title: A multicentric survey of the practice of hand hygiene in haemodialysis units: factors affecting compliance.
abstract: BACKGROUND
  This study intended to investigate the degree of compliance with hand hygiene and use of gloves by health workers in haemodialysis (HD) units, and the factors that influenced adherence to hand hygiene protocols.
  
  
  METHODS
  During the month of November 2003, one person observed the health care staff in each of nine different dialysis units, during 495 randomly distributed 30 min observation periods that covered all steps of a haemodialysis session (connection, dialysis and disconnection). The observers noted the number of potential opportunities to implement standard precautions and the number of occasions on which the precautions were actually taken. Adherence to standard precautions was evaluated, analysing the influence of the following variables: the patient-to-nurse ratio, the number of HD shifts scheduled per day, acute HD units vs chronic, whether or not infectious patients were isolated and in-house vs contract cleaning personnel.
  
  
  RESULTS
  There were a total of 977 opportunities to wear gloves for, and to wash the hands following, a patient-oriented activity, and 1902 opportunities to wash hands before such an activity. Gloves were actually used on 92.9% of these occasions. Hands were washed only 35.6% of the time after patient contact, and only 13.8% of the time before patient contact. Poor adherence to hand washing was associated with the number of shifts per HD unit per day and with higher patient-to-nurse ratios. In the acute HD units, there was greater adherence to standard precautions than in the chronic units, although there too it was substandard. The personnel's knowledge of patients' infectious status did not modify their adherence to hand hygiene practices. A higher patient-to-nurse ratio independently influenced hand washing both before and after patient contact.
  
  
  CONCLUSIONS
  The overall adherence of health care workers to recommended hand washing practices is low. Whether or not programmes promoting higher hand hygiene standards and the potential use of alcohol-based hand cleansers will improve hand hygiene practices in HD units requires further investigation.
authors.affiliation: Hospital Perpetuo Socorro, Alicante, Spain. arenasd@perpetuosocorro.nehos.com
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Arenas
authors.forename: José
authors.initials: J
authors.lastname: Sánchez-Payá
authors.forename: Guillermina
authors.initials: G
authors.lastname: Barril
authors.forename: Juan
authors.initials: J
authors.lastname: García-Valdecasas
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Gorriz
authors.forename: Antonio
authors.initials: A
authors.lastname: Soriano
authors.forename: Andres
authors.initials: A
authors.lastname: Antolin
authors.forename: José
authors.initials: J
authors.lastname: Lacueva
authors.forename: Sergio
authors.initials: S
authors.lastname: García
authors.forename: Ana
authors.initials: A
authors.lastname: Sirvent
authors.forename: Mario
authors.initials: M
authors.lastname: Espinosa
authors.forename: Manuel
authors.initials: M
authors.lastname: Angoso
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D017575:Gloves, Protective / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000592:standards; D006526:Hepatitis C / Q000517:prevention & control; D006757:Hospital Units / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000592:standards*; D006435:Renal Dialysis; D013030:Spain; D016635:Universal Precautions