Hand hygiene compliance in critical and semi-critical care area of tertiary care hospital

ABSTRACT:Objective To study the Hand Hygiene compliance of Critical care and Semi critical care centers in a tertiary care hospital.Methods: Direct observation is meant to be a gold standard for evaluation of HH compliance in health care centers. A covert observer was used to make direct observation in order to get purely true results out of the observation process. This study was conducted in critical (Medical ICU, Neuro-ICU, Coronary Care Unit) and semi-critical care units (High Dependency Unit, Surgical Recovery, Cardiac Recovery, Dialysis unit, Emergency). Doctors, nurses, General duty assistant/ House Keepers (GDA/HK), Others (Technicians, Dieticians, and Physiotherapists) were included as categories of HCWs in this study hand hygiene was observed during 5 moments of hand hygiene: before patient contact, before aseptic procedure, after body fluid contact, and after patient contact and after touching patient surroundings. The preference of hand wash and hand rub by HCWs was also observed in this study.Results: The overall compliances of HH compliance were found out to be 40.32%, which is an average HH compliance value according to WHO and CDC. The maximum HH compliance was observed in Nurse (48.33%) while minimum were in Doctors (27.12%). Out of all Hand Hygiene actions performed, HR was mostly preferred by Doctors (81.25%) and Nurses (72.36%) while HW was mostly preferred by GDA/HK (54.79%). In Semi critical care areas, the compliance rate was found to be highest in Nurses (43.19%) and least in Doctors but in Critical care units, GDA/HK (53.95%) had highest compliance and Doctors (28.07%) had least compliance.Conclusion The hand hygiene compliance in hospital is found to be very low despite of having all the facilities. In almost all the case the result for doctors are not up to the expectations as their compliance came out to be quite low as compared to other healthcare workers. As Doctors are the seniors to all the health care workers, so their compliances were expected to be more than other health care workers. The thing which is concluded out of this study is attitude and behavior is the main reason of low compliance. As this hospital is JCI accredited, they are having all facilities, sufficient education, and awareness programs but still they lack in compliance due to the lack of positive attitude that HCWs are having towards hand hygiene compliance. There is a need to take few steps for the improvement of behavior and attitude of HCWs towards hand hygiene.Keywords: Hand hygiene; moments of hand hygiene; steps of hand hygiene; compliance among HCWs; alcohol based hand Rub; hand washing; direct observation; World Health Organization; hospital acquired infection