We need to be sure that pre-pandemic standards of hand hygiene compliance are sustained or improved , and that hand hygiene does not become perceived as less of a priority in busy hospitals where healthcare workers may feel that their personal safety has been improved by immunization .” the healthcare worker ’ s hands compared with a contamination-elimination task and a relatively higher risk of contaminating healthcare worker ’ s hands compared with a sterile task . Similarly , a device-blood task would have a relatively higher risk of transmitting pathogens to the patient compared with a task involving contact only with patient ’ s intact skin but a relatively lower risk of transmitting pathogens to the patient compared with a sterile task .”
Using the STAR * ICU hand hygiene data , the researchers generated 13,523 patient-care sequences and 42,349 transitions . When the researchers sorted transitions by the risk to patients if healthcare workers did not perform hand hygiene , hand hygiene compliance rate was 50.8 percent when healthcare workers transitioned from dirtier to cleaner tasks and 42.7 percent when they transitioned in the opposite direction . However , when the researchers performed multivariable analysis to statistically adjust for position in the patient-care sequence , hand hygiene at the prior opportunity , healthcare worker type , glove use , and isolation precautions , the researchers found that healthcare workers were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks compared with transitioning from cleaner to dirtier tasks .
Chang and Jones , et al . ( 2021 ) emphasize that the order in which healthcare workers perform patient care tasks could affect the risk to patients if they do not perform hand hygiene at appropriate points : “ The Institute for Healthcare Improvement recommended monitoring compliance with hand hygiene at each opportunity during an episode of care . However , several studies by Eveillard , et al . are the only previously published studies that evaluated hand hygiene during sequences of care . They found that healthcare workers were significantly more likely to perform hand hygiene for extra-series opportunities ( i . e ., before or after single contacts or before the first contact or after the last contact in a series of successive contacts ) than they were for the opportunities during a series of contacts . Compliance in intensive care units ( ICUs ) was about 30 percent for each intra-series opportunity , but on non-ICU wards , it increased from 13.8 percent between the first and second contact to 35.7 percent after the fourth contact . Moreover , very few healthcare workers performed hand hygiene at all opportunities .”
As the researchers note , “ Healthcare workers were less likely to perform hand hygiene when they transitioned in a manner posing more risk to patients compared with when they transitioned in a manner posing less risk to patients . This finding is particularly disconcerting because such behavior could increase the likelihood that healthcare workers will transmit pathogens from dirty body sites to clean body sites , to invasive devices , to surfaces in the patient care area , or to other patients .” The researchers add , “ Healthcare workers may have good reasons for performing dirtier tasks before cleaner tasks . For example , healthcare workers may intentionally ‘ batch ’ dirtier tasks together and cleaner tasks together to be more efficient . They may choose to perform the dirtier tasks first to ‘ get them out of the way ’ before they perform their other tasks . In addition , healthcare workers who enter a patient ’ s room intending to perform clean or sterile tasks may deviate from their care plans if they discover the patient was incontinent of stool . The study by Harbarth , et al . suggests that such deviations might decrease the likelihood that the healthcare workers would perform hand hygiene during the transition from cleaning up the stool ( a contaminating task ) to the planned clean or sterile task . Moreover , healthcare workers may not recognize that transitioning from cleaner tasks to dirtier tasks may both decrease the risk of contaminating vulnerable patient sites , such as invasive devices and surgical wounds and decrease their workload by reducing the number of hand hygiene opportunities .”
Hand Hygiene and COVID
Prescott , et al . ( 2021 ) consider whether one legacy of the COVID-19 pandemic might be a beneficial effect on hand hygiene compliance by healthcare workers . They observe , “ Hand hygiene has never been more important than in 2021 . Not only is hand hygiene crucial in protecting healthcare workers and patients from the ongoing risk of transmission of COVID-19 , but as nations begin to emerge from the pandemic and tackle the growing backlog of elective treatments , hospitals will become busier than ever . We need to be sure that pre-pandemic standards of hand hygiene compliance are sustained or improved , and that hand hygiene does not become perceived as less of a priority in busy hospitals where healthcare workers may feel that their personal safety has been improved by immunization .”
They add , “ While provision of hand hygiene at the point of care is vital , especially in the context of providing protection from COVID-19 , it is clear that we cannot assume that the pandemic will change the attitudes of most healthcare workers to hand hygiene . As such , monitoring of hand hygiene compliance will remain important with direct observation ( DO ) currently the most prevalent method used . However , this strategy is made more difficult by the need to ensure social distancing for control of COVID-19 . DO of hand hygiene at the point of care is also more difficult than observing compliance at centralized hand hygiene facilities … Unfortunately , the limited data available so far suggest that the experience of healthcare workers during the COVID-19 pandemic will not revolutionize their attitudes toward hand hygiene . Robust and longer-term clinical- and cost-effectiveness studies are required to allow a full assessment of the impact of interventions that improve hand hygiene , and to show that any benefits are sustainable . Most hand hygiene studies to date have used only rates of hand hygiene compliance as the primary outcome measure . This will not be enough to justify investment in improving hand hygiene during the challenging times that lie ahead .”
Huang , et al . ( 2021 ) sought to understand how the COVID-19 pandemic affected healthcare workers in their clinical practice , seeing as how they were challenged with new guidelines and practices to protect themselves from occupational risks . The study used an automated hand hygiene recording system to measure healthcare worker hand hygiene on entry to and exit from patient rooms throughout the COVID-19 pandemic . The correlation between hand hygiene compliance and COVID-19 epidemiological data was analyzed .
The researchers found that healthcare worker hand hygiene