ABSTRACT

Introduction

This study aimed to assess the compliance of different occupational groups with hand hygiene practices in a tertiary-care educational hemato-oncology hospital.

Methods

A prospective observational study was conducted to assess hand hygiene (HH) compliance among doctors, nurses, and auxiliary staff before and after multiple interventions, including in-house education, informing the staff instantly in case of HH incompliance and distribution of warning and appreciation emails. Unblinded HH observations were performed by infection control nurses, following the World Health Organization's 5 indications, between November 2022 and July 2024. Statistical analysis was performed by Chi-square test and p value <0.05 was considered to be significant.

Results

A total of 6990 HH opportunity observations were made during the 21-month period which resulted in a 71.8% (5020/6990) compliance. On annual basis, the highest compliance was in nurses (76.6%) while the lowest compliance was among doctors at 63.4% (p<0.001). On a monthly basis, the lowest HH compliance was in May 2023 (36%) while the highest was in April 2024 (92.1%). After the first cycle of emails that were sent in May, the compliance steadily increased from 36% to 74%. Statistical analysis demonstrated a significant improvement in hand hygiene compliance between May 2023 and June 2023 (p=0.013). Further analysis comparing compliance rates across May through October 2023 revealed statistically significant differences (p<0.001). Besides, the HH compliance improved consistently between November 2022-April 2023 [606/1102-55%] vs May 2023-October 2023 [1405/2376-59.1%] vs. November 2023-April 2024 [1866/2242-83.2%] vs. May 2024-July 2024 [1143/1270=90%] (p<0.001). After December 2023, the HH compliance remained consistently over 80%.

Conclusions

Following an 18-month implementation period, our hand hygiene compliance rates exceeded 80%. The implementation of personalized feedback mechanisms and other interventions demonstrated a substantial positive impact on hand hygiene adherence levels. It was also justified with fair and transparent observations among the staff on duty. Additional supportive studies are needed to increase HH further.