Volume 1 Supplement 1

Safety in Health

Open Access

Hand hygiene compliance in a tertiary university hospital

  • Kathrin Pepper1Email author,
  • Hermine Hörhan1,
  • Cornelia Jeuschnigger1,
  • Christine Prietl1,
  • Claudia Höfer1,
  • Brigitte Kober2,
  • Renate Zierler1 and
  • Gerald Sendlhofer2, 3
Safety in Health20151(Suppl 1):A13

https://doi.org/10.1186/2056-5917-1-S1-A13

Published: 30 October 2015

Background

Health care-associated infections (HAI) are a major patient safety issue worldwide and several reports found that improved hand hygiene (HH) was associated with reduced HAI [1]. Reasons for low adherence to HH are diverse [2] and the Joint Commission set the targeted goal for HH compliance to achieve > 90% [1].

In 2012 the University Hospital Graz initiated the campaign "Clean Hands" and paid particular attention to improving healthcare professionals' knowledge of the WHO's My Five Moments for HH [3]. The main components of the campaign comprised training, distribution of posters and provision of materials encouraging patients and relatives to clean their hands. In 2013 and 2014 direct observations to assess HH compliance took part [1]. The aim of this study was to assess the compliance of HH within professional groups in three different environments.

Material and methods

In total, 23 units (wards and intensive care units) were informed that direct observations will be performed by trained hygiene experts for the WHO's My Five Moments for Hand Hygiene model. Results are shown for a non-surgical ICU, surgical ICU and pediatric ward.

Phase 1 - baseline direct observation:Baseline direct observation took place and for each indication at least 20 direct observations had to be performed. The overall compliance was calculated when more than 150 direct observations in a unit had been performed. At the end of the direct observation feedback was given by hygiene experts.

Phase 2 - follow up direct observation:Each unit was given the opportunity to reflect their habits according to the baseline results. After 6 to 12 months, a follow up observation was performed and again feedback was given.

Results

In a non-surgical ICU, the overall compliance rate increased from 53% to 83%, in a surgical ICU from 68% to 82% and in a pediatric ward from 85% to 91% (Table 1).

Compliance rates for all professional groups increased over time and were highest within "others" (Table 2).
Table 1

Compliance results in selected units (*less than 20 observations).

Indication

Observations (n)

Hand hygiene (n)

Compliance (%)

1) Before patient contact

   

Baseline (nonsurgical ICU)

48

23

48

Follow up (nonsurgical ICU)

57

49

86

Baseline (surgical ICU)

52

33

63

Follow up (surgical ICU)

55

50

91

Baseline (ward)

66

52

79

Follow up (ward)

47

38

81

2) Before aseptic task

   

Baseline (nonsurgical ICU)

29

13

45

Follow up (nonsurgical ICU)

30

26

87

Baseline (surgical ICU)

30

18

60

Follow up (surgical ICU)

31

18

58

Baseline (ward)

25

19

76

Follow up (ward)

20

18

90

3) After body fluid exposure risk

   

Baseline (nonsurgical ICU)

24

19

79

Follow up (nonsurgical ICU)

33

28

85

Baseline (surgical ICU)

28

24

86

Follow up (surgical ICU)

30

28

93

Baseline (ward)

12

12

-*

Follow up (ward)

22

22

100

4) After patient contact

   

Baseline (nonsurgical ICU)

74

46

62

Follow up (nonsurgical ICU)

61

56

92

Baseline (surgical ICU)

69

49

71

Follow up (surgical ICU)

66

58

88

Baseline (ward)

68

60

88

Follow up (ward)

58

54

93

5) After contact with patient surroundings

   

Baseline (nonsurgical ICU)

53

20

38

Follow up (nonsurgical ICU)

25

13

52

Baseline (surgical ICU)

21

12

57

Follow up (surgical ICU)

22

14

64

Baseline (ward)

50

44

88

Follow up (ward)

32

30

94

Table 2

Compliance results in selected cohorts (%).

 

Physician

Nurses

Others

Baseline (nonsurgical ICU)

43

56

39

Follow up (nonsurgical ICU)

54

88

79

Baseline (surgical ICU)

34

79

58

Follow up (surgical ICU)

39

90

96

Baseline (ward)

87

90

29

Follow up (ward)

84

99

48

Conclusions

HH is considered to be the most important measure to prevent nosocomial infections [4] and results of direct observations show that HH motivation can be addressed with comprehensive HH campaigns. Overall, improvements in the HH behavior were achieved for all indications and had been near or even above to the Joint Commission recommendation. The compliance rate for the professional group "others" showed the highest increase.

Acknowledgements

We would like to thank the entire organization and their employees for supporting the HH-campaign. We also would like to thank "National Reference Centre for the Surveillance of Nosocomial Infections" (http://www.nrz-hygiene.de) for data analysis.

Declarations

Authors’ Affiliations

(1)
Department of Surgery, University Hospital Graz
(2)
Department of Quality and Risk Management, University Hospital Graz
(3)
Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz

References

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  3. World Health Organization. Patient Safety. WHO Guidelines on Hand Hygiene in Health Care. First global patient safety challenge clean care is safer care. 2009, (accessed 30 August 2014), [http://www.who.int/gpsc/5may/en/]
  4. Erasmus V, Daha TJ, Brug H, et al: Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010, 283-294. 31Google Scholar

Copyright

© Pepper et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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