Adherence to hand hygiene in critical sectors: Can we go on like this?

AIMS AND OBJECTIVES: The rates of healthcare-associated infections are high around the world. Hand hygiene is considered the most effective measure to reduce the transmission of pathogens in the hospital environment. Our objective was to evaluate adherence to hand hygiene in critical units of a tertiary-level hospital in Central-West Brazil. DESIGN: Observational study employing cross-sectional data. Reporting rigour was demonstrated using the STROBE checklist. METHODS: Observation of hand hygiene practices of 129 professionals from the health team, including nursing staff, physicians and physical therapists. Data collection was carried out using the World Health Organization form. RESULTS: A total of 3,025 hand hygiene opportunities were observed, and the overall rate of adherence was only 46.25%. There was a greater frequency of hand hygiene after risk of exposure to bodily fluids and after contact with patients, 60.80% and 53.45%, respectively. Nurses obtained a higher rate of adherence to hand hygiene (59.80%). The neonatal ICU had a higher rate of adherence to hand hygiene when compared to other sectors. CONCLUSIONS: The physical structure for hand hygiene in the institution was poor, and no professionals reached the minimum time required for execution of hand hygiene techniques. There were low rates of adherence to hand hygiene by professionals at all five times and in all categories and sectors observed, which may have been influenced by poor infrastructure present in the institution. RELEVANCE TO CLINICAL PRACTICE: This study is of great relevance to patient safety, given the rates of healthcare-associated infections worldwide, with emphasis on underdeveloped countries. It is hoped that the results of this research can guide organisations to validly and systematically evaluate adherence to hand hygiene and achieve higher rates of adherence to hand hygiene and consequently reduce the number of infections in health environments.

Influencing factors of hand hygiene in critical sections of a brazilian hospital.

INTRODUCTION: The aim of this study was to monitor adherence to hand hygiene by health professionals working in critical sections and to assess the factors that influenced adherence, such as physical structure of the units, use of procedure gloves, employment bond of the worker, and perception of patient safety climate. METHODOLOGY: Observational and correlational study carried out in critical areas of a university hospital in the Midwest region of Brazil. RESULTS: The overall hand hygiene adherence rate was 46.2% (n = 3,025). Adherence was higher among nurses 59.8% (n = 607) than among nursing technicians (p < 0.001), and the section with the greatest adherence was the neonatal Intensive Care Unit 62.9% (n = 947) (p < 0.001). Unlike the neonatal unit, in the adult unit the dispensers of alcohol-based handrubs were poorly located, without arms reach, and the taps were manual. In this section, a greater frequency of procedure glove use was also observed, 90.6% (n = 536), as compared to the other sections (p < 0.001). Regarding safety climate perception, temporary employees had higher means as compared to regular employees (p = 0.0375). CONCLUSIONS: Hand hygiene adherence was affected and/or influenced by the physical structure, use of procedure gloves, work regime, and patient safety climate.

Efficacy of the multimodal strategy for Hand Hygiene compliance: an integrative review.

OBJECTIVE: Evaluate, from the literature, the effectiveness of the implementation of the multimodal strategy for health professionals compliance with Hand Hygiene and its sustainability over time. METHOD: Integrative review, with a view to answering the following question: "Is the implementation of the multimodal strategy effective in health professionals compliance with Hand Hygiene and can it be sustained over time?". The MEDLINE, SCOPUS, LILACS and CINAHL databases were used to retrieve the primary articles. RESULTS: Twenty-five studies were analyzed. Among the components of the multimodal strategy, three need to be better worked: health education, feedback from practices and management involvement. Although it needs to focus more on its five elements, interventions based on the multimodal strategy have favored HH compliance and its long-term sustainability. CONCLUSION: The strategy proved to be effective for HH compliance, especially when all integrating components are adequately addressed.

Clima de segurança e a prática de higiene das mãos: percepção de trabalhadores e gestores / Safety climate and hand hygiene practice: perception of workers and managers / Práctica de seguridad climática e higiene de manos: percepción de trabajadores y gestores

Objetivo: avaliar o clima de segurança entre trabalhadores de saúde de ambientes críticos e a percepção de gestores sobre as práticas de higiene das mãos. Método: trata-se de um estudo transversal e analítico, realizado com profissionais de saúde (n=142) e gestores (n=54) de um hospital público. A equipe assistencial respondeu ao Safety Attitudes Questionnaire (SAQ) e os gestores ao questionário recomendado pela OMS sobre higiene das mãos. Resultados: observou-se que a percepção do clima de segurança esteve comprometida em todos os domínios avaliados, com pior avaliação para a Percepção da gerência. Para os gestores, há pouco comprometimento dos profissionais de saúde com a prática de higiene das mãos e, além disso, 37% dos gestores não acreditam que a participação do paciente seja ação eficaz na melhoria dessa prática. Conclusão: constatou-se que o clima de segurança deficitário e a percepção limitada sobre higiene das mãos são uma dualidade que pode comprometer a segurança do paciente.(AU)

to assess the safety climate among health workers in critical environments and the perception of managers about hand hygiene practices. Method: this is a cross-sectional and analytical study, carried out with health professionals (n = 142) and managers (n = 54) from a public hospital. The assistance team answered the Safety Attitudes Questionnaire (SAQ) and the managers answered the questionnaire recommended by WHO on hand hygiene. Results: it was observed that the perception of a security climate was compromised in all domains evaluated, with a worse evaluation for the Perception of management. For managers, there is little commitment by health professionals to the practice of hand hygiene and in addition, 37% of managers do not believe that patient participation is effective action in improving this practice. Conclusion: it was found that the deficient safety climate and the limited perception of hand hygiene is a duality that can compromise patient safety.(AU)

