Hand hygiene in pediatric and neonatal intensive care unit patients: Daily opportunities and indication- and profession-specific analyses of compliance

BackgroundHand hygiene is considered to be the single most effective tool to prevent health care-associated infections. Daily hand hygiene opportunities and compliance for pediatric/neonatal intensive care units (ICU) are currently unknown.MethodsThis was a prospective observational study in pediatric and neonatal ICU patients with analyses of hand hygiene behavior in relation to profession, indication, and shift and correlation with disinfectant usage.ResultsHand hygiene opportunities were significantly higher for pediatric (321/24 hours) than neonatal (194/24 hours; P = .024) patients. Observed compliance rates were 53% (pediatric) and 61% (neonatal) and found to be significantly higher in nurses (57%; 66%) than in physicians (29%, 52%, respectively; P < .001; P = .017, respectively). For neonates, compliance rates were significantly higher before patient contact and aseptic tasks (78%) than after patient, patient body fluid, or patients’ surrounding contact (57%; P < .001). Calculating disinfectant usage revealed a 3-fold lower compliance rate of 17%.ConclusionThis study provides the first data on opportunities for and compliance with hand hygiene in pediatric/neonatal patients encompassing the whole day and night activities and including a comparison of observed and calculated compliance rates. Observation revealed high compliance especially in nurses and in situations of greatest impact. The data provide a detailed characterization of hand hygiene performance in the neonatal/pediatric ICU setting.