Hand Hygiene Compliance in the NICU

Good hand hygiene compliance is essential to prevent nosocomial infections in healthcare settings. Many experts acknowledge that direct observation of hand hygiene compliance is the gold standard but is time-consuming. An electronic dispenser with built-in wireless recording equipment allows continuous monitoring of its usage. Helder, et al. (2012) describe their study in which  the use of alcohol-based hand rub dispensers was monitored with a built-in electronic counter in a neonatal intensive care unit (NICU) setting and to determine compliance with hand hygiene protocols by direct observation.
 
A one-year observational study was conducted at a 27-bed, level III NICU at a university hospital. All healthcare workers employed at the NICU participated in the study. The use of bedside dispensers was continuously monitored and compliance with hand hygiene was determined by random direct observations.

A total of 258,436 hand disinfection events were recorded; i.e. a median (interquartile range) of 697 (559-840) per day. The median (interquartile range) number of hand disinfection events performed per healthcare worker during the day, evening, and night shifts was 13.5 (10.8 - 16.7), 19.8 (16.3 - 24.1), and 16.6 (14.2 - 19.3), respectively. In 65.8 percent of the 1,168 observations of patient contacts requiring hand hygiene, healthcare workers fully complied with the protocol.
 
The researchers conclude that electronic devices provide useful information on frequency, time, and location of its use, and also reveal trends in hand disinfection events over time. Direct observations offer essential data on compliance with the hand hygiene protocol. In future research, data generated by the electronic devices can be supplementary and used to evaluate the effectiveness of hand hygiene promotion campaigns. Their research was published in BMC Infectious Diseases.
 
Reference: Helder OK, et al. Hand disinfection in a neonatal intensive care unit: continuous electronic monitoring over a one-year period. BMC Infectious Diseases 2012, 12:248 doi:10.1186/1471-2334-12-248