Evaluation of hand hygiene in the neonatal intensive care unit: An observational study

Background: Very low birth weight (VLBW) infants are at high risk for nosocomial sepsis. Hands of health care workers (HCWs) are important vectors of pathogen transmission from colonized or infected infants to susceptible infants. In the Neonatal intensive care unit (NICU), adherence to hand hygiene is recognized as one of the most important means of preventing healthcare-associated infections. Adherence to hand hygiene by health personnel is often poor. However, after a multimodal intervention program (MIP) in a NICU in The Netherlands, a significant increase in adherence to hand hygiene guidelines from 23% to 50% was established in 2006. The aim of the present study was to follow up the evaluation of the adherence to hand hygiene practice, five years after completing a MIP. Methods: An observational cross-sectional design in the NICU of Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands. The population under study were all HCWs. After the observation, prompt feedback was given by the observer. Subsequently HCWs were asked to fill in a questionnaire. Results: 160 observations were carried out; 55 HCWs filled in the questionnaire. An improved adherence rate was observed. Conclusion: An increased adherence to hand hygiene was demonstrated. With this knowledge about increased adherence to hand hygiene, policy makers can better judge the necessity of implementing interventions to establish or improve adherence to hand hygiene. There is a need for careful consideration before setting a goal of zero tolerance to hand hygiene non-compliance to avoid failure and frustration.