Compliance with hand hygiene in intensive care units

Introduction: Nosocomial infections are an important problem in modern hospitals. The prevalence in German intensive care units is 15.3%. Hand washing or hand disinfection is believed to be the most important means of preventing nosocomial infections. We wished to answer the following questions: 1. How good is the compliance of hand hygiene on intensive care units? 2. Is compliance associated with the patient/nurse-ratio? Method: In a study of 8 intensive care units the compliance of hand hygiene was observed on two occasions, once in May 1996 and again in November 1997. The prime necessity for hand disinfection occurred when handling ventilation devices, intravascular catheters, urinary catheters and dressings. In addition the patient/nurse-ratio was calculated. Results: A total of 1,879 infection-relevant handlings were observed. The compliance of hand hygiene ranged from 25.7 to 83.2% (mean 55.2%). The most commonly observed handlings were the manipulation of venous catheters (52.7%), the highest compliance was observed with the manipulation of ventilation equipment (91.8%). With a better patient nurse ratio the compliance did not improve but remained the same or was even reduced. Discussion: The compliance of hand disinfection is similar to other study results, but on some intensive care units there was considerable room for improvement. In this study the compliance of hand hygiene is more of a constant factor in individual intensive care units than associated with the patient/nurse-ratio.