Factors Affecting Hand Hygiene Adherence at a Private Hospital in Turkey

Abstract

Objective: Nosocomial infections are the main problems rising morbidity and mortality in health care settings. Hand hygiene is the most effective method for preventing these infections. In this study, we aimed to investigate the factors related with hand hygiene adherence at a private hospital in Turkey. Materials and Methods:This study was conducted between March and June 2010 at a private hospital in Turkey. During the observation period, employees were informed about training, then posters and images were hanged in specific places of the hospital. After the initial observation, training on nosocomial infections and hand hygiene was provided to the hospital staff in March 2010. Contacts were classified according to occupational groups and whether invasive or not. These observations were evaluated in terms of compatibility with hand hygiene guidelines. Results:Hand hygiene adherence rate of trained doctors was higher than untrained ones before patient contact and after environment contact [48% (35/73) versus 82% (92/113) p<0.05 and 23% (5/22) versus 76% (37/49) p<0.05 respectively]. Hand hygiene adherence rate of trained nurses was higher than untrained ones before patient contact [63% (50/79) versus 76% (37/49) p<0.05]. Hand hygiene adherence rate of trained assistant health personnel was higher than untrained ones before asepsis [20% (2/10) versus 73% (16/22) p<0.05]. In addition, it was seen that hand antiseptics were used when hand washing was not possible. Conclusion:The increase at the rate of hand washing after training reveals the importance of feedback of the observations, as well as the training. One of the most important ways of preventing nosocomial infections is hand hygiene training that should be continued with feedbacks. Sonuç: Eğitim sonrası el yıkama oranlarındaki artış gözlemlerin geribildiriminin yanı sıra, eğitimin önemini ortaya koymaktadır. Hastane enfeksiyonlarını önlemede en önemli yollardan biri geri bildirimler ile sürdürülmesi gereken el hijyeni eğitimidir.

Hand hygiene: nurses’ adherence after training

“…Only one of the included studies focused on a single professional group: nurses (7) . It should be noted that adherence to hand hygiene was higher among trained professionals than among untrained ones (76% versus 63%; p<0.005), and that antiseptic solutions were used when hand washing was not possible (9) . In the same line of thought, other authors have also reported an increase in the adherence to hand hygiene from Chart 2 -Description of the selected studies…”

“…Some authors (8) have analyzed the hand hygiene procedure ("five moments" for hand hygiene (5) ). According to these studies, after the training program, adherence was higher in steps 3 and 4 (self-protection) (8)(9) and lower after aseptic procedures (8) and after touching patient surroundings (10) . Similarly, the authors of another study observed that only 47% of the professionals washed their hands before touching the patient and that 70% washed their hands after touching the patient (6) .…”

“…In each study, a training program was implemented with the purpose of assessing health professionals' adherence to hand hygiene, as well as the quality of hand hygiene, before and after the training program (6)(7)(8)(9)(10) . These programs consisted of multiple components, such as lectures on hand hygiene (6,10) ; training sessions on hand hygiene and fight against HAIs (7,9) ; preparation of booklets or flyers (7,10) ; and display of posters about the topic in key locations (9)(10) . Four studies compared the adherence to and training in hand hygiene among different professional groups.…”

“…Four studies compared the adherence to and training in hand hygiene among different professional groups. In three of those studies, nurses were the professional group with higher levels of training in this procedure (6,(9)(10) , when compared to doctors, health technicians, and allied healthcare workers . However, one of the studies reported that, despite the higher levels of training, only 43% of nurses and 18% of health technicians had washed their hands during the observation period, which may suggest that the knowledge about a certain procedure does not, in itself, translate into best practices (6) .…”

“…Three of the included studies have explored the reasons that compromise professionals' adherence and the quality of the procedure (6,(8)(9) . "Lack of time" (41.4%) and "skin irritation" (6.3%) were some of the reasons mentioned in one study (6) .…”