U.S. scientists studied the influence of workload on hand hygiene compliance in intensive care. Above a certain workload limit, hygiene behavior deteriorates enormously.
Intensive care units around the world have been experiencing staff shortages and dangerous workload overloads that have only been exasperated by the COVID 19 pandemic. This can have a negative effect on patients, who may not receive optimal treatment. Increasing hand hygiene compliance is key to improving patient outcomes. Poor compliance is already a global issue. Now researchers have found that, as workloads increase, ICU staff use hand sanitizer dispensers less.
Hand hygiene compliance in intensive care units
The study was published in the September 2022 issue of the renowned journal Infection Control & Hospital Epidemiology. The research team conducted compliance observations as part of the scientific study and recorded a total of 42,349 indications for hand disinfection according to the “Five moments for hand hygiene” model recommended by the World Health Organization (WHO). 
Hand hygiene compliance in ICUs averaged about 40 percent, but only up to a certain point. Hand hygiene compliance decreased with higher workloads—measurable by an associated increase in the number of indications for hand disinfection. According to the research team, a value of 30 occasions per hour turned out to be the threshold. Above this level, compliance decreased by approximately one percent for each additional opportunity for hand hygiene.
The results of the American scientists shows that there are certain limits to hand hygiene compliance and that it is very difficult to achieve 100 percent implementation of the hygiene guidelines under certain working conditions.
Relieving staff and creating incentives for hand disinfection
One starting point is to improve staffing levels, which can help avoid possible peaks in workload and failures to disinfect hands. Positive effects on the disinfection behaviour of hospital staff can also be achieved through making adjustments to hygiene infrastructure.
This ranges from hand sanitizer dispensers in eye-catching, hi-vis colours to smart systems that provide nursing staff and doctors with visual feedback when the correct amount of sanitizer has been dispensed. In addition, the study authors emphasize in their conclusion that hand hygiene compliance must be improved, especially before critical indications such as the placement of a catheter.
Study: Chang N-CN, et al. (2022). The impact of workload on hand hygiene compliance: Is 100% compliance achievable?. Infection Control & Hospital Epidemiology, 43: 1259–1261, https://doi.org/10.1017/ice.2021.179
 World Health Organization. “WHO guidelines on hand hygiene in health care.” WHO guidelines on hand hygiene in health care. 2009. 270-270.