Resources, implementation, and performance of hand hygiene practices and their impact on hospital care: A multicenter cross-sectional survey in Greece.

Abstract

Background: Limited data exist on hand hygiene practices in Greek hospitals. This study assessed hand hygiene resources, implementation, and compliance in 8 public hospitals and their impact on health care-associated bloodstream infections (BSIs).

Methods: The World Health Organization's "Ward Infrastructure Survey," "Hand Hygiene Self-Assessment Framework" (HHSAF), and the "5 Moments" concept were employed. Hand hygiene indicators and BSI rates were assessed using Poisson regression.

Results: Handwashing facilities were provided in 87% of patient room toilets. Νearly, all sinks (96%) had soap, but disposable paper towels availability was 51%. Alcohol-based hand rub (ABHR) availability at the point of care was 41.8%. Hospitals scored at the "Basic" (n = 5, 62%) or "Inadequate" (n = 3, 38%) hand hygiene implementation level with a mean HHSAF score of 140. Compliance was 58.8% (95% CI: 56.9%-60.6%) in 1 surveyed tertiary hospital but only 9.8% (95% CI: 8.7%-11%) in 1 secondary. BSI rates in the wards were higher with higher ABHR availability (incidence rate ratio 1.09 per 10% increase in ABHR, P = .002) and when powdered gloves were not used (incidence rate ratio 2.09, P < .001).

Conclusions: Significant hand hygiene compliance discrepancies and ineffective implementation strategies within surveyed hospitals were determined. Improving hand hygiene infrastructure, education, and feedback could foster current scores.