Determinants of hand hygiene non-compliance in a cardiac center in Saudi Arabia

OBJECTIVE: To evaluate the baseline hand hygiene non-compliance rate, and identify the factors associated with non-compliance in a cardiac center in Saudi Arabia.

METHODS: This observational study was conducted in Prince Sultan Cardiac Center, Riyadh, Saudi Arabia, a 176 beds specialized cardiac center. In total, 6,022 observations were recorded by using the Infection Control Link Nurse program from all the high and non-high risk areas from October to December 2012. The data was collected from different healthcare workers (HCW) for World Health Organization 5 indications of hand hygiene. Non-compliance rate was calculated, and univariate and multivariate analysis was performed using logistic regression to identify factors significantly associated with non-compliance.

RESULTS: The overall hand hygiene non-compliance rate was observed to be approximately 34%. Factors significantly associated with non-compliance included physicians (OR=2.71, 95% confidence intervals [CI]=2.33-3.13), after touching the patient's surrounding (OR=4.8, 95% CI=3.98-5.78), before touching a patient (OR=3.3, 95% CI=2.87-3.86), and high-risk areas (OR=1.16, 95% CI=1.03-1.31). Morning shifts were significantly associated (OR=1.13, 95% CI=1.00-1.29) with non-compliance as compared to the evening shifts.

CONCLUSION: Stratified analysis indicated that non-compliance is still a noticeable concern. The results suggest that broad spectrum educational activities and behavioral modification strategies should be advocated to include all HCW, particularly physicians, and should emphasize on performing hand hygiene during all the indications and not just the ‘after’ indications.