Hand hygiene in the intensive care unit: audit and intervention

Abstract

This is a Master of Public Health practicum project done in the Intensive Care Unit (ICU) at the American University of Beirut Medical Center (AUBMC) with the center’s Infection Control and Prevention Program (ICPP). The practicum project’s aim was to increase the compliance to proper hand hygiene (HH) practices in the ICU at AUBMC. The objectives were: (1) assessing the compliance to hand hygiene practices in the ICU at AUBMC, (2) finding gaps in the hand hygiene practices, (3) developing and implementing an intervention plan, and lastly, (4) evaluating the effectiveness of the intervention. The project consists of an audit on the hand hygiene practices of the personnel who were present in the ICU, which includes medical staff from the attending physician to medical interns, nursing staff, and others such as technicians, respiratory therapists, and patient’s family visitors, using the World Health Organization HH Observation Tool. For the physicians, out of 74 opportunities, HH was done 44 times (59.4%) and missed 30 times (40.6%). For nurses, out of 107 opportunities, HH was done 100 times (93.4%) and missed 7 times (6.6%). For others, out of 63 opportunities, HH was done 55 times (87.3%) and was missed 7 times (12.7%). The gap in HH compliance was identified in the medical staff, therefore, an educational intervention was conducted. After the intervention, an evaluation audit showed that with for physicians, out of 97 opportunities, HH was done 84 times (86.5%) and missed 13 times (13.5%). For nurses, out of 118 opportunities, HH was done 112 times (94.9%) and missed 6 times (5.1%). And for others, out of 76 opportunities, HH was done 69 times (90.7%) and was missed 7 times (9.3%). In conclusion, the project resulted in increased compliance to HH practices in the ICU at AUBMC leading to better patient outcomes.