Compliance with hand hygiene practice in pediatric intensive care

To determine the frequency and predictors of compliance with hand hygiene (HH) practice in pediatric intensive care.

Observational, prospective cohort study performed from February to April 2000.

Three intensive care units at a tertiary care children's hospital.

Nurses, physicians, respiratory therapists, and other healthcare workers.

During 156 30-min daytime observation periods, an unidentified observer monitored 2811 opportunities for HH during patient care and recorded HH compliance.

Average HH compliance was 34% (946/2811). It was higher (p < 0.001) among respiratory therapists (68%; 171/251) than physicians (37%; 157/426) or nurses (29%; 587/2031). Contact with body fluid secretions was associated with the highest compliance (77%; 46/60), and contact with wounds (71%; 10/14) or indwelling devices (66%; 110/167) were associated with somewhat lesser compliance. The following were important predictors of compliance (all p < 0.01): being a respiratory therapist (odds ratio [OR], 5.1); working in the neonatal intensive care unit (OR, 1.6); and contact with invasive devices (OR, 2.5), wounds (OR, 6.9), or body fluids (OR, 11.5). Compliance was lowest after interrupted patient-care activities (9%; OR, 0.15). Surprisingly, decreased patient-to-nurse ratio (mean, 1.3 +/- 0.3) or opportunities per hr of care (mean, 37 +/- 7) were not independent predictors of compliance.

Average HH compliance was low, but it increased during high-risk patient-care activities. Intensified efforts are necessary to increase caretakers' compliance and the awareness of the risk of bacterial contamination after interrupted patient-care activities.