Hand decontamination practices and the appropriate use of gloves in two adult intensive care units in Malaysia.
BACKGROUND
Hand decontamination is a critical infection control practice in the prevention of nosocomial infection. This study was conducted to observe the hand hygiene practices of nurses and doctors in two intensive care units (ICUs) in Malaysia.


METHODS
Staff members were observed during patient contacts, and their hand washing techniques and hand hygiene practices were monitored. Five contact periods were observed for staff members while they cared for their assigned patients. Hand hygiene practices before and after patient contacts were categorized as clean uncontaminated, clean recontaminated, new gloves, and unchanged contaminated gloves. Compliance to hand-washing steps and time taken for hand washing were analyzed. Appropriate use of gloves based on CDC criteria also was assessed.


RESULTS
Compliance to hand hygiene practices was 70% before each patient contact. Staff members did not completely adhere to the hand-washing steps. The average time taken to wash hands was 20 seconds, and the necessary steps (rubbing palm over dorsum; rubbing fingers interlaced, and rotational rubbing of thumbs) were practiced minimally by all staff. Hand washing protocol was generally followed by all staff (100%). Alcohol hand rubs were available but were used moderately (60%); when used, staff members did not wait for the alcohol to dry. Only 4% of staff changed contaminated gloves between patients.


CONCLUSIONS
Hand hygiene compliance by ICU staff members needs to be improved. Improving adherence to correct hand hygiene techniques will require effective education programs and behavioral modification techniques. Moreover, hand hygiene guidelines must be incorporated into new staff orientation programs and the continuing education curriculum in the two hospitals studied.
Katherason
Supaletchimi Gopal
SG
Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia. supa0026@yahoo.co.uk
Naing
Lin
L
Jaalam
Kamarudin
K
Nik Mohamad
Nik Abdullah
NA
Bhojwani
Kavita
K
Harussani
Najah Dato' Seri Hj
ND
Ismail
Asma
A
D000328:Adult; D003666:Decontamination / Q000706:statistics & numerical data*; D005260:Female; D017575:Gloves, Protective / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006235:Hand Disinfection / Q000379:methods / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D008296:Malaysia; D008297:Male; D013997:Time Factors