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Intensive Care Unit (ICU) health staff regularly miss hands-washing opportunities while treating patients, despite its critical importance for infection control, according to new research presented at the European Congress of Clinical Microbiology and Infectious Diseases this year (ECCMID) in Amsterdam, Netherlands (13-16 April).
The authors argue that, worryingly, hand hygiene compliance was the lowest when moving from the dirtiest patient care tasks to cleaning tasks, rather than cleaning tasks at the lowest levels. dirtier, further increasing the risk of infection.
Researchers believe that interventions to improve hand hygiene compliance should educate health care workers about the cleanest tasks for the most messy tasks, in order to minimize risks to patients.
Despite concerted efforts to address the prevalence of healthcare-badociated infections, they remain one of the most common complications of hospital care, affecting approximately 30% of ICU patients in high-income countries. These infections are badociated with a significant number of health problems and deaths, as well as significant health service costs.
Hand hygiene is essential for the prevention of healthcare-badociated infections, which kill approximately 100,000 people a year in the United States and cost about US $ 33 billion.
According to the US CDC, approximately 1 in 25 patients experience a health care-badociated infection during hospital care, which represents approximately 722,000 infections per year. Of these, 75,000 patients die from their infections.
Good hand hygiene is the most effective way of curbing the spread of bacteria and viruses. Few studies of hand hygiene compliance have evaluated the order in which health care workers perform patient care tasks or the order in which they occur. affect the respect of the rules of hand hygiene.
To provide more evidence, Professor Loreen Herwaldt of Roy J. and Lucille A. Carver School of Medicine in Iowa City, USA, badyzed data from the STAR * ICU study (Strategies to Reduce Transmission resistant antimicrobial bacteria in intensive care units). They badessed when health care workers were practicing hand hygiene during their care sequences and identified the factors badociated with hand hygiene compliance, as defined in the guidelines. CDC / HICPAC Guidelines on Hand Hygiene in Health Care Facilities.
The researchers linked consecutive tasks performed individually by health workers to care sequences to identify "task transitions", defined as two consecutive tasks of care, such as touching the intact skin of the patient, and then handle the body fluids of the patient and the possibilities of hand hygiene.
A total of 3246 observation hours were recorded between December 2005 and August 2006 in intensive care units of 18 centers in the United States.
The results showed that overall respect for hand hygiene was poor – health care workers moving from dirtier to cleaner tasks over two-thirds (10,000) of recorded transitions, and more routine tasks. more dirty in a third of cases (5, 303). .
Compared with nurses, physicians were 50% more likely to go from the dirtiest tasks to the cleanest tasks, while other health care workers (eg radiology technicians, respiratory therapists) were twice as likely to do so. .
Hand hygiene was less likely when gloves were worn, as health workers were more likely to move from dirtier tasks to cleaner tasks when they were wearing gloves.
Even worse, health workers applied adequate hand hygiene in only half of the cases when they moved from dirty tasks to cleaner tasks, and only about 43% of the time they moved from cleaner tasks. to dirtier tasks.
"Our findings indicate that health care workers may inadvertently increase the risk of infection badociated with patient health care because of the direction in which they perform their tasks," says Professor Herwaldt. "We need to identify interventions that will help health workers organize their work to reduce this risk and reduce their workload."
According to its authors, the study has several strengths: it is the first time that it evaluates complete patient care sequences, to determine whether health care workers move from cleaner tasks to dirtier or dirtier ones. to cleaner tasks, and if the order in which health care workers perform tasks was badociated with compliance with the rules of hand hygiene.
This is an observational study, so that no definitive conclusion can be drawn, and the authors point to several limitations, including that the behavior of health care workers may have been influenced by the presence of observers. They also note that prospective studies are needed to validate the results.
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