Hospital study Number of doctors meeting handwashing standards rises to 65% after awareness programme
Hand hygiene practices among hospital doctors dramatically improved following an awareness programme, a Cork-based study has revealed.
Before the study, levels of hand hygiene practice were significantly lower among doctors compared with other healthcare professionals. While only 31 per cent of doctors observed were meeting handwashing procedure standards before the study, this figure rose to 65 per cent after a practical awareness programme. By comparison, nurses were 56 per cent compliant before and 89 per cent compliant after, while physiotherapists were 66 per cent compliant before and 96 per cent compliant after.
The study, by Síle Creedon of the School of Nursing and Midwifery at UCC, was carried out in the Intensive Care Unit (ICU) of a busy teaching hospital in Cork city and involved monitoring the handwashing behaviour of a sample of 370 people in the different healthcare professions, for 40 hours before and after a month-long practical programme. The programme focused on raising handwashing awareness and the introduction of an alcohol hand rub.
The study focused on an ICU because the rate of infection there is higher than in other areas of hospitals and, as a result, infection prevention there needs to be a priority.
While it is not possible to separate the effectiveness of alcohol hand rubs from the awareness campaign, it would appear that the provision of the alcohol hand rubs was a key factor in the remarkable rise in handwashing.
According to Ms Creedon, alcohol hand rubs are superior to the soap or chlorhexidine and water more commonly used in hospitals. A good microbiotic hand rub is more user friendly, because it can be left beside each patient's bed, and can be easily carried around by healthcare workers. It also doesn't dry out the skin and it kills more germs.
The aim of the study, Ms Creedon said, was to encourage the health service to tackle the issue of hospital infection in a new way. It specifically focused on pinpointing present levels of handwashing in hospitals and on increasing overall compliance. Infection in hospitals is a huge problem which affects everybody - healthcare workers, patients and their relatives.
The high rates of infection are due to the close proximity of patients to one another in an ICU, as well as the greater presence of invasive devices such as drips. Patients also tend to be sicker in ICUs and hence more susceptible to infection.
"Providing that healthcare workers are facilitated to comply with hand hygiene guidelines, it would be logical to suggest that the use of effective alcohol hand rubs would lead to an increase in handwashing and consequently the incidence of infection would decrease," said Ms Creedon.
This could have dramatic implications for the cost of running the health service. According to recent research, 10 per cent of people who are admitted to hospital acquire an infection while up to 30 per cent of people who are cared for in an ICU acquire an infection. Although there have been no similar surveys carried out in Ireland, a 1999 UK survey estimated that the cost of hospital infection to the NHS is in the region of £1 billion (€1.5 billion) a year. The study also reveals that Ireland is top of the league tables in this area. Before the practical intervention programme, the overall compliance levels in the hospital were recorded at 51 per cent. This compares favourably with the findings of similar studies in other parts of the world: 22 to 33 per cent in the US; 13 to 25 per cent in the UK; 32 per cent in Australia; and 34 per cent in Denmark.
It is the first study of its kind in Ireland and part of an overall drive to establish national guidelines on the issue.