Effectiveness of an Intervention Program to Improve Compliance with Hand Hygiene among Health Staff in NAFH

Introduction

Healthcare associated infections occur in 5–10% of hospitalized patients during their hospital stay. HAI is a major source of anxiety to patients and is very costly to health services.^(1–6)

HAI is a principal cause of the increase of morbidity, mortality and additional costs.⁽⁶⁾It is well recognized that the risk of transmission of pathogens when providing medical care and the incidence of HAI can be kept low through appropriate standardized prevention procedures.^(7–8) Hand hygiene is recognized as the leading measure to prevent cross-transmission of micro-organisms and to reduce the incidence of health care associated infections.⁽⁹⁾

The importance of hand hygiene in preventing HAIs is well sustained in evidence-base models. Although adherence to appropriate HH practices is considered one of the cornerstones for HAI prevention.⁽¹⁰⁾ Average compliance with HH recommendations varies between hospital wards, among professional categories of health care workers and according to working conditions.⁽¹¹⁾

In our hospital, we documented disappointing levels of hand hygiene compliance among medical and paramedical staff especially in male and female wards. Our main objective in this study was to increase Hand Hygiene compliance to at least 10% among health staff in female and male wards after six months of a pilot intervention program.

Materials and Methods

Study design : It was a pre-post intervention study in Najran Armed forces Hospital during the year 2015.

Studied population : All doctors and nurses in male and female wards in Najran Armed Forces Hospital were included in the study:

Results

The studied population was composed of 21 (58.3%) nurses and 15 (41.7%) medical doctors. In terms of age, the population showed an equal age distribution between the different age intervals (table 1). The gender population was also equally distributed comprising 18 (50%) male and 18 (50%) female. The majority of the studied population (75%) was trained in hand hygiene. About 11 (30.6%) of the population is working in Najran Armed Forces Hospital for less than 1 year, 10 (27.8%) for 1 to 3 years, 7 (19.4%) for 3 to 5 years, and 8 (22.2%) for more than 5 years.

Table 2 showed the positive improvement in the most percentages of knowledge items especially those regarding main route of cross-transmission, frequent source of germs and hand hygiene actions.

Table 3 showed the assessment of healthcare workers attitude on hand hygiene. All of the healthcare workers (100%) agreed that they adhere to correct hand hygiene practices at all times and have sufficient knowledge about hand hygiene. Most of them (94.4%) feel frustrated when others and them omit hand hygiene. The majority of the studied population (97.2%) stated that adhering to hand hygiene practices is easy in the current set-up.

Positive attitude was consistently 100% during preintervention and post-intervention on aspects concerning adhering to correct hand hygiene practices and hand hygiene current set-up.

Figure 3 showed the improvement of hand hygiene compliance in Female and Male Ward. At the preintervention phase hand hygiene compliance of Female Ward and Male Ward were respectively 63% and 77.89%. After the intervention, an increase of 6.44% and 7.56% were observed in Female and Male Ward respectively. As a result, Female Ward hand hygiene compliance reached 69.44% vs 85.45% in Male Ward.

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Figure 1:

Hand Hygiene Compliance of Nurses and Doctors in Male and Female Wards Pre and Post Intervention Results.

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Discussion

Medical staffs come into close contact with patients and are frequently contaminated during routine patient care¹². Therefore hand hygiene is considered an essential, cheap and most effective means of preventing HAI. This method is designed to save lives and provide a safe treatment atmosphere for all patients and health staff.^(13,14

Many factors lie behind hand hygiene adherence among health staff. It has been demonstrated that simple interventions can easily increase hand hygiene compliance.^(15–17 Although the limited number of doctors and nurses involved and the relative short period of the intervention, the results of our study showed a positive effect on knowledge, attitude and compliance on hand hygiene.

Other studies reported similar results. Feather et al¹⁸ studied the hand hygiene practices at the Royal London Hospital School of Medicine and dentistry in UK and found a positive trend of hand hygiene practice after a simple intervention of displaying hand hygiene signs.

Pittet et al¹⁹ monitored the compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, before and during implementation of a hand hygiene campaign. The main findings showed that compliance has been improved progressively from 48% in 1994 to 66% in 1997 accompanied with a significant decrease of nosocomial infections.

Routinely conducting hand hygiene training program and making the health care workers knowledgeable on hand hygiene guidelines improve progressively hand hygiene compliance. It is also important to encourage the infection control team to continue their active role in hand hygiene training in the hospital. They should be encouraged to interact with the staff members and thereby exert a positive influence on their attitudes and practices regarding hand hygiene.

Conclusion

Direct contact between patients and healthcare workers who are transiently contaminated with nosocomial pathogens is believed to be the primary route of transmission for several organisms and can lead to patients becoming colonized or infected. Although hand hygiene is a vital component for controlling hospital acquired infections, the entire healthcare team has to maintain a positive trend of hand hygiene compliance. The infection control team should be encouraged to maintain a continuous monitoring of hand hygiene compliance and have a positive interaction with the health staff.