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The Role of Handwashing in Prevention of Endemic Intensive Care Unit Infections

Published online by Cambridge University Press:  21 June 2016

Bryan Simmons ,
Jerri Bryant ,
Kim Neiman ,
Linda Spencer  and
Kris Arheart
Bryan Simmons*
Affiliation:
Department of Medicine, the Methodist Hospitals of Memphis, Memphis, Tennessee
Jerri Bryant
Affiliation:
Infection Control Department, Cleveland Clinic, Cleveland, Ohio
Kim Neiman
Affiliation:
Division of Public Health, and the Emory University School of Nursing, Emory University, Atlanta, Georgia
Kris Arheart
Affiliation:
Department of Biostatistics, the University of Tennessee, Memphis, Tennessee
*
188 S. Bellevue, Suite 419, Memphis, TN 38104
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Abstract

Handwashing is believed to be the most important means of preventing nosocomial infections. Previous studies of healthcare workers (HCWs) have shown that handwashing practices are poor. No one has shown that handwashing practices can be easily improved and that this prevents endemic (non-epidemic) nosocomial infection. Handwashing and infection rates were studied in two intensive care units (ICUs) of a community teaching hospital. Handwashing rates were monitored secretly throughout the study. After six months of observation, we started interventions to increase handwashing. Handwashing increased gradually, but overall rates before (22.0%) and after (29.9%) interventions were not significantly different (p = .071). Handwashing never occurred before intravenous care, whereas it occurred 67.5% for all other indications (p<.0001). When questioned, nurses felt they were washing appropriately nearly 90% of the time. Infection rates seemed unrelated to handwashing throughout the study, and no clusters of infection were detected. We conclude that handwashing rates, when measured against arbitrary but reasonable standards, are suboptimal, difficult to change and not closely related to evidence of cross-infection. Further, nurses wash hands selectively, depending on the indication for handwashing, and generally believe they are washing much more frequently than an objective observer believes they are.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 11 , November 1990 , pp. 589 - 594
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

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