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 Table of Contents  
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 22-24

Hand hygiene: From semmelweis to present!

1 Department of Lab Medicine, Sahara Hospital, Lucknow, Uttar Pradesh, India
2 Department of Infection Control, Sahara Hospital, Lucknow, Uttar Pradesh, India

Date of Web Publication31-Mar-2017

Correspondence Address:
Areena Hoda Siddiqui
Department of Lab Medicine, Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow - 226 010, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2214-207X.203537

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Background: In the era of multidrug-resistant organisms and dearth of new antimicrobials, hand hygiene has become an important tool in reducing the burden of healthcare associated infections (HAIs). The content of this article is based on awareness and practice of hand hygiene among healthcare workers (HCWs).
Objectives: Hand hygiene has emerged as one of the most important strategies to prevent HAIs. Hand hygiene practice has led to the decrease in infections. The present study was undertaken to assess the compliance among HCWs.
Materials and Methods: Hand hygiene compliance and number of opportunities were evaluated for 2 years (2013 and 2014), and the data were compared. The study was carried out in the emergency department and critical care areas of our hospital.
Results: It was found that the number of events monitored and compliance increased considerably in the subsequent year. The compliance rate on an average increased from 57.6% to 61.6%.
Conclusions: The present results emphasise on the regular training and education of hand hygiene among HCWs. They should be made aware of the HAIs and that hand wash and hand rub help in decreasing the rate of HAIs.

Keywords: Hand hygiene, hand hygiene compliance, hand hygiene opportunities, healthcare-associated infections, healthcare worker

How to cite this article:
Siddiqui AH, Srivastava VK, Aneeshamol P P, Prakash C. Hand hygiene: From semmelweis to present!. J Patient Saf Infect Control 2016;4:22-4

How to cite this URL:
Siddiqui AH, Srