Assessing Nurses Hand Hygiene: A Comprehensive Analysis from Pre-Pandemic to Post-Pandemic Periods

Year 2025, Volume: 5 Issue: 1, 15 - 25, 18.04.2025

Saliha Koç Aslan , Sesın Kocagöz , Güllüzar Bozkır , Neslihan Şebnem Çakın

Abstract

This longitudinal multicenter study, it was aimed to examine the hand hygiene practices of nurses in pre-pandemic, pandemic and post-pandemic periods. The study was conducted in a private health institution in Turkey (2019-2023). Hand hygiene assessment was done among 2253 nurses using Hand-in-Scan™ (Semmelweis Systems by Hand-in-Scan; Hungary) technology. In the pre-pandemic phase, a sample of 936 evaluation was used as a set baseline mean cleanliness score of 93.32 (establishing a reference point for subsequent evaluations). During the pandemic, there was a significant increase in the evaluation scores, with an average score of 97.94 based on 892 recorded assessments conducted using this system. This increase emphasis the intensified focus on hygiene protocols during the pandemic, indicative of heightened awareness and adherence to hand hygiene practices. At the post-pandemic phase, with 425 observations, demonstrated a slight decline in the mean cleanliness score to 96.79. Despite this decrease, the overall cleanliness levels remained notably higher than the pre-pandemic baseline. A detailed breakdown of mean cleanliness scores for different hand regions, along with 95% Confidence Intervals, offered nuanced insights into expected cleanliness levels during each period. Statistical analysis revealed highly significant differences in hand hygiene practices between the pre-pandemic period and both the pandemic and post-pandemic periods. Interestingly, no significant difference was found between the post-pandemic and pandemic periods, indicating that the elevated levels of hand hygiene practices observed during the pandemic were maintained even after it ended. The study not only contributes valuable insights into evolving hand hygiene practices but also highlights the lasting impact of increased awareness and adherence introduced during the pandemic. The incorporation of Hand-in-Scan™ technology enriches measurement precision, augmenting overall hand hygiene compliance within healthcare settings. The findings underscore the need for continued emphasis on hand hygiene protocols, emphasizing their enduring impact on healthcare practices beyond the pandemic.

Keywords

Hand hygiene, nurses, pandemic, Hand-in-Scan™ technology, post-pandemic, pre-pandemic

Ethical Statement

Since this article is a sharing of experience, the management of the institution was duly informed before publication and permission was given to disseminate this information. Ethical approval was not obtained for this publication as it does not contain personal data.

Supporting Institution

The author declare that the study has no financial support

Thanks

We extend our sincerest appreciation to all participants who graciously contributed to this research endeavor.

Hemşirelerin El Hijyeninin Değerlendirilmesi: Pandemi Öncesi ve Pandemi Sonrası Dönemlere Kapsamlı Bir Analiz

Abstract

Bu boylamsal çok merkezli çalışmada, pandemi öncesi, pandemi ve pandemi sonrası dönemlerde hemşirelerin el hijyeni uygulamalarının incelenmesi amaçlandı. Çalışma Türkiye'de özel bir sağlık kuruluşunda gerçekleştirildi (2019-2023). El hijyeni değerlendirmesi, Hand-in-Scan™ (Semmelweis Systems by Hand-in-Scan; Macaristan) teknolojisi kullanılarak 2253 hemşire ile yapıldı. Elde edilen bulgulara göre, pandemi öncesi dönemde 936 örneklemle 93,32'lik bir temizlik puanı belirlendi. Ancak, pandemi döneminde kaydedilen örneklerin ortalaması dikkat çekici bir şekilde arttı, 892 kaydedilen örneklemle ortalama 97,94 puan görüldü. Bu artış, pandemi sürecinde hijyen protokollerine odaklanmanın ve el hijyeni uygulamalarına artan farkındalığın bir göstergesidir. Pandemi sonrası dönemde ise, 425 örneklemle birlikte ortalama temizlik puanında 96,79'a kadar hafif bir düşüş gözlendi. Farklı el bölgeleri için ortalama temizlik puanlarının ayrıntılı bir dökümü ve %95 Güven Aralıkları, her dönem boyunca beklenen temizlik seviyelerine ilişkin ayrıntılı bilgiler sundu. İstatistiksel analizler, pandemi öncesi dönem ile hem pandemi sonrası hem de pandemi dönemleri arasında oldukça anlamlı farklılıklar olduğunu ortaya koydu. Ancak, pandemi sonrası ve pandemi dönemleri arasında önemli bir fark tespit edilmedi ve pandemi sırasında gözlemlenen yüksek seviyelerle karşılaştırılabilir bir pandemi sonrası el hijyeni uygulamalarının devam ettiği vurgulandı. Bu çalışma, el hijyeni uygulamalarının gelişimine ilişkin değerli bilgiler sunmanın yanı sıra, pandemi sırasında artan farkındalık ve bağlılığın kalıcı etkisinin altını çizmektedir. Hand-in-Scan™ teknolojisinin kullanılması, ölçümlerin hassasiyetini artırarak sağlık hizmeti ortamlarında el hijyeni protokollerine uyumu güçlendirmektedir. Sonuçlar, el hijyeni prosedürlerine ve bunların pandeminin ötesinde sağlık hizmetleri uygulamaları üzerindeki kalıcı etkilerine sürekli dikkat edilmesi gerektiğinin altını çizmektedir.

