The Importance of Education in the Compliance of Healthcare Workers with Hand Hygiene

Abstract

Objectives: Hospital infections occur generally as a result of inappropriate patient care practices. At the present time, providing behavioral change in health care workers is among the most compelling fields in infection control. Compliance rate of healthcare workers with hand hygiene recommendations is below 50% on average worldwide. In that respect, the role of infection control team in detection and prevention of hospital infections is very important. Materials and Methods: In this prospective and observational study, we aimed to investigate the behaviours of healthcare workers about the compliance with hand hygiene, in three different adult ICUs of Ankara Numune Training and Research Hospital between October 2006 and January 2007. One of the ICUs (General Surgery) was classified as the study group (Group A), and other 2 ICUs (Reanimation 1 and 2) (Group B and C) were collectively termed as the control group. The study was conducted in three consecutive stages as uninformed observation, post-educational and post-feedback observation. Results: The compliance of seventy-four health care workers with hand hygiene were observed during 2072 patient hours and 13263 patient contacts were investigated. In the 1st stage, the incompatibility was 93% in all groups. In the A group, the incompatibility rate of 92% at the 1st stage fell to 58% and 24% in the 2nd and 3rd stages, respectively (p<0.05). In the control group, there was no statistically significant change between 1st and 2nd stage incompatibility rates (96% and 94%, respectively, p=0.5). Conclusion: The compliance rates of our ICU healthcare workers with hand hygiene were found to be low. It has been demonstrated that interactive and applied education were found to be effective in increa

Keywords

• Hand Hygiene
• Education
• Feedback

Sağlık Çalışanlarının El Hijyenine Uyumunda Eğitimin Önemi

Abstract

Amaç: Hastane enfeksiyonları büyük oranda uygun olmayan hasta bakım uygulamalarının sonucunda ortaya çıkmaktadır. Sağlık çalışanlarında davranış değişiminin sağlanması, günümüzde enfeksiyon kontrolünün en zorlayıcı alanlarından birisidir. Sağlık çalışanlarının el hijyeni önerilerine uyumu evrensel olarak ortalama %50’nin altında kalmaktadır. Enfeksiyon kontrol ekibinin hastane enfeksiyonlarının saptanması ve önlenmesinde rolleri bu açıdan çok önemlidir. Gereç ve Yöntem: Bu prospektif ve gözlemsel çalışmada, Ekim 2006 ile Ocak 2007 tarihleri arasında Ankara Numune Eğitim ve Araştırma Hastanesi’nin 3 farklı erişkin YBÜ’de, sağlık çalışanlarının el hijyenine uyumu ile ilgili davranışları incelendi. Yoğun bakım ünitelerinden birisi çalışma, diğer ikisi kontrol grubu olarak alındı. Çalışma habersiz gözlem, eğitim sonrası gözlem ve geribildirim sonrası gözlem olmak üzere üç aşamada yapıldı. Bulgular: Toplam 74 çalışanın el hijyenine uyumu 2072 hasta saati süresince gözlendi ve 13263 hasta teması incelendi. Birinci aşamada, sağlık çalışanlarının el hijyeni uyumsuzluğunun ortalama %93 oranında olduğu gözlendi. İkinci aşamada, eğitim verilen A ünitesinin uyumsuzluk oranlarının %92’den %58’e düştüğü, üçüncü aşamada ise uyumsuzluk oranlarının %58’den %24’e gerilediği saptandı. Bu sonuçlar istatistiksel olarak anlamlı bulundu. B ve C ünitelerinde ise birinci aşamaya göre karşılaştırıldığında ikinci aşamada anlamlı bir değişiklik gözlenmedi Sonuç: Çalışmamızda hastanemiz YBÜ’lerinde sağlık çalışanlarının el hijyeni uyumsuzluk oranlarının yüksek olduğu belirlenmiştir. Teorik bilgi aktarımının yanı sıra interaktif ve uygulamalı eğitimin el hijyenine uyumu artırmakta etkili olduğu; ancak bireysel geribildirim verilmesinin el hijyenine uyumun artmasında daha başarılı bir yöntem olduğu gösterilmiştir.

