Adherence to hand hygiene technique: an observational study

This is an observational study, with 41 professionals from the Adult Intensive Care Unit of a Brazilian teaching hospital. Data collection took place from September to December 2021, using a sociodemographic questionnaire and observation form from the World Health Organization. Statistical tests of binomial analysis and mixed-effects logistic regression model were applied, and a significance level of 0.05 was adopted.

Results

A total of 1,055 hand hygiene opportunities were observed; the adherence rate was 23.98%; and it can be seen that professionals did not perform the recommended technique. The binomial test verified greater adherence to moments “after” when compared to moments “before” (p< 0.001) and a negative impact of using gloves was found (p< 0.001). The logistical model reinforced greater adherence in moments “after”. Even though adherence is low among all professional categories, the logistical model demonstrated more chances of hand hygiene by nurses.

Conclusion

Adherence to hand hygiene was considerably low, especially considering the appropriate technique. A negative impact of using gloves on hand hygiene adherence was verified. Professionals demonstrated greater chances of adhering to hand hygiene in the moments “after” when compared to moments “before”.

Hand hygiene; Health personnel; Infection control; Patient safety; Intensive Care Units

Variables	Opportunities	Actions	Adhesion (%)	CI %	Appropriate technique actions	Appropriate technique adhesion (%)	CI %
Professional category
Nurses	117	47	40.17	(31.16; 49.19)	5	4.27	(0.55; 7.99)
Nursing technician	830	175	21.08	(18.30; 23.87)	12	1.45	(0.63; 2.26)
Physical therapists	54	13	24.07	(12.30; 35.85)	2	3.70	(0.00; 8.91)
Physicians	54	18	33.33	(20.35; 46.32)	0	0.00	(0.00; 0.00)
Sex
Female	738	177	23.98	(20.90; 27.07)	11	1.49	(0.61; 2.37)
Male	317	76	23.97	(19.25; 28.70)	8	2.52	(0.79; 4.26)
Recommendation of moments for hand hygiene
Before touching a patient	224	20	8.93	(5.17; 12.69)	1	0.45	(0.00; 1.33)
Before clean/aseptic procedures	173	8	4.62	(1.46; 7.79)	0	0.00	(0.00; 0.00)
After body fluid exposure/risk	201	31	15.42	(10.39; 20.46)	2	1.00	(0.00; 2.38)
After touching a patient	181	60	33.15	(26.23; 40.07)	3	1.66	(0.00; 3.54)
After touching patient surroundings	83	33	39.76	(29.01; 50.51)	2	2.41	(0.00; 5.78)
Before putting PPE	95	20	21.05	(12.70; 29.40)	1	1.05	(0.00; 16.30)
Before removing PPE	98	81	82.65	(75.02; 90.28)	10	10.20	(4.10; 16.30)
Total	1055	253	23.98	(21.40; 26.56)	19	1.80	(1.00; 2.60)

Variables	Opportunities	Actions not performed	Frequency of using gloves	Proportions (%) CI
Recommendation of moments for hand hygiene	224	204	133	65.20 (58.66; 71.73)
Before touching a patient	173	165	143	86.67 (81.48; 91.85)
Before clean/aseptic procedures	201	170	103	60.59 (53.24; 67.93)
After body fluid exposure/risk	181	121	42	34.71 (26.23; 43;19)
After touching a patient	83	50	6	12.00 (4. 97; 25.00)
After touching patient surroundings	862	710	427	60.14 (56. 42; 63. 75)

Variables	95% Confidence Interval
Variables	Odds Ratio	Lower limit	Upper limit	p-value
Intercept	0.34	0.23	0.50	< .001
Sex
Male – Female	1.23	0.75	2.24	0.361
Observation period
Evening – Morning	1.11	0.61	2.03	0.723
Night – Morning	1.46	0.86	2.49	0.162
Professional category
Nursing technician - Nurse	0.41	0.21	0.81	0.010
Physician – Nurse	0.53	0.18	1.55	0.248
Physical therapist – Nurse	0.22	0.07	0.74	0.014
Recommendation of HH moments
2 – 1	0.50	0.21	1.19	0.119
3 – 1	2.08	1.12	3.88	0.021
4 – 1	5.34	3.01	9.48	< .001
5 – 1	7.18	3.70	13.94	< .001
6 – 1	2.92	1.45	5.87	0.003
7 – 1	68.44	32.29	145.06	< .001

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author : Marília Duarte Valim E-mail: marilia.duarte.valim@gmail.com