title: Hand hygiene in intensive care units: a matter of time?
abstract: BACKGROUND
  Healthcare-associated infections are a frequent threat to patient safety and cause significant disease burden. The most important single preventive measure is hand hygiene (HH). Barriers to adherence with HH recommendations include structural aspects, knowledge gaps, and organizational issues, especially a lack of time in daily routine.
  
  
  OBJECTIVE
  To determine the number of hand hygiene opportunities (HHOs), compliance rates, and time spent on hand hygiene in intensive care units (ICUs).
  
  
  METHODS
  We conducted an observational study in two ICUs to determine the average number of HHOs per patient. Documentation was based on the World Health Organization concept of 'five moments for hand hygiene'. HHOs were collected in 12 patient rooms for 12h each.
  
  
  RESULTS
  On average, 134 (internal ICU) and 182 (surgical ICU) HHOs per patient were observed during the 12h observation period. Overall HH compliance was 42.6%. Considering additional HHOs during the night shift, we estimated 218 (internal ICU) and 271 (surgical ICU) HHOs per patient-day. The average duration of hand disinfection was 7.6s. The time spent on HH was 8.3 (internal ICU) and 11.1 (surgical ICU) min during the day shift for each patient for all healthcare workers (nurses: 6.9min in the internal ICU and 8.3min in the surgical ICU). If nurses fully complied with guidelines, 58.2 (internal ICU) and 69.8 (surgical ICU) min would be spent on HH for each patient during the day shift.
  
  
  CONCLUSIONS
  Complying with guidelines is time-consuming. Sufficient time for HH should be considered in staff planning.
authors.affiliation: Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany. Electronic address: Stahmeyer.Jona@mh-hannover.de.
authors.forename: J T
authors.initials: JT
authors.lastname: Stahmeyer
authors.affiliation: Hannover Medical School, Medical Psychology Unit, Hannover, Germany; Leipzig University Hospital, Institute of Hygiene/Hospital Epidemiology, Leipzig, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Lutze
authors.affiliation: Hannover Medical School, Medical Psychology Unit, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: von Lengerke
authors.affiliation: Leipzig University Hospital, Institute of Hygiene/Hospital Epidemiology, Leipzig, Germany; Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Hannover, Germany.
authors.forename: I F
authors.initials: IF
authors.lastname: Chaberny
authors.affiliation: Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Krauth
mesh_terms: D019983:Guideline Adherence; D063373:Hand Hygiene; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D013995:Time
keywords: Compliance; Guidelines; Hand hygiene; Healthcare workers; Intensive care units