journal of Hospital Infection (200 I ) 48 (Supplement A): S47-549 doi: IO. I053/jhin.200 I .0978, available online at http://www.idealibrary.

com

on IBE

M
University Medical College, Krakow, Poland

Handwashing practices in Polish hospitals: results of a survey conducted by Polish Society of Hospital Infection
F?B. Heczko and I? Kleszcz
Department of Bacteriology, Chair ofMicrobiology,]agiellonian

Summary:

Handwvashing is the most important and least expensive measure for preventing transmission of hospital-acquired infections. Nevertheless, healthcare workers do not seem to understand the risks associated with non-compliance. Thus, compliance is usually poor and rarely exceeds 40%. The Polish Society of Hospital Infection has made a short study of handwashing practices in Polish hospitals as observed by members of infection control teams. The study \\-as based on questionnaires given to infection control workers attending the annual congress of the society. The workers were asked to complete the forms during the congress according to their perceived estimations. Altogether 78 complete questionnaires were analysed. The responding staff members were from hospitals of all sizes, reference levels and regions. Nearly all (95.6%) hospitals had a written protocol for handwashing procedures but according to the estimates of their infection control teams, the compliance rates varied from 20 to 80% although in most institutions \l\-as between 40% and 60%. In the vast majority of the hospitals, alcoholic rub preparations lvere used (70.3%), but in some both handwashing with chlorhexidine in detergents and alcohol-based antiseptics were used in different situations. According to the respondents, the mean time of hand disinfection varied from 1 to 3 min. The hand\\-ashing procedures were mostly performed in examination, operating and patients rooms. Thus, it seems that as in other countries, Polish healthcare lvorkers fail to understand the importance of hand\vashing.
0 200 I The Hospital Infection Society

Keyzco&:

Hand disinfection;

handwashing

practices; Polish hospitals.

Introduction Hand hygiene is considered by most healthcare professionals to be the most important and least expensive measure of preventing transmission of healthcare associated infections,2 although this belief is not supported by well-designed clinical studies. Although many guidelines and recommendations concerning proper hand disinfection have been released by national and international infection control
Author for corrrspondence: Professor Piotr B. Heczko, Chair of LIicrobiolog!; Jagiellonian Uniwrsit\; Medical College, 18 Czysta Street, 31-121 Krakow, Poland. Tel.: +1812 633 2567; Fax: +4812 423 3924; E-mail: mhheczko~~c~f-kr.edu.pl

organisations, compliance rates are unacceptably low usuallv i below 50!4~~-~ Contemporary infection con&o1 measures have been recently implemented in Polish hospitals starting with training epidemiology nurses and establishing infection control teams. The Polish Society of Hospital Infection initiated in 1997 a nation-wide surveillance system for hospital infections based upon voluntary reporting which for the first time gave insight into epidemiology of hospital infections in Poland.,x In 1999, about 200 Polish hospitals joined the programme and started to collect data on hospital infections. This fact prompted us to try to estimate adherence to recommended handwashing practices in Polish hospitals. Also, during the last ten years, new

0 195-670 I/O I IOAOS47 + 03 $35.0010

0 200 I The Hospital

Infection

Society

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I? B. Heczko and F! Kleszcz

methods of hand-rubbing using alcohol-based preparations have been implemented and become more popular than former hand-scrub with water solutions of detergent and antiseptic agent. Thus, our additional aim was to discover which approach to hand hygiene is now common practice in Polish hospitals. Methods A questionnaire containing a set of questions related to hospital size and hand hygiene practices was distributed to members of the Polish Society of Hospital Infection, who were also members of the infection control teams attending the annual congress of the society in 1999. Members were asked to complete the forms during the congress. The questionnaires were then collected and basic data calculated using Microsoft Excel. Results and discussion

Table I Methods of hand participating hospitals

Method Alcoholic rub Detergent+ chlorhexidine scrub Both rub and scrub Not defined

disinfection

recommended

in

No. of hospitals 64 8

Percentage 70.3

a.9
19.7 I.1

18
I

Table

II

recommended

Estimated rates of compliance procedures No. of hospitals I

with

Rate (%)
90

Percentage I.1 5.5 5.5 21.9 20.9 16.5 15.3 4.4

80
70 60 50 40 30 20 No answer

5
5 20 I9 15 I4 4

a 91

a.9 100.0

Of 200 infection control teams in the participating hospitals, 91 responded to our questionnaire but only 78 (85.7%) of the returned questionnaires were filled in completely. The completed questionnaires represented views of infection control teams working in all types of the hospitals according to numbers of hospital beds. Most hospitals had 500-600 beds (21.9%), 200-300 beds (18.7%) or 100-200, 300-400 and 600-800 beds (13.19%). Written recommendations for hand disinfection were present in nearly all hospitals (95.6%). Hand-rub procedures using alcohol-containing preparations were recommended in over 70% of the hospitals (Table I). It is of interest that the procedures were not performed with equal frequency in patients rooms (50.5%) and other places such as examination rooms (91.2%) or treatment rooms (93.4%). The time the procedures needed to complete hygienic hand disinfection was estimated by the most of the respondents as 1 min (49.5%) or 3 min (36.3%), whilst surgical disinfection this was 5 min (41.7%) and 3 min (31.9%). Rates of compliance during patient care were estimated by respondents as between 30% and 60% (Table II). These figures are in concordance with several previous reports from other countries.3* Lack of knowledge of hand hygiene guidelines, recognition of hand hygiene opportunities during patient care and awareness of the risk of cross-transmission of microbial pathogens constitute barriers to hand hygiene compliance.3 The Society is planning, therefore, a greater educational programme for

Total

hospital infection control team members to achieve higher level of understanding importance of hand disinfection and higher rates of compliance.

References
1. Larson EL. CIC 1992-2993 and 1994 APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. AmJ Infect Control 1995; 23: 251-269. 2. Bauer TM, Ofner E, Just HM, Just H, Dashner E An epidemiological study assessing the relative importance of airborne and direct contact transmission of microorganisms in a medical intensive care unit. J Hasp Infect 1990; 15: 301-309. 3. Hugonnet S, Pittet D. Hand hygiene-beliefs or science? Clin Microbial Infect 2000; 6: 350-356. 4. Meengs MR, Giles BK, Chisholm CD, Cordell WH, Nelson DR. Hand washing frequency in an emergency department. r Emerg Nun 1994; 20: 183-I 88. 5. Pittet D, Mourouga I, Perneger TV and members of the Infection Control Team. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999; 130:126-130. 6. Bischoff WE, Reynolds TM, Sessler CN, Edmond MB, Wenzel RF? Handwashing compliance by health care workers: the impact of introducing accessible, alcohol-based hand antiseptic. Arch Intern Med 2000; 160: 1017-1021. 7. Coignard B, Richet H, Jarvis WR et al. Nosocomial infection in Poland: preliminary results of a nationwide

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practices

in Polish hospitals

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surveillance system. Proc. CDC 4th Decennial Conference on Nosocomial and Healthcare Associated Infections, Atlanta 2000; 262. 8. Wojkowska-Mach J, Roaska A, Kuthan R, Bulanda M, Heczko PB. Mortality related to hospital infections. An analysis based on data derived from nation-wide

hospital infection surveillance programme in 1998. Epidemiol Rev 2000: (in press). 9. Rotter ML. Hand washing and disinfection. In: Mayhall CG et al. Eds. Hospital epidemiology and infection control, 2nd edn. Philadelphia: Lippincott, Williams & Wilkins, 1999; 1339-1355.