Enhancing hand hygiene in a polyclinic in Singapore

This project intended to enhance the compliance rate of nurses (registered nurses and enrolled nurses) in a polyclinic to the five moments of hand hygiene. It proposed to conduct a preliminary baseline audit on the standard of hand hygiene practice, educate nurses on the five moments of hand hygiene in the polyclinic and conduct a post-implementation audit to capture the compliance rate of nurses on practising the five moments of hand hygiene.

The team conducted a pre- and post-implementation audit using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programme, from July 2011 through November 2011, over a period of 5 months. The pre-implementation audit, which involved 23 nurses from a polyclinic in Singapore, also adopted five out of the seven criteria suggested by the Joanna Briggs Institute. The intervention composed of educating the nurses on the five moments of hand hygiene, providing guidance to nurses in a non-intimidating manner, adopting an open communication approach and the appropriate placement of alcohol-based hand rub at the point of care in the service rooms.

The post-implementation audit results showed significant improvement in four of the five criteria, with the greatest improvement observed for criterion 2: 'Hands are decontaminated immediately before each and every episode of direct patient contact or care, and/or all inanimate objects, including equipment'.

This study has proven that by conducting the pre- and post-implementation audit using the five criteria gathered from the Joanna Briggs Institute Practical Application of Clinical Evidence System, nurses' hand hygiene compliance can be enhanced. From this study, we could also conclude that nurses' knowledge and accessibility/suitability of alcohol-based hand rubs play an important role in achieving better hand hygiene practices. Positive results were seen even though the project was conducted within a short period. Contributing factors could be attributed to efforts by researchers in identifying barriers for compliance from the ground and addressing them in the intervention phase. In addition, the relentless enthusiasm and commitment of stakeholders, team members and nurses had also contributed to the success of this study. This project was the first to report an improvement in the hand hygiene compliance of primary healthcare nurses in Singapore.