New Hand Hygiene Toolkit Published for Intensive Care Units

NUI Galway researchers designed toolkit to identify and address barriers to hand hygiene compliance

Research led from NUI Galway has resulted in the publication of a toolkit to help staff in the Intensive Care Unit (ICU) to identify barriers to hand hygiene compliance, and the interventions that can be used to addressed these barriers. This toolkit is the accumulation of more than three years of Health Research Board funded research on hand hygiene in the ICU, and was carried out with the collaboration of ICU staff from across Ireland, the public, and national and international researchers.

Healthcare associated infections, infections acquired in a healthcare setting such as a hospital, are the most frequent complications experienced by hospital patients, and affect 4% of patients worldwide and account for almost 100,000 deaths annually in the United States. Healthcare associated infections are of particular concern in the ICU, where prevalence rates between 20% and 30% have been reported. Effective hand hygiene practices are considered to be one of the most important strategy for preventing these types of infections.

The aim of the recently completed Health Research Board funded project ‘A Moment for Hand Hygiene in the Intensive Care Unit: How Can Compliance Be Improved?’ was to take a scientific approach to identifying how to improve hand hygiene in Irish ICUs. This project was led by Dr Paul O’Connor from NUI Galway’s School of Medicine, with support from leading national and international researchers, and ICU staff- particularly from the Saolta Healthcare group.

Dr O’Connor said: “Although hand hygiene practice is simple to carry out, the behaviour related to hand hygiene is complex and is not readily understood, explained, or changed. International bodies, such as the World Health Organization, have made recommendations for how to improve hand hygiene practices. However, there are serious weaknesses in the research evidence to guide the implementation of these recommendations. As a result, interventions to improve hand hygiene practices are often not based on sound scientific knowledge, may be of limited effectiveness, and limited resources are not being used efficiently.”

Dr Michael Power, Co-Principal Investigator on the project and Clinical Lead of the National Clinical Programme for Critical Care, stated:  “The project is a rigorous analysis of the factors influencing hand hygiene behaviour in Ireland. We know that hand hygiene interrupts the transmission of bacteria and viruses – it is more important than ever during the COVID-19 pandemic.”

The project found that there was potential to improve hand hygiene practice in ICUs. In general ICUs in Ireland had the required equipment and resources to carry out hand hygiene, and ICU staff recognised the importance of hand hygiene in preventing infection. However, it was found that ICU staff may over-estimate how often they engage in hand hygiene practice, and did not think that frequently used approaches to improving hand hygiene such as standardised training packages and audits were effective. It was also clear that each ICU has a unique set of barriers to improving hand hygiene practice.

Recognising the issues with improving hand hygiene practice, the project team worked with researchers, ICU nurse, ICU doctors, and members of the public to identify 21 potential interventions for improving hand hygiene practice. These interventions were then rated in terms of how effective they were likely to be. Ensuring the availability of essential supplies was regarded as the most important for encouraging hand hygiene practice. Senior leaders acting as role models, and individual focused training were also well regarded. Punitive methods such as punishment letters were not well regarded.

Dr Power added: “This realistic and relevant NUI Galway study of Hand Hygiene is welcomed as an important contribution to Hand Hygiene improvement in the acute hospital setting in Ireland.”

Dr O’Connor continued: “Hand hygiene is crucial to infection prevention and control. There is no universal solution to improving hand hygiene practice. There is a need for an intervention to be tailored to the specific needs of a particular unit rather than a one-size fits all approach. The toolkit developed as part of the moment for hand hygiene project will support ICU staff to identify the barriers to hand hygiene practice in their unit, and interventions that are appropriate to address these barriers.”

According to Dr Mairéad O’Driscoll, Chief Executive at the Health Research Board: “Covid-19 has forced everyone to think about hand hygiene differently. Compliance with good practice is even more important in Intensive Care settings. Because this toolkit is based on evidence about people’s behaviour and responses to hand hygiene measures in ICU, and it’s tailored based on individual experience, we believe it will be very effective to help address any barriers to compliance.”

To download the hand hygiene toolkit visit: https://aran.library.nuigalway.ie/handle/10379/16192, or watch a video at https://www.youtube.com/watch?v=siiOavW8Czo&feature=youtu.be

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