NDT Advance Access originally published online on March 15, 2005
Nephrology Dialysis Transplantation 2005 20(6):1164-1171; doi:10.1093/ndt/gfh759
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A multicentric survey of the practice of hand hygiene in haemodialysis units: factors affecting compliance
1 Hospital Perpetuo Socorro, Alicante, 2 Unidad de Control de Infecciones y Epidemiología de Hospital de Alicante, 3 Haemodialysis Unit, Elda, 4 Haemodialysis Unit, Elche, 5 Hospital de la Princesa, Madrid, 7 Hospital Clínico, Granada, 6 Hospital Dr Peset, 8 Cediat-Aldaia, 9 Cediat-Turia and 10 Clinica Virgen del Consuelo Valencia, 11 Hospital de Poniente, Almeria and 12 Hospital Reina Sofía, Córdoba, Spain
Correspondence and offprint requests to: M. Dolores Arenas, Jiménez Plaza, Dr Gomez Uua, IS 03013, Alicante (Spain). Email: arenasd{at}perpetuosocorro.nehos.com
Background. This study intended to investigate the degree of compliance with hand hygiene and use of gloves by health workers in haemodialysis (HD) units, and the factors that influenced adherence to hand hygiene protocols.
Methods. During the month of November 2003, one person observed the health care staff in each of nine different dialysis units, during 495 randomly distributed 30 min observation periods that covered all steps of a haemodialysis session (connection, dialysis and disconnection). The observers noted the number of potential opportunities to implement standard precautions and the number of occasions on which the precautions were actually taken. Adherence to standard precautions was evaluated, analysing the influence of the following variables: the patient-to-nurse ratio, the number of HD shifts scheduled per day, acute HD units vs chronic, whether or not infectious patients were isolated and in-house vs contract cleaning personnel.
Results. There were a total of 977 opportunities to wear gloves for, and to wash the hands following, a patient-oriented activity, and 1902 opportunities to wash hands before such an activity. Gloves were actually used on 92.9% of these occasions. Hands were washed only 35.6% of the time after patient contact, and only 13.8% of the time before patient contact. Poor adherence to hand washing was associated with the number of shifts per HD unit per day and with higher patient-to-nurse ratios. In the acute HD units, there was greater adherence to standard precautions than in the chronic units, although there too it was substandard. The personnel's knowledge of patients’ infectious status did not modify their adherence to hand hygiene practices. A higher patient-to-nurse ratio independently influenced hand washing both before and after patient contact.
Conclusions. The overall adherence of health care workers to recommended hand washing practices is low. Whether or not programmes promoting higher hand hygiene standards and the potential use of alcohol-based hand cleansers will improve hand hygiene practices in HD units requires further investigation.
Keywords: haemodialysis; hand hygiene; hepatitis C prevention; standard universal precautions