Hand hygiene compliance in nursing home wards - the effect of increased accessibility of alcohol-based hand rub.

BACKGROUND: Elderly nursing home (NH) residents are vulnerable to infections due to age, weakened immune system and comorbidities. Furthermore, microorganisms are easily transmitted in shared facilities. Hand hygiene (HH) is considered one of the most important measures to prevent transmission. We determined the effect of increased accessibility to alcohol-based hand rub (ABHR) in NH wards by monitoring HH compliance (HHC) among healthcare workers (HCWs).

METHODS: An 11-month intervention study was conducted in a Danish six-ward NH. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. We compared baseline HHC with the HHC during an immediate intervention period and a long-term intervention period.

RESULTS: We included 159 HCWs. The AHHMS registered 341,078 HH opportunities. Overall baseline HHC was 31% (95% CI: 30-32). A significant +18% absolute immediate effect (first five months) (95% CI: 17-19; p<0.0001) and +13 percentage points (95% CI: 11, 14; p<0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (p<0.0001).

CONCLUSIONS: Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, showcasing a noteworthy effect. The study is the first to report the effect on NH dispenser accessibility as a single intervention and demonstrate a significant unmet potential.