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 Table of Contents  
Year : 2022  |  Volume : 1  |  Issue : 1  |  Page : 9-11

Compliance of hand hygiene practices in operating rooms by care workers: A preliminary observational study

1 Department of Anaesthesiology and Critical Care, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
2 Department of Anaesthesia and Critical Care, Rajiv Gandhi Cancer Institute, Delhi, India

Date of Submission14-Dec-2021
Date of Acceptance26-Apr-2022
Date of Web Publication20-May-2022

Correspondence Address:
Dr. Mahima Lakhanpal
Flat No. 904, Tower 4, Orange County, Ghaziabad, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jica.jica_5_21

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Context: Hand hygiene is the most important measure to prevent healthcare-associated infections. As part of a major global effort to improve hand hygiene in health care, the SAVE LIVES: Clean Your Hands annual global campaign was launched by the World Health Organization (WHO) in 2009. The “My 5 Moments for Hand Hygiene” approach by the WHO defines the key moments when health-care workers should perform hand hygiene. Aims: This is a preliminary observational study to monitor the level of adherence to hand hygiene practice by health-care workers (HCWs) in an operating room. Materials and Methods: This study was conducted in the surgery operation theater (OT) of our hospital. Direct observation of various personnel working in the OT was done by a single-trained observer. The time of observation was taken from the transfer of the patient on the OT table to the draping of the patient by the surgeon. The hand hygiene opportunities (HHO) as stated by WHO My 5 moments of hand hygiene were noted. Results and Conclusion: A total of 524 HHO were observed among health-care workers, among which 301 were missed and 223 were utilized. Out of the opportunities used were moments 3 and 4, which are primarily for the personal protection of Healthcare workers. Overall compliance of hand hygiene is very low among health-care professionals in the OT. There is an urgent need to educate the health-care personnel about “5 moments of hand hygiene” and ensure strict compliance to ensure patient's safety.

Keywords: Hand hygiene, health-care workers, patient safety

How to cite this article:
Lakhanpal M, Kumar R, Chawla R, Sarkar D, Yadav I. Compliance of hand hygiene practices in operating rooms by care workers: A preliminary observational study. J Ind Coll Anesth 2022;1:9-11

How to cite this URL:
Lakhanpal M, Kumar R, Chawla R, Sarkar D, Yadav I. Compliance of hand hygiene practices in operating rooms by care workers: A preliminary observational study. J Ind Coll Anesth [serial online] 2022 [cited 2023 Sep 25];1:9-11. Available from: https://www.jicajournal.in//text.asp?2022/1/1/9/345601

  Introduction Top

Infection due to hospital-acquired microbes is a major concern worldwide. The World Health Organization (WHO) prevalence of healthcare-associated infection (HCAI) varies between 5.7% and 19.1% in low- and middle-income countries. Patient contact in the operating theater (OT) can contribute to HCAI through microbial contamination. Hand hygiene is considered the single most cost-effective public health measure in preventing HCAI. A simple act of hand hygiene that should be routine behaviour among health care workers (HCWs) is universally low worldwide.[1],[2]

It has been observed that strictly following adequate hand hygiene protocols by health-care personnel could lead to a significant 15%–30% reduction in hospital-acquired infection (HAI); however, studies have shown that hand hygiene compliance rates are about 50% of opportunities in hospitals.[3],[4]

The WHO's first global safety challenge, “Clean Care is Safe Care,” launched in October 2005, focuses on improving health-care workers' hand hygiene standards and practices. “Clean Care is Safe Care” is not a choice but a fundamental right. The WHO introduced global guidelines on health care in 2009, My 5 Moments of Hand Hygiene [Table 1].[1] Recently, in the wake of the global Covid-19 pandemic, WHO in May 2021, started a “Seconds save lives – clean your hands”: campaign to focus on the utmost necessity of improving hand hygiene practices to stop the spread of SARS-CoV-2 and continue good practices even after the pandemic.[5]
Table 1: World Health Organization: The 5 moments of hand hygiene in health care

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Aim of the study

This study aims to monitor the adherence to hand hygiene practices by health-care workers in an operating room at our hospital.

  Materials and Methods Top

It is an observational study conducted for 6 months in our hospital's neurosurgery elective OT and elective general surgery OT. A single-trained observer directly observed the hand hygiene adopted by various personnel working in the OT.

OT staff was categorized as follows:

  • Anesthesia consultants
  • Surgery consultants
  • Anesthesia residents
  • Surgery residents
  • Anesthesia technicians.

Members of staff were unaware of the nature of the study to eliminate a Hawthorne-like effect. The observer kept the washing area in view to observe hand hygiene. Hand hygiene application is defined as using soap and water for hand wash or alcohol-based hand rub irrespective of the duration and amount of cleaning product used. The time of observation was taken from the transfer of the patient on the OT table to the start of draping of the patient by the surgeon; thus, the surgery consultants and surgery residents who were scrubbed and donned sterile gowns were not included in the study.

The hand hygiene opportunities (HHOs) as stated by the “WHO-My five moments of hand hygiene” were noted.

Hand wash or rub:

  1. Before patient contact
  2. Before an aseptic task
  3. After body fluid exposure risk
  4. After patient contact
  5. After contact with the patient's surroundings.

Compliance was measured as a percentage using the formula:

(Hand hygiene application/HHO) × 100

The use of gloves with or without hand hygiene was noted.

