Systematic Review of Studies on Compliance with Hand Hygiene Guidelines in Hospital Care

Objectives.

To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care.

Design.

A systematic review of studies published before January 1, 2009, on observed or self-reported compliance rates.

Methods.

Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed.

Results.

We included 96 empirical studies, the majority (n= 65) in intensive care units. In general, the study methods were not very robust and often ill reported. We found an overall median compliance rate of 40%. Unadjusted compliance rates were lower in intensive care units (30%–40%) than in other settings (50%–60%), lower among physicians (32%) than among nurses (48%), and before (21%) rather than after (47%) patient contact. The majority of the time, the situations that were associated with a lower compliance rate were those with a high activity level and/or those in which a physician was involved. The majority of the time, the situations that were associated with a higher compliance rate were those having to do with dirty tasks, the introduction of alcohol-based hand rub or gel, performance feedback, and accessibility of materials. A minority of studies (n= 12) have investigated the behavioral determinants of hand hygiene, of which only 7 report the use of a theoretical framework with inconclusive results.

Conclusions.

Noncompliance with hand hygiene guidelines is a universal problem, which calls for standardized measures for research and monitoring. Theoretical models from the behavioral sciences should be used internationally and should be adapted to better explain the complexities of hand hygiene.

Relationship between systems-level factors and hand hygiene adherence

This study was a cross-sectional descriptive survey of acute care hospitals in California to describe staff hand hygiene compliance and related predictors and explore the relationship between hand hygiene adherence and health care-associated infections. Although there was a relatively small sample size, institutions with morning huddles reported a significantly higher proportion of 95% or more hand hygiene compliance. Huddles are an organizational tool to improve teamwork and communication and may offer promise to influence hand hygiene adherence.

Compliance with hand hygiene and glove change in a general hospital, Mashhad, Iran: an observational study

BACKGROUND

Hand hygiene is the single most important element of strategies to prevent health care-associated infections. However, handwashing rates among health care workers have ranged from 9% to 50%. This observation took place as a structured, overt strategy to assess the hospital staff's hand hygiene compliance. The study was carried out in Imam Reza General Hospital, Mashhad, Iran.

METHODS

All hospital staff, including physicians, nurses, and unlicensed assistive personnel in 4 randomly selected wards, were observed by 2 infection control nurse specialists for 5 observation periods on each ward. The observation was overt, and observers compiled data by filling out 2 checklists. All staff knew that they were being observed, and the observers made no interventions.

RESULTS

The overall compliance with hand hygiene activities was 47.9% (438 episodes out of 913 potential opportunities) and, with sole emphasis on handwashing, was only 8.5%.

CONCLUSION

Inappropriate glove use might be a component of poor hand hygiene compliance. Training campaigns should be implanted for health care personnel and all hospital staff to re-emphasize the importance of adherence to hand hygiene protocols.