Improving hand hygiene adherence in an endoscopy unit

Background and study aims: Although hand hygiene is the most important measure in preventing infection transmission in healthcare settings, adherence to recommendations among healthcare workers is low. We implemented and assessed the impact of a World Health Organization-recommended educational intervention to improve hand hygiene adherence at the endoscopy unit of a Brazilian tertiary hospital.

Patients and methods: Hand hygiene adherence and techniques used by healthcare workers of the endoscopy unit in the course of their duties were observed unobtrusively by four nurses from the infection control unit. Data were collected at every opportunity for hand hygiene. Evaluations were carried out before and 1 and 10 months after an educational intervention. The intervention consisted of task-orientated training sessions, with live demonstrations of the multitude of opportunities for hand hygiene and the appropriate techniques. In addition to assessing hand hygiene practices, we also evaluated staff knowledge through standardized questionnaires administered before and after the education intervention. Adherence was defined as hand hygiene/disinfection at an opportunity for hand hygiene.

Results: Adherence improved from 21.4 % before the intervention to 63.3 % 1 month and 73.5 % 10 months after the educational intervention. Correct answers to the questionnaire were 82.1 % on pre-intervention test and 85.7 % on post-intervention test.

Conclusion: Hand hygiene rates were low before the education intervention and improved significantly after it. Against expectations, adherence to hand hygiene practices had increased further at 10 months after the intervention, reinforcing the intervention’s positive impact.

• References

• 1 Rotter ML. Semmelweis’ sesquicentennial: a little-noted anniversary of handwashing. Curr Opin Infect Dis 1998; 11: 457-460
• 2 Sax H, Allegranzi B, Chraiti MN et al. The World Health Organization hand hygiene observation method. Am J Infect Control 2009; 37: 827-834
• 3 World Health Organization. WHO guidelines on hand hygiene in health care : first global patient safety challenge: clean care is safer care. Geneva, Switzerland: World Health Organization, Patient Safety; 2009
• 4 Joint Commission Resources Inc. Measuring hand hygiene adherence: overcoming the challenges. Oakbrook Terrace, Ill: Joint Commission Resources; 2009
• 5 Sax H, Allegranzi B, Uckay I et al. “My five moments for hand hygiene”: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007; 67: 9-21
• 6 Higienização das mãos em serviços de saúde. 2007 Accessed at: *http://bvsms.saude.gov.br/bvs/publicacoes/higienizacao_maos.pdf
• 7 Beilenhoff U, Neumann CS, Rey JF et al. ESGE-ESGENA Guideline: cleaning and disinfection in gastrointestinal endoscopy. Endoscopy 2008; 40: 939-957
• 8 Clemens JQ, Dowling R, Foley F et al. Joint AUA/SUNA white paper on reprocessing of flexible cystoscopes. J Urol 2010; 184: 2241-2245
• 9 Petersen BT, Chennat J, Cohen J et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2011. Infect Control Hosp Epidemiol 2011; 32: 527-537
• 10 Gillespie EE, Kotsanas D, Stuart RL. Microbiological monitoring of endoscopes: 5-year review. J Gastroenterol Hepatol 2008; 23: 1069-1074
• 11 Chu NS, Favero M. The microbial flora of the gastrointestinal tract and the cleaning of flexible endoscopes. Gastrointest Endosc Clin N Am 2000; 10: 233-244
• 12 How-to Guide: Improving hand hygiene. a guide for improving practices among health care workers. Accessed at: http://www.shea-online.org/Assets/files/IHI_Hand_Hygiene.pdf
• 13 Hugonnet S, Chevrolet JC, Pittet D. The effect of workload on infection risk in critically ill patients. Critical Care Medicine 2007; 35: 76-81
• 14 Sax H, Uckay I, Richet H et al. Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns. Infect Control Hosp Epidemiol 2007; 28: 1267-1274
• 15 Boyce JM. Measuring healthcare worker hand hygiene activity: current practices and emerging technologies. Infect Control Hosp Epidemiol 2011; 32: 1016-1028
• 16 Kiesslich R, Goetz M, Hoffman A et al. New imaging techniques and opportunities in endoscopy. Nat Rev Gastroenterol Hepatol 8: 547-553
• 17 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
• 18 Joint Commission Resources Inc. Hand hygiene: toolkit for implementing the national patient safety goal. Oakbrook Terrace, Ill: Joint Commission Resources; 2008
• 19 Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis 2001; 7: 234-240
• 20 Magiorakos AP, Leens E, Drouvot V et al. Pathways to clean hands: highlights of successful hand hygiene implementation strategies in Europe. Euro Surveill 2009; 15
• 21 Son C, Chuck T, Childers T et al. Practically speaking: rethinking hand hygiene improvement programs in health care settings. Am J Infect Control 2011; 39: 716-724
• 22 Stewardson A, Allegranzi B, Sax H et al. Back to the future: rising to the Semmelweis challenge in hand hygiene. Future Microbiol 2011; 6: 855-876