A Multifaceted Approach to the “Bare below the Elbow” Concept and Hand Hygiene Compliance among Healthcare Professionals—Multicenter Population-Based Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants of the Study Cohort
2.2. Study Examination
2.3. Ethics Statement
2.4. Statistical Analysis
3. Results
Assessment of Compliance with the BBE Concept
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Loveday, H.P.; Wilson, J.A.; Pratt, R.J.; Golsorkhi, M.; Tingle, A.; Bak, A.; Browne, J.; Prieto, J.; Wilcox, M.; UK Department of Health. epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J. Hosp. Infect. 2014, 86 (Suppl. S1), S1–S70. [Google Scholar] [CrossRef] [PubMed]
- Gupta, M.K.; Lipner, S.R. Hand hygiene in preventing COVID-19 transmission. Cutis 2020, 105, 233–234. [Google Scholar] [PubMed]
- Allegranzi, B.; Sax, H.; Pittet, D. Hand hygiene and healthcare system change within multi-modal promotion: A narrative review. J. Hosp. Infect. 2013, 83 (Suppl. S1), S3–S10. [Google Scholar] [CrossRef] [PubMed]
- Mathai, E.; Allegranzi, B.; Seto, W.H.; Chraiti, M.N.; Sax, H.; Larson, E.; Pittet, D. Educating healthcare workers to optimal hand hygiene practices: Addressing the need. Infection 2010, 38, 349–356. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cherry, M.G.; Brown, J.M.; Bethell, G.S.; Neal, T.; Shaw, N.J. Features of educational interventions that lead to compliance with hand hygiene in healthcare professionals within a hospital care setting. A BEME systematic review: BEME Guide No. 22. Med. Teach. 2012, 34, e406–e420. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Huis, A.; Schoonhoven, L.; Grol, R.; Donders, R.; Hulscher, M.; van Achterberg, T. Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: A cluster randomised trial. Int. J. Nurs. Stud. 2013, 50, 464–474. [Google Scholar] [CrossRef]
- Martos-Cabrera, M.B.; Mota-Romero, E.; Martos-Garcia, R.; Gomez-Urquiza, J.L.; Suleiman-Martos, N.; Albendin-Garcia, L.; Canadas-De la Fuente, G.A. Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review. Int. J. Environ. Res. Public Health 2019, 16, 3039. [Google Scholar] [CrossRef] [Green Version]
- Lotfinejad, N.; Peters, A.; Tartari, E.; Fankhauser-Rodriguez, C.; Pires, D.; Pittet, D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infect. Dis. 2021, 21, e209–e221. [Google Scholar] [CrossRef]
- Vermeil, T.; Peters, A.; Kilpatrick, C.; Pires, D.; Allegranzi, B.; Pittet, D. Hand hygiene in hospitals: Anatomy of a revolution. J. Hosp. Infect. 2019, 101, 383–392. [Google Scholar] [CrossRef]
- Gould, D.J.; Moralejo, D.; Drey, N.; Chudleigh, J.H.; Taljaard, M. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst. Rev. 2017, 9, CD005186. [Google Scholar] [CrossRef]
- Luangasanatip, N.; Hongsuwan, M.; Limmathurotsakul, D.; Lubell, Y.; Lee, A.S.; Harbarth, S.; Day, N.P.; Graves, N.; Cooper, B.S. Comparative efficacy of interventions to promote hand hygiene in hospital: Systematic review and network meta-analysis. BMJ 2015, 351, h3728. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Erasmus, V.; Daha, T.J.; Brug, H.; Richardus, J.H.; Behrendt, M.D.; Vos, M.C.; van Beeck, E.F. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect. Control Hosp. Epidemiol. 2010, 31, 283–294. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Szumska, E.; Czajkowski, P.; Zablocki, M.; Rozkiewicz, D. The Association between Hand Disinfection Techniques and Their Barriers, as Well as the “Bare below the Elbows” Concept, among Healthcare Professionals—A Study Based on a Polish Population. Int. J. Environ. Res. Public Health 2022, 19, 11781. [Google Scholar] [CrossRef] [PubMed]
- WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care; WHO Guidelines Approved by the Guidelines Review Committee; WHO: Geneva, Switzerland, 2009.
