Healthcare Workers Low Compliance With Hand Hygiene Is Responsible For Bacterial Contamination Not Only In Hospital Settings

Main Category: MRSA / Drug Resistance
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 22 Apr 2008 - 2:00 PDT

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A study conducted by D. van der Vegt and A. Voss (Nijmegen, NL) presented at the 18th European Congress of Clinical Microbiology and Infectious Diseases in Barcelona, has found that compliance with hand hygiene in the healthcare setting is generally low (on average 40%), despite the fact that good hand hygiene still is one of the most important measures to prevent nosocomial infections.

Since the main indications for hand hygiene differ between healthcare and non-healthcare settings, but no comparison has been done previously, the aim of the study was to investigate the degree of compliance with hand hygiene after toilet visits in and outside the healthcare setting. Authors evaluated different groups of healthcare workers (hospital/laboratory personnel and participants of ECCMID 2007) and users of public lavatories along motorways with regard to their compliance with hand washing after toilet visits. Compliance with hand hygiene after toilet visits was 46% for hospital/laboratory personnel, 84% for participants of ECCMID 2007 and 75% for users of public lavatories along motorways, with healthcare workers showing the lowest compliance rates. Fortunately, healthcare workers showed different compliance with hand hygiene in and outside the healthcare setting: in fact the group of healthcare-workers participating to the ECCMID 2007 had the highest compliance. While the comparison of these different groups most certainly is not a perfect study, it is interesting to see that hand hygiene compliance after toilet visits is the lowest in the healthcare setting. Possibly, the feeling of a 'miasmic' environment (presumed 'dirty' public toilets) triggers hand hygiene compliance, whereas the "clean" hospital environment may jam the trigger to do so.

The same authors (A. Voss et al.) tested directly a possible method to prompt healthcare workers to comply with hand hygiene. This consists of visual reminders including 'speaking walls' (posters). The aim of the study was to evaluate the effect of "promotional toilet paper" on hand-rub use in hospital wards. This is a new and innovative way of placing reminders for hand hygiene within the hospital. The hand-rub use was measured using dispensers equipped with sensors that allowed wireless transfer of data to a central computer. In order to do that, a software was specifically developed to translate the different dispenser motions into hand-rub use data.

The results confirmed that placement of promotional toilet paper significantly increased the hand rub use of healthcare workers. The effect decreases after some time and could be repeated after introduction of a new design. This study shows that a simple, low cost intervention, namely the placement of toilet paper containing motivational messages, may have a significant impact on the use of hand disinfectants and may therefore become a part of the multimodal interventions to increase hand hygiene compliance. As with many interventions, the effect loses its impact over time, but can be boosted by a changing the messages.

18th ECCMID (European Congress of Clinical Microbiological and Infectious Diseases), Barcelona, Spain
http://www.akm.ch/eccmid2008

European Society of Clinical Microbiology and Infectious Diseases