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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 23  |  Issue : 2  |  Page : 59-62

Assessment of hand hygiene compliance amongst health-care workers during COVID-19 pandemic in intensive care unit's


Department of Microbiology, Apollo Hospital, Bengaluru, Karnataka, India

Date of Submission13-Oct-2021
Date of Decision22-Oct-2021
Date of Acceptance01-Nov-2021
Date of Web Publication27-Jan-2022

Correspondence Address:
Dr. Chandana Devaraj
Department of Microbiology, Apollo Hospital, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacm.jacm_65_21

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  Abstract 


BACKGROUND: Hands are the main pathway of germ transmission during health care delivery. Health care associated infections are important cause for morbidity and mortality, reduced quality of life, prolonged hospital stay and are associated with increase in the health care cost each year1,2. Hand hygiene is a simple and low-cost measure to reduce health care associated infection. Hand hygiene has been recommended as an important strategy to help prevent the spread of COVID-19 infection in hospitals3. This study aims at assessing the hand hygiene compliance among health care workers during Covid 19 pandemic in ICU settings.
AIMS AND OBJECTIVES: To assess the compliance of hand hygiene among health care workers during COVID -19 pandemic in ICU's settings. To increase the compliance of hand hygiene among health care workers during COVID-19 pandemic.
SETTINGS AND DESIGN: A prospective study was conducted in a 250 bedded tertiary care multispeciality hospital from March 20 to November 20. We followed direct observation method for assessing WHO's five moments of hand hygiene during this covid -19 pandemic in ICU's which included MICU-1, MICU-2, SICU, NICU, NSICU, CCU, CTICU. Study was carried on health care workers like doctors, nurses and others which included housekeeping, food and beverage, dietary, pharmacy staff and physiotherapy staff.
METHODS AND MATERIAL: Hand hygiene is assessed by direct observation method.5 moments of hand hygiene has been observed like before aseptic task, before patient contact, after patient contact, after touching patient surroundings and after exposure to contaminated fluids.
STATISTICAL ANALYSIS USED: Microsoft excel
RESULTS: We used direct observation method for assessing 5 moments of hand hygiene which is a gold standard method. Percentage of compliance for hand hygiene for nurses, doctors and others were 72.4, 71.4 and 68.1 and overall compliance was 70.55 respectively during March 20. Later by November 20, percentage of compliance for nurses, doctors and others were 91.9, 88.5 and 84.5 and overall compliance was 88.2. So, there was a improvement in the compliance among nurses, doctors and others from 72.4, 71.4, 68.1 to 91.9, 88.5, 84.5 respectively.
CONCLUSION: The overall percentage of compliance was 70.55 in the month of March 2020, which showed improvement by November 2020 to 88.2 during the Covid-19 pandemic in seven ICU's.

Keywords: Hand hygiene, health-care-associated infection, intensive care unit's


How to cite this article:
Devaraj C, Shivadasan J. Assessment of hand hygiene compliance amongst health-care workers during COVID-19 pandemic in intensive care unit's. J Acad Clin Microbiol 2021;23:59-62

How to cite this URL:
Devaraj C, Shivadasan J. Assessment of hand hygiene compliance amongst health-care workers during COVID-19 pandemic in intensive care unit's. J Acad Clin Microbiol [serial online] 2021 [cited 2022 Jul 1];23:59-62. Available from: https://www.jacmjournal.org/text.asp?2021/23/2/59/336590




  Introduction Top


Hands are the main pathway of germ transmission during health-care delivery. Health-care-associated infections (HAI's) are the major concern when it comes to patient safety. Lack of hand hygiene leads to a serious problem in health-care services as they may cause prolonged hospital stay.[1] HAI's are important cause for morbidity and mortality, reduced quality of life and are associated with increase in the health-care cost each year.[2] Hand hygiene is a simple and low-cost measure to reduce health-care-associated infections. Hand hygiene helps in preventing cross-contamination of microorganisms which helps in preventing the occurrence of hospital-acquired infections or nosocomial infections. Hand hygiene has been recommended as an important strategy to help prevent the spread of COVID-19 infection in hospitals.[3] The use of invasive diagnostic tests and therapeutic procedures are the added risk factors for HAI's in intensive care units (ICUs); these risk factors are very common making ICU's more prone for HAI's.

