Hand hygiene in intensive care units: Do we have problems?

Research results show problems in the implementation of guiding principles of hand disinfection.

Nosocomial infections are a great challenge to health care systems worldwide. They occur comparatively frequently on intensive care units. In Germany almost every 7th patient is affected and suffers additional complications making treatment more difficult. Careful hand disinfection is the most effective measure to avoid the transmission of hospital infections.

Workload is a huge hurdle for compliance

The knowledge about the importance of hand hygiene is offset by shortcomings in the implementation of hand hygiene in a hectic clinical day. There are diverse reasons for these shortcomings and they range from inadequate availability of disinfectants to a lack of time of hospital care staff.

Researchers at the medical high school in Hannover investigated just how long proper hand hygiene needs to fulfil guidelines on an intensive care unit.

In a scientific research programme researchers observed hygiene behaviour on both an internal medicine ward and a surgical intensive care ward.  Based on the WHO-Model of   „Five moments of hand hygiene“ the number of moments where hand disinfection is required was compared to the number of actual hand disinfections. Furthermore the experts also examined how long each hand disinfection lasted and how far away these hand disinfections were from the stipulated 30 second requirement.

Intensive Care Unit: Adequate hand disinfection behaviour is practically impossible

In a total observation period of more than 144 hours the researchers registered a total of 1896 hand hygiene indications and projected these values to individual patient days. On the internal medicine ward a figure of 218 required hand disinfections per patient per day was determined and on the surgical intensive care ward a figure of 271 was recorded. Assuming an average patient ratio of 2.5 patients per staff member on an intensive care ward and recognising the required 30 seconds per hand disinfection, each healthcare worker would spend over 70 minutes per shift disinfecting their hands – a questionable situation.

It is not surprising that in practice things look very different and deviations from any theory exist:  the scientists have shown that hospital care staff working on the intensive care unit spend only 10 minutes disinfecting their hands.  One of the reasons for this is that each hand hygiene event lasted only 7.6 seconds and only 42.6 per cent of all required hand disinfections were actually carried out.

The results clearly show that adequate hand disinfection on an intensive care ward takes time – time that is not available and that first and foremost endangers patient safety. A correction of the allocation of personnel could improve the situation sustainably. Further measures to ensure correct hand hygiene should be considered as an integral part of any intervention strategy.

Source: Stahmeyer JT, Lutze B, von Lengerke T et al (2017) Hand hygiene in intensive care units: a matter of time? J Hosp Infect 95:338–343