Role of a multimodal intervention to promote hand hygiene compliance among healthcare workers

Background: Hand hygiene with alcohol-based hand rub is widely recognized the most effective procedure to prevent pathogen cross-transmission and healthcare-associated infections; nevertheless, adherence to WHO recommendations is often inadequate. This study quantified hand hygiene compliance rates among healthcare workers in the main ICU unit of the “Umberto I” teaching hospital of Sapienza University of Rome, both before and after a multimodal intervention. Methods: From November 2016, three nurses and two physicians performed covert observations filling out an anonymous questionnaire developed according to the WHO Guidelines for Hand Hygiene in HealthCare. The check sheet focused on four possible interactions between healthcare workers and patients, with hand hygiene opportunities before and after each interaction. After six months, we conducted an educational intervention comprehensive of performance feedback sessions with the staff to discuss defective practices. For other twelve months, we continued to monitor their adherence. Results: We collected a total of 7908 hand hygiene opportunities, 2370 before the intervention and 5538 after. Generally, we recorded a statistically significant improvement in all the investigated indications. The average overall compliance increased from 34.3% to 61.6% (p < 0.001). The compliance proportion before patient interactions increased from 19.0% to 42.8% (p < 0.001) but remained still significantly lower than after the interactions (p < 0.001). Hand hygiene opportunities after the patient interactions registered the highest adherence and raised from 49.6% to 80.4% (p < 0.001). During all the 18 months, nurses compliance rates were always higher than physicians adherence. Conclusions: After conducting the multimodal intervention with the ICU staff to promote hand hygiene adherence, we recorded a significant improvement in all the investigated compliance rates even if, especially before approaching patients, they are still suboptimal.