Evaluation of Hand Hygiene Compliance among Healthcare Workers: Strategies for Improvement

Abstract

Despite its known importance, hand hygiene (HH) compliance among health care workers (HCWs) is widely variable and often below 50%. By means of a 4-step step-by-step approach to implementation and monitoring of HH compliance, a total of 519 HH opportunities were assessed at baseline. Strategies are offered such as staff reinforced training followed by feedback. By use of a cohort stepped-wedge study design, the strategies were implemented in various hospital departments escalating from the medical ward, supported by a structure change on how the handrub was provided, and advanced to the operating theatre, the intensive care unit, and a cutaneous leishmaniasis treatment center. The actual implementation of strategies, daily refill and provision of handrub as well as feedback provision was supervised. Thereafter, a first follow-up assessment was performed 2 months after the full implementation of the intervention in all participating departments. A second follow-up with the same method was then performed after a total of 6 months since the intervention was fully set up in the last department, including as well a qualitative study part of selected interviews among HCWs in the last participating department. A structured observational checklist was used to record HH opportunities and indications following the WHO “my five moments for hand hygiene” model. An exclusive surveillance of compliance was implemented at baseline, first, and second follow-up assessments