title: Improving hand hygiene compliance rates in the haemodialysis setting: more than just more hand rubs.
abstract: BACKGROUND
  Haemodialysis patients are at high risk for developing healthcare-associated infections as well as acquiring multidrug-resistant microorganisms. Hand hygiene is considered to be the single most effective tool to prevent healthcare-associated infections. The number of indications and the extent of indication-specific compliance with hand rubs in the haemodialysis setting are currently unknown.
  
  
  METHODS
  We conducted a prospective, three-phase, observational intervention study on hand hygiene during haemodialysis treatments. Optimized hand hygiene standard operating procedures (SOPs) for dialysis connections (Intervention I) and disconnections (Intervention II) were compiled and implemented during two predefined intervention periods.
  
  
  RESULTS
  A total of 8897 indications for hand rubs were observed throughout this study. In the course of the study, we identified an increase in the number of hand rubs performed (6-9, mean number per dialysis procedure), parallelled by a decrease in the indications for hand rubs (21-15), resulting in a significant increase of overall hand rub compliance (30-62%). The greatest improvement was seen before aseptic tasks (21-52%), the indication with the greatest impact on preventing healthcare-associated infections. There was no difference between haemodialysis via central venous catheter access or arterio-venous (AV) fistulas.
  
  
  CONCLUSIONS
  This study provides the first detailed data on the number of and indications for hand rubs during dialysis. An >100% increase in overall hand hygiene compliance could be achieved by a comparably moderate increase in hand rubs performed in combination with optimized hand hygiene SOPs.
authors.affiliation: Department of Infection Control and Infectious Diseases, RWTH Aachen University Hospital, Aachen, Germany. sscheithauer@ukaachen.de
authors.forename: Simone
authors.initials: S
authors.lastname: Scheithauer
authors.forename: Frank
authors.initials: F
authors.lastname: Eitner
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mankartz
authors.forename: Helga
authors.initials: H
authors.lastname: Haefner
authors.forename: Katharina
authors.initials: K
authors.lastname: Nowicki
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
authors.forename: Sebastian W
authors.initials: SW
authors.lastname: Lemmen
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006235:Hand Disinfection / Q000592:standards*; D006436:Hemodialysis Units, Hospital; D006801:Humans; D006920:Hygiene / Q000592:standards*; D017053:Infection Control / Q000592:standards; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D008297:Male; D011446:Prospective Studies; D058996:Quality Improvement; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods