European Journal of Cardiovascular Medicine

Compliance to hand hygiene (HH) is an important measure in preventing infections to patients in health care settings. Wellness and safety of patients and health care workers (HCWs) can be achieved by promoting best practices in infection control. Hospital-acquired infections (HAIs) are considered as undesirable outcome and since they are preventable, they are considered as a quality indicator of patient care.

The impact of HAI may be due to prolonged hospital stays are long-term disability, increased resistance of microorganisms to antimicrobials, massive additional financial burdens, and excess of deaths, high costs for the health systems, and emotional stress for patients and their families.¹

Transmission of health care-associated pathogens occurs through direct and indirect contact, droplets, air, and/or some common vehicle. Transmission through contaminated HCWs’ hands is a common pattern in most settings.²

Many studies have pointed out that HCWs can contaminate their hands or gloves with pathogens while performing “clean procedures” or touching intact areas of skin of hospitalized patients.^3,4,5

It has been shown that organisms are capable of surviving on HCWs’ hands for at least several minutes following contamination.² Thus, if hand hygiene practices are suboptimal, microbial colonisation is more easily established.²

Based on this evidence and the demonstration of its effectiveness, optimal hand hygiene behaviour is considered the cornerstone of healthcare associated infection (HCAI) prevention.² Furthermore, not only is it a key element of standard and isolation precautions, but its importance is emphasised also in the most modern ‘bundle’ approaches for the prevention of specific site infections such as catheter-related bloodstream infection (CRBSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI), and ventilator-associated pneumonia (VAP).^6-9

Objectives:

To assess hand hygiene compliance among all cadres of HCWs and its association with HAI rates in patients.

Place of study:  This study will be conducted in the Department of Microbiology and all the clinical wards of Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram Andhra Pradesh.

Duration of study:  From June 2023 to April 2025

Ethics:  Ethical approval taken from institutional ethics committee of Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram.

Study design: prospective observational study

Collection of data: After approval of ethics committee and Hospital Infection Control Committee data was collected.

Method: A standard checklist based on World Health Organization’s (WHO’s) 5 Moments for Hand Hygiene will be used as a tool to measure the Hand hygiene compliance. All cadres of HCWs will be observed for HH compliance by infection control nurses and also through cctv footage, observing health care professionals by observation for a minimum time period of 1 hour per 24 hours. The rates of health care associated infections like central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP) as well as surgical site infections (SSI)  were calculated and compared with the hand hygiene compliance.

Statistical analysis

Data will be analysed using Statistical Package for the Social Sciences (SPSS®) software version 24. For continuous variable will be analysed by mean with standard deviation and for categorical variables will be analysed by frequencies and percentages.

2023

2024:

2025:

In the present study and the HH rates and HAI rates which are calculated every month and for convenience of presentation the representation of tables and graphs are divided year wise. Most of the time good HH rate showed low HAI rates. Along with this comparision study, we have noticed that extensive sensitization and regular classes taken for all health care workers and the regular feedback of HH rates were updated in the Hospital Infection Control Committee meeting helped us to improve hand hygiene rates in our institute from 59% to 71% and we have also noticed there is great decrease in rates of HAIs. In this study there is direct inverse relation between HH and HAI rates mainly CLABSI, CAUTI and SSI. However the relation between HH and VAE are varying may be mostly the VAE rates might be more associated with VAP bundle care.

In H.Ojanpera et al study, they also mentioned that during their study period there is a good increase in hand hygiene compliance rates mainly in surgical wards and also mentioned that there are decreased HAI rates by the end of their study¹⁰. V.mauajou et al in their systemic review of HH compliance also mentioned that in their study they observed that when the HH compliance is more than 60 % the HAI rates are observed to decrease¹¹.

Muller MP et al study stated that the high frequency of invasive procedures  which are performed in the emergency department  represented that an opportunity for improvement in HH showed reduction in HAIs ¹².

The Institute for Healthcare Improvement has introduced a central line bundle that includes the five best evidence based practices to prevent CLABSI. They stated that HH is the most convenient and also cost effective way to reduce  CLABSI, which is HAI. Sheila Nainan Myatra in their study stated that education and awareness of HH decreases the CLABSI rates¹⁴. Fadwa Abu et al in their study stated that appropriate HH is one of the important step to decrease CLABSI rates¹⁵.

Rosenthal et al in their study mentioned that hand hygiene is very effective method to reduce nosocomial infections and mainly CAUTI¹⁶. Winter et al study foe the elimination of CAUTI cases also mentioned the importance of HH to reduce CAUTI rates¹⁷. Huang et al in their study also mentioned and showed that hand hygiene is also a key step to decrease CAUTI rates¹⁸. JA Navoa-Ng et stated that hand hygiene improvement reduced the rates of CAUTI in ICUs in their study¹⁹.

Tartari et al in their study stated that Appropriate hand hygiene of HCWs remains the most effective strategy to protect patients from healthcare-associated infections and limit the spread of antimicrobial resistant bacteria and mainly perioperative surgical infections thus reducing SSI²⁰. Pittet et al in their study noted there is strong evidence supporting implementing hand hygiene activities using multimodal strategies to improve compliance and reduce healthcare associated infections ²¹. Stewardson AJ et al stated that hand hygiene is very important to reduce SSI and multi drug resistant organisms²².

In this study there are decreased VAP cases with good HH rates except for 3 months, with might be varying mainly due to improper VAP bundle care. Kang cheng su in their study mentioned that both VAP bundle care and HH the dual care is very important to reduce the VAE²³. Shaolei Ma et al in their Meta analysis showed that enhanced hand cleaning could protect patients from VAP²⁴.

Over the past few years, scientific evidence to support the role of hand hygiene in the improvement of patient safety has increased considerably, but some key controversial issues still challenge care practitioners and researchers. HH compliance is associated with the decrease in HAIs. HH could be a simple and cost-effective method in prevention of HAIs and also reduce the patient hospital stay, financial burdens and mainly the resistance strains that could spread through hands of HCWs and finally reduce AMR.

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