SCIENTIFIC LETTER

Hand Hygiene Compliance Among Doctors in a Tertiary CareHospital of India

Payel Biswas & Subhankar Chatterjee

Received: 13 February 2013 /Accepted: 17 June 2013# Dr. K C Chaudhuri Foundation 2013

To the Editor: Hospital acquired infection (HAI) is oneimportant preventable threat to us and hand hygiene(HH) has been singled out as the most important mea-sure to limit the deleterious consequences of HAI [1].Presently, infection is a major cause of neonatal deathin developing countries like India [2]. Resurgence ofoutbreak of HAI among neonates in our institution inrecent past compelled us to start this observationalcross-sectional study with objective to assess the knowl-edge and practices of doctors regarding HH.

A total of 90 doctors involved in Labour Room andNeonatal Intensive Care Unit (NICU)were interviewed.Getting approval from the Institutional Ethics Commit-tee, formal permission was taken from the respectiveHead of the Departments i.e., Department of Gynecolo-gy & Obstetrics and Department of Pediatrics. All thedoctors of different professional status from both thedepartments (a total of 150 individuals) were includedas the study-population, amongst them 90 people gavethe consent to response as the study-subjects. Thestudy-subjects were approached individually; the ques-tionnaire was administered as per their convenient time.The administered questionnaire contained questionsbased on a model questionnaire [3] with adding somequestions reflecting HH-practices. Data were analysedby Epi Info, Version 3.6.

Amongst the 90 doctors, 8 (8.9 %) were Teaching-faculties, 5 (5.6 %) were Medical officers, 10 (11.1 %)were Senior Residents, 16 (17.7 %) were Junior Residentsand Internees were 51 (56.7 %) in number. This studyreflected that 67.78 % doctors received formal-training onHH and 77.78 % claimed that they knew the six steps ofproper hand-washing. 53.33 % of all did not washtheir hands before approaching each patient and only51.11 % used alcohol-based hand-rub for routine hand-washing. Among those 67.78 % doctors who had training,91.8 % knew the six steps of hand-washing but amongstthe doctors without training 51.17 % knew the steps(p 0.0063) and 57.38 % washed their hands before ap-proaching patients while 24.14 % doctors without trainingdid the same (p 0.0031) (Table 1). 60 % thought that theminimal time needed for killing organisms by alcohol-based hand-rub was 20–30 s. Among all study-subjects,72.22 % felt that one’s HH-behavior impacted their col-leagues’ HH-practices and 67.78 % found difficulties topursue proper HH-practices in wards. Patient load andunavailability of materials were pointed-out as major rea-sons respectively by 83.6 % and 63.9 % of doctorsexperiencing difficulties whereas a recent study [4]showed that the major limiting factors for poorer HH-compliance particularly in ICUs were the lack of facilitiesand resources.

Overall HH-compliance among doctors was unsatisfac-tory and knowledge about HH was not effectivelyreflected in original practice. So in this setting, incrementof doctor-patient ratio, ensuring availability of the suffi-cient materials and strict monitoring of doctors’ HH prac-tice are needed. The hospital authority must arrangerepetitive formal training sessions, seminars, workshop,

P. Biswas (*) : S. ChatterjeeR.G.Kar Medical College & Hospital 1, Kshudiram Bose Sarani,Kolkata 700004, West Bengal, Indiae-mail: itiranisarkar@gmail.com

Indian J PediatrDOI 10.1007/s12098-013-1150-4

Continuing Medical Educations etc. along with agendasfor behavioral modifications of doctors in order to im-prove HH compliance.

References

1. Sridhar MR, Boopathi S, Lodha R, Kabra SK. Standard precautionsand post exposure prophylaxis for preventing infections. Indian JPediatr. 2004;71:617–25.

2. Million Death Study Collaborators, Bassani DG, Kumar R, Awasthi S,Morris SK, Paul VK, et al. Causes of neonatal and childmortality in India:A nationally representative mortality survey. Lancet. 2010;376:1853–60.

3. World Health Organization. Hand hygiene knowledge questionnairefor health-care workers. Last accessed on September 12, 2012.Available from http://www.who.int/gpsc/5may/tools/evaluation_feedback/en/.

4. Anwar MA, Rabbi S, Masroor M, Majeed F, Andrades M, Baqi S.Self-reported practices of hand hygiene among the trainees of ateaching hospital in a resource limited country. J Pak Med Assoc.2009;59:631–4.

Table 1 Distribution of study subjects by their knowledge and self-reported practice of proper HH and status of formal training

Knowledge and practice Received formal training(n=61)

Had not received formal training(n=29)

X2 df p

No. % No. %

Knew the 6 steps of proper hand-washing 54 91.8 16 51.17 12.65 1 0.0063

Washed hands before approaching each of the patients 35 57.38 7 24.14 8.73 1 0.0031

Indian J Pediatr