Hand hygiene compliance in the intensive care unit of the Onderstepoort Veterinary Hospital, South Africa

Abstract

Infection prevention and control (IPC) practices play an important role in the prevention and management of hospital-acquired infections (HAIs) in healthcare facilities and hand hygiene is the cornerstone of all IPC practices. Despite the effectiveness of IPC in the management of HAIs, its adoption in veterinary medicine has been limited. Additionally, there is paucity of data on IPC practices in veterinary medicine. Therefore, this study evaluated hand hygiene compliance among healthcare workers in the intensive care unit (ICU) at the Onderstepoort Veterinary Academic Hospital. A cross-sectional study was conducted among healthcare workers (HCWs) and visitors in the ICU. The infection control assessment tool (ICAT), focusing on the five hand hygiene moments criteria was used to evaluate compliance. The level of compliance and a 95% confidence interval was calculated for all variables. Individual bottles of alcohol-based hand rub solutions and hand-wash basins with running water, soap dispensers, and paper towels were available in the ICU. In total, 296 observations consisting of 734 hand hygiene opportunities were recorded. In addition, hand hygiene compliance was also evaluated during invasive (51.4%) and non-invasive (48.6%) procedures. Most HCWs did not sanitize stethoscopes, leashes, and cellular phones used in between patients. Additionally, the majority of them were not bare “below the elbows” because they wore jewellery. The overall hand hygiene compliance was 24.3% (178/734). The most common method of hand hygiene was hand rub (58.4%) followed by hand-wash (41.6%). Nurses had a higher (44%) level of compliance compared to students (22%) and doctors (15%). Compliance was also higher after body fluid exposure (42%) compared to after patient contact (32%), before patient contact (19%), after contact with patient surroundings (16%), and before an aseptic procedure (15%). Furthermore, nurses had the lowest compliance after body fluid exposure (14%), students had the lowest compliance before patient contact (16%) and doctors had the lowest compliance after contact with patient surroundings (0%). The low levels of hand hygiene compliance in this study raises concerns of potential transmission of HAIs and zoonosis in the ICU. Therefore, intervention strategies are recommended to improve the compliance level in the hospital. These may include an educational campaign on the importance of adhering to hand hygiene, development and promotion of written hand hygiene protocols, and programs promoting regular hand hygiene auditing could be developed.