Nurses' practice of hand hygiene in surgical wards

Abstract

The aim of this descriptive observational study was to describe the hand hygiene practice of qualified nurses in surgical wards of the local general hospital in Malta. Hand hygiene is acknowledged to be the single most effective and most cost effective intervention to promote infection control in the clinical setting (Horton, 1995; Pittet et al, 2000). However, nurses seem to underestimate this procedure as observational studies showed a low adherence to hand hygiene guidelines (Gould and Ream, 1994). This study attempted to describe the local situation, where nurses' behaviour was addressed. Additionally, the ward environment was also assessed for factors that may enhance or inhibit optimum practice. A convenience sample of 10 participants consented to participate in this study, all of whom were qualified nurses of different age groups, educational background and clinical experience. Each nurse was observed for two hours during the first hours of the morning shift. This time of the day was preferred since nursing care is more intense and hectic, thus resulting in an increased frequency of hand contamination. Hence, a total of 20 hours of observational data was collected by non-participant method in which 210 hand decontamination techniques were expected to be carried out. However, only 14.76% (n=31) were actually performed. Furthermore, even when hand decontamination was carried out, nurses seemed to perform the techniques poorly by missing some parts of the hand surfaces. Also, recontamination occurred by various methods such as turning off the faucets with their hands. Alcohol-based hand rubs, which may have a prominent role in preventing cross-contamination were minimally used. Moreover, lack of hand hygiene facilities were observed throughout both wards. Findings suggest the need of education and increased motivation in these wards in order to enhance practice of hand hygiene. Moreover, hand hygiene facilities such as alcohol-based hand rub dispensers, should be installed in strategic places throughout the wards in order to make hand hygiene more convenient and less time consuming for nurses.