Hand Hygiene Compliance Not Sustained Following Pandemic's End, Study Finds


In a letter to the editor of Infection Control & Hospital Epidemiology, Rodrigo Pires dos Santos, MD, and colleagues at Hospital de Clínicas de Porto Alegre, describe the significant impact that the H1N1 influenza outbreak had in Brazil and discuss hand hygiene behavior during and after the 2009 influenza pandemic.

At the 790-bed, university-affiliated, tertiary-care hospital, from June through September 2009, a total of 548 inpatients were evaluated for 2009 H1N1 influenza A infection. Among 154 patients tested for the presence of the H1N1 virus with real-time polymerase chain reaction assay, 75 (48.7 percent) had positive results.

Dos Santos and colleagues report that adherence to hand hygiene was monitored by means of direct observation in the ICU since 2006, and that the ICU staff are aware that observation occurs but cannot detect it or predict when it will occur. From July 2006 through March 2010, the handwashing technique of physicians, nurses and technicians was observed daily for 20- to 30-minute intervals during five morning, five afternoon, and three night shifts, during all five weekdays. Weekends were excluded from the observation schedule. In addition, the consumption of alcohol-based hand rub was measured in milliliters per 100 patient-days. From July 2006 through March 2010, 21,438 opportunities for hand hygiene were observed. The overall mean adherence rate was 57.1 percent; the mean rate of adherence to hand hygiene was 76.6 percent for nurses, compared with 54.1 percent for technicians and 44.2 percent for physicians

Analysis revealed no difference in the observed rate of adherence before the 2009 H1N1 influenza A pandemic, compared with during and after the pandemic. The use of alcohol-based hand rub from wall dispensers showed no significant difference in immediate consumption in the ICU but a significant decrease thereafter. The use of hand rub from wall dispensers throughout the entire hospital showed a transient significant increase in consumption and a slope decrease thereafter.

Despite the increase in consumption of alcohol-based hand rub during the peak period of the pandemic, this behavior was not sustained through the subsequent months. Although there was an increase in the use of alcohol-based hand rub, this was not accompanied by a change in behavior. More focused educational programs addressing the World Health Organization's five moments for hand hygiene should be implemented to improve handwashing practices in hospitals during the next pandemic.

Reference: dos Santos R, et al. The 2009 H1N1 Influenza A Pandemic and Hand Hygiene Practices in a Hospital in the South of Brazil.

Infect Control Hosp Epidemiol 2010;31:13131315

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