  Results Top

Five hundred and twenty-four HHOs were observed among health-care workers [Table 2]. They were subdivided into two groups:
Table 2: Hand hygiene opportunities observed

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  • Missed: Hand hygiene application was not made
  • Utilized: Hand hygiene application was made
  • Total number of HHOs observed (N) =524
  • 301 were missed (57.44%)
  • 223 were utilized (42.55%).

  Discussion Top

Although the present study was conducted in the pre-COVID-19 era, the present scenario warrants utmost care and strict adherence to hand hygiene in health-care workers. Not only does it protect the health-care worker, but it also prevents infection transmission as well as cross-infection among patients. During this COVID-19 time, it has been proven and advised that simple hand hygiene decreases the spread of infection.[5],[6] Megeus et al. reported that an overall adherence to hand hygiene guidelines was 5.3% and was more common after a procedure than before one.[7] Krediet et al., in their study on the compliance of hand hygiene, stated that hand hygiene on entering or leaving the OT was rare (2% and 8%, respectively).[8]

The present study observed 524 HHOs among various health-care professionals in neurosurgery OT. The health-care workers touched the patient without hand hygiene application; adherence to HHO moment 1 is 5.6%. However, only 17.8% of HCWs used hand hygiene applications. HCW's hand hygiene application was relatively better after body fluid exposure risk, after patient contact, and after contact with patient surroundings in 30.2%, 41%, and 47%, respectively [Graph 1].

Personal protection is the reason for high compliance for HHO moment 3, 4, and 5. The use of gloves was taken as a substitute for hand hygiene applications. 72.5% used gloves without hand hygiene applications. Even aseptic procedures like catheterization were done using gloves without hand hygiene applications [Graph 2]. The Royal Free Hospital NHS Trust research observed more than 7,000 patient contacts. Found hand hygiene compliance “disappointingly low” at 47.7 %. Compliance was even lower where gloves were worn: just over 41%.[9]

Several observational studies have demonstrated a reduction in HAI rates related to improved hand hygiene.[10] Koff et al., in a controlled study, observed that the incidence of HCAI 30 days after the surgery reduced from 17.2% to 3.8%, with an increase in the frequency of hand hygiene in the O.T. from 0.15–0.38 to 7.1–8.7 hand hygiene applications per hour.[11] Rosenthal et al. observed an improvement in hand hygiene adherence from 23.1% to 64.5% after educating HCW. The overall nosocomial infection decreased from 47.55% to 27.93% during the same period.[12]

  Conclusion Top

This study illustrates that adherence to hand hygiene is extremely low among OT staff. This is likely to increase HCAIs. An institutional and organizational intervention is needed to raise awareness among health-care workers, ensuring strict adherence to hand hygiene practices. It will promote and facilitate the application of hand hygiene and reduce HCAI.

Our study was limited as the microbial study was not done. Moreover, the number of opportunities observed is less. The present study is only limited to OT; however, to ensure patient's safety and lower incidence of infection, this practice is to be extended to other workplaces in the hospital.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge: Clean Care is Safer Care. Geneva, Switzerland: World Health Organization, Patient Safety; 2009.  Back to cited text no. 1
Consensus Measurement in Hand Hygiene Project Expert Advisory Panel. Measuring Hand Hygiene Adherence: Overcoming the Challenges. Oakbrook Terrace, IL: The Joint Commission; 2009.  Back to cited text no. 2
Grol R, Grimshaw J. From best evidence to best practice: Effective implementation of change in patients' care. Lancet 2003;362:1225-30.  Back to cited text no. 3
Larson E. A causal link between handwashing and risk of infection? Examination of the evidence. Infect Control Hosp Epidemiol 1988;9:28-36.  Back to cited text no. 4
WHO Calls for Better Hand Hygiene and Other Infection Control Practices. Departmental News. Geneva, Switzerland: WHO; 2021.  Back to cited text no. 5
WHO. Infection Prevention and Control during Health Care When Novel Coronavirus (nCoV) Infection Is Suspected. Interim Guidance. Geneva, Switzerland: WHO; 2020.  Back to cited text no. 6
Megeus V, Nilsson K, Karlsson J, Eriksson BI, Andersson AE. Hand hygiene and aseptic techniques during routine anesthetic care-Observations in the operating room. Antimicrob Resist Infect Control 2015;4:5.  Back to cited text no. 7
Krediet AC, Kalkman CJ, Bonten MJ, Gigengack AC, Barach P. Hand-hygiene practices in the operating theatre: An observational study. Br J Anaesth 2011;107:553-8.  Back to cited text no. 8
Fuller C, Savage J, Besser S, Hayward A, Cookson B, Cooper B, et al. “The dirty hand in the latex glove”: A study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol 2011;32:1194-9.  Back to cited text no. 9
Laher AE, Van Rooyen LR, Jawa A, Enyuma CO, Swartzberg KM. Compliance with hygiene practices among healthcare workers at an academic hospital emergency department. Afr J Emerg Med 2021;11:352-5.  Back to cited text no. 10
Koff MD, Loftus RW, Burchman CC, Schwartzman JD, Read ME, Henry ES, et al. Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a novel device. Anesthesiology 2009;110:978-85.  Back to cited text no. 11
Rosenthal VD, Guzman S, Safdar N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005;33:392-7.  Back to cited text no. 12


  [Table 1], [Table 2]


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