Efforts to Increase Compliance With Hand Hygiene and Correct Timing of Putting on and Taking off Gloves

Abstract

  Healthcare-associated infections are mainly transmitted by the hands of healthcare workers, so hand hygiene is the most basic and important precaution to prevent infection. The efficacy of hand hygiene depends on both following the appropriate procedure and correct timing. In our hospital, the compliance rate with hand hygiene of our nursing staff has been rising every year as a result of hand hygiene surveillance by the direct observation method conducted since 2010. However, the outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in our ICU in 2012 resulted in identification of various issues with the timing of putting on and taking off gloves in addition to the timing of hand hygiene, so that we initiated new surveillance of the timing issue and the results were given to our nursing staff. Subsequently, the mean compliance rate of timing showed a nonsignificant increase from 90% to 96% (p=0.096), but the detection rate of MRSA significantly decreased from 4.56/1000 patient days to 1.8/1000 patient days (p=0.002). Incidents of MRSA outbreak also diminished. These findings suggest that repeated surveillance by direct observation method, provision of effective education including surveillance results and improvement plans in person and by poster presentation, and improvement of nursing procedures such as environmental arrangements and nursing workflow including cooperation between staff members are effective to increase and maintain the compliance of timing of hand hygiene and putting on and taking off gloves, with consequent reduced detection rate of MRSA.