P125: Promoting hand hygiene in intensive care: a permanent challenge

Introduction

Healthcare workers (HCWs) compliance with hand hygiene (HH) remains a permanent challenge in ICUs and requires repeated adaptation of practices.

Objectives

To monitor compliance with HH and appropriate use of gloves to help improving daily infection control practices.

Methods

We monitored HH according to the WHO “My Five Moments for Hand Hygiene” concept and reviewed the appropriate use of gloves in a 36-bed mixed adult ICU admitting 2500 patients per year for an average length of stay of 3 days. The attack rate of methicillin-resistant Staphylococcus aureus(MRSA) cross-transmission was monitored based on active surveillance screening. In 2012, 9 % of admitted patients in the ICU carried MRSA. The intervention to improve HH practices included: simplifying the WHO “patient zone” concept in harmony with all wards at HUG; benchmarking of HH compliance with hospital-wide rates; promoting adherence with HH, with emphasis on improving adherence with the indication "before aseptic care"; stopping the routine use of gloves for "contact isolation" (except for C. difficile). Strategy implementation also included: additional installation and improved localization of alcohol-based handrub dispensers; teaching of glove use for paramedical staff; simulator training; and targeted training of new staff and clinical leaders.

Results

A total of 1680 opportunities for HH were observed in 2011/2012. Overall compliance with HH improved from 51% in 2011 to 60% in 2012, and compliance with the WHO “before aseptic task" indication improved from 39% to 49%, respectively. Improvement was significant for all major HCW categories: nurses (from 59% to 65%), doctors (from 45% to 59%) and nursing assistants (from 41% to 66%). The MRSA attack rate decreased in parallel from 4.9 ICU-acquired cases/1000 patient-days in 2011 to 2.4 in 2012.

Conclusion

The significant decrease of MRSA transmission associated with improved adherence to HH is encouraging. The 2013 target is to achieve an overall compliance with HH of 70% in ICU. Efforts will focus on a multimodal innovative approach.

Disclosure of interest

None declared