Quality Assessment of Hand Hygiene and Effectiveness of WHO 6 Step Training among Healthcare Personnel in a Tertiary Care Cancer Hospital in Trivandrum, India: A Cross-sectional Study

Introduction: World Health Organization (WHO) 6 steps for effective Hand Hygiene (HH) practice to prevent cross infections emphasises on coverage of all aspects of the hand with the Alcohol Based Hand Rub (ABHR). The quality of hand rubbing usually remains un-monitored among healthcare workers. Hence, interventions to ensure both compliance and quality combined with periodic training would fill the deficiency in these practices in the healthcare setting.

Aim: To analyse the quality of HH using an Ultraviolet (UV) sensitive ABHR among healthcare workers in the Operation Theatre (OT) and post-surgical Intensive Care Unit (ICU).

Materials and Methods: This cross-sectional study was conducted in Regional Cancer Centre, Trivandrum, Kerala, India. Study population included 104 healthcare providers in the OT and post-surgical ICU, over a period of two months, from June 2017 to July 2017. Participants were asked to disinfect their hands according to WHO 6 steps using an ABHR to which an UV light sensitive pigment was added, and then place them in an UV light sensitive cabinet. Digital images of both sides of their hands were recorded. Every area of the hand not covered by the hand rub appeared as a dark spot and was considered an error. Pass criteria allowed a maximum of two small uncovered areas (dark spots <0.6 cm2) on the dorsal side of the hand and no uncovered areas on the palmar aspect. Each hand was observed specifically at four areas and the most missed areas were identified. Statistical analysis was done by Fisher’s-exact test using Statistical Package for Social Sciences (SPSS) version 28.0.

Results: Out of the total 104 participants, 28 were doctors, 46 were nurses, 22 were nursing students and 8 were OT technicians. A total of 65 participants were males (62%) and 85 participants (82%) were in the 35-40 years age group. The HH was found to be better on the right hand in all the sub-groups studied. The difference in the hand rub coverage on all the four observed areas of the right hand was not significant. On the left-side, hygiene in between the fingers (p-value 0.012) and at the finger tips (p-value 0.007) was poorest. Among the groups studied, doctors performed better with a higher group score of 60.7% compared to 22.7% of that of nursing students (p-value 0.030).

Conclusion: Quality of HH practice using ABHR among personnel involved in peri-operative care is poor and requires improvement with regular monitoring and training.