Major article
Diurnal variation in hand hygiene compliance in a tertiary level multidisciplinary intensive care unit

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Background

Hand hygiene compliance among health care providers is considered to be the single most effective factor to reduce hospital acquired infections. Despite continuous education and awareness, compliance with hand hygiene guidelines has remained low, particularly during evening shifts.

Objective

Our objective was to determine the compliance with hand hygiene guidelines among doctors, nurses, and paramedical staff during day and night duties in a multidisciplinary intensive care unit (ICU).

Methods

We used a prospective, observational, 6-month study conducted in a 34-bed ICU within a tertiary care teaching hospital. All doctors, nurses, and paramedical staff in the ICU were included. An investigator, placed within the ICU setting, observed the hand hygiene practices during day and night. Day and night shift change times were 08:00 and 20:00 hours, respectively.

Results

Of the 5639 opportunities for hand hygiene, 3383 (59.9%) were properly performed. Overall rates of compliance were 66.1% for doctors, 60.7% for nurses, and 38.6% for paramedical staff. Hand hygiene compliance dropped during the night for doctors (81% vs 46%, respectively, P < .001), for nurses (64% vs 55%, respectively, P = .02), and for paramedical staff (44% vs 31%, respectively, P = .01). Characterization of noncompliance is as follows: “No handwashing after procedure” in 41%, “improper duration of handwashing” in 32%, and “no handwashing done at all” in 27% of the events. “No handwashing done at all” occurred in 55% of the time at night with doctors having the highest rate of noncompliance, making 163 (34%) contacts without handwashing.

Conclusion

Whereas compliance with hand hygiene guidelines was lower at night compared with day, irrespective of discipline in all 3 groups of health care providers, both periods of compliance would benefit from additional training focusing on the importance of hand hygiene around the clock.

Section snippets

Setting

The study was conducted in a 34-bed multidisciplinary tertiary level ICU of a 650-bed super specialty teaching hospital in India. Critically ill patients from all specialties were admitted to the ICU. The ICU is divided into 4 cubicles: 2 cubicles with 9 patients each and 2 additional cubicles with 8 patients each. The study had approval from the hospital Ethics Committee.

Study design

This was a prospective, observational study, conducted over a period of 6 months. Hand hygiene guideline compliance was

Results

During the 6 months of observation 5639 hand hygiene opportunities were recorded for doctors (including physicians, surgeons, physiotherapists, interns, residents, and fellows), nurses, and other paramedical staff. Of the 5639 events of hand hygiene, only 3383 events were properly performed, for a compliance rate of 59.99%. Among doctors, the overall hand hygiene compliance rate was 66.12% (1388/2099), which was higher than the 60.71% of nursing staff (1725/2841) (1388/2099 vs 1725/2841,

Discussion

Results of this study suggest that there is a significant diurnal variation in compliance of hand hygiene for doctors, nurses, and paramedical staff. In general, significant differences existed in the compliance with hand hygiene guidelines among the 3 groups of health care providers.

Previous studies have reported very low rates of hand hygiene practices in the ICU.2, 3, 8, 11, 12, 13, 14, 15, 16, 17, 18 Average compliance with hand hygiene for this study was higher than in previous reports.2, 3

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      HH compliance (HHC) monitoring is often done in the daytime due to logistic reasons. HHC decreases during evening and night shifts2-4; however, documentation of the same and the extent of variation are scarce. The 5 moments of HH as recommended by WHO include before touching a patient, before aseptic procedures, after body fluid exposure, after touching a patient and after touching patient surroundings.

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    Conflicts of interest: None to report.

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