General Internal Assessment of Hand Hygiene Practices Among Diverse Healthcare Personnel in Critical Care and General Wards of a Tertiary Hospital

TL;DR

This study audits hand hygiene compliance among healthcare workers in critical care and general wards, finding significant variation by profession and shift.

Contribution

The study provides empirical data on hand hygiene compliance in a tertiary hospital, identifying key predictors like profession and ward type.

Findings

Overall hand hygiene compliance was 62.4% with physicians showing the highest compliance at 75.6%.

ICU staff had significantly higher compliance (71.1%) compared to general ward staff (60.3%).

Morning shifts had higher compliance (65.9%) than night shifts (59.3%).

Abstract

Background: Hand hygiene (HH) is a key infection prevention and control (IPC) measure in departments at risk of infection, including pathology and the critical care department. Although the World Health Organization (WHO) has provided its framework of Five Moments of HH, the level of compliance among health workers is uneven. The purpose of this study was to audit HH practice among pathology staff in critical care and general wards through structured observational practice.

Methods: In this cross-sectional observational audit, based on the Five Moments of HH as established by the WHO, the performance of HH compliance was evaluated across various professional groups (medical staff, nursing, and allied health staff). A total of 1,730 HH opportunities were documented among 87 healthcare professionals over the period of six months. Compliance was analyzed by profession, ward type, and shift. While the predictors of compliance were assessed using logistic regression.

Results: Total HH compliance observed was 62.4% (1,080/1,730). Physicians showed the highest compliance (263/348; 75.6%), followed by the allied health professionals (34/49; 69.4%), while nurses (598/1015; 58.9%) and laboratory technicians (185/318; 58.2%) demonstrated lower compliance rates (p<0.001). ICU staff were seen to comply significantly more often than general ward staff (246/346; 71.1% vs. 834/1,384; 60.3%, p<0.001). Compliance was highest during morning shifts (456/692; 65.9%) and lowest at night (246/415; 59.3%, p=0.047). Logistic regression confirmed that professional category, ward type, shift, staffing adequacy, and resource availability were independent predictors of compliance.

Conclusion: The audit revealed moderate HH compliance with significant variation by professional categories and clinical areas. The implementation of behavior-specific interventions and real-time feedback on targeted IPC training is crucial to increase HH adherence and decrease the risk of contracting healthcare-associated infection.