Haenen, et al. (2022) sought to evaluate compliance with hand hygiene recommendations by different nursing professionals in long-term care facilities and to investigate determinants potentially influencing hand hygiene and whether these differed between the different cadres of staff.

The researchers conducted two sub-studies, including measuring hand hygiene compliance of 496 professionals in 14 long-term care facilities (23 wards) through direct observation using the World Health Organization’s ‘Five Moments of Hand Hygiene’ observation tool. In addition, they performed a survey to examine determinants that may influence hand hygiene and to determine differences between different cadres of staff.

The researchers found an overall mean hand hygiene compliance of 17%. There was considerable variation between wards (5–38%) and between specific World Health Organization hand hygiene moments. In addition, hand hygiene compliance varied widely within and between different cadres of staff. The determinant analysis was conducted on 177 questionnaires. For all nursing professionals, they found multiple determinants in four domains: ‘social context and leadership’, ‘resources’, ‘individual healthcare professional factors’ and ‘risk perception’. In two domains, several barriers were perceived differently by nursing assistants and nurses. In the domain ‘social context and leadership’, this included (1) how the manager addresses barriers to enable hand hygiene as recommended and (2) how the manager pays attention to correct adherence to the hand hygiene guidelines. In the ‘risk perception’ domain, this included a resident's risk of acquiring an infection as a result of the nursing professional’s failure to comply with the hand hygiene guidelines.

Hand hygiene compliance was low and influenced by multiple factors, several of which varied among different cadres of staff. When designing interventions to improve hand hygiene performance in long-term care facilities, strategies should take into account these determinants and how they vary between different cadres of staff. The researchers recommend exploring hand hygiene determinants at ward level and among different cadres of staff, for example by using our exploratory questionnaire.

Reference: Haenen A, et al. Hand hygiene compliance and its drivers in long-term care facilities; observations and a survey. Antimicrobial Resistance & Infection Control. Volume 11, article number 50 (2022).