This study aims at assessing the hand hygiene compliance amongst health-care workers during COVID-19 pandemic in ICU settings.

The word hygiene is derived from the word Hygeia, which refers to the Greek goddess of health and hygiene. Hand hygiene is defined by the WHO as 'A general term referring to any action of hand cleansing ', it is the mode of cleaning one's hand either with the help of soap and w cater or with the use of alcohol-based sanitizer to get rid of microorganisms, dirt and etc.[4] Holmes and Semmelweis proved that puerperal sepsis was mainly caused by contamination of hands of health-care workers. Hand hygiene can be done either by using alcohol-based hand rub which provides residual effect or with soap and water which is the most effective method of preventing infections.[5] Even though hand hygiene techniques are easier, studies have not shown promising results of adherence to compliance amongst health-care workers. Hand hygiene practices improved after 2009 WHO guidelines on hand hygiene.[6] WHO introduced 'My Five moments for hand hygiene'. The five moments of hand hygiene are,

  1. Before touching the patient
  2. Before doing any aseptic and clean procedure
  3. After exposure to body fluids
  4. After touching a patient
  5. After touching patient surroundings.


Hand washing is the easiest and convenient method to prevent infection from COVID-19 pandemic and HAI's.[7]


  Subjects and Methods Top


A direct observational study was conducted in a 250-bedded tertiary care multispeciality hospital from March 20 to November 20. We followed the direct observation method for assessing WHO's five moments of hand hygiene during this COVID-19 pandemic in ICU's which included MICU-1, MICU-2, SICU, NICU, NSICU, CCU and CTICU. Study was carried on health-care workers such as doctors, nurses and others which included housekeeping, food and beverage, dietary, pharmacy staff and physiotherapy staff. Study assessed the adherence to hand hygiene and handwashing techniques by health-care workers in seven ICU's. All health-care workers in adult age group both male and female working in seven ICU's were included in the study. Hand hygiene compliance is calculated by the formula,

Hand hygiene compliance = Number of performed actions of hand hygiene/total number of opportunities × 100

Audit tool which we used to assess the compliance is mentioned in Annexure.

Audit tool which we used to assess the compliance is mentioned in Annexure. Audit tool comprised details such as start time and end time of the observation and five moments of hand hygiene in the respective unit.[8] [Table 1] shows the audit tool which was used to assess the hand Hygiene compliance. Compliance which was observed for five moments of hand hygiene for health care workers were before doing aseptic task, before patient contact, after patient contact, after touching patient surroundings and after exposure to contaminated fluids.
Table 1: Audit Tool which was followed to assess the Hand hygiene compliance[8]

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  1. To assess the compliance of hand hygiene amongst health-care workers during COVID-19 pandemic in ICU's settings
  2. To increase the compliance of hand hygiene amongst health-care workers during COVID-19 pandemic
  3. To reduce the risk of HAI's.



  Results Top


We used direct observation method for assessing five moments of hand hygiene which is a gold standard method. Percentage of compliance for hand hygiene for nurses, doctors and others was 72.4, 71.4 and 68.1, and overall compliance was 70.55, respectively, during March 20. Later by November 20, percentage of compliance for nurses, doctors and others was 91.9, 88.5 and 84.5, and overall compliance was 88.2. Hence, there is a improvement in the compliance among nurses, doctors and others from 72.4, 71.4, 68.1-91.9, 88.5, 84.5, respectively. Percentage of compliance is highest in nurses followed by doctors followed by others in every month. Following tables shows the percentage of compliance from March 2020 to November 2020 for nurses, doctors and others [Table 2], [Table 3], [Table 4], [Table 5], [Table 6].
Table 2: Percentage of hand hygiene compliance for nurses, doctors and others for March and April 2020

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Table 3: Percentage of hand hygiene compliance for nurses, doctors and others for May and June 2020

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Table 4: Percentage of hand hygiene compliance for nurses, doctors and others for July and August 2020

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Table 5: Percentage of hand hygiene compliance for nurses, doctors and others for September and October 2020

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Table 6: Percentage of hand hygiene compliance for nurses, doctors and others for November 2020

