Lack of correlation between consumption of alcohol-based solutions and adherence to guidelines for hand hygiene
Faculty of Medicine and Health Sciences
New York, N.Y.
The journal of hospital infection. - New York, N.Y.
, p. 163-164
Hand hygiene is recognized as being the best way of preventing cross-transmission of micro-organisms and reducing the incidence of healthcare-worker-associated infections.1 and 2 The hand-hygiene procedures recommended in France are either handwashing, or rubbing with alcohol-based gels, or solutions (ABS).3 and 4 Rub-in hand disinfection appears to be the best technique; it has several benefits, including better compliance, and is more acceptable to staff. Furthermore, it has been proven to decrease infection rates significantly as a result of improved compliance.5 and 6 At a conference devoted to the prevention of nosocomial infections, the French Minister of Health proposed that French hospitals should record their consumption of ABS in the immediate future to make it possible to evaluate hand-hygiene practices in healthcare settings (Infections nosocomiales: quelle surveillance pour une meilleure prevention? http://www.sante.gouv.fr/). It is conceivable that this indicator will then be used to classify hospitals, wards and units. In our hospital, the introduction of this hand-disinfection technique was accompanied by in-service education and the distribution of information leaflets. In the first year after the introductory phase, the mean consumption of ABS in our hospital was 11 L/1000 patient-days, but this varied from 2 to 76 L/1000 patient-days depending on the unit. The purpose of this report is to evaluate whether these differences reflect appropriate hand-hygiene practices within each unit. During the same period, adherence to hand-hygiene recommendations was directly observed during routine patient care by an external investigator in 24 care units. The main judgement criterion in this observational study was the rate of compliance, defined as the number of times that hands were disinfected compared with the number of situations where it was necessary. The secondary judgement criterion was the proportion of correct procedures. A procedure was classified as correct if performed properly (according to prerequisite conditions and hand application conditions), irrespective of its appropriateness to the clinical situation. The overall compliance rate for the 24 hospital units (348 observations) was 64%, and varied from 24 to 100% according to the unit. The proportion of correct procedures (out of 222 disinfection procedures) was 5%, varying from 0 to 40%. By testing the association between consumption of ABS and adherence within units, we observed that compliance and the proportion of correct procedures were not correlated with the consumption of ABS. Indeed, the correlation coefficients, determined using the Spearman Rank Correlation Coefficient, were 0.14 (P=0.52) and 0.13 (P=0.54), respectively. Although the hand-hygiene procedure is simple, its application by healthcare workers is a complex phenomenon that is not easily explained. This report cannot explain the lack of correlation between the consumption of ABS and adherence to guidelines for hand hygiene. However, it suggests that the consumption of ABS (expressed in L/1000 patient-days) is not a good reflection of hand-hygiene practices in our hospital. The classification of units according to this simplistic indicator could lead to incorrect conclusions. Further studies are needed to explore whether this observation is valuable when comparing different hospitals. Measures to improve hand-hygiene adherence, such as performance feedback on hand-hygiene compliance, in-service education and distribution of information, should be implemented before producing the indicator consumption of ABS.7 Compared with adherence to guidelines, the consumption of ABS is of little significance for the infection control department.