Hand hygiene.pdf

14. HAND HYGIENE PRACTICES AMONG HEALTH-CARE
WORKERS AND ADHERENCE TO RECOMMENDED
PRACTICES
14.1 HAND HYGIENE PRACTICES AMONG HEALTH-CARE WORKERS
Understanding hand hygiene practices among HCWs is essential in planning interventions
in health care. In observational studies conducted in hospitals, HCWs cleaned their hands
on average from five times to as many as 30 times per shift (Table I.14.1) 35,82,154,190,454,498 .
The average frequency of hand hygiene episodes fluctuates with the observed compliance
and the setting where the observations were made, and ranges from 0.7 to 12 episodes
per hour (Table I.14.1). On the other hand, the average number of opportunities for hand
hygiene per HCW varies markedly between hospital wards; nurses in paediatric wards, for
example, had an average of eight opportunities for hand hygiene per hour of patient care,
compared with an average of 22 opportunities for nurses in ICUs 485 . In some acute clinical
situations, the patient is cared for at the same time and, on average, as many as 82 hand
hygiene opportunities per patient per hour of care have been observed at post-anaesthesia
care unit admission 499 . The number of opportunities for hand hygiene depends largely on
the process of care provided: revision of protocols for patient care may reduce unnecessary
contacts and, consequently, hand hygiene opportunities.
In 17 observational studies, the duration of hand cleansing episodes by HCWs ranged on
average between as little as 6.6 seconds and 30 seconds. In 16 of these studies, the hand
hygiene technique used was handwashing 35,70,80,148-151,153,426,457 , and handrubbing was used
in one study 342 (Figure I.14.1). In addition to washing their hands for very short time periods,
HCWs often failed to cover all surfaces of their hands and fingers 498 .
In summary, the frequency of hand hygiene opportunities per hour of care may be very
high, and despite the hand hygiene compliance rate, the applied technique may fail.
Figure I.14.1 Average duration of hand cleansing by health-care workers
Sources: 35,70,80,148-151,153,342,426,457 153 342 426 457.