Hand hygiene: An effective key HIC parameter for reducing healthcare-associated infections in a haemodialysis unit – Identification and analysis of work system factors

Introduction: Infection is the most common cause of hospitalisation and the second most common cause of mortality amongst haemodialysis (HD) patients, after cardiovascular disease. Hand hygiene (HH) reduces infections and enhances patient safety across all settings. However, the lack of compliance with HH amongst health-care providers is problematic worldwide. With the above background, a study was conceptualised to ascertain the current status of the HH practices during a complete HD procedure among nursing staff of an HD unit at a tertiary healthcare teaching institute in India. Methodology: A prospective cross-sectional study was conducted from 10 October, 2018, to 10 December, 2018. A structured checklist for HH during a complete HD procedure was developed as per the WHO's five moments of HH. One hundred and fifty HD procedures were observed for compliance appropriate number of HH. Data analysis was done using the SPSS version 22. Results: Despite being a very simple step, the compliance rates of health-care workers (HCWs) in HH were found extremely poor, ranging from 23% to 35% only. Reasons for non-compliance by HCWs told by them were: poor nurse-to-patient ratio, frequent turnover of nursing staff, lack or inadequate training and lower level of competency among HD staff. Conclusion: The high number of times an HD staff is required to perform HH could be a reason for lack of compliance. However, compliance can be improved by continuous education and supervision and by providing, in convenient locations, sufficient number of sink with soap dispensers, paper towels, hand lotions and Anti-Bacterial Hand Rubs (ABHRs) placed at each patient station.