Handwashing before entering the intensive care unit: what we learned from continuous video-camera surveillance

Handwashing is one of the most important factors in controlling the spread of bacteria and in preventing the development of infections. This simple procedure does not have a high compliance rate. The Association for Professionals in Infection Control and Epidemiology, Inc, guideline recommends that hands must be washed before and after patient contact. In our intensive care unit (ICU), we have made it a rule that everyone should wash their hands before entering the ICU. The purpose of this study was to ascertain the handwashing compliance of all personnel and visitors to the ICU. A ceiling-mounted video camera connected to a time-lapse video cassette recorder recorded each person's actions when they entered the ICU during a 7-day period. Handwashing compliance was assessed for 3 different categories: ICU personnel, non-ICU personnel, and visitors to patients. There were 1030 entries to the ICU during the observation period. ICU personnel complied with handwashing in 71% of entries, non-ICU personnel in 74% of entries, and visitors to patients in 94% of entries. Handwashing compliance by visitors to patients was significantly higher than among personnel (P <.001). Handwashing compliance among personnel before entering the ICU was low. Continuous effort is needed to raise awareness of the handwashing issue, not only to ensure compliance with APIC recommendations but also in our facility, to ensure that health care personnel wash their hands on entry to the ICU.