2009 Press Releases
Culture of hospitals affects hand hygiene compliance
25.03.2009
A UCC/HSE study has found marked differences in healthcare workers’ hand hygiene behaviour among similar types of hospitals in Ireland.
25.03.2009
A UCC/HSE study has found marked differences in healthcare workers’ hand hygiene behaviour among similar types of hospitals in Ireland.
It also suggests that approaches that look at the culture of the hospitals rather than the actions of individuals may be more successful in combating the problem.
The study was conducted in four Irish public acute care hospitals and the factor that most impacted on healthcare workers hand hygiene behaviour was the hospital in which the healthcare worker was employed according to researcher Sile Creedon, School of Nursing & Midwifery. She found that healthcare workers in one hospital were significantly less likely to comply than their counterparts in the other three - irrespective of discipline, gender or area of work. The best of the four hospitals surveyed had a non-compliance rate of 24% while the worst hospital had a non-compliance rate of 44%.
Her study raises the question: why there are such marked differences in practices among healthcare workers in similar type hospitals in Ireland? Her study also raises the question: did this variation in hand hygiene practice contribute to the wide variation in infection rates reported by hospitals in the 2007 national infection prevalence study. Hand hygiene is recognised as the single most effective infection control behaviour that stops the spread of infection. However, this simple behaviour remains stubbornly difficult to raise to acceptable levels – nationally or internationally. “Investigating compliance with hand hygiene behaviour requires an understanding of what motivates such behaviour,” says Ms Creedon. “For example, healthcare staff are generally aware of guidelines regarding hand hygiene but knowledge and education do not in themselves motivate good hand hygiene behaviour.” Self-reported and observed rates of compliance with hand hygiene differ and there was also evidence that staff may be unaware of their poor compliance when their intention to perform good hand hygiene is there.
Attempts to target individuals by using posters, television media and extra provision of alcohol hand rubs such as that used in the ‘Say No To Infection’ by the HSE in Ireland or ‘Clean Your Hands’ campaign by the NHS in the UK have clearly not had a major impact.
The study, Hand hygiene compliance: exploring variations between hospitals in Ireland, found that the overall rate of non-compliance was 30% but varied by hospital. Men (irrespective of discipline) had a higher rate of non-compliance to women (38% vs 28%). Doctors had the highest rate of non-compliance at 41%, followed by porters (38%), technicians and physiotherapists (33%), nurses (28%) and healthcare assistants (21%). The area of work also impacted on hand hygiene practices: non compliance in A&E units was 36% compared to ICU at 28%. “This may well be due to busyness and urgency of patient care activities in these units,” suggests Ms Creedon.
The most recent survey of national infection prevalence in Ireland was reported by the Hospital Infection Society in 2007. An overall infection rate of 4.9% was found which varied depending on the type of hospital surveyed: regional/tertiary 6%, general 4% and specialist 2%. Rate variation is explicable due to risk factors inherent in patients attending these hospitals. However, when infection rates are considered within similar hospital categories, the variation in rates becomes wider. In regional hospitals rates varied from 2.0% to 8.2%. In general hospitals rates varied from 0.0% to 13.3%. In specialist hospitals rates varied from 0.0% to 6.6%. As all are funded by the Department of Health and Children and administered in a similar fashion by the Health Services Executive (HSE), this raises the question, why are there such marked differences in rates of infections among similar type hospitals in Ireland?
Adopting an approach which focuses on the organisational behaviour or culture of a hospital may be more successful in achieving improved delivery of care according to Ms Creedon. A specific example of one such approach is the Magnet Hospital Movement in the US where hospitals awarded ‘Magnet’ status have clearly been associated with increased compliance with guidelines and improved patient outcomes such as lower mortality, increased patient satisfaction, and fewer medication errors. Key to the magnet hospital movement is provision of a supportive work environment for healthcare workers. Critical features of a supportive work environment include multidisciplinary collaboration, provision of information in relation to hospital goals, provision of resources and a supportive culture from top level management.
Ms Creedon has carried out a national survey of nurses perceptions of support within their work environment and is currently aggregating the data by hospital and correlating it with hospital infection rates as identified by the most recent national infection prevalence survey. Ms Creedon has also observed 134 multidisciplinary healthcare workers and surveyed them in relation to their perceptions of support within their work environment which she hopes will provide the answers to the questions as to ‘do hospitals that provide a more supportive work environment for nurses have better patient outcomes and do healthcare workers who feel more supported in their workplace comply more fully with hand hygiene guidelines? This study is the first of its type, nationally and internationally, and it hopes to explain the organisational features that encourage healthcare workers to comply with hand hygiene guidelines and the resultant patient infection rates.
