Major article
Hand hygiene in pediatric and neonatal intensive care unit patients: Daily opportunities and indication- and profession-specific analyses of compliance

The results have been partly presented as a poster (No. 1513) at the 20th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), April 10-13, 2010, Vienna, Austria.
https://doi.org/10.1016/j.ajic.2010.12.020Get rights and content

Background

Hand hygiene is considered to be the single most effective tool to prevent health care-associated infections. Daily hand hygiene opportunities and compliance for pediatric/neonatal intensive care units (ICU) are currently unknown.

Methods

This was a prospective observational study in pediatric and neonatal ICU patients with analyses of hand hygiene behavior in relation to profession, indication, and shift and correlation with disinfectant usage.

Results

Hand hygiene opportunities were significantly higher for pediatric (321/24 hours) than neonatal (194/24 hours; P = .024) patients. Observed compliance rates were 53% (pediatric) and 61% (neonatal) and found to be significantly higher in nurses (57%; 66%) than in physicians (29%, 52%, respectively; P < .001; P = .017, respectively). For neonates, compliance rates were significantly higher before patient contact and aseptic tasks (78%) than after patient, patient body fluid, or patients’ surrounding contact (57%; P < .001). Calculating disinfectant usage revealed a 3-fold lower compliance rate of 17%.

Conclusion

This study provides the first data on opportunities for and compliance with hand hygiene in pediatric/neonatal patients encompassing the whole day and night activities and including a comparison of observed and calculated compliance rates. Observation revealed high compliance especially in nurses and in situations of greatest impact. The data provide a detailed characterization of hand hygiene performance in the neonatal/pediatric ICU setting.

Section snippets

Hospital setting

This study was performed at the University Hospital Aachen, a tertiary care center, in 2009. A pediatric and neonatal ICU with 19 beds participated. Written protocols on hand hygiene had been implemented, trainings on hand hygiene had been carried out on a regular basis, and the equipment with disinfectant dispensers was sufficient.

Patients

Patients were divided into 2 groups: The pediatric ICU (PICU) patient group consisting of PICU patients with a high number of post open heart surgery patients and

Results

During the 192-hour observation period, a total of 2,060 hand hygiene opportunities was documented, with 1,284 for PICU patients and with 776 for NICU patients, respectively. The number of daily opportunities was significantly higher for the PICU group with 321/patient-days than for the NICU group with 194/patient-days (P = .02; RS). Daily hand hygiene activities were significant higher in PICU patients than in NICU patients with 170 performed hand rubs per PICU patient-days versus 118

Discussion

Pediatric patients and neonates on ICUs may have different care requirements in comparison with adults, potentially resulting in different daily opportunities for hand hygiene. However, there were no previous data for these patient groups that investigated whole day activities. Previously published studies on adult patients reported 589 contacts during a 40-hour observation period on 2 different ICUs; however, this group did not picture the work flow over a complete day nor did they

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    Supported in part by a restricted grant from Bode Chemie GmbH, Hamburg, Germany.

    Conflicts of interest: All authors disclose receipt of financial and/or material support from an organization that may either gain or lose financially from the results or conclusions of this study or invited editorial.

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