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Nurses lead doctors in hand hygiene, study finds

27 August 2013

Doctors lag behind nurses in hand hygiene in hospitals according to a new study from the World Health Organization (WHO).

It also says that poor hand hygiene causes millions of infections every year, leading to hundreds of thousands of deaths.

Professor Mary-Louise McLaws from the School of Public Health and Community Medicine, co-authored the study and helped draft the WHO Hand Hygiene Guidelines. She said nurses have the highest compliance rates internationally at 71 per cent before intervention and also after the introduction of hand hygiene practices. Doctors had the lowest compliance rates at 60%.

The study, published in The Lancet Infectious Diseases, assessed the effectiveness of the WHO's Hand Hygiene Program, which launched in 2009. The researchers looked at 55 departments in 43 hospitals across five countries – Africa, Costa Rica, Italy, Pakistan and Saudi Arabia. 

Professor McLaws said that previous research revealed nurses are quicker to follow an organisation’s request to comply with new practices.

"They may well speak as an individual but they will come together as a group,” she said.

"Doctors will talk about it as an individual and talk amongst their peers and then assume that rules or new practices don’t apply to them because they are very individual.”

The hand hygiene program, featuring an alcohol-based hand rub, had proven a major success with nurses, according to Professor McLaws.

"It’s quite remarkable. Just finding the time with a little bit of effort and having the resources you can actually persuade nurses to come on board with a really easy program that reduces infections,” she said.

Overall, the researchers found that the WHO Hand Hygiene Program was effective in low, mixed and high resourced medical settings. The program was able to improve hand hygiene by 16 percentage points (51% before implementation to 67% after) and knowledge about its importance increased by a third.

"The program provides healthcare workers with global and local support for the first time," added Professor McLaws.

"The introduction of awareness of hand hygiene and simple resources is a great success with very little financial burden to each country."

But despite the program's success, stumbling blocks remain.

"Before the launch, healthcare workers missed around half of the appropriate hand hygiene opportunities and after the program they missed a third," Professor McLaws says.

"The launch is just the first step. The next phase will be harder – changing entrenched poor hand hygiene behaviour in some healthcare workers who have yet to respond to the program."

The WHO hand-hygiene compliance strategy

WHO’s hand-hygiene compliance strategy consists of five main components:

  1. Ensuring health-care workers have access to alcohol-based handrub at the point of patient care;
  2. Training and education of health-care workers on the most important times in patient care for hand hygiene;
  3. Monitoring and feedback on compliance;
  4. Visual reminders at the point of care in the workplace;
  5. Creation of a culture of attention to patient and health-care worker safety within the institution.

According to the WHO Clean Care is Safer Care Programme, when working with patients, hand hygiene should be performed at five key moments, preferably by using an alcohol-based rub or by handwashing with soap and water if hands are visibly dirty. The five moments for hand hygiene are:

  1. Before touching a patient;
  2. Before clean and aseptic procedures (e.g., inserting devices such as catheters);
  3. After contact with body fluids;
  4. After touching a patient;
  5. After touching patient surroundings.