Assessing the quality of hand hygiene in the community

Introduction: To protect against coronavirus, hand hygiene (HH) of good quality, i.e. covering all the surfaces of the hands with alcohol based handrub (ABHR), is paramount. It was shown that the WHO method is rarely performed correctly by healthcare workers. It is thus likely that HH performance in the community is even worse. Objectives: In this descriptive study, we measured the quality of HH performed by visitors at the entry of an hospital according to different HH methods. Methods: Due to the Covid-19 pandemic, visitors passed on a checkpoint at the entry of Geneva Hospitals where they had to sanitize their hands with an ABHR containing a fluorescent component. We performed 2 interventions that consisted in placing posters at the checkpoint explaining 2 simplified HH methods: “Fingertips first” with focus given to the fingertips and “Spray based” with a controlled volume of ABHR sprayed on the hands. We also formed a control group without any instructions. Visitors ignored that their HH would be assessed. We used the Semmelweis Hand Hygiene Scanner® (SHHS) to evaluate the quality of HH. The investigator approached the visitors after they passed the checkpoint to evaluate their hands. During each period of observations, 30 visitors were enrolled in each of the 3 arms of the study. The primary outcome was the % of hand surface covered by ABHR as measured by the SHHS. It was good when the result was superior to 95%. Results: The study lasted from February to April 2021. In the control group, HH of 405 visitors were assessed;the % of hand coverage was 80.4% and 29.6% of the visitors performed good HH. In the “Fingertips first” group, out of 425 participants, the result was good for 27.5% and the coverage was 81.2%. And, in the “Spray based” group, 26.9% out of 498 visitors obtained a good result and the coverage was 83.3%. The results were not significantly different between the 3 groups. Conclusion: The quality of HH was better than expected. The quality was not different with or without instructions and between the methods with a regular dispenser and a spray dispenser. We actually observed that visitors didn't paid attention to the instructions. Those results may overestimated HH in the community because our study took place in an hospital and visitors rubbed their hands with ABHR more carefully not to contaminate the patients.