Doctors showed the lowest compliance levels and the smallest improvement in hand washing study

Jul 20 2005

Hand washing among healthcare staff working in a large urban hospital improved by an average of 32 per cent after a six-week hygiene programme, according to a paper in the latest Journal of Advanced Nursing.

A study of Intensive Care Unit staff by Sile Creedon from University College Cork found that overall hand washing rose from 51 per cent to 83 per cent.

Doctors showed the lowest compliance levels and the smallest improvement, rising from 31 per cent before the campaign to 55 per cent after it.

Nurses increased from 50 per cent to 89 per cent and other healthcare staff, such as physiotherapists and care assistants, rose from 66 per cent to 96 per cent.

"Hospital acquired infection poses a very real and serious threat to all who are admitted to hospital" says Sile Creedon. "Pathogens are readily transmitted on health care workers’ hands and hand hygiene substantially reduces this transmission."

The research also looked at how hand washing related to specific tasks. It found that the greatest improvements were in the numbers of staff washing their hands between dealing with different patients (rising from 48 per cent to 93 per cent) and when caring for patients after touching inanimate objects likely to be contaminated (from 40 per cent to 86 per cent).

Only 75 per cent of staff washed their hands after coming into contact with bodily substances, although this was an improvement on the 42 per cent recorded before the campaign.

And the number washing their hands actually fell in one category, with only 47 per cent washing their hands before starting or resuming care, compared with 51 per cent at the start of the study.

After the awareness campaign 100 per cent of staff knew the correct procedure in these key categories, together with the need for hand washing before invasive care and after dealing with a patient who was already infected or likely become infected. Figures had ranged from 79 per cent to 91 per cent in the pre-campaign phrase.

Staff also reported that using alcohol hand rubs, which were enriched with emollients, improved their skin condition.

"In this study staff were using a hand rub that was both effective and dermatologically effective" says Sile Creedon. "However many healthcare workers are currently given hand hygiene agents that irritate their skin.

"Further research is needed to ensure wide-scale use of hand hygiene agents that are not only effective, but also acceptable to the healthcare workers using them."

The study comprised a four-week observation phase followed by a six-week awareness campaign that included feedback on the pre-test results, a poster campaign, educational handout and alcohol hand rub placed beside each patient's bed.

Staff were then observed for another four-week period and the results compared.

152 staff were observed in the pre-test phase and 158 post-test. Approximately two-thirds of each sample were nurses.

"As a result of our study we recommend that an alcohol hand rub is provided at each bedside and that staff are regularly observed and given feedback on their performance" says Sile Creedon.

"Providing alcohol hand rub beside each bed is currently Department of Health policy in England and Wales, but the same guidance has not been issued in southern Ireland.

"Healthcare staff from all disciplines also need greater education on infection control."