June 5: Global Handwashing Day
A study shows that modifying professional behavior regarding hand hygiene would reduce the frequency of hospital-acquired infections.
May 5 was declared by the World Health Organization (WHO) as World Handwashing Day, a practice that prevents 40 percent of hospital infections. Although the WHO recommends that hand hygiene be performed in five moments (before and after contact with a patient; after contact with fluids; before an aseptic task and after contact with the patient's environment) various studies show that That practice is far from reaching 100 percent compliance among doctors, nurses and other health professionals around the world.
This year, a clinical trial was carried out in Argentina that constitutes the first research of this type that aims to achieve a change in professional behavior on this issue. The study was carried out by the Department of Quality in Medical Care and Patient Safety of the Institute of Clinical and Health Effectiveness (IECS) in conjunction with the Argentine Association of Nurses in Infection Control (ADECI) and was financed by the WHO.
El Dr. Ezequiel García Elorrio, director of the aforementioned department of the IECS, and Lic. Carolina Giuffre, former president of ADECI and current Director of the National Campaign to improve hand hygiene in Argentina, explain: “The objective of the study was to improve adherence to the hand hygiene in health professionals (mainly doctors and nurses), for which an intervention was carried out in 11 intensive therapies in hospitals in the metropolitan region” (which have a clear interest in improving a panorama that concerns all health institutions in the world).
“The intervention consisted of anonymous observers (members of medical teams who were specially trained) verifying through direct observation whether the professionals sanitized their hands in the situations recommended by the WHO. It was found that, on average, 57 percent complied with this recommendation,” says García Elorrio.
Given these results, a team of experts in quality in medical care and patient safety designed a multifaceted intervention for 348 doctors and nurses from the 11 therapies that were part of the study regarding the fact that hand hygiene saves lives because it prevents adverse events. as unintentional harm to patients.
The next step was to conduct direct observations again anonymously, to see if the intervention translated into behavioral changes. In subsequent measurements, the results (which are finishing being processed) showed that there was a significant change: the rate of adherence to hand hygiene rose, on average, to between 70 and 75 percent, acceptable data ( although still improvable) within international terms.
“Although alcohol gels were introduced in many hospitals and clinics that allow you to sanitize quickly and effectively in just 30 seconds, adherence to this measure is not total. We have not found reports of institutions with 100% adherence. That is why it is important that these types of interventions, which are based on scientific evidence and have low costs, can be reproduced in other health institutions. In this way, it would be possible to improve the level of compliance with a key habit when seeking better levels of quality and patient safety,” concludes Giuffre.
For its part, the Dr. Viviana Rodríguez, doctor and researcher at the IECS and member of the team that worked on the training of professionals, emphasizes: “The resistance to incorporating effective habits in this sense requires a cultural change in health professionals and, especially, the approach of leaders. institutional (directors of social works and hospitals). Your role should be to show interest in compliance with the practice of hand hygiene. In addition, they should stimulate the education of health personnel, promote reminders and guarantee access to the necessary elements (such as soap or alcohol-based solutions) to be able to comply with the WHO recommendations.
GENERAL INFORMATION ON HAND WASHING
- In 1847, Hungarian doctor Ignaz Semmelweis began using hand hygiene to reduce infections associated with healthcare. The implementation of this measure in that first experiment managed to reduce the mortality of postpartum women from 12 to 1,28 percent.
- Studies carried out in the last 40 years confirmed the role that contaminated hands of healthcare personnel play in the transmission of microorganisms between patients.
- Handwashing adherence is low around the world. It is estimated that it has an average of 40% in different countries (Source: Boyce JM et al. Guideline for hand hygiene in health-care settings, 2002).
QUALITY IN MEDICAL CARE
- It is a discipline that has been in force for approximately 100 years.
- In October 2004, the World Health Organization (WHO) launched the Global Alliance for Patient Safety, whose objective is to coordinate, disseminate and improve patient safety throughout the planet.
- Various initiatives that have emerged over the last century have shown that health professionals are concerned about the care they provide to their patients, but unfortunately this concern is not enough to change the reality of health systems.