Picture: Sile Creedon, School of Nursing & Midwifery, UCC
1034RMcD
The study was conducted in four Irish public acute care hospitals and the factor that most impacted on healthcare workers hand hygiene behaviour was the hospital in which the healthcare worker was employed according to researcher Sile Creedon, School of Nursing & Midwifery. She found that healthcare workers in one hospital were significantly less likely to comply than their counterparts in the other three - irrespective of discipline, gender or area of work. The best of the four hospitals surveyed had a non-compliance rate of 24% while the worst hospital had a non-compliance rate of 44%.
Her study raises the question: why there are such marked differences in practices among healthcare workers in similar type hospitals in Ireland? Her study also raises the question: did this variation in hand hygiene practice contribute to the wide variation in infection rates reported by hospitals in the 2007 national infection prevalence study. Hand hygiene is recognised as the single most effective infection control behaviour that stops the spread of infection. However, this simple behaviour remains stubbornly difficult to raise to acceptable levels – nationally or internationally. “Investigating compliance with hand hygiene behaviour requires an understanding of what motivates such behaviour,” says Ms Creedon. “For example, healthcare staff are generally aware of guidelines regarding hand hygiene but knowledge and education do not in themselves motivate good hand hygiene behaviour.” Self-reported and observed rates of compliance with hand hygiene differ and there was also evidence that staff may be unaware of their poor compliance when their intention to perform good hand hygiene is there.
Attempts to target individuals by using posters, television media and extra provision of alcohol hand rubs such as that used in the ‘Say No To Infection’ by the HSE in Ireland or ‘Clean Your Hands’ campaign by the NHS in the UK have clearly not had a major impact.
The study, Hand hygiene compliance: exploring variations between hospitals in Ireland, found that the overall rate of non-compliance was 30% but varied by hospital. Men (irrespective of discipline) had a higher rate of non-compliance to women (38% vs 28%). Doctors had the highest rate of non-compliance at 41%, followed by porters (38%), technicians and physiotherapists (33%), nurses (28%) and healthcare assistants (21%). The area of work also impacted on hand hygiene practices: non compliance in A&E units was 36% compared to ICU at 28%. “This may well be due to busyness and urgency of patient care activities in these units,” suggests Ms Creedon.
The most recent survey of national infection prevalence in Ireland was reported by the Hospital Infection Society in 2007. An overall infection rate of 4.9% was found which varied depending on the type of hospital surveyed: regional/tertiary 6%, general 4% and specialist 2%. Rate variation is explicable due to risk factors inherent in patients attending these hospitals. However, when infection rates are considered within similar hospital categories, the variation in rates becomes wider. In regional hospitals rates varied from 2.0% to 8.2%. In general hospitals rates varied from 0.0% to 13.3%. In specialist hospitals rates varied from 0.0% to 6.6%. As all are funded by the Department of Health and Children and administered in a similar fashion by the Health Services Executive (HSE), this raises the question, why are there such marked differences in rates of infections among similar type hospitals in Ireland?
Adopting an approach which focuses on the organisational behaviour or culture of a hospital may be more successful in achieving improved delivery of care according to Ms Creedon. A specific example of one such approach is the Magnet Hospital Movement in the US where hospitals awarded ‘Magnet’ status have clearly been associated with increased compliance with guidelines and improved patient outcomes such as lower mortality, increased patient satisfaction, and fewer medication errors. Key to the magnet hospital movement is provision of a supportive work environment for healthcare workers. Critical features of a supportive work environment include multidisciplinary collaboration, provision of information in relation to hospital goals, provision of resources and a supportive culture from top level management.
Ms Creedon has carried out a national survey of nurses perceptions of support within their work environment and is currently aggregating the data by hospital and correlating it with hospital infection rates as identified by the most recent national infection prevalence survey. Ms Creedon has also observed 134 multidisciplinary healthcare workers and surveyed them in relation to their perceptions of support within their work environment which she hopes will provide the answers to the questions as to ‘do hospitals that provide a more supportive work environment for nurses have better patient outcomes and do healthcare workers who feel more supported in their workplace comply more fully with hand hygiene guidelines? This study is the first of its type, nationally and internationally, and it hopes to explain the organisational features that encourage healthcare workers to comply with hand hygiene guidelines and the resultant patient infection rates.
Picture: Sile Creedon, School of Nursing & Midwifery, UCC
1034RMcD