[Healthcare workers' hand hygiene: compliance of the recommendations]

Handwashing is the most effective method of preventing the spread of nosocomial infection. Despite its simplicity, handwashing is frequently omitted by health care personnel. In order to promote hand hygiene at Farhat Hached hospital (Sousse-Tunisia), the team of hygiene sets up a programme of hand hygiene programme.This work enters within the framework of the evaluation of the program's impact relatively on the healthcare worker's hand decontamination practices (physicians and nurses).

Our aim is to determine the evolution of hand washing rates, specific compliance (per unit and category of healthcare workers) and adapted compliance.

Our study is experimental with comparison of the results of 2 audits, the first carried out before the installation of the program (winter 2003) and the second after (winter 2006). The study was conducted in 4 units: two medical units (internal medicine and pneumology), a surgical unit (general surgery) and intensive care unit.

On the whole, 208 and 319 acts of care were observed respectively during the first and the second audit. The rate of total observance and that of correct observance of handwashing doubled and passed respectively from 28% to 46.4% (p = 2 x 10(-5)) and from 13.9% to 23.5% (p = 4 x 10(-5)). Failures causes observed at washing hands time (2006) are mainly related to a later recontamination of the hands. The observance of handwashing increased only for nurses, from 34% to 47.5% (p < 10(-2)).

With the aim to improve hand washing compliance, hand hygiene programme must target even more the physicians and provide alcohol hand rubs.