WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE
Perceived barriers to adherence with hand hygiene practice
recommendations include skin irritation caused by hand hygiene
agents, inaccessible hand hygiene supplies, interference with
HCW–patient relationships, patient needs perceived as a
priority over hand hygiene, wearing of gloves, forgetfulness,
lack of knowledge of guidelines, insufficient time for hand
hygiene, high workload and understaffing, and the lack of
scientific information showing a definitive impact of improved
hand hygiene on HCAI rates. 608,656,663,666,722-725,729,731,732 Some
of the perceived barriers to adherence with hand hygiene
guidelines have been assessed or quantified in observational
studies. 608,663,666,720,722-724 Table I.16.3 lists the most frequently
reported reasons that are possibly, or effectively, associated
with poor adherence. Some of these barriers are discussed in
Part I, Section 14 (i.e. skin irritation, no easy access to hand
hygiene supplies), and in Part I, Section 23.1 (i.e. impact of use
of gloves on hand hygiene practices).
Lack of knowledge of guidelines for hand hygiene, lack of
recognition of hand hygiene opportunities during patient
care, and lack of awareness of the risk of cross-transmission
of pathogens are barriers to good hand hygiene practices.
Furthermore, some HCWs believed that they washed their
hands when necessary even when observations indicated that
they did not. 218,220,666,667,676,733
Additional perceived barriers to hand hygiene behaviour
are listed in Table I.16.3. These are relevant not only on the
institutional level, but also to particular HCWs or HCW groups.
Table I.16.1
Frequency of hand hygiene actions among health-care workers
Reference Year of publication Average no. of hand hygiene actions
Ayliffe et al. 137 1988 5 per 8 hours
Broughall 218 1984 5–10 per shift
Winnefeld et al. 262 2000 10 per shift
McCormick, Buchman & Maki 624 2000 13.1–15.9 per day*
Boyce, Kelliher & Vallande 264 2000 1.7 per hour*
Boyce, Kelliher & Vallande 264 2000 1.8 per hour**
Ojajarvi, Makela & Rantasalo 219 1977 20–42 per 8-hour shift*
Larson et al. 647 2000 1.8 per hour*
Larson et al. 647 2000 2.0 per hour
Berndt et al. 623 2000 22 per day
Larson et al. 217 1991 1.7–2.1 per hour
Larson et al. 79 1998 2.1 per hour*
Lam, Lee & Lau 648 2004 2.2 per hour*
Taylor 611 1978 3 per hour
Gould 649 1994 3.3 per hour
Girard, Amazian & Fabry 613 2001 3.5 per hour
Noritomi et al. 650 2007 6.3 per hour
Rosenthal et al. 651 2003 9.9 per hour*
Pittet et al. 652 2003 4.4 per hour
Harbarth et al. 653 2001 12 per hour
Larson, Albrecht & O’Keefe 654 2005 7.0 per hour
Girou et al. 655 2006 15.2 per hour
* Handwashing only reported in the study.
** Handrubbing only reported in the study.
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