In their investigation of hand hygiene compliance among 150 healthcare workers before the COVID-19 pandemic and 136 personnel during , Sandbøl , et al . ( 2022 ) found that handwashing was significantly higher before the pandemic than during the pandemic in several departments throughout the healthcare institution ; they also found that in a single department , the total hand hygiene compliance rate was unchanged during the pandemic compared to before .” hand hygiene performance rates ( a proxy or estimate of compliance ) were calculated by dividing events by opportunities .
Performance rates were consistent from weeks 1-8 and then began to increase in weeks 9-10 , suggesting that performance rates were beginning to increase before the event of interest ( school closures ). There was a significant upward shift in the level of performance rates between pre- and post-test data , and then in weeks 11-20 , a significant decrease in performance rates over time . Performance rates remained higher than 60 percent during the first four weeks of the postschool closure period before declining significantly . By week 20 , performance rates were still higher than the rates during weeks 1-8 of the study but were lower than the peak performance rate which occurred two weeks after the week of school closures .
During their 20-week study period , the researchers captured more than 35 million hand hygiene opportunities and found that hand hygiene performance rates seen in weeks 1-8 represent typical performance in 2020 . Performance reached higher than typical levels during the initial period of pandemic-related hospital and public health prevention measures ( including school closures ), however , began to decline . Even during pandemic conditions , the researchers report it “ appears to be difficult to sustain improvements in hand hygiene performance .”
They say that possible factors for the spike in performance include increased emphasis on the importance of hand hygiene ; significant decrease in opportunities ( workload ) making higher performance more achievable ; decrease in the room entries and exits from visitors and patients ( non-healthcare workers ); and heightened perception of risk to healthcare workers themselves and their families .
The researchers point to the importance of the perception of risk found in their study , explaining that , “ COVID-19 has received significant media attention which can amplify perceptions of personal risk . Healthcare workers may have improved their hand hygiene behaviors , in part , to protect themselves and their family members . Previous studies have reported self-protection as a major driver of hand hygiene among healthcare workers .”
Also not surprising to the researchers is the finding of decreased hand hygiene opportunities ( patient room entries and exits ), which they attribute to visitor restrictions and decreased patient census ( a result of postponement of elective surgeries and procedures ). They note that bundling of nursing activities to decrease unnecessary patient room entries and exits and conservation of hand hygiene products and personal protective equipment likely also played a role .
Moore , et al . ( 2021 ) suggest that the decrease in performance rates ( weeks 14-20 as compared to weeks 11-13 ) can be attributed to an increase in workload as opportunities for hand hygiene increased , concerns over limited supplies of hand hygiene products , use of gloves in lieu of hand hygiene , and less frequent direct observation / reminders from nurse managers and infection prevention leaders due to competing pandemic-related priorities . They observe , “ Further study can include analysis of data over an extended time to determine if increased hand hygiene will become the new normal or resemble a campaign that drives an increase but is not sustained due to lack of a multi-modal , long-term program . Comparison of hand hygiene performance rates between hospitals with comparison of the various unit types and COVID-patient census may also provide insight into the impact of this pandemic on hand hygiene in hospitals . Consideration can also be given to examining the impact of visitor restrictions and reintroduction of visitors on opportunities and performance rates by hospital .”
Surgical departments experienced the same fluctuation in hand hygiene compliance during the pandemic , as found by Stangerup , et al . ( 2021 ) who investigated the hand hygiene practices of physicians and nurses . The researchers found that hand hygiene compliance was significantly lower in the pre-pandemic follow-up period ( 46 percent versus 58 percent ) and in the follow-up period during COVID-19 ( 34 percent versus 58 percent ) compared with the intervention period . The researchers say that despite the pandemic , healthcare personnel ’ s handwashing decreased over time once data-presentation meetings from institution management stopped . They point out that healthcare workers “ fall back into old hand hygiene routines once improvement initiatives are stopped .”
In their investigation of hand hygiene compliance among 150 healthcare workers before the COVID-19 pandemic and 136 personnel during , Sandbøl , et al . ( 2022 ) found that handwashing was significantly higher before the pandemic than during the pandemic in several departments throughout the healthcare institution ; they also found that in a single department , the total hand hygiene compliance rate was unchanged during the pandemic compared to before . Interestingly , the researchers found that the pandemic did not raise hand hygiene compliance .
Each department ’ s patient beds remained the same throughout the study periods . Likewise , admission numbers , average durations of stay and number of employees and participation in the study were similar in the period leading up to and during COVID-19 . The total participation rate was 76.5 percent in the before COVID-19 study period and 77.3 percent in the COVID-19 study period . Data on hand hygiene compliance were based on a total of 23,507 compliant hand hygiene opportunities and 84,485 patient contact opportunities and varied by department , study period and profession . The researchers found that hand hygiene compliance levels differed with overall compliance being higher in favor of the period initiated