Assessing the improvement of healthcare workers' alcohol-based hand rub with the Pulpe'Friction audit

Hand hygiene is essential to prevent the transmission of pathogens between healthcare workers (HCWs) and patients. Launched in 2019, Pulpe'Friction is a declarative audit that provides a quick assessment of hand hygiene in healthcare facilities. This audit consists of interviewing HCWs and patients. Some facilities performed a second audit after the first one, as well as a sufficient period of implementation of actions. The question was, did these facilities improve in terms of hand hygiene practices and informating the patients? In two stable cohorts of French medical-facility wards, this study aimed to assess whether there was an improvement in reported and observed alcohol based hand rub (ABHR) practices and in the proportion of patients informed about hand hygiene when two audits were conducted consecutively. A first cohort of 416 wards from 130 facilities was constituted including 5,521 HCWs interviewed during the first audit and 5,383 HCWs during the second audit. A second cohort of 139 wards from 62 facilities was formed including 2,090 patients interviewed during the first audit and 1,726 patients during the second audit. A significant improvement was observed in self-reported alcohol hand rub practices by HCWs before and after contact with the patient, and after contact with the patient's immediate environment. Significantly, more patients declared they received information about when to perform hand hygiene during the second audit. To conclude, the wards in which two audits were performed significantly improved their reported practices. The pulpe'friction method is not only useful to evaluate reported practices and barriers, it also offers a simple way to evaluate the impact of the actions implemented in a ward.