# Compliance and Performance of Hand Hygiene in Dutch General Practice Offices Using Electronic Dispensers

## TL;DR

This study measured hand hygiene compliance in Dutch general practice offices using electronic dispensers and found an average compliance rate of 41%, with improvements during the pandemic.

## Contribution

This is the first study to use electronic monitoring to assess hand hygiene compliance in Dutch general practice offices.

## Key findings

- Hand hygiene compliance was 41% overall, with general practitioners having the lowest compliance at 38%.
- Compliance increased from 42% pre-pandemic to 56% during the pandemic.
- The average alcohol-based hand rub volume per event was 2.44 ml, which is considered appropriate.

## Abstract

One of the most effective measures for the reduction and prevention of healthcare-associated infections (HAI) is hand hygiene (HH). Covert direct observation of HH is difficult to realize in general practice office (GPO). The World Health Organization recognizes electronic monitoring as a form of measuring product use and estimating compliance. This is the first study to monitor HH performance electronically in Dutch GPOs.

The main aim of this study was to evaluate HH compliance in general practice offices.

An observational study was conducted at 4 Dutch GPOs between 2019 and 2021. We measured HH compliance using data on HH events (HHE) from alcohol-based hand rub (ABHR) dispensers with a built-in electronic counter. Daily HH opportunities were calculated according to the ‘Five Moments for Hand Hygiene’ based on the continuously documented activities using general practitioners (GPs) patient electronic dossier systems.

In total, hand hygiene was performed during 1786 of the estimated 4322 opportunities (41%). HH compliance for the general practitioners, practice assistants, and nurse practitioners was 38%, 51%, and 43%, respectively. The overall HH compliance within the same GPOs was 42% pre-pandemic and rose to 56% during the pandemic. The overall mean volume of ABHR was 2.44 ml, varying per HHE between 1.91 to 2.55 ml. The mean volume of ABHR measured before and during the pandemic rose from 2.55 ml to 2.81 ml. The overall self-reported compliance was 86% and was highest among nurse practitioners.

Hand hygiene compliance among HCWs in Dutch GPOs was found to be 41%, with general practitioners having the lowest compliance and practice assistants the highest compliance. While the mean volume of ABHR used per HHE seems appropriate, directed observations would be needed to ensure that an adequate hand-rub technique was used to cover the whole hand. Multi-modal interventions are needed to improve HH-compliance and stimulate the switch to ABHR with in the Dutch general practice office.