- Al-Allak, A.; Sarasin, S.; Key, S.; Morris-Stiff, G. Wedding rings are not a significant source of bacterial contamination following surgical scrubbing. Ann. R. Coll. Surg. Engl. 2008, 90, 133–135. [Google Scholar] [CrossRef] [Green Version]
- Burger, A.; Wijewardena, C.; Clayson, S.; Greatorex, R.A. Bare below elbows: Does this policy affect handwashing efficacy and reduce bacterial colonisation? Ann. R. Coll. Surg. Engl. 2011, 93, 13–16. [Google Scholar] [CrossRef] [Green Version]
- Willis-Owen, C.A.; Subramanian, P.; Kumari, P.; Houlihan-Burne, D. Effects of ‘bare below the elbows’ policy on hand contamination of 92 hospital doctors in a district general hospital. J. Hosp. Infect. 2010, 75, 116–119. [Google Scholar] [CrossRef]
- Boyce, J.M.; Pittet, D.; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am. J. Infect. Control 2002, 30, S1–S46. [Google Scholar] [CrossRef]
- Pittet, D.; Simon, A.; Hugonnet, S.; Pessoa-Silva, C.L.; Sauvan, V.; Perneger, T.V. Hand hygiene among physicians: Performance, beliefs, and perceptions. Ann. Intern. Med. 2004, 141, 1–8. [Google Scholar] [CrossRef] [Green Version]
- Smiddy, M.P.; O’ Connell, R.; Creedon, S.A. Systematic qualitative literature review of health care workers’ compliance with hand hygiene guidelines. Am. J. Infect. Control 2015, 43, 269–274. [Google Scholar] [CrossRef]
- Fonguh, S.; Uwineza, A.; Catry, B.; Simon, A. Belgian hand hygiene campaigns in ICU, 2005–2015. Arch. Public Health 2016, 74, 47. [Google Scholar] [CrossRef] [Green Version]
- Lee, S.S.; Park, S.J.; Chung, M.J.; Lee, J.H.; Kang, H.J.; Lee, J.A.; Kim, Y.K. Improved Hand Hygiene Compliance is Associated with the Change of Perception toward Hand Hygiene among Medical Personnel. Infect. Chemother. 2014, 46, 165–171. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- McLaws, M.L.; Farahangiz, S.; Palenik, C.J.; Askarian, M. Iranian healthcare workers’ perspective on hand hygiene: A qualitative study. J. Infect. Public Health 2015, 8, 72–79. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mortell, M.; Balkhy, H.H.; Tannous, E.B.; Jong, M.T. Physician ‘defiance’ towards hand hygiene compliance: Is there a theory-practice-ethics gap? J. Saudi Heart Assoc. 2013, 25, 203–208. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hautemaniere, A.; Cunat, L.; Diguio, N.; Vernier, N.; Schall, C.; Daval, M.C.; Ambrogi, V.; Tousseul, S.; Hunter, P.R.; Hartemann, P. Factors determining poor practice in alcoholic gel hand rub technique in hospital workers. J. Infect. Public Health 2010, 3, 25–34. [Google Scholar] [CrossRef]
- Skodova, M.; Garcia Urra, F.; Gimeno Benitez, A.; Jimenez Romano, M.R.; Gimeno Ortiz, A. Hand hygiene assessment in the workplace using a UV lamp. Am. J. Infect. Control 2015, 43, 1360–1362. [Google Scholar] [CrossRef]
