Effectiveness of Alcohol Based Hand Rubs and Compliance with Hand Hygiene, The

Kentucky Nurse, Jan-Mar 2004 by Lowe, Jonathan R

Compliance with hand hygiene and the rate of nosocomial infections are concerns all hospitals face. Nurses must bear the load of this responsibility and provide teaching and education on proper hand hygiene techniques. The purpose of a group research utilization project is to provide education on the efficacy and compliance with hand hygiene in reducing the numbers of nosocomial infections. The purpose of this paper was to analyze Pittet et al.'s. (2000) study for research utilization potential.

Analysis of an Individual Research Paper

Pittet et al. (2000) examined the compliance of hand hygiene and its effects on reducing the rate of nosocomial infections. The purpose of this study was to examine the effectiveness of a hospital-wide hand hygiene campaign, which included alcohol based hand rubs, based on compliance and incidence of nosocomial infections. "We hypothesized that our program would not only increase compliance with hand hygiene, but also . . . nosocomial infection rates" (Pittet, et al., 2000, 1307). The literature review focused on reasons for poor compliance, hand hygiene techniques, and measures to prevent nosocomial infections. A research framework was not identified. This quantitative study used a descriptive correlational design. Approval of the study was given by senior management: however, informed consent was not addressed. The participants in the study were all health care workers (HCWs) of the University of Geneva Hospital, Switzerland. Limitations of the study were the lack of randominzation, and although the observers were unobtrusive, the Hawthorne effect must be considered. A specific group of infection control nurses monitored and recorded the practices of hand hygiene among the HCWs. Data were collected from 2,629 observation periods, and data were obtained from 20,082 opportunities for hand hygiene. Categories for observational data obtained included: nurses (68.8%), nursing assistants (18.0%), doctors (8.3%), and other HCWs (4.9%). The large number of observations and the length of the study (1994-1997) were strengths; reliability and validity were addressed. Data were analyzed using chi-square and logistic regression techniques. The findings included: an increase in compliance from 47.6% in 1994 to 68.2% in 1997, a decrease in the prevalence of nosocomial infections from 16.9% in 1994 to 9.9% in 1997, and that hand hygiene improved significantly among nurses and nursing aides.

Summary

Pittet et al.'s (2000) study observed that an increase in compliance with hand hygiene, especially alcohol based hand rubs, was related to a decrease in the rate of nosocomial infections. The results of this study can be used in a group utilization project of providing information on efficacy and compliance issues related to hand hygiene. All HCWs, but most importantly nurses, can recommend hand hygiene programs on specific units to ensure client health and reduce unwanted health care cost. Feasibility issues would include teaching correct hand hygiene technique and compliance for new hospital employees and costs of educational materials. Considerations would be the length of program, location, and implementation strategies. Future research might focus on the use of a smaller sample size, where more control can be obtained, and the use of different hand hygiene techniques in the prevention of nosocomial infections.

References

Pittet, D., Hugonnet. S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S., Perneger, T.V. (2000). Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. The Lancet, 365, 1307-1312.

Jonathan R. Lowe, BSN Student

Department of Baccalaureate and Graduate Nursing

Eastern Kentucky University

Richmond, Kentucky