Hand Hygiene in Nursing homes
Hand hygiene is important to prevent infections in long-term care facilities.

Hand hygiene in nursing homes with clear deficits

A large-scale study shows that just one in six necessary hand disinfection is carried out in long-term care facilities and nursing homes.

In Germany alone, more than four million people are considered to be in need of long-term care, of whom about 25 percent receive full inpatient care. [1] The patients, who are often immunocompromised, are confronted with a large number of potential germs due to the close contact with nursing staff and residents. In this respect, hygienic hand disinfection takes on a special role in nursing homes and homes for the elderly. The World Health Organization (WHO) even classifies hand disinfection as the most important single measure for preventing infections. [2]

However, what is the actual state of hand hygiene in care facilities? A Dutch research team led by Anja Haenen and Prof. Andreas Voss from Radbound University in Nijmegen has investigated this question.

Hand hygiene in nursing homes: Sanitizer dispensers are used far too infrequently

The experts from hygiene and infection prevention examined hand hygiene compliance on 23 wards in 14 care facilities over a period of several months. Of the total of 1691 observed indications for hygienic hand disinfection, on average only 17 percent were actually performed by the facilities’ staff. This is a shockingly low figure, which is even lower than that of hospitals. In hospitals hand hygiene compliance ranges between 30-40 percent – depending on the occupational group and hospital ward. [3]

Hand hygiene in nursing homes.

The Dutch study on nursing facilities also shows situational differences in hand hygiene behaviour. In percentage terms, staff disinfect their hands more frequently after direct contact with a nursing home resident (25%) than, for example, before an aseptic activity (9%).

Multiple reasons for low hand hygiene compliance

In addition to recording hand hygiene compliance, the Dutch study also investigated the reasons for hand hygiene behaviour. For this purpose, the researchers distributed questionnaires to the staff of nursing homes and homes for the elderly. The most frequently cited reason for not following hand hygiene rules, at 37 percent, was skin irritation that staff develop as a result of frequent disinfection. More than one-third of respondents admit that sometimes they simply forget to perform a required hand disinfection. In this context, reminders or highly visible hand sanitizer dispensers – for example in an eye-catching colour – can provide support to integrate the topic of hygiene even more strongly into everyday nursing care.

Hand hygiene in nursing homes
The ingo-man SmartNose for automated feedback.

In their conclusion, the authors led by Professor Andreas Voss recommend that “activities to improve hand hygiene be included in daily practice and service meetings” in order to optimize infection protection in care facilities. At this point, for example, automated feedback systems on hand hygiene can make a valuable contribution.

Study: Haenen, Anja, et al. “Hand hygiene compliance and its drivers in long-term care facilities; observations and a survey.” Antimicrobial Resistance & Infection Control 11.1 (2022): 1-10.

Further sources:

[1] Statistisches Bundesamt (Destatis), 2022

[2] World Health Organization. “WHO guidelines on hand hygiene in health care.” WHO guidelines on hand hygiene in health care. 2009. 270-270.

[3] Erasmus, Vicki, et al. “Systematic review of studies on compliance with hand hygiene guidelines in hospital care.” Infection Control & Hospital Epidemiology 31.3 (2010): 283-294.


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