Nurses and other healthcare providers complied with hand hygiene guidelines less than half of the time before participating in medical procedures, results of a new study showed.
Compliance was better after procedures, with 72% following guidelines after procedures compared with 41.7% before procedures, according to a report published in the May issue of Applied Nursing Research.
Overall compliance with hand hygiene guidelines was just 34.3%.
"It is important to note that preprocedure hand hygiene intends to protect patients against infections and maximize risk reduction, whereas postprocedure hand hygiene intends to protect the healthcare provider and other patients who may contract patient-to-patient infections," wrote Denise M. Korniewicz, PhD, RN, of the University of Miami, and Maher El-Masri, PhD, RN, of the University of Windsor, in Ontario, Canada.
"Thus," they wrote, "these findings may suggest that healthcare providers are probably driven to wash their hands by their need to protect themselves more than their patients."
Each year, an estimated 2.5 million patients in the U.S. develop healthcare-associated infections that result in 90,000 deaths and cost the healthcare system an estimated $4.5 to $5.7 billion dollars.
Practices that reduce hand-to-hand or hand-to-skin contamination are considered the most effective way to decrease the risk of healthcare-associated infections, yet previous studies suggest that compliance with hand hygiene guidelines is still poor.
To explore the factors associated with compliance, Korniewicz and El-Masri observed 612 procedures at an academic oncology hospital. Data were recorded for 47 healthcare providers and were collected over a 16-week period from inpatient and outpatient units during day, evening, and night shifts.
The researchers used the CDC definition of proper hand hygiene, which includes such things as hand washing, use of hand sanitizers, and gloving. Procedures were classified as high-risk -- including drawing blood, changing surgical dressings, emptying a urinary bag, and airway suctioning -- or low-risk, including giving oral medications and checking IV tubes.
They found that compliance was higher in high-risk procedures (OR 1.77; 95% CI 1.18 to 2.65) and when the healthcare providers were exposed to blood (OR 1.40; 95% CI 1.07 to 1.73). Yet noncompliance occurred even in cases where nurses were exposed to blood, urine, saliva, sweat, and feces.
They also noted that hand hygiene was better on medical-surgical oncology units than on the hematology-oncology unit.
"Regardless of the possible explanations of these findings, they are disturbing and reflect a continuing trend of poor compliance with proper hand hygiene practices among healthcare providers," the authors wrote.
Despite their efforts to account for the possibility that observation might cause participants to change their behavior, Korniewicz and El-Masri cautioned that they could not rule this possibility out all together.
"Regardless of these limitations, our findings shed light on the issue of hand hygiene practices in acute healthcare settings and the factors impacting these practices," they continued. "They also highlight the need to continue to uphold the issue of compliance with hand hygiene through many innovative approaches that go beyond traditional teaching and inservice training."
The study was partially funded by Packaging Concepts Assoc.
The authors reported no financial conflicts of interest.
Zalman S. Agus, MD Emeritus Professor
University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner