Irish Medical News


In response to ‘Lending hygiene a helping hand’


Dr Michael Mulhern

Consultant Microbiologist,

Letterkenny General Hospital,

Co Donegal


Marie Feely’s recent prominent reporting (IMN, 24/10/2011) of national hand hygiene audits in acute healthcare facilities is welcomed as a reminder to all that compliance with good hand hygiene is the most effective way to prevent the spread of healthcare associated infections. The accompanying analysis of the report requires a degree of clarification to ensure that the objective of the audits is not misinterpreted.

Even though all hospitals used the same protocol and auditors were trained and assessed prior to performing audits, the results of the audit do not enable comparisons between hospitals to be made. It is clear that in most hospitals, auditors introduced themselves on arrival to the ward and explained the nature of the audit to be conducted, this is in line with the national protocol and World Health Organisation recommendations. In other hospitals this did not occur to the same extent, thus staff in these units may have been less aware that a hand hygiene audit was taking place. These variations should be resolved prior to further audits.

Hand hygiene audits performed overtly by local staff are known to over estimate compliance levels with hand hygiene, this is widely reported in the infection control literature. A recently published report of hand hygiene compliance across 13 hospitals in Ontario, Canada gives an average compliance of 31.2 per cent. These audits were done on a random basis at random times. Other results from Ontario report hand hygiene compliance increasing from an average of 50.3 per cent across four centres in 2009 to an average of 72.2 per cent in 2010, it was not stated if these were random or overt audits.

Another recent report from a hospital in London, UK shows that in a series of audits, baseline hand hygiene compliance ranged from 4.5-8.7 per cent. These audits were done covertly with the auditors pretending to be doing something else. It should be clear that a compliance of 86 or 91 per cent in the national hand hygiene audit report does not imply that compliance is at this level when no auditors are present. Lower reported compliances may be closer to the mark and it is most likely that compliance is at roughly similar levels in all acute healthcare facilities.

These audits are one of a number of methods being used with the aim of improving hand hygiene compliance in real life day to day practice. They do not, in most cases, reflect accurately normal compliance but are very useful in pinpointing areas where further input and improvement is required.



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