DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20214703

Hand hygiene compliance of health care workers in a neonatal intensive care unit: a prospective observation study

Gamze Alci, Hulya Bilgen, Eren Ozek, Aysegul Karahasan Yagci

Abstract


Background: We aimed to determine hand hygiene (HH) compliance of the healthcare workers (HCW’s) and evaluate if there is an epidemiological relation between the microorganisms isolated from the hands of HCWs and patients clinical materials in the neonatal intensive care unit (NICU).

Methods: HH compliance was observed in two unannounced phases in March and in August within the scope of 5 indications determined by WHO. Between two phases personnel was trained to improve HH by educational sessions and introduction of Semmelweis system hand in scan (HIS, Sysmex) in the unit.  A total of 22 nurses, 11 physicians and 5 staff was working in the NICU. Hand samples taken from HCW by glove juice method were inoculated quantitatively in culture plates and colonies were identified by MALDI-TOF MS. Epidemiological relation between clinical isolates and hand samples was investigated with arbitrary primed PCR.

Results: Although overall compliance remained only 50%, a significant increase in compliance was detected in August prior to aseptic procedures and after contact with patients and body fluids. Alcohol scrub was preferred as 60.4% in March and 75.2% in August. HH efficacy reached to 72% by implementing HIS. During this period, 10.7% of 607 patient’s samples revealed clinically significant growth. Potential pathogens were isolated in 5.2% of 144 hand samples, but any epidemiological correlation with patient isolates was detected.

Conclusions: HH compliance observations should be done at regular intervals and current technology could be utilized in trainings to overcome hospital related infections.


Keywords


AP-PCR, Gloves juice method, Hand hygiene, Neonatal intensive care unit

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References


Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/ Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51:1-45.

Pittet D, Allegranzi B, Sax H, Dharan S, Pessoa-Silva CL, Donaldson L, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis. 2006;6:641-52.

Lucet JC, Rigaud MP, Mentre F, Kassis N, Deblangy C, Andremont A, et al. Hand contamination before and after different hand hygiene techniques: a randomized clinical trial. J Hosp Infect. 2002;50:276-80.

Rangelova V, Raycheva R, Kevorkyan A, Krasteva M, Dermendzhiev T. Surveillance of nosocomoial infections in a Bulgarian neonatal intensive care unit. Folia Med. 2020;62(4):753-41.

Zingg W, Posfay-Barbe KM, Pitted D. Healthcare-associated infections in neonates. Curr Opin Infect Dis. 2008;23(3):228-34.

Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet. 2005;365(9465):1175-88.

Bolat F, Uslu S, Bolat G, Comert S, Can E, Bulbul A, et al. Healthcare-associated infections in a neonatal intensive care unit in Turkey. Indian Pediatr. 2012;49(12):951-7.

Nuran U, Sibel Ö, Özgül B, Sertac A, Fahri O. Evaluation of 3 year surveillance of device associated infections in a neonatal intensive care unit. J Contemp Med. 2020;10(3):319-23.

Lizeth O, Marcela PH, Ivoline FC, Jorge A. Colonization and infection in the newborn infant: does chlorhexidine play a rola in infection prevention? Arch Argent Pediatr. 2017;115(1):65-70.

Meltem K, Gulsum K, Taner H, Oguz K. Effect of camera monitoring and feedback along with training on hospital infection rate in a neonatal intensive care unit. Ann Clin Microbiol Antimicrob. 2019;18:35.

Karaaslan A, Kepenekli Kadayifci E, Atıcı S. Compliance of healthcare workers with hand hygiene practices in neonatal and pediatric intensive care units: overt observation. Interdiscip Perspect Infect Dis. 2014;306-478.

ASTM International Standard Test Method For Evaluation of Surgical Hand Scrub Formulations (E1115-11). West Conshohocken, PA: ASTM International; 2017.

Hoşbul T, Özyurt M, Karademir F, Süleymanoğlu S, Haznedaroğlu T. Investigation of a nosocomial outbreak caused By ESBL positive Klebsiella pneumoniae in neonatal intensive care unit by AP-PCR. Mikrobiyol Bül. 2012;46:101-5.

Szilágyi L, Haidegger T, Lehotsky A, Nagy M, Csonka EA, Sun X, et al. A large-scale assessment of hand hygiene quality and the effectiveness of the "WHO 6-steps". BMC Infect Dis. 2013;13:249.

Pittet D, Allegranzi B, Boyce J. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol. 2009;30:611-22.

Huang GK, Stewardson AJ, Grayson ML. Back to basics: hand hygiene and isolation. Curr Opin Infect Dis. 2014;27(4):379.

Wendt C, Knantz D, Von Baum H. Differences in hand hygiene behavior related to the contamination risk of healthcare activities in different groups of healthcare workers. Infect Control Hosp Epidemiol. 2004;25:203-6.

García-Vázquez E1, Murcia-Payá J, Allegue JM, Canteras M, Gómez J. Influence of a multiple intervention program for hand hygiene compliance in an ICU. Med Intensiva. 2012;36:69-76.

Verbeek JH, Rajamaki B, Ijaz S, Tikka C, Ruotsalainen JH, Edmond MB, et al. Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff. Cochrane Database Syst Rev. 2019;7:CD011621.

Lehotsky Á, Szilágyi L, Demeter-Iclănzan A, Haidegger T, Wéber G. Education of hand rubbing technique to prospective medical staff, employing UV-based digital imaging technology. Acta Microbiol Immunol Hung. 2016;63(2):217-28.

Kramer A, Pittet D, Klasinc R, Krebs S, Koburger T, Fusch C, Assadian O. Shortening the application time of alcohol-based hand rubs to 15 seconds may improve the frequency of hand antisepsis actions in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2017;38(12):1430-4.

Visalachy S, Palraj KK, Kopula SS, Sekar U. Carriage of multidrug resistant bacteria on frequently contacted surfaces and hands of health care workers. J Clin Diagn Res. 2016;10(5):18-20.

Waters V, Larson E, Wu F, San Gabriel P, Haas J, Cimiotti J, et al. Molecular epidemiology of gram-negative bacilli from infected neonates and health care workers' hands in nenatal intensive care units. Clin Infect Dis. 2004;38(12):1682-7.

Ferng YH, Clock SA, Wong-Mcloughlin J, DeLaMora PA, Perlman JM, Gray KS, et al. Multicenter study of hand carriage of potential pathogens by neonatal ICU Healthcare Personnel. J Ped Infect Dis Soc. 2015;4(3):276-9.

Jamal O, O’Grady G, Harnett E, Dalton D, Andresen D. Improving hand hygine in a paediatric hospital: a multimodal quality improvement approach. BMJ Qual Saf. 2012;21:171-6.

Hussein R, Khakoo R, Hobbs G. Hand hygiene practices in adult versus pediatric intensive care units at a university hospital before and after intervention. Scand J Infect Dis. 2007;39(6-7):566-70.