Enhancing hand hygiene compliance in healthcare settings: a long time intervention study

This study aimed to enhance hand hygiene compliance among healthcare workers (HCWs) to reduce the incidence of hospital-acquired infections (HAIs) by employing the Plan-Do-Check-Act (PDCA) cycle, a quality management approach introduced by W. Edwards Deming.

A tailored Hand Hygiene Survey Form was developed based on the Hand Hygiene Technical Specification for Healthcare Personnel and WHO guidelines. Data was collected from January 2017 to December 2023 and Jiangsu Provincial Geriatric Hospital (Jiangsu province official hospital), including hand hygiene compliance metrics (assessed via observations of WHO's Five Moments for Hand Hygiene), hospital infection cases, and consumption of hand hygiene consumables. A questionnaire survey identified factors affecting compliance, leading to the implementation of targeted interventions, including regular training, performance assessments, promotional campaigns, and monitoring of consumable usage.

The survey revealed that the need for a diverse range of hand sanitizers (95.53%), timely replenishment of consumables (63.70%), and skin irritation from frequent use (48.83%) significantly impact hand hygiene compliance. From 2017 to 2023, there was a significant increase in hand hygiene compliance rate from 49.25 to 86.67%, accuracy rate from 13.02 to 86.67%, and awareness rate from 61.61 to 96.52%. The total consumption of hand sanitizers increased from 6,277,457 mL in 2017 to 18,130,112 mL in 2023, and the daily consumption per bed-day rose from 8.15 mL to 16.65 mL. The hospital infection rate decreased from 2.63% in 2017 to 0.90% in 2023. A strong negative correlation was observed between hand hygiene compliance rate (r = -0.962, p < 0.001) and hospital infection rates, indicating that higher compliance is associated with lower infection rates.

The continuous application of the PDCA cycle and targeted interventions significantly improved hand hygiene compliance and reduced HAIs. The study emphasized the importance of ongoing monitoring, feedback, and corrective actions. It also highlighted the need for improving the supply and quality of hand hygiene consumables, enhancing education and supervision, and establishing incentive mechanisms to promote hand hygiene compliance. Despite limitations such as potential overestimation of actual hand hygiene consumables usage, the use of intelligent dispensers with identity recognition is recommended for more accurate data capture in future efforts.