This article is authored by Ms. Sedigheh Teymouri and Mahboobeh Forouzandeh and submitted to the 11th Congress of Infection Control.
Abstract
Introduction:
Handwashing is one of the simplest strategies for infection prevention. Poor hand hygiene leads to the spread of infections, which can increase mortality rates, as well as hospitalization costs due to prolonged and repeated admissions. Effective hand hygiene can reduce hospital-acquired infections (HAIs). A standardized method for measuring hand hygiene compliance in hospitals can significantly impact infection prevention. This study examines the hand hygiene compliance of healthcare workers in Zahedan Social Security Hospital.
Methodology:
This descriptive cross-sectional study involved healthcare professionals including nurses, midwives, general practitioners, specialists, operating room staff, and physiotherapy students. The data was collected using the Ministry of Health’s checklist.
Findings:
The overall average hand hygiene compliance rate was 64.6%. The highest compliance was after contact with body fluids (64.3%), while the lowest was before aseptic procedures (44.6%). Alcohol-based hand sanitizers were used more frequently than soap and water.
Conclusion:
Based on the results, there is a need for increased education and supervision to improve hand hygiene compliance. Providing the necessary equipment for this crucial preventive measure is essential.
Keywords: hand hygiene, infection, healthcare workers
Introduction and Problem Statement:
Hospital-acquired infections (HAIs) are defined as infections acquired in hospitals or healthcare centers that were not present during the patient’s admission. The symptoms of these infections may appear during the hospital stay or even after discharge in both patients and staff. HAIs remain a significant problem globally, causing high morbidity and mortality rates among hospitalized patients.
In 2011, researchers reported that the rate of HAIs in developing countries was 15.5%, and in African countries, it was 14.8%, which was significantly higher than the 7.1% in European countries.
Hand hygiene is one of the most effective, simplest, and least costly ways to reduce HAIs. Recognizing its importance, international organizations like the CDC have developed comprehensive guidelines to ensure proper hand hygiene practices. These guidelines are regularly updated and adapted by national health authorities.
Infections transmitted from healthcare workers to patients are a leading cause of morbidity and mortality in hospitals. Studies show that 5-10% of hospitalized patients acquire at least one HAI.
Previous studies indicate that hand hygiene compliance among healthcare workers is generally low. Other studies show that continuous observation and feedback on hand hygiene practices can effectively increase compliance. Healthcare workers frequently come into contact with patients and their environment, which can lead to the transmission of microorganisms. If healthcare workers understand this connection, compliance with hand hygiene will be easier to achieve.
The primary goal of handwashing with disinfectants is to eliminate transient microorganisms and reduce resident ones.
Methodology:
This descriptive cross-sectional study utilized a checklist that covered occupational data and hand hygiene compliance across five key moments: before patient contact, before aseptic procedures, after contact with body fluids, after patient contact, and after contact with the patient’s environment.
The observer directly monitored hand hygiene practices during each shift, covering all healthcare workers in the ward. Each observation session lasted 10-20 minutes, according to national guidelines. The observations included various healthcare professionals, including nurses, midwives, general practitioners, and students.
Hand hygiene compliance was assessed using either handwashing (with soap and water) or hand rubbing (with alcohol-based solutions). The data was analyzed to calculate compliance percentages for different healthcare groups and the five key moments of hand hygiene.
Findings:
The average hand hygiene compliance rate in Zahedan Social Security Hospital was 64.5%. Nursing students had the highest compliance rate at 75%, followed by cardiologists (69.7%), nurses (67.4%), and infectious disease specialists (66.7%). Emergency room physicians had the lowest compliance at 50.9%.
Alcohol-based hand sanitizers were used more frequently (59.6%) compared to soap and water (35.38%). Among nurses, 79% of hand hygiene was performed using alcohol-based hand rub, while 28% used soap and water. Among service staff, alcohol-based hand rub was used in only 25% of cases, with soap and water used in 78% of cases. Among physicians, 90% of hand hygiene was performed with alcohol-based solutions.
Hand hygiene compliance was highest after contact with body fluids (95.3%), followed by after patient contact (79.2%), after contact with the patient environment (68.3%), before patient contact (47.2%), and lowest before aseptic procedures (44.6%).
Discussion:
This study revealed that hand hygiene compliance in Zahedan Social Security Hospital was 64.6%. Similar studies, such as one conducted by Zandieh et al. in 2011, reported hand hygiene compliance of 53% in operating rooms. A study in Sri Lanka found that over 60% of nurses routinely complied with hand hygiene practices, with nursing students performing the best in hand hygiene techniques.
In line with other studies, this research highlights the importance of hand hygiene in preventing HAIs, though compliance remains variable among different healthcare workers.
Conclusion:
Based on the study results, it is necessary to improve education and oversight of hand hygiene practices to better control HAIs. Comparative studies in other hospital departments are also recommended. Additionally, the reasons for non-compliance, such as high patient volume, lack of resources, and misperceptions about glove use, should be further explored.
Effective organizational strategies include providing appropriate materials, increasing awareness, and creating a culture of hand hygiene compliance.
