before the COVID-19 pandemic , indicating that the COVID-19 pandemic did not have a beneficial effect on healthcare personnel hand hygiene as they had expected .
Other studies published in the context of the COVID-19 pandemic and focusing on healthcare personnel adherence to hand hygiene have presented contradictory results . For example , Israel , et al . showed that average hand hygiene compliance rates before the COVID-19 pandemic ranged from 35 percent to 71 percent and increased to 46 percent to 89 percent during the pandemic . Roshan , et al . reported that hand hygiene compliance rates from November 2019 to February 2020 ranged from 41 percent to 62 percent which increased in the period from March 2020 to April 2020 to 97 percent . Both studies used direct observations based on the WHO ’ s five moments of hand hygiene guidelines and the findings may have been impacted by the Hawthorne Effect .
As we have seen , the pandemic required healthcare personnel to apply infection control interventions in new ways , asking them to tap into existing skill sets and build new ones as evolving data about SARS-CoV-2 was assimilated into practice to prevent occupational risks .
Huang , et al . ( 2021 ) used real-time measurement to see how hand hygiene compliance related to the dynamics of the unfolding pandemic . Using an automated hand hygiene recording system to measure healthcare worker hand hygiene on entry to and exit from patient rooms throughout the pandemic , the researchers collected data to identify the correlation between hand hygiene compliance and COVID-19 epidemiological data .
They discovered that healthcare personnel hand hygiene rate on room entry decreased over time ; on room exit , it increased by 13.73 percent during the first wave of COVID-19 , decreased by 9.87 percent during the post-lockdown period , then rebounded by 2.82 percent during the second wave of the epidemic . They also found that hand hygiene during patient care and hand hygiene on room exit had a positive relationship with the local COVID-19 epidemic ; conversely , hand hygiene on room entry did not depend on the trend of the epidemic , nor on nursing of COVID-19 patients , and it decreased over time .
The main takeaway is that healthcare personnel “ modified their behaviors to face the risk propensity of the pandemic . However , to improve the poor compliance at room entry , reducing confusion between the hand hygiene recommendation and glove recommendation may be necessary ; disinfection of gloving hands might solve this issue ,” the researchers wrote .
In their meta-analysis of studies investigating the rate of hand hygiene compliance and the characteristics of hand hygiene during the COVID-19 pandemic Wang , et al . ( 2021 ) identified seven studies with 2,377 healthcare providers reporting hand hygiene compliance . The estimated overall compliance rate was 74 percent , which was higher than that reported in previous studies ( WHO , 2009 ). Nurses had the highest compliance levels while auxiliary workers had the lowest . For the WHO 5 Moments , the healthcare providers had the highest compliance after contact with the body fluids of the patients , while before contact with patient ’ s healthcare providers had the lowest compliance -- which was consistent with before the pandemic . There were significant compliance differences between automatic monitoring systems versus open and secret observation .
Previous studies have documented that the compliance of hand hygiene was affected by many factors , such as heavy workloads , interruption by other things , forgetting to wash hands , shortages of handwashing facilities , and intolerance to the hand skin disinfectant caused by frequent hand hygiene .”
Wang , et al . ( 2021 ) observe that despite the known barriers to hand hygiene practice , hospitals have attempted to address them specifically during the pandemic , but studies have not determined how healthcare personnel have internalized this messaging and how it impacts practice . They note , “ Previous studies have documented that the compliance of hand hygiene was affected by many factors , such as heavy workloads , interruption by other things , forgetting to wash hands , shortages of handwashing facilities , and intolerance to the hand skin disinfectant caused by frequent hand hygiene . From the front-line experience , during the outbreak of COVID-19 , hospitals strengthened intervention measures for the hand hygiene compliance among healthcare providers , including strengthening education , increasing monitoring frequency , posting notices and warning signs , and other measures . In addition , healthcare providers may have had a higher self-awareness of and ability to perform hand hygiene compared with other daily working conditions in during the contingency status of COVID-19 . However , it is not known whether hand hygiene behavior and compliance among healthcare providers changed and what kind of changes may have taken place after the outbreak .”
Makhni , et al . ( 2021 ) describe changes in compliance during the COVID-19 pandemic in a large academic medical center as well as in units temporarily converted into COVID cohort units , with the researchers hypothesizing that such units would provide an estimate for maximum compliance . To provide context for the compliance data , the researchers examined the number of hand hygiene opportunities , such as room entries and exits , and COVID-positive inpatient admissions by month . Analyses included 13 validated inpatient units and six intensive care units . Before the pandemic , monthly hand hygiene compliance across all units was similar to the September baseline of 54.5 percent . The facility admitted 1,159 inpatients with COVID-19 during the study period . During the pandemic , compliance reached a daily peak of 92.8 percent in late March 2020 across all units , and 100 percent during the same time across cohort units ; there was also a monthly peak of 75.5 percent across all units and 84.4 percent on cohort units in April . Compliance declined across all units to a daily nadir of 51.5 percent in mid-August 2020 , a weekly nadir of 55.1 percent , and a monthly nadir of 56 percent .
One caveat , the researchers say , is that they were unable to assess the quality of the hand hygiene performed . They add that the “ concomitant changes in hand hygiene opportunities suggest the compliance surge was driven by fear and increased awareness of the importance of hand hygiene associated with the start of the pandemic , as well as fewer room entries and exits resulting from
www . healthcarehygienemagazine . com • may 2022
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