Nursing staff in intensive care units (ICUs) are regularly missing opportunities to clean their hands during the care of patients, despite its critical importance for infection control, warn researchers.
Worryingly, they found that hand hygiene compliance was lowest when moving from dirtier to cleaner patient care tasks than from cleaner to dirtier tasks, further increasing the risk of infection.
“Workers may inadvertently increase patients’ risks for healthcare-associated infection by the direction in which they do tasks”
When they looked at different types of staff, they found physicians and other healthcare workers were more likely than nurses to move from dirtier to cleaner tasks.
As a result, the US researchers said that interventions to improve hand hygiene compliance should teach healthcare workers to move from cleaner to dirtier tasks to minimise risks to patients.
The authors of the new study, from the Roy J. and Lucille A. Carver College of Medicine in Iowa City, noted that healthcare-associated infections (HCAI) were still one of the most common complications of hospital care, affecting around 30% of patients in ICUs in high-income countries.
For example, they said roughly one in every 25 hospital patients in the US acquired an HCAI, adding up to about 722,000 infections a year. Of these, 75,000 patients died of their infections.
They highlighted that good hand hygiene was the most effective way of stopping the spread of bacteria and viruses.
But they said few previous studies of hand hygiene compliance had evaluated the order in which staff performed care tasks, or whether this order affected hand hygiene compliance.
As a result, the US researchers analysed data from the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study.
They assessed when staff engaged in hand hygiene and identified factors associated with compliance as defined by US guidance – the CDC/HICPAC Guideline for Hand Hygiene in Health-Care Settings.
The researchers linked consecutive tasks that individual staff performed into care sequences to identify “task transitions” – defined as two consecutive tasks, such as touching a patient’s intact skin followed by handling the patient’s body fluids, and the intervening hand hygiene opportunities.
In total, 3,246 hours of observation were recorded between December 2005 and August 2006 in ICUs in 18 centres across the US.
Results showed that general compliance with hand hygiene was poor, with healthcare workers moving from dirtier to cleaner tasks during two-thirds of the transitions recorded, and from cleaner to dirtier tasks in only a third of instances.
“We need to identify interventions that will help healthcare workers organise their work in a way that decreases this risk”
Compared with nurses, physicians were 50% more likely to move from dirtier to cleaner tasks, while other healthcare workers were more than twice as likely to do this.
Hand hygiene was less likely when gloves were worn, with healthcare workers more likely to move from dirtier to cleaner tasks when they used gloves.
Worse still, the study found staff performed proper hand hygiene in just half the instances when moving from dirtier to cleaner tasks, and only around 43% of the instances when moving from cleaner to dirtier tasks.
Lead study author Professor Loreen Herwaldt said: “Our findings indicate that healthcare workers may inadvertently increase patients’ risks for healthcare-associated infection by the direction in which they do tasks.
“We need to identify interventions that will help healthcare workers organise their work in a way that decreases this risk and also reduces their workloads,” she added.
The authors noted that their study was the first to evaluate complete sequences of patient care, to assess whether healthcare workers moved from cleaner to dirtier tasks or dirtier to cleaner tasks, and whether the order in which staff did tasks was associated with hand hygiene compliance.
The findings were presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam in the Netherlands, which is on during 13-16 April.
- See attached PDFs below for study abstract and poster