Highlights
- •Opportunities for hand hygiene are frequent at the bedside.
- •Compliance with WHO 5 moments of hand hygiene in ICUs was poor, 35%.
- •Few healthcare workers recall the WHO 5 moments.
Background
We aimed to assess compliance, knowledge, and attitudes regarding the World Health
Organization (WHO) 5 moments for hand hygiene (HH).
Methods
We assessed HH compliance from July-August 2016, using a modified WHO HH observation
form. A 26-question survey was used to assess health care personnel (HCP) knowledge,
opinions, and barriers to HH. A subgroup of HCPs participated in a 2-round focused
survey to assign priority to the moments.
Results
Three hundred two HH opportunities were observed in 104 unique HCP-patient interactions.
HH was performed at 106 (35%) opportunities, 37% (25 of 68) before touching a patient,
9% (6 of 70) before aseptic procedures, 5% (1 of 22) after body fluid exposure or
risk, 63% (55 of 88) after touching a patient, and 35% (19 of 54) after touching patient
surroundings. Two hundred eighteen HCPs completed the survey; 63 (29%) were familiar
with the WHO 5 moments but only 13 (21%) were able to recall all 5 moments. In the
focused surveys, 46% (6 of 13) ranked “before aseptic procedure” as the most important
HH moment, and 86% (11 of 13) identified “after touching patient surroundings” as
the least important.
Conclusions
We found frequent opportunities for HH with infrequent compliance. Lack of recognition
of opportunities at the bedside and frequent glove use may contribute to lower compliance.
Key Words
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References
- ‘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
- Preventing transmission of multidrug-resistant pathogens in the intensive care unit.Infect Dis Clin North Am. 2017; 31: 535-550
- A multimodal intervention to improve hand hygiene compliance in a tertiary care center.Am J Infect Control. 2018; 46: 775-780
Siegel JD, Rhinehart E, Jackson M, Chiarello L. Healthcare Infection Control Practices Advisory Committee. 2007 Guidelines for isolation precautions: preventing transmission of infectious agents in healthcare settings. Am J Infect Control 2007;35:S65-164.
World Health Organization. Tools for evaluation and feedback. Available from: http://www.who.int/gpsc/5may/tools/evaluation_feedback/en/. Accessed June 20, 2016.
- Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions—is less more?.Am J Infect Control. 2015; 43: 922-927
- Feasibility of monitoring compliance to the my 5 moments and entry/exit hand hygiene methods in US hospitals.Am J Infect Control. 2016; 44: 938-940
- “The dirty hand in the latex glove”: a study of hand hygiene compliance when gloves are worn.Infect Control Hosp Epidemiol. 2011; 32: 1194-1199
- Comparison of hand hygiene monitoring using the 5 moments for hand hygiene method versus a wash in-wash out method.Am J Infect Control. 2015; 43: 16-19
- Hand hygiene compliance in the setting of trauma resuscitation.Injury. 2017; 48: 165-170
- Guiding hand hygiene interventions among future healthcare workers: implications of knowledge, attitudes, and social influences.Am J Infect Control. 2018; 46: 1026-1031
- Compliance with hand disinfection and its impact on hospital-acquired infections.J Hosp Infect. 2001; 48: 40-46
- How much time is needed for hand hygiene in intensive care? A prospective trained observer study of rates of contact between healthcare workers and intensive care patients.J Hosp Infect. 2006; 62: 304-310
- The effect of contact precautions on healthcare worker activity in acute care hospitals.Infect Control Hosp Epidemiol. 2013; 34: 69-73
- Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial.JAMA. 2013; 310: 1571-1580
- Measuring hand hygiene adherence: overcoming the challenges.Joint Commission, Oakbrook Terrace, IL2009
Article Info
Publication History
Published online: December 21, 2018
Footnotes
Funding/support: This project received support from an Agency for Healthcare Research and Quality grant ( 1RO1HS024108-01 ), a Centers for Disease Control and Prevention grant ( 1U54CK000450-01 ), and a QIPS Council–sponsored Healthcare Quality Improvement and Patient Safety grant (2016). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflicts of interest: None to report.
Ethics approval and consent to participate: This study was exempted by the institutional review board of the University of Maryland School of Medicine, Baltimore, MD.
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
