Hand hygiene compliance in home-based nursing care: Insights from an unobtrusive observational study.

Abstract

Abstract Title Hand hygiene compliance in home-based nursing care: Insights from an unobtrusive observational study. Rationale Every month, 270,000 people in the Netherlands receive home-based nursing care (HBNC). Patients receiving HBNC are at a high risk for healthcare-associated infections (HAIs). Hand hygiene is the most important measure to prevent HAIs. However, literature on HAIs and hand hygiene compliance in HBNC is scarce. Objective The primary objective of this research is to examine hand hygiene performance (i.e. compliance and technique) in HBNC. Secondary objectives are compliance with personal hygiene and handling of mobile devices with regards to hygiene. Methods With a quantitative, cross-sectional study design data were collected at a Dutch HBNC organization. Nurses and professional caregivers were observed directly and unobtrusively. Compliance data were analyzed using descriptive statistics. Pearson’s chi-square tests were performed to assess possible differences between the overall compliance and the compliance rates of the five hand hygiene moments and between the overall compliance and the professional statuses. A possible relation between hand hygiene compliance and compliance with personal hygiene was explored using correlation measures. Results Twenty-two healthcare workers were observed visiting 134 patients. This resulted in 443 hand hygiene opportunities. Hand hygiene compliance for individual participants varied from 10.0% to 63.0%, with an overall compliance of 35.0%. When technique was added, this compliance rate decreased to 13.1%. The compliance with personal hygiene (81.8%) and correct use of devices (27.5%) differed strikingly. Conclusion and recommendations Hand hygiene was performed correctly in only 13.1% of 443 opportunities. The results of this study are a first insight into hand hygiene compliance in HBNC in the Netherlands and should be repeated at multiple Dutch HBNC organizations. These results could help in developing a hand hygiene improvement intervention for the HBNC setting.