A STUDY has found marked differences in healthcare workers’ hand hygiene behaviour among similar types of hospital in Ireland. It also suggests that approaches that look at the culture of hospitals rather than the actions of individuals may be more successful in combating the problem.
The joint UCC/HSE study carried out by Síle Creedon of UCC’s School of Nursing and Midwifery looked at four Irish public acute care hospitals and how healthcare workers in each hospital viewed hand hygiene.
Ms Creedon found that there was significant difference between the hospitals, and the factor which most affected healthcare workers’ hand hygiene behaviour was not their discipline, gender or area of work but rather the hospital in which they were employed.
The study was conducted over four months and involved data collectors observing 280 healthcare workers including nurses, doctors, physiotherapists and healthcare attendants in some 1,737 observations at the four public acute hospitals
Ms Creedon said she found healthcare workers in one hospital were significantly less likely to comply than their counterparts in the other three, with the best of the four hospitals surveyed having a non-compliance rate of 24 per cent compared with 44 per cent in the worst hospital.
The study raises the question as to why there are such marked differences in practices among healthcare workers in similar type hospitals in Ireland. A possible explanation for that may be related to variations in organisational support and hospital culture, she said.
Ms Creedon said hand hygiene was recognised as the single most effective infection-control behaviour and yet it remained stubbornly difficult to raise this simple behaviour to acceptable levels either nationally or internationally.
Adopting an approach which focuses on the organisational behaviour or culture of a hospital may be more successful in achieving improved delivery of care than one that is targeted at individuals, Ms Creedon said.
She cited the Magnet Hospital Movement in the US where, through the provision of a supportive work environment for healthcare workers, hospitals with “Magnet” status had been associated with increased compliance with guidelines and improved patient outcomes.
According to Ms Creedon, the study, Hand Hygiene Compliance: Exploring variations between hospitals in Ireland, found that within the overall non-compliance rate of 30 per cent, there was variation between hospitals but also within different groups.
Men, irrespective of their discipline, had a higher rate of non-compliance than women (38 per cent vs 28 per cent ) while doctors had the highest rate of non-compliance at 41 per cent, followed by porters (38 per cent), technicians and physiotherapists (33 per cent), nurses (28 per cent) and healthcare assistants (21 per cent). The work area also had an impact on hand hygiene practices with non-compliance in AE units at 36 per cent compared with ICU at 28 per cent. “This may well be due to busyness and urgency of patient care activities in these units,” said Ms Creedon.