Compliance with hand hygiene on surgical, medical, and neurologic intensive care units: Direct observation versus calculated disinfectant usage

• Published in: American journal of infection control 2009-12, Vol.37 (10), p.835-841
• Main Authors: Scheithauer, Simone, MD, Haefner, Helga, MD, Schwanz, Thomas, MD, Schulze-Steinen, Henna, MD, Schiefer, Johannes, MD, Koch, Alexander, MD, Engels, Astrid, Lemmen, Sebastian W., MD
• Format: Article
• Language: English
• Subjects: Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiseptics; Biological and medical sciences; Compliance; Disinfectants; Disinfection & disinfectants; Drug Utilization - statistics & numerical data; Epidemiology. Vaccinations; General aspects; Germany; Guideline Adherence - statistics & numerical data; Hand Disinfection - standards; Hand hygiene; Hands; Health care; Health Services Research - methods; Hospitals, University; Humans; Hygiene; Infection Control; Infectious Disease; Infectious diseases; Intensive care; intensive care unit; Intensive Care Units; Medical sciences; nosocomial infection; Observation - methods; Pharmacology. Drug treatments; Studies
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2009.06.005

Background Hand hygiene (HH) is considered the single most effective measure to prevent and control health care-associated infections (HAIs). Although there have been several reports on compliance rates (CRs) to HH recommendations, data for intensive care units (ICUs) in general and for shift- and indication-specific opportunities in particular are scarce. Methods The aim of this study was to collect data on ICU-, shift-, and indication-specific opportunities, activities and CRs at a surgical ICU (SICU), a medical ICU (MICU), and a neurologic ICU (NICU) at the University Hospital Aachen based on direct observation (DO) and calculated disinfectant usage (DU). Results Opportunities for HH recorded over a 24-hour period were significantly higher for the SICU (188 per patient day [PD]) and MICU (163 per PD) than for the NICU (124 per PD). Directly observed CRs were 39% (73/188) in the SICU, 72% (117/163) in the MICU, and 73% (90/124) in the NICU. However, CRs calculated as a measure of DU were considerably lower: 16% (29/188) in the SICU, 21% (34/163) in the MICU, and 25% (31/124) in the NICU. Notably, CRs calculated from DO were lowest before aseptic tasks and before patient contact. Conclusions To the best of our knowledge, this study provides the first data picturing a complete day, including shift- and indication-specific analyses, and comparing directly observed CRs with those calculated based on DU, the latter of which revealed a 2.75-fold difference. Worrisomely, CRs were very low, especially concerning indications of greatest impact in preventing HAIs, such as before aseptic task. Thus, the gathering of additional data on CRs and the reasons for noncompliance is warranted.