Hand hygiene among health care workers (HCW) is the most important, the easiest and the cheapest preventative measure against nosocomial infections. Hand disinfection is more effec­tive, faster and less harmful for the skin than all other hand hygiene techniques. This study evaluated compliance with hand hygiene rules in an intensive care unit (ICU) where alco­holic hand disinfection is the standard procedure for hands that are not visibly soiled.

Patients and methods. Opportunities for hand hygiene were defined according to CDC guidelines. HCW in 6 patient rooms was observed during routine care and clinical rounds over 2 months. One month into the study, additional infection-control measures were imple­mented, encouraging HCW to use alcoholic hand disinfection more consistently. Compliance with hand hygiene guidelines was related to the transmission of methicillin-resistant Staphylococcus aureus (MRSA) between patients in the ICU. 531 opportunities for observing hand hygiene were documented. In 75% of the opportunities, HCW performed a hand hygiene procedure: hand disinfection was used in 97% with a mean duration of 7 seconds, whereas hand washing was used in 3% and required a mean of 11 seconds. Compliance was higher after removing gloves (85%), after direct patient contact (89%) and after contact with a patien­t’s bodily fluids (100%) than between care of clean and dirty bodily areas (21%) and before manipulating vascular and urinary catheters (25%) (p<0.05). After implementing additional infection-control measures, compliance increased significantly, from 72% to 82% (p<0.05). This correlated with a decrease in the incidence of MRSA transmission from 11% to 2% (p=0.003) in the same period. During the study, compliance did not significantly differ among age groups, gender or profession. The overall compliance with hand hygiene in HCW was good (75%). Hand disinfection was performed in 97% of cases. An increase in compliance with hand hygiene was achieved as a result of additional motivation of HCW to use hand disinfection; this also correlated with a significant decrease in MRSA transmission in the ICU.