Keywords

• El Hijyeni
• Eğitim
• Geri Bildirim

References

1. 1. Creedon SA. Healthcare workers’ hand decontamination practices: compliance with recommended guidelines. J Adv Nurs. 2005;51:208-216.
2. 2. Simon AC. Hand hygiene, the crusade of the infection control specialist. Alcohol-based handrub: the solution! Acta Clin Belg. 2004;59:189-193.
3. 3. Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med. 1999;130:126-130.
4. 4. McGuckin M, Waterman R, Porten L, et al. Patient education model for increasing handwashing compliance. Am J Infect Control. 1999;27:309-314.
5. 5. Conly JM, Hill S, Ross J, et al. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control. 1989;17:330-339.
6. 6. Simmons B, Bryant J, Neiman K, et al. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol. 1990;11:589-594.
7. 7. Bryan JL, Cohran J, Larson EL. Hand washing: a ritual revisited. Crit Care Nurs Clin North Am. 1995;7:617-625.
8. 8. Lotfinejad N, Peters A, Tartari E, et al. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infect Dis. 2021;21:e209-e221.

9. 9. Ojanperä H, Kanste OI, Syrjala H. Hand-hygiene compliance by hospital staff and incidence of health-care-associated infections, Finland. Bull World Health Organ. 2020;98:475-483.
10. 10. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet. 2000;356:1307-1312.
11. 11. Mayer JA, Dubbert PM, Miller M, et al. Increasing handwashing in an intensive care unit. Infect Control. 1986;7:259-262.
12. 12. Muto CA, Sistrom MG, Farr BM. Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control. 2000;28:273-276.
13. 13. Larson E, Kretzer EK. Compliance with handwashing and barrier precautions. J Hosp Infect. 1995;30 Suppl:88-106.
14. 14. Rosenthal VD, Guzman S, Safdar N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control. 2005;33:392-397.
15. 15. Albert RK, Condie F. Hand-washing patterns in medical intensive-care units. N Engl J Med. 1981;304:1465-1466.
16. 16. Lam BC, Lee J, Lau YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics. 2004;114:e565-e571.
17. 17. Avila-Agüero ML, Umaña MA, Jiménez AL, et al. Handwashing practices in a tertiary-care, pediatric hospital and the effect on an educational program. Clin Perform Qual Health Care. 1998;6:70-72.
18. 18. Pittet D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol. 2000;21:381-386.
19. 19. Won SP, Chou HC, Hsieh WS, et al. Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2004;25:742-746.
20. 20. Dubbert PM, Dolce J, Richter W, et al. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol. 1990;11:191-193.
21. 21. Raboud J, Saskin R, Wong K, et al. Patterns of handwashing behavior and visits to patients on a general medical ward of healthcare workers. Infect Control Hosp Epidemiol. 2004;25:198-202.
22. 22. Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/ Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51:1-45, quiz CE1-4.
23. 23. Larson E. Compliance with isolation technique. Am J Infect Control. 1983;11:221-225.
24. 24. Meengs MR, Giles BK, Chisholm CD, et al. Hand washing frequency in an emergency department. Ann Emerg Med. 1994;23:1307-1312.
25. 25. Olsen RJ, Lynch P, Coyle MB, et al. Examination gloves as barriers to hand contamination in clinical practice. JAMA. 1993;270:350-353.
26. 26. Pettinger A, Nettleman MD. Epidemiology of isolation precautions. Infect Control Hosp Epidemiol. 1991;12:303-307.
27. 27. Trampuz A, Widmer AF. Hand hygiene: a frequently missed lifesaving opportunity during patient care. Mayo Clin Proc. 2004;79:109-116.
28. 28. Bissett L. Can alcohol hand rubs increase compliance with hand hygiene? Br J Nurs. 2002;11:1072, 1074-7.