Hand washing compliance in the intensive care unit

Background

Nosocomial infections constitute a major problem and challenge in the critical care area. Compliance is a variable and estimated to be less than 50%. In a study by Petite and colleagues, the compliance varied from 10% before patient care to 22% after patient care.

Association for Professional in Infection Control guidelines suggest that hands be washed with soap and water or be disinfected for at least 15 s: before and after patient contact or after contact with source of microorganism or after removing gloves.

Objectives

To measure the hand washing compliance among health care workers in the four teaching intensive care units in Hamilton, Ontario, Canada

Design

A prospective, observational study

Setting

Four intensive care units in a teaching hospital in Hamilton, Canada.

Participants

Fifty-nine percent nurses, 25% physicians (including intensivists and rotator residents), and 18% respiratory therapists.

Main measurements

Direct observation of compliance with hand washing of 115 heath care professionals.

Results

One hundred and fifteen health care workers were observed. The average compliance with hand hygiene recommendations ranged between 0% before patient contact to 57.4% after patient contact (95% confidence interval [CI], 48.3–66.0). In logistic regression analysis the effect of the caregiver on the use of hand hygiene is significant (P = 0.041). We chose a nurse as the reference group to compare the other group with: noncompliance was high among residents (odds ratio [OR], 0.321 [95% CI, 0.107–0.964]), staff intensivists (OR, 0.458 [95% CI, 0.131–1.602]), respiratory therapies (OR, 2.051 [95% CI, 0.667–6.304]). Only the OR of resident to nurse is significant (CI does not cross 1.0).

When we entered the site to the model, the effect of site on hand hygiene is significant (P = 0.036). When we entered both caregiver and site into the logistic regression model at the same time, neither of them display a significant effect on the hand hygiene (caregiver P = 0.059, site P = 0.053).

Conclusion

Compliance with hand washing was consistent with previous reports in the literature. Poor compliance among residents suggest that education and a role model by intensivists may be useful. Variation in compliance between site to site in the city may suggest that an increased workload affects the hand hygiene compliance.