Practice Forum
Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic*

https://doi.org/10.1067/mic.2000.103242Get rights and content

Abstract

Objective: The objective of the study was to improve health care workers' compliance with hand hygiene after patient contact by use of an alcohol-based hand antiseptic. Design and Methods: Six commercially available alcohol-based hand antiseptics were evaluated. The one most pleasing to the evaluators' hands was selected for the study. Baseline handwashing rates were assessed on 2 medical wards. Alcohol dispensers were mounted by every door on the 2 wards. An educational campaign was conducted with 4 weekly visits to these floors to remind and reinstruct staff about the use of the alcohol dispensers and to address questions. After 2 months handwashing rates were reassessed. Setting: The study was set in a university hospital. Results: The baseline handwashing rate was 60% (76/126). Physicians were most compliant (83%), followed by nurses (60%), technologists (56%), and housekeepers (36%). Two months later overall hand hygiene rates had decreased to 52% (P = .26). Nurses were most compliant (67%), followed by technologists (57%), physicians (29%), and housekeepers (25%). Physician compliance was associated with compliance by attending physicians whose example was usually followed by all other physicians on rounds. Conclusions: A brief educational campaign and installation of dispensers containing a rapidly acting hand hygiene product near hospital rooms did not affect hand hygiene compliance. The behavior of attending physicians was predictive of handwashing rates for all others in the attending's retinue. Compliance with handwashing after half of all patient contacts was a result of perfect compliance by some and total noncompliance by others being observed. (AJIC Am J Infect Control 2000;28:273-6)

Section snippets

Methods

The University of Virginia Health System has a 600-bed teaching hospital with 31 nursing units, including 9 intensive care units. The hospital provides both primary and tertiary care, admitting about 28,000 patients each year.

Six commercially available alcohol hand antiseptics containing emollients were evaluated during a 2-week period by a group of 15 health care workers who had been working in the hospital for a median of 15 years. The product selected by most of the workers as most pleasing

Results

The baseline handwashing compliance rate was 60% (76/126 opportunities). Physicians were found to be most compliant with a rate of 83%, followed by nurses (60%), technologists (56%), and housekeeping employees (36%) (Table 1).

. Baseline handwashing compliance by type of health care worker and location

WorkersMICU (%)3 West (%)Total (%)
Physicians11/13 (85)4/5 (80)15/18 (83)
Nurses28/42 (66.7)11/23 (47.8)39/65 (60)
Technicians13/17 (76)5/15 (33.3)18/32 (56)
Housekeepers0/2 (0)4/9 (52)4/11 (36)
Total

Discussion

The rate of nosocomial infections has increased in the 1990s,15, 16 and a higher proportion of infections are a result of multiply antibiotic-resistant microorganisms,17 which spread from patient to patient on the unwashed hands and equipment of health care workers. Hand hygiene has been shown to remove such pathogens from clinicians' hands13, 18 and to decrease both spread of nosocomial pathogens19 and nosocomial infection rates.20, 21, 22 Unfortunately, most studies have shown poor compliance

References (22)

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    Frequency and duration of handwashing in a neonatal intensive care unit

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    *

    Reprint requests: Barry M. Farr, MD, MSc, Box 473, University of Virginia Health System, Charlottesville, VA 22908.

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