Objetivo: evaluar el clima de seguridad entre los trabajadores de la salud en entornos críticos y la percepción de los gestores sobre las prácticas de higiene de manos. Método: se trata de un estudio transversal y analítico, realizado con profesionales de la salud (n = 142) y gestores (n = 54) de un hospital público. El equipo de asistencia respondió el Cuestionario de Actitudes de Seguridad (SAQ) y los gestores respondieron el cuestionario recomendado por la OMS sobre higiene de manos. Resultados: se observó que la percepción de clima de seguridad se vio comprometida en todos los dominios evaluados, con una peor evaluación para la Percepción de gestión. Para los gestores hay poco compromiso por parte de los profesionales de la salud con la práctica de la higiene de manos y además, el 37% de los gestores no cree que la participación del paciente sea una acción efectiva para mejorar esta práctica. Conclusión: se encontró que el clima de seguridad deficiente y la percepción limitada de la higiene de manos es una dualidad que puede comprometer la seguridad del paciente.(AU)

Efficacy of the multimodal strategy for Hand Hygiene compliance: an integrative review / Eficacia de la estrategia multimodal en la adhesión a la Higiene de las Manos: revisión integradora / Eficácia da estratégia multimodal para adesão à Higiene das Mãos: revisão integrativa

ABSTRACT Objective: Evaluate, from the literature, the effectiveness of the implementation of the multimodal strategy for health professionals compliance with Hand Hygiene and its sustainability over time. Method: Integrative review, with a view to answering the following question: "Is the implementation of the multimodal strategy effective in health professionals compliance with Hand Hygiene and can it be sustained over time?". The MEDLINE, SCOPUS, LILACS and CINAHL databases were used to retrieve the primary articles. Results: Twenty-five studies were analyzed. Among the components of the multimodal strategy, three need to be better worked: health education, feedback from practices and management involvement. Although it needs to focus more on its five elements, interventions based on the multimodal strategy have favored HH compliance and its long-term sustainability. Conclusion: The strategy proved to be effective for HH compliance, especially when all integrating components are adequately addressed.

RESUMEN Objetivo: Evaluar, a partir de la literatura, la eficacia de la implementación de la estrategia multimodal en la adhesión de los profesionales de salud a la Higiene de las Manos y su sostenibilidad a lo largo del tiempo. Método: Revisión integradora, para responder a la siguiente pregunta: "¿La implementación de la estrategia multimodal es eficaz en la adhesión de los profesionales de la salud a la Higiene de las Manos y puede ser sostenida a lo largo del tiempo?" Se utilizaron las bases de datos MEDLINE, SCOPUS, LILCAS y CINAHL para recuperar los artículos primarios. Resultados: Se analizaron 25 estudios. Entre los componentes de la estrategia multimodal, tres necesitan ser mejor trabajados: educación en salud, feedback de prácticas e involucramiento de la gestión. Aunque necesite un mayor enfoque de sus cinco elementos, las intervenciones basadas en la estrategia multimodal favorecieron la adhesión a la HM y su sostenibilidad a largo plazo. Conclusión: La estrategia se mostró eficaz en la adhesión a la HM, en particular cuando todos los componentes integradores están adecuadamente contemplados.

RESUMO Objetivo: Avaliar, a partir da literatura, a eficácia da implementação da estratégia multimodal para adesão dos profissionais de saúde à Higiene das Mãos e sua sustentabilidade ao longo do tempo. Método: Revisão integrativa, com vistas a responder a seguinte questão: "A implementação da estratégia multimodal é eficaz na adesão dos profissionais de saúde à Higiene das Mãos e pode ser sustentada ao longo do tempo?". Utilizaram-se as bases de dados MEDLINE, SCOPUS, LILACS e CINAHL para recuperar os artigos primários. Resultados: Foram analisados 25 estudos. Dentre os componentes da estratégia multimodal, três precisam ser melhor trabalhados: educação em saúde, feedback de práticas e envolvimento da gestão. Embora necessite maior enfoque dos seus cinco elementos, as intervenções baseadas na estratégia multimodal favoreceram a adesão à HM e sua sustentabilidade em longo prazo. Conclusão: A estratégia se mostrou eficaz para adesão à HM, em especial, quando todos componentes integradores são adequadamente contemplados.