Hand hygiene: “Simple, inexpensive and an effective tool”

Abstract

Hospital acquired infection severely affects patients, prolongs hospital stays and presents a major challenge for quality of patients' care (Emmerson et al, 1996; Hand washing Liaison Group, 1999). Improvement in hand hygiene can help in reduction of hospital acquired infection (Hand washing Liaison Group, 1999; Kilpatrick et al, 2007; Whitby et al, 2007; Duerink et al, 2006; Sohn et al, 2005; Jumaa 2005; Randle et al, 2006). Three observational audits were carried out to ascertain existing hand hygiene practice. In the first audit, prescribed standards were achieved in only 29% of cases. After appropriate educational interventions, a repeat study after three months showed significant improvement in up to 84% of cases. The final audit, eight months after the second study, showed that although consultants and registrars had maintained high standards (90%), senior house officers' (SHOs) practice deteriorated (46%). Although both SHOs and registrars changed during this period, only SHO performance deteriorated. Possible reasons may be either that SHOs need more education, or that because they have a busier workload, omission is more common among them, but, this requires more exploration. Conclusion: Hand hygiene is a simple but important practice. Repeat audits plus education appears to drive up standards. Recommendations: To achieve desirable and sustained behaviour change, there is a need to present information on hand hygiene to all doctors at regular intervals. Regular but random covert surveillance observation of practice with a professionals' prior consent appeared to assist in improving practice in this study.