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Year : 2020  |  Volume : 13  |  Issue : 1  |  Page : 71-72  

Going back to basics: Improving hand hygiene compliance

Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Date of Submission18-Jul-2019
Date of Decision13-Aug-2019
Date of Acceptance15-Oct-2019
Date of Web Publication16-Dec-2019

Correspondence Address:
Sarit Sharma
Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_203_19

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How to cite this article:
Sharma S. Going back to basics: Improving hand hygiene compliance. Med J DY Patil Vidyapeeth 2020;13:71-2

How to cite this URL:
Sharma S. Going back to basics: Improving hand hygiene compliance. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2022 Jun 25];13:71-2. Available from: https://www.mjdrdypv.org/text.asp?2020/13/1/71/272879

  Prevention is Better Than Cure Top

This age-old wisdom rings more true especially in the case of health care-associated infections (HCAIs). Treatment of HCAIs has become more and more challenging due to the development of antibiotic resistance by many microorganisms, also called superbugs. The accidental discovery of the first antibiotic, i.e., penicillin, by Alexander Fleming in 1928 revolutionized the way to treat primary and nosocomial infections, but along with this, there was also a dawn of the era of multidrug-resistant organisms (MDROs). Penicillin resistance in  Escherichia More Details coli was discovered in as early as 1940s and down the years, more and more antibiotics were discovered, with bacteria becoming smarter and developing resistance to single as well as multiple antibiotics. MDROs spread by cross-transmission from health-care workers' (HCW) hands during patient care and injudicious use of antibiotics, which results in selection pressure and ultimately survival of virulent strain of microorganisms.[1]

  Burden of Healthcare-Associated Infections Top

HCAIs are infections that first appear 48 h or more after hospitalization or within 30 days after having received health care. Studies conducted in high-income countries (HICs) found that 5%–15% of the hospitalized patients acquire HCAIs which can affect from 9% to 37% of those admitted to intensive care units. The incidence of hospital-acquired infections (HAIs) is significantly higher in low- and middle-income countries as compared to HICs.[2],[3] HCAIs result in prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobials, massive additional costs for health systems, high costs for patients and their family, and unwanted deaths.[4]

Hence, the time has come that in every health-care setting, there should be proper surveillance of HCAIs along with an effective infection prevention policy.

  Objectives of an Effective Infection Prevention Policy Top

Prevent, reduce, and ultimately eliminate HAIs. Our target is (a) To decrease microbial population of the hospital environment; (b) to eliminate the danger of transmission of microorganisms from one individual to another: (i) from HCW to patient, (ii) from patient to HCW, and (iii) from patient to patient; and (c) to prevent hospital items from becoming sources of cross-contamination.

Effective infection prevention and control (IPC) reduces HCAIs by at least 30%–70%. Performing hand hygiene, most commonly through the use of antibacterial hand rub (ABHR), leads to a significant reduction in the bacterial counts present on hands and therefore reduces the likelihood of cross-transmission.[5],[6]

  Barriers to Effective Surveillance in Low- and Middle-Income Countries Top

A WHO survey demonstrated that barriers to effective surveillance include insufficient financial resources, scarcity of training in IPC and hospital epidemiology, limited microbiological and radiological services, and other important competing health-care priorities.[3]

  Steps for Effective Surveillance of Health Care-Associated Infections Top

Successful and sustained hand hygiene improvement is achieved by implementing multiple actions to tackle different obstacles and behavioral barriers. The WHO Multimodal Hand Hygiene Improvement Strategy has been proposed to translate into practice the WHO recommendations on hand hygiene. The steps for improving compliance to hand hygiene as pointed by the WHO include:[3],[7]

  1. System change: It is to be ensured that health-care facilities have the necessary infrastructure to allow HCWs to perform hand hygiene. There should be reliable and uninterrupted provision of ABHR at the point of care along with continuous supply of safe water, soap, towels, and disposable nonpowdered gloves
  2. Staff education and training: HCWs should be educated about the impact of HCAIs and the role of hand hygiene in preventing HCAIs. They need to be trained about “My 5 Moments for Hand Hygiene” and correct hand hygiene technique. This training should be repeated as often as possible as staff in health-care facilities can change. It has also been emphasized that training in hand hygiene and other infection prevention practices should be made a part of an undergraduate training program of clinical and nonclinical staff
  3. Evaluation and feedback: Regular surveillance of hand hygiene compliance along with performance feedback and motivation of the HCWs works as an effective strategy. Here, good practices when noticed are appreciated, areas or professions that have poor compliance are highlighted, and training is conducted accordingly
  4. Reminders in the workplace: Posters in the local and regional languages can continually prompt HCWs regarding the importance of and the appropriate indications and procedures for performing hand hygiene
  5. Institutional safety climate: Work environment should be such that it gives priority to high standards of infection prevention practices and high compliance with hand hygiene. These initiatives are taken by leaders within the institution, setting benchmarks or targets, and also at an individual level, where every HCW identifying hand hygiene as a priority is committed and highly self-motivated.

The WHO advocates that effective hand hygiene is the single most important practice to prevent and control HCAIs.[8] Several studies report that a simple and straightforward process, taking only a few seconds to clean hands with an ABHR, helps prevent HCAIs and saves lives, reduces morbidity, and minimizes health-care costs.[9]

  References Top

Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, et al. Antibiotic resistance: A rundown of a global crisis. Infect Drug Resist 2018;11:1645-58.  Back to cited text no. 1
Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections-An overview. Infect Drug Resist 2018;11:2321-33.  Back to cited text no. 2
Loftus MJ, Guitart C, Tartari E, Stewardson AJ, Amer F, Bellissimo-Rodrigues F, et al. Hand hygiene in low- and middle-income countries. Int J Infect Dis 2019;86:25-30.  Back to cited text no. 3
World Health Organization. The burden of health care-associated infection worldwide. World Health Organization; Available from: https://www.who.int/gpsc/country_work/burden_hcai/en/. [Last accessed on 2019. Jul 13].  Back to cited text no. 4
Bellissimo-Rodrigues F, Pires D, Soule H, Gayet-Ageron A, Pittet D. Assessing the likelihood of hand-to-hand cross-transmission of bacteria: An experimental study. Infect Control Hosp Epidemiol 2017;38:553-8.  Back to cited text no. 5
Salmon S, Truong AT, Nguyen VH, Pittet D, McLaws ML. Health care workers' hand contamination levels and antibacterial efficacy of different hand hygiene methods used in a Vietnamese hospital. Am J Infect Control 2014;42:178-81.  Back to cited text no. 6
World Health Organization. A Guide to the Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy. Geneva: World Health Organization; WHO/IER/PSP/2009.02. Availtable from: https://www.who.int/gpsc/5may/Guide_to_Implementation.pdf. [Last accessed on 2019 Jul 14].  Back to cited text no. 7
Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641-52.  Back to cited text no. 8
Widmer AF, Conzelmann M, Tomic M, Frei R, Stranden AM. Introducing alcohol-based hand rub for hand hygiene: The critical need for training. Infect Control Hosp Epidemiol 2007;28:50-4.  Back to cited text no. 9


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