Doctors are worst hand-hygiene offenders

In the war to prevent hospital-acquired infections, nurses are better about washing their hands than doctors, a new study found.

Despite widespread evidence that alcohol-based hand rub is the cheapest and most effective way to prevent infection, the World Health Organization says poor hand hygiene remains the cause of millions of infections every year and leads to hundreds of thousands of deaths.

"As resistance to antibiotics and other key medicines becomes more common, it is more essential than ever to reduce the number of avoidable infections in hospital," said Edward Kelley, coordinator of the patient safety program at WHO. "The best way of reducing the number of people contracting antimicrobial resistant infections is to protect them from cross-transmission of germs through healthcare workers' hands in the first place."

The study, published this week in the The Lancet Infectious Diseases, examined the effectiveness of the educational initiative of the WHO's hand-hygiene program. So far the five-step strategy has been implemented at more than 15,700 healthcare settings in 168 countries worldwide and more than 50 governments have based their national hand-hygiene campaigns on it. Researchers looked at 43 hospitals in Costa Rica, Italy, Pakistan, Saudi Arabia and Africa and found the program helped improve compliance with handwashing by 16 percent. Among the findings:

  • Nurses had the highest compliance rates (71 percent) across all sties before the intervention and doctors had the lowest (60 percent)
  • Nurses continued to have a higher compliance rate after the intervention across almost all the test sites, except Mali in Africa
  • Compliance improved across the board after the intervention, from 51 percent to 67 percent
  • Knowledge about the importance of handwashing increased by a third after the intervention
  • Alcohol-based hand rubs have been a key factor in practice improvement
  • The program has a greater effect in low- and middle-income countries than those with high-incomes
  • Two years after the intervention, all sites reported ongoing hand-hygiene activities with sustained or further improvement, including national scale-up.

"Before the launch, healthcare workers missed around half of the appropriate hand-hygiene opportunities and after the program they missed a third," said Australian author, UNSW Professor Mary-Louise McLaws, who co-authored the study and helped draft the WHO Hand-Hygiene Guidelines.

"The launch is just the first step," she said. "The next phase will be harder--changing entrenched poor hand-hygiene behavior in some healthcare workers who have yet to respond to the program."

The WHO's strategy is based on five steps:

  • Ensure healthcare workers have access to alcohol-based handrub at the point of patient care;
  • Train and educate healthcare workers on the most important times in patient care for hand hygiene (before touching a patient, before clean and aseptic procedures, after contact with body fluids, after touching a patient and after touching a patient's surroundings;
  • Monitor compliance and provide feedback;
  • Post visual reminders at the point of care in the workplace;
  • Create a culture of attention to patient and healthcare worker safety within the institution.

She noted that in Australia, doctors only comply about 65 percent of the time. "As a group they have universally poor hand-hygiene practices. Yet hand hygiene is a fundamental clinical practice that must be practiced without excuses," McLaws said.

The study authors recommended worldwide acceptance of the WHO's hand-hygiene strategy based on their findings. They conclude the strategies are feasible and sustainable across a range of settings in different countries and lead to significant compliance and knowledge improvement in healthcare workers.

For more:
- here's the announcement about the study
- read the study (subscription required)
- check out the WHO's statement
- see the WHO's statistics

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