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  Discussion Top


The current study was done to assess the hand hygiene compliance amongst health-care workers in ICU's. WHO guidelines recommend direct observation for measuring the compliance of hand hygiene by checking five moments of hand hygiene. Direct observation helps in finding out weakness and strengths in the hand hygiene behaviour. In a study by Musu et al., the percentage of compliance was 63.9% amongst doctors and 95.6% amongst nurses.[2] In a study by Subbalakshmi et al., the compliance rate was ranging from 9.2% to 57% amongst doctors and 9.6% to 54% amongst nurses.[4] Overall compliance of hand hygiene in nurses in ICU's was 41.4% in a study by Karaaslan et al. Nurses prefer to wash their hands after touching a patient (74.6%). Overall compliance of hand hygiene amongst doctors was 31.9%. Doctors prefer to wash their hands after touching a patient (55.5%) and overall compliance of hand hygiene was more in nurses when compared to doctors in ICU's.[5] This is in concordance with our study. The main drawback of direct observation is getting bias and Hawthorne effect which is the tendency of people to behave differently from the way they would behave while being observed by someone. Overall compliance of hand hygiene by HCW's was <50% in a study by Nair et al. and hand hygiene practice differed amongst different professional categories of HCW's.[6] Compliance amongst physicians is less when compared to nurses. This study shows the importance of improving the hand hygiene compliance by training to medical and nursing staff. There should be continuous training and constant monitoring to improve the compliance. These all can be done by regular presentations, models, posters, group activities, feedback forms, pre- and post-assessment questionnaire and training sessions.


  Conclusion Top


The overall percentage of compliance was 70.55 in the month of March 2020, which showed improvement by November 2020-88.2 during the COVID-19 pandemic in seven ICU's. The compliance was more amongst nurses followed by doctors followed by others which includes housekeeping staff, dieticians, pharmacy staff, F&B and physiotherapy staff. Direct observation is considered as a gold standard method to assess the hand hygiene compliance since the technology to assess the adherence may not be available. It can assess five moments of hand hygiene. The improved hand hygiene compliance was achieved in this scenario by easy access and adequate supply of hand rub solutions, display of posters, continuous training to the staff and constant monitoring and by awareness amongst health-care providers about hand hygiene by themselves during this COVID-19 pandemic. This improved compliance helps in preventing HAI's and preventing the spread of COVID-19 infection.

Acknowledgement

I want to acknowledge all staff of Microbiology department and all ICU staffs and infection control team.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chavali S, Menon V, Shukla U. Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian J Crit Care Med 2014;18:689-93.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Musu M, Lai A, Mereu NM, Galletta M, Campagna M, Tidore M, et al. Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units. J Prev Med Hyg 2017;58:E231-7.  Back to cited text no. 2
    
3.
Moore LD, Robbins G, Quinn J, Arbogast JW. The impact of COVID-19 pandemic on hand hygiene performance in hospitals. Am J Infect Control 2021;49:30-3.  Back to cited text no. 3
    
4.
Subbalakshmi A, Abirami P, Subramanian V, Sumitha A, Victor HK. Awareness of hand hygiene in hospital set up for infection control: Knowledge based questionnaire for health care workers in a teaching hospital. Biomed Pharmacol J 2020;13:1773-9.  Back to cited text no. 4
    
5.
Karaaslan A, Kadayifci EK, Atici S, Sili U, Soysal A, Culha G, et al. Compliance of healthcare workers with hand hygiene practices in neonatal and pediatric Intensive Care Units: Overt observation. Interdiscip Perspect infect Dis 2014; 2014:306478.  Back to cited text no. 5
    
6.
Nair SS, Hanumantappa R, Gurushantswamy H, Siraj MA, Raghunath P. Knowledge, attitude and practice of hand hygiene among medical and nursing students at a tertiary health care centre in Raichur, India. ISRN Prev Med 2014; 2014:608927.  Back to cited text no. 6
    
7.
Haque M. Hand washing in averting infectious diseases: Relevance to COVID-19. J Popul Ther Clin Pharmacol 2020;27:e37-52.  Back to cited text no. 7
    
8.
WHO Guidelines for Observation form-Basic Compliance Calculation.Geneva: World Health Organization; 2010.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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Abstract
Introduction
Subjects and Methods
Results
Discussion
Conclusion
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