- Randle, J.; Arthur, A.; Vaughan, N. Twenty-four-hour observational study of hospital hand hygiene compliance. J. Hosp. Infect. 2010, 76, 252–255. [Google Scholar] [CrossRef]
- Pittet, D.; Mourouga, P.; Perneger, T.V. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann. Intern. Med. 1999, 130, 126–130. [Google Scholar] [CrossRef]
- Mernelius, S.; Svensson, P.O.; Rensfeldt, G.; Davidsson, E.; Isaksson, B.; Lofgren, S.; Matussek, A. Compliance with hygiene guidelines: The effect of a multimodal hygiene intervention and validation of direct observations. Am. J. Infect. Control 2013, 41, e45–e48. [Google Scholar] [CrossRef]
- Pittet, D.; Donaldson, L. Clean care is safer care: The first global challenge of the WHO World Alliance for Patient Safety. Am. J. Infect. Control 2005, 33, 476–479. [Google Scholar] [CrossRef]
- Allegranzi, B.; Gayet-Ageron, A.; Damani, N.; Bengaly, L.; McLaws, M.L.; Moro, M.L.; Memish, Z.; Urroz, O.; Richet, H.; Storr, J.; et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: A quasi-experimental study. Lancet Infect. Dis. 2013, 13, 843–851. [Google Scholar] [CrossRef]
BBE N = 3932 | Non-BBE N = 3612 | Total N = 7544 | |
---|---|---|---|
Medical personnel | 2712 (51.5%) | 2559 (48.5%) | 5271 (100.0%) |
Physicians | 687 (46.7%) | 783 (53.3%) | 1470 (100.0%) |
Nurses | 2025 (53.3%) | 1776 (46.7%) | 3801 (100.0%) |
Non-medical personnel (other) | 1220 (53.7%) | 1053 (46.3%) | 2273 (100.0%) |
Cleaning service | 522 (51.4%) | 494 (48.6%) | 1016 (100.0%) |
Food service | 119 (52.9%) | 106 (47.1%) | 225 (100.0%) |
Physiotherapists | 154 (67.8%) | 73 (32.2%) | 227 (100.0%) |
Radiologic technologists | 91 (47.6%) | 100 (52.4%) | 191 (100.0%) |
Administration specialists | 216 (53.3%) | 189 (46.7%) | 405 (100.0%) |
Pharmacists | 57 (52.8%) | 51 (47.2%) | 108 (100.0%) |
Laboratory staff | 61 (60.4%) | 40 (39.6%) | 101 (100.0%) |
Location of Work | Physicians N = 1395 | Nurses N = 3436 | Medical Personnel N = 4831 | Non-Medical Personnel N = 2065 | Total N = 6896 |
---|---|---|---|---|---|
Surgical departments | 334/243 * | 750/514 | 1084/757 | 213/154 | 1297/911 |
57.9/42.1 | 59.3/40.7 | 58.9/41.1 | 58.0/42.0 | 58.7/41.3 | |
Operating theatres | 92/25 | 193/61 | 285/86 | 43/17 | 328/103 |
78.6/21.4 | 76.0/24.0 | 76.8/23.2 | 71.7/28.3 | 76.1/23.9 | |
Orthopedics | 36/22 | 71/57 | 107/79 | 35/27 | 142/106 |
62.1/37.9 | 55.5/44.5 | 57.5/42.5 | 56.5/43.5 | 57.3/42.7 | |
Surgery | 129/122 | 336/261 | 465/383 | 106/86 | 571/469 |
51.4/48.6 | 56.3/43.7 | 54.8/45.2 | 55.2/44.8 | 54.9/45.1 | |
Ophtalmology | 77/74 | 150/135 | 227/209 | 29/24 | 256/233 |
51.0/49.0 | 52.6/47.4 | 52.1/47.9 | 54.7/45.3 | 52.4/47.7 | |
General departments | 224/365 | 791/723 | 1015/1088 | 456/412 | 1471/1500 |
38.0/62.0 | 52.2/47.8 | 48.3/51.7 | 52.5/47.5 | 49.5/50.5 | |
Neonatology | 46/34 | 108/59 | 154/93 | 74/39 | 228/132 |
57.5/42.5 | 64.7/35.3 | 62.3/37.7 | 65.5/34.5 | 63.3/36.7 | |
