Hand hygiene compliance: the experience of three Italian tertiary care hospitals

Introduction Hand hygiene is an important measure in infection prevention to decrease transmission of microbial pathogens. Especially in these last two years, COVID-19 pandemic brought focus on the importance of a correct and frequent hand hygiene. Currently, direct observation is considered the gold standard for hand hygiene surveillance. The purpose of this observational study is to assess healthcare professionals hand hygiene compliance during the World Health Organization's ‘Five Moments for hand hygiene'. Methods In this study we examined perceptions, compliance, techniques, and contextual issues of hand hygiene practices among healthcare workers, in three different hospitals. Twelve different wards were observed, including ICU, surgical wards and medical wards. At least 200 hand hygiene opportunities (based on the WHO's ‘Five Moments') were recorded for each ward, using a mobile application called SpeedyAudit™. Results The results showed highly variable levels of adherence to the hygiene practices, with compliance rates ranging from 20% to 84%. There was also a wide variability of compliance between the different moments, with compliance rates ranging from 75% after touching patient surroundings to 59% before touching a patient. Overall, physicians had the worst score among the healthcare workers, resulting in 55% of compliance, while social health operators performed best with 70%. Conclusions There is still a huge variability in hand hygiene among healthcare workers. Despite the conceivable Hawthorne Effect influence, general compliance was not optimal. Overall hand hygiene adherence and knowledge should be achieved by implementing hand sanitizer distribution, offering further education and raising awareness on the importance of a correct hand hygiene, for the sake of both patients and healthcare workers. Key messages Hand hygiene adherence and knowledge should be achieved by implementing hand sanitizer distribution, offering further education and raising awareness on the importance of a correct hand hygiene. There is still a huge variability in hand hygiene among healthcare workers.