The effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital

Abstract

Summary: Hand washing is widely accepted as the cornerstone of infection control in the intensive care unit (ICU). Nosocomial infections are frequently viewed as indicating poor compliance with hand washing guidelines. To determine the hand hygiene (HH) compliance rate among healthcare workers (HCWs) and its effect on the nosocomial infection rates in the ICU of our hospital, we conducted an interventional study. The study spanned a period of 7 months (February 2011–August 2011) and consisted of education about HH indications and techniques, workplace reminder posters, focused group sessions, and feedback on the HH compliance and infection rates. The WHO HH observation protocol was used both before and after a hospital-wide HH campaign directed at all staff members, particularly those in the ICU. Compliance was measured by direct observation of the HCWs, using observation record forms in a patient-directed manner, with no more than two patients observed simultaneously. The overall HH compliance rate was calculated by dividing the number of HH actions by the total number of HH opportunities. The nosocomial infection rates for the pre- and post-interventional periods were also compared to establish the effect of the intervention on rate of infections acquired within the unit. The overall rate of HH compliance by all the HCWs increased from 42.9% pre-intervention to 61.4% post-intervention, P < 0.001. Individually, the compliance was highest among the nurses, 49.9 vs. 82.5%, respectively (P < 0.001) and lowest among the doctors, 38.6 vs. 43.2%, respectively (P = 0.24). The effect of the increase in the HH compliance rate on the nosocomial infection rate was remarkable. There were significant reductions in the following: the rate of overall health care-associated infections/1000 patient-days, which fell from 37.2 pre-intervention to 15.1 post-intervention (P < 0.001); the rate of bloodstream infections, which fell from 18.6 to 3.4/1000 central-line-days (P < 0.001); and the rate of lower respiratory tract infections, which fell from 17.6 to 5.2/1000 ventilator-days (P < 0.001). Similarly, there were significant reductions in the isolation rates of 4 major hospital pathogens (P < 0.001 and P = 0.03). These findings suggest that although cross-infection in the ICU is a complex process, its frequency can be affected by meticulous adherence to hand hygiene recommendations. Keywords: Hand hygiene, Compliance, Nosocomial infections, Multidrug-resistant organisms