Pediatrics | 28/55 | 86/58 | 114/113 | 24/21 | 138/134 |
33.7/66.3 | 59.7/40.3 | 50.2/49.8 | 53.3/46.7 | 50.7/49.3 | |
Internal medicine | 114/212 | 478/482 | 592/694 | 164/224 | 756/918 |
35.0/65.0 | 49.8/50.2 | 46.0/54.0 | 42.3/57.7 | 45.2/54.8 | |
Neurology | 22/43 | 52/51 | 74/94 | 23/40 | 97/134 |
33.8/66.2 | 50.5/49.5 | 44.0/56.0 | 36.5/63.5 | 42.0/58.0 | |
Rehabilitation | 14/21 | 67/73 | 81/94 | 171/88 | 252/182 |
40.0/60.0 | 47.9/52.1 | 46.3/53.7 | 66.0/34.0 | 58.1/41.9 | |
ICU | 52/39 | 136/125 | 188/164 | 27/20 | 215/184 |
57.1/42.9 | 52.1/47.9 | 53.4/46.6 | 57.4/42.6 | 53.9/46.1 | |
ED | 13/19 | 66/108 | 79/127 | 84/101 | 163/228 |
40.6/59.4 | 37.9/62.1 | 38.4/61.6 | 45.4/54.6 | 41.7/58.3 | |
Other ** | 45/61 | 112/111 | 157/172 | 311/287 | 468/459 |
42.5/57.5 | 50.2/49.8 | 47.7/52.3 | 52.0/48.0 | 50.5/49.5 | |
Total | 668/727 | 1855/1581 | 2523/2308 | 1091/974 | 3614/3282 |
47.9/52.1 | 54.0/46.0 | 52.2/47.8 | 52.8/47.2 | 52.4/47.6 |
Medical Personnel | |||||
---|---|---|---|---|---|
Physicians N = 687 | Nurses N = 2025 | Total N = 2712 | Other ** N = 1220 | Total N = 3932 | |
Sex | |||||
Female | 279 (40.6) * | 1974 (97.5) | 2253 (83.1) | 1026 (84.1) | 3279 (83.4) |
Male | 408 (59.4) | 51 (3.5) | 459 (16.9) | 194 (15.9) | 653 (16.6) |
Time of participation in the study | |||||
The first time (1x) | 620 (90.2) | 1843 (91.0) | 2463 (90.8) | 1079 (88.4) | 3542 (90.1) |
The second time (2x) | 67 (9.8) | 182 (9.0) | 249 (9.2) | 141 (11.6) | 390 (9.9) |
Job seniority | |||||
≤10 years | 438 (63.8) | 1158 (57.2) | 1596 (58.8) | 710 (37.2) | 2306 (58.6) |
>10 years | 249 (36.2) | 867 (42.8) | 1116 (41.2) | 510 (41.8) | 1626 (41.4) |
Location of work | |||||
Hospital | 668 (97.3) | 1855 (91.6) | 2523 (93.0) | 1091 (89.4) | 3614 (91.9) |
Clinic | 16 (2.3) | 119 (5.9) | 135 (5.0) | 47 (3.9) | 182 (4.6) |
LTCF | 3 (0.4) | 51 (2.5) | 54 (2.0) | 82 (6.7) | 136 (3.5) |
Hospital | 668 | 1855 | 2523 | 1091 | 3614 |
Surgical departments | 334 (50.0) | 750 (40.4) | 1084 (43.0) | 213 (19.5) | 1297 (35.9) |
General departments | 224 (33.5) | 791 (42.6) | 1015 (40.2) | 456 (41.8) | 1471 (40.7) |
ED | 13 (1.9) | 66 (3.6) | 79 (3.1) | 84 (7.7) | 163 (4.5) |
ICU | 52 (7.9) | 136 (7.4) | 188 (7.5) | 27 (2.5) | 215 (5.9) |
Other | 45 (6.7) | 112 (6.0) | 157 (6.2) | 311 (28.5) | 468 (13.0) |
Level of healthcare referral system | 668 | 1855 | 2523 | 1091 | 3614 |
Primary | 316 (47.3) | 1078 (58.1) | 1394 (55.3) | 646 (59.2) | 2040 (56.4) |
Secondary | 174 (26.0) | 435 (23.5) | 609 (24.1) | 290 (26.6) | 899 (24.9) |
Tertiary | 178 (26.7) | 342 (18.4) | 520 (20.6) | 155 (14.2) | 675 (18.7) |
Medical Personnel | |||||
---|---|---|---|---|---|
Physicians N = 687 | Nurses N = 2025 | Total N = 2712 | Other ** N = 1220 | Total N = 3932 | |
Sex | |||||
Female | 424 (54.2) * | 1750 (98.5) | 2174 (85.0) | 885 (84.0) | 3059 (84.7) |
