand hygiene was poor--with healthcare workers moving from dirtier to cleaner tasks during two-thirds (10,000) of the transitions recorded, and from cleaner to dirtier tasks in only a third of instances (5, 303).

Compared with nurses, physicians were 50% more likely to move from dirtier to cleaner tasks, whilst other healthcare workers (eg, radiology technicians, respiratory therapists) were more than twice as likely to do this [4].

Hand hygiene was less likely when gloves were worn, with healthcare workers more likely to move from dirtier to cleaner tasks when they used gloves.

Worse still, healthcare workers performed proper hand hygiene in just half the instances when moving from dirtier to cleaner tasks, and only around 43% of the instances when moving from cleaner to dirtier tasks.

"Our findings indicate that healthcare workers may inadvertently increase patients' risks for healthcare-associated infection by the direction in which they do tasks", says Professor Herwaldt. "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."

The study has several strengths, say its authors, including that it is the first to evaluate complete sequences of patient care, to assess whether healthcare workers moved from cleaner to dirtier tasks or dirtier to cleaner tasks, and whether the order in which healthcare workers did tasks was associated with hand hygiene compliance.

This is an observational study so no firm conclusions can be drawn, and the authors point to several limitations including that healthcare workers' behaviour may have been influenced by the presence of observers. They also note that prospective studies are needed to validate the findings.
-end-


European Society of Clinical Microbiology and Infectious Diseases

Related Healthcare Articles:

Mitochondrial disease has a disproportionate healthcare burden in US
Mitochondrial diseases are a diverse group of disorders caused by mutated genes that impair energy production in a patient's cells, often with severe effects.
Healthcare providers should individualize patient education
Health information should be tailored to a patient's ability to understand health concepts and keep them motivated to maintain long-term changes.
High prevalence of CRE in Washington, D.C. healthcare facilities
Carbapenem-resistant Enterobacteriaceae (CRE), a family of highly pathogenic antibiotic-resistant organisms, are endemic across Washington, D.C. healthcare facilities, with 5.2 percent of inpatients testing positive for the bacteria, according to new research published online today in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.
Better, cheaper healthcare with dry blood samples
A drop of blood on filter paper, allowed to dry and stored for future diagnostic purposes -- considerably easier than the present-day, resource-consuming method using frozen blood samples in plastic tubes.
Undetected Ebola infection in international healthcare workers very unlikely
Undiagnosed Ebola virus infection was probably very rare in international workers who were deployed during the 2013-2015 outbreak of the virus in West Africa, despite mild and asymptomatic cases of Ebola being known to occur, according to new research led by the London School of Hygiene & Tropical Medicine.
Can we put a price on healthcare innovation in cancer?
Is there evidence that the money spent on innovation 'for the cure' actually benefits cancer patients?
Leaders in Healthcare
Join aspiring leaders to address some of the biggest issues facing healthcare leadership and management in the UK, affecting the professional workforce as well as the population.
New study: Estimated burden of healthcare-associated infections
A study published today by PLOS Medicine, estimates the combined burden of six healthcare-associated infections as being higher than that of diseases such as influenza, HIV/AIDS and tuberculosis together.
Healthcare corruption taken to task by technology, study shows
Mobile phone technology could help to beat bad practices in healthcare delivery, research led by the University of Edinburgh suggests.
Improving LGBT healthcare for military veterans
The U.S. Veterans Health Administration (VHA), which is likely the largest provider of LGBT healthcare in the world, is implementing various system-wide changes aimed at improving LGBT care, including transgender e-consultations to aid interdisciplinary providers and the addition of a self-identified gender identity field to all veteran record systems.

Related Healthcare Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Changing The World
What does it take to change the world for the better? This hour, TED speakers explore ideas on activism—what motivates it, why it matters, and how each of us can make a difference. Guests include civil rights activist Ruby Sales, labor leader and civil rights activist Dolores Huerta, author Jeremy Heimans, "craftivist" Sarah Corbett, and designer and futurist Angela Oguntala.
Now Playing: Science for the People

#521 The Curious Life of Krill
Krill may be one of the most abundant forms of life on our planet... but it turns out we don't know that much about them. For a create that underpins a massive ocean ecosystem and lives in our oceans in massive numbers, they're surprisingly difficult to study. We sit down and shine some light on these underappreciated crustaceans with Stephen Nicol, Adjunct Professor at the University of Tasmania, Scientific Advisor to the Association of Responsible Krill Harvesting Companies, and author of the book "The Curious Life of Krill: A Conservation Story from the Bottom of the World".