Hand hygiene: nurses’ adherence after training

Hand hygiene plays a key role in the prevention of healthcare-associated infections. Therefore, this study aims to analyze nurses’ adherence to hand hygiene and identify intervention strategies to improve this procedure.

Method:

Integrative literature review, using the Cochrane methodology, to answer the following question: “What is the level of effectiveness of training in improving nurses’ adherence to hand hygiene?”.

Results:

Studies show that nurses’ adherence to hand hygiene has increased from 42.9% to 61.4% (p<0.001), or even from 63% to 76% (p<0.005) after a specific training intervention.

Conclusion:

After training, nurses’ adherence to hand hygiene improved, particularly when compared to the other professionals involved. Despite its simplicity, the implementation of a training program and its subsequent follow-up have a positive on nurses’ attitudes and adherence to hand hygiene.

Descriptors:
Hand Hygiene; Staff Development; Nurses; Infection Control; Infection

PI(C)O(D) Method		Keywords
P (Participants)	Nurses	hand washing, nurse; knowledge; adherence; training; healthcare.
I (Interventions)	Training
O (Outcomes)	Adherence to hand hygiene
D (Design)	Qualitative or quantitative studies

Ref.	Description of the study
⁽ ⁶6 De Vita V, Weisburd G, Beltramino EBD. Conocimiento, actitudes y prácticas del personal de salud relacionados con el lavado de manos clinico en una unidad de cuidados intensivos. Rev Méd Rosario [Internet]. 2014 [cited 2017 Feb 15]; 80(1):105-16. Available from: http://www.circulomedicorosario.org/Upload/Directos/Revista/1a1e43De Vita Lavado de Manos.pdf http://www.circulomedicorosario.org/Uplo... ⁾	Type of Study: Descriptive, cross-sectional, interventional, prospective, analytical study. Objectives: To identify health professionals' level of knowledge and compliance with handwashing procedures. Participants: Nurses and doctors working in an intensive care unit. Results: Only 61.2% of respondents knew the correct hand hygiene technique; 50% of nurses knew the correct hand washing technique. Adherence to hand hygiene improved from 47% before the intervention to 55.7% after the intervention.
⁽ ⁷7 Erkan T, Findik UY, Tokuc B. Hand-washing behaviour and nurses’ knowledge after a training programme. Int J Nurs Pract [Internet]. 2011 [cited 2017 Feb 15]; 17(5):464-9. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1440-172X. 2011.01957.x/pdf http://onlinelibrary.wiley.com/doi/10.11... ⁾	Type of Study: Cross-sectional, interventional, prospective, analytical study. Objectives: To evaluate nurses' handwashing behavior and knowledge before and after a training program. Participants: 200 nurses from a university hospital in Turkey. Results: After the training program, nurses showed a significant increase in the frequency of handwashing (from 41.1% to48.6%; t=-2.202; p=0.029), the time spent in handwashing (from 64.5% to 72.5%; p=0.024; p<0.05), the knowledge (from 36.9% to 46.3%; t=-16.081; p<0.05), and the quality of the handwashing technique (from 15.38% to17.56%; t=-10,874; p<0.05).
⁽ ⁸8 Chavali S, Menon V, Shukla U. Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian J Crit Care Med [Internet]. 2014 [cited 2017 Feb 15]; 18(10):689-93. Available from: doi: 10.4103/0972-5229.142179 10.4103/0972-5229.142179... ⁾	Type of Study: Cross-sectional, observational study. Objectives: To assess nurses and allied healthcare workers' adherence to hand hygiene after a one-year training intervention. Participants: Nurses and allied healthcare workers. Results: Nurses' adherence to hand hygiene was 63%; adherence was 93% after patient contact and 63% before patient contact. Participants showed an overall adherence of 78%, and it was concluded that this behavior can be ensured by continuous training.
⁽ ⁹9 Teker B, Ogutlu A, Gozdas HT, Ruayercan S, Hacialioglu G, Karabay O. Factors affecting hand hygiene adherence at a private hospital in Turkey. Eurasian J Med [Internet]. 2015 [cited 2017 Feb 15]; 47(3):208-12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659524/pdf/eajm-47-3-208.pdf https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Type of Study: Cross-sectional and interventional prospective analytical study. Objectives: To investigate factors associated with adherence to hand hygiene. Participants: Health professionals from a private hospital in Turkey. Results: Adherence to hand hygiene was higher in trained doctors than in untrained doctors before patient contact and after environment contact [48% (35/73) versus 82% (92/113) p<0.05 and 23% (5/22) versus 76% (37/49); p<0.05 respectively].Trained allied health personnel showed greater adherence to hand hygiene than untrained ones before asepsis [20% (2/10) versus 73% (16/22); p<0.05]. Adherence to hand hygiene was higher in trained nurses than in untrained ones before patient contact [63% (50/79) versus 76% (37/49); p<0.05]. In addition, antiseptic solutions were used when hand washing was not possible.
⁽ ¹⁰10 Salama MF, Jamal WY, Mousa H Al, Al-AbdulGhani KA, Rotimi VO. The effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital. J Infect Public Health [Internet]. 2013 [cited 2017 Feb 15]; 6(1):27-34. Available from: http://www.jiph.org/article/S1876-0341(12)00130-X/pdf http://www.jiph.org/article/S1876-0341(1... ⁾	Type of Study: Interventional study. Objectives: To determine the adherence to hand hygiene and its effect on HAIs in an intensive care unit in Kuwait. Participants: Health professionals working at the intensive care unit of a hospital. Results: Adherence increased from 42.9% before the intervention to 61.4% after the intervention (p<0.001). Nurses' adherence increased from 43.2% to 82.5% (p<0.001), showing a greater adherence than doctors and other health professionals. There was a significant reduction in the number of HAIs, from 37.2% to 15.1%.

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[1] CORRESPONDING AUTHOR: João Manuel Garcia do Nascimento Graveto E-mail: jgraveto@esenfc.pt