Male | 359 (45.8) | 26 (1.5) | 385 (15.0) | 168 (16.0) | 553 (15.3) |
Time of participation in the study | |||||
The first time (1x) | 703 (89.8) | 1588 (89.4) | 2291 (89.5) | 939 (89.2) | 3230 (89.4) |
The second time (2x) | 80 (10.2) | 188 (10.6) | 268 (10.5) | 114 (10.8) | 382 (10.6) |
Job seniority | |||||
≤10 years | 473 (60.4) | 1048 (59.0) | 1521 (59.4) | 634 (60.2) | 2155 (59.7) |
>10 years | 310 (39.6) | 728 (41.0) | 1038 (40.6) | 419 (39.8) | 1457 (40.3) |
Location of work | |||||
Hospital | 727 (92.9) | 1581 (89.0) | 2308 (90.2) | 974 (92.5) | 3282 (90.8) |
Clinic | 52 (6.6) | 156 (8.8) | 208 (8.1) | 48 (4.6) | 256 (7.1) |
LTCF | 4 (0.5) | 39 (2.2) | 43 (1.7) | 31 (2.9) | 74 (2.1) |
Hospital | 727 | 1581 | 2308 | 974 | 3282 |
Surgical departments | 243 (33.4) | 514 (32.5) | 757 (32.8) | 154 (15.8) | 911 (27.8) |
General departments | 224 (30.8) | 723 (45.7) | 947 (41.1) | 412 (42.3) | 1500 (45.7) |
ED | 19 (2.6) | 108 (6.8) | 127 (5.5) | 101 (10.4) | 228 (6.9) |
ICU | 39 (5.4) | 125 (7.9) | 164 (7.1) | 20 (2.0) | 184 (5.6) |
Other | 61 (8.4) | 111 (7.0) | 172 (7.5) | 287 (29.5) | 459 (14.0) |
Level of healthcare referral system | 727 | 1581 | 2308 | 974 | 3282 |
Primary | 362 (49.8) | 993 (62.8) | 1355 (58.7) | 573 (58.8) | 1928 (58.7) |
Secondary | 176 (24.2) | 391 (24.7) | 567 (24.6) | 260 (26.7) | 827 (25.2) |
Tertiary | 189 (26.0) | 197 (12.5) | 386 (16.7) | 141 (14.5) | 527 (16.1) |
Correct Disinfection | Incorrect Disinfection | Total | |
---|---|---|---|
Medical personnel (5271) | 2043/1462 * | 669/1097 | 2712/2559 |
Physicians (1470) | 511/415 | 176/368 | 687/783 |
Nurses (3801) | 1532/1047 | 493/729 | 2025/1776 |
Non-medical personnel (2273) | 832/542 | 388/511 | 1220/1053 |
Total (7544) | 2875/2004 | 1057/1608 | 3932/3612 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Szumska, E.; Czajkowski, P.; Zablocki, M.; Rozkiewicz, D. A Multifaceted Approach to the “Bare below the Elbow” Concept and Hand Hygiene Compliance among Healthcare Professionals—Multicenter Population-Based Study. Int. J. Environ. Res. Public Health 2023, 20, 4435. https://doi.org/10.3390/ijerph20054435
Szumska E, Czajkowski P, Zablocki M, Rozkiewicz D. A Multifaceted Approach to the “Bare below the Elbow” Concept and Hand Hygiene Compliance among Healthcare Professionals—Multicenter Population-Based Study. International Journal of Environmental Research and Public Health. 2023; 20(5):4435. https://doi.org/10.3390/ijerph20054435
Chicago/Turabian StyleSzumska, Emilia, Przemyslaw Czajkowski, Michal Zablocki, and Dorota Rozkiewicz. 2023. "A Multifaceted Approach to the “Bare below the Elbow” Concept and Hand Hygiene Compliance among Healthcare Professionals—Multicenter Population-Based Study" International Journal of Environmental Research and Public Health 20, no. 5: 4435. https://doi.org/10.3390/ijerph20054435