Hand hygiene compliance among health care providers in intensive care unit (ICU) has remained unacceptably low more so at nighttime.
A prospective observational study, over 6 months, in a tertiary care, 34 bedded multidisciplinary ICU of a teaching hospital. All doctors, nurses and paramedical staff were included. An investigator, sitting quietly, observed the hand hygiene practices during day and night.
Of the total of 5639 oppurtunities of hand hygiene, 3383(59.9%) were properly done. 1388(66.1%) in doctors, 1725(60.7%) in nurses and 270(38.6%) in paramedical staff. Hand hygiene compliance significantly fell during night in doctors (980/1212vs408/887,P<0.001), in nurses (1150/1802vs575/1039,P=0.02) and in paramedical staff (176/396vs94/303,P=0.01). On comparing doctors with nurses for hand hygiene compliance, during night duties, we found nurses were more compliant than doctors (575/1039 vs 408/887, P=0.019). The diurnal variation in hand hygiene compliance was highest in doctors (34.8±2%), followed by paramedical staff (13.08±3.6%) and least in nurses (8.47±1.84%). 2256(40%) events of improperly done hand washing were observed, “no hand washing after procedure” in 41%(918/2256),“improper duration of hand washing” in 32%(723/2256) while “no hand washing done” in 27%(615/2256). 342(55%) events of “no hand washing done” occurred in night with doctors being the highest, making 163 contacts without hand washing at all.
In our study, we found that overall compliance with hand hygiene fell during night duties in all three groups of health care providers. The diurnal variation was significantly higher in doctors as compared to other groups even though they had the highest overall hand hygiene compliance rate. The diurnal variation was least among nurses. The paramedic group showed the least compliance for hand hygiene.
In spite of paramount importance, health care providers are still far from achieving appropriate hand hygiene practices.Hand hygiene practice needs strict adherence which can only be achieved by understanding the importance of infection control by each and every health care personnel.
Sauren Panja, No Financial Disclosure Information; No Product/Research Disclosure Information