Keywords

El hijyeni, hemşireler, pandemi, Hand-in-Scan™ teknolojisi, pandemi sonrası, pandemi öncesi

References

• Ojanperä H, Kanste OI, Syrjala H. Hand-hygiene compliance by hospital staff and incidence of health-care-associated infections, Finland. Bull World Health Organ. 2020;98(7):475-83.
• Mo Y, Pham TM, Lim C, et al. The effect of hand hygiene frequency on reducing acute respiratory infections in the community: a meta-analysis. Epidemiol Infect. 2022;150:e79.
• Babes LMD. Hand hygiene practices to reduce hospital acquired infection. Journal of Clinical & Biomedical Research. Published online December 31, 2019:1-4.
• Ataee R, Ataee M, Tavana A, Salesi M. Bacteriological aspects of hand washing: A key for health promotion and infections control. Int J Prev Med. 2017;8(1):16.
• Szilágyi L, Haidegger T, Lehotsky Á, et al. A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps.” BMC Infect Dis. 2013;13(1):249.
• Graveto JMG do N, Rebola RIF, Fernandes EA, Costa PJ dos S. Hand hygiene: nurses’ adherence after training. Rev Bras Enferm. 2018;71(3):1189-93.
• Lacey G, Showstark M, Van Rhee J. Training to proficiency in the WHO hand hygiene technique. J Med Educ Curric Dev. 2019;6.
• World Health Organization & WHO Patient Safety. WHO guidelines on hand hygiene in health care. https://www.who.int/publications/i/item/9789241597906.
• World Health Organization. WHO Research Agenda for Hand Hygiene in Health Care 2023–2030.; 2023. Accessed January 18, 2024. https://iris.who.int/bitstream/handle/10665/367527/9789240073715-eng.pdf?sequence=1
• Ariyarathne M, Gunasekara T, Weerasekara M, Kottahachchi J, Kudavidanage B, Fernando S. Knowledge, attitudes and practices of hand hygiene among final year medical and nursing students at the University of Sri Jayewardenepura. Sri Lankan Journal of Infectious Diseases. 2013;3(1):15.
• Alqahtani AN, Almaghrabi RH, Albaadani MM, Almossa K. Impact of infection control training program in improving the quality of healthcare. European Journal of Medical and Health Sciences. 2020;2(5). doi:10.24018/ejmed.2020.2.5.498
• Alwatifi M, Hattab W. Barriers to hand hygiene performance among nursing staff during the pandemic of Corona Virus Disease. Kufa Journal for Nursing Sciences. 2022;12(1). doi:10.36321/kjns/2022/120113
• Mal DK, Mukherjee B. Educational motivation and legislative approaches for safe and effective hand washes and hand rubs in hand health care during COVID-19 Pandemic. Asia Pacific Journal of Public Health. 2020;32(8):495-6.
• Moore LD, Robbins G, Quinn J, Arbogast JW. The impact of COVID-19 pandemic on hand hygiene performance in hospitals. Am J Infect Control. 2021;49(1):30-3.
• Escobar-Escobar MB, García-García N. Knowledge of COVID-19 and hand washing. Revista de Salud Publica. 2020;22(3). doi:10.15446/RSAP.V22N3.88152
• Tartari E, Pires D, Bellissimo-Rodrigues F, et al. The global hand-sanitizing relay: promoting hand hygiene through innovation. Journal of Hospital Infection. 2017;95(2):189-93.
• Smith T, Hess O, Pryor R, Doll M, Bearman G. Addressing frontline healthcare worker perspectives on hand-hygiene monitoring badges. Antimicrobial Stewardship & Healthcare Epidemiology. 2023;3(S2):72.
• Lehotsky Á, Szilágyi L, Ferenci T, et al. Quantitative impact of direct, personal feedback on hand hygiene technique. Journal of Hospital Infection. 2015;91(1):81-4.
• An B, Yang SJ. The evaluation of a multimodal hand hygiene improvement strategy in Cambodian hospitals. The Journal of Infection in Developing Countries. 2020;14(09):1047-53.
• Delea MG, Snyder JS, Woreta M, Zewudie K, Solomon AW, Freeman MC. Development and reliability of a Quantitative Personal Hygiene Assessment tool. Int J Hyg Environ Health. 2020;227:113521.
• Liu P, Cao F, Yao Q, Xu L, Dai H. Effectiveness of educational and training intervention for improving hand hygiene compliance amongst nurses: a systematic review and meta-analysis of randomised controlled trials. Scott Med J. 2023;68(3):72-9.
• Lin T, Lin C, Chen K, Hsu H. Information technology on hand hygiene compliance among health care professionals: A systematic review and meta‐analysis. J Nurs Manag. 2021;29(6):1857-68.
• Masroor N, Doll M, Stevens M, Bearman G. Approaches to hand hygiene monitoring: From low to high technology approaches. International Journal of Infectious Diseases. 2017;65:101-4.
• Fouad M, Eltaher S. Hand hygiene initiative: comparative study of pre- and postintervention outcomes. Eastern Mediterranean Health Journal. 2020;26(2):198-205.
• Clancy C, Delungahawatta T, Dunne CP. Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. Journal of Hospital Infection. 2021;111:6-26.
• Ghorbanmovahhed S, Shahbazi S, Gilani N, Ostadi A, Shabanloei R, Gholizadeh L. Effectiveness of implementing of an infection control link nurse program to improve compliance with standard precautions and hand hygiene among nurses: a quasi-experimental study. BMC Med Educ. 2023;23(1):265.
• Cserháti P. Hand hygiene practice in motherland of semmelweis. Antimicrob Resist Infect Control. 2015;4(S1). doi:10.1186/2047-2994-4-s1-p308
• Duong A, Haidegger T, Davies J, Ackerman M, Michael A. Evaluation of hand disinfection using the semmelweis system. InfectionControl.tips. 2017;5:1-9.
• Feith H, Lehotsky Á, Lukács Á, et al. Methodological approach to follow the effectiveness of a hand hygiene peer education training programme at Hungarian schools. Developments in Health Sciences. 2018;1(2). doi:10.1556/2066.2.2018.13
• Alci G, Bilgen H, Ozek E, Yagci AK. Hand hygiene compliance of health care workers in a neonatal intensive care unit: a prospective observation study. Int J Res Med Sci. 2021;9(12):3534.
• Kohli E, Ptak J, Smith R, Taylor E, Talbot EA, Kirldand KB. Variability in the hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units. Infect Control Hosp Epidemiol. 2009;30(3):222-5.
• Singh A, Haque A, Alahi A, et al. Automatic detection of hand hygiene using computer vision technology. Journal of the American Medical Informatics Association. 2020;27(8):1316-20.
• Dinu E, Repanovici A, Nemet C. Study about using of polymeric materials for improving hand hygiene quality for healthcare staff. Macromol Symp. 2022;404(1). doi:10.1002/masy.202100426
• Schmitz K, Kempker RR, Tenna A, et al. Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control. 2014;3(1):8.
• Shrestha GS, Shrestha M, Sharma R, et al. Hand hygiene skills of the health care workers and the effect of training and educational intervention: A single center cross-sectional study. Bangladesh Critical Care Journal. 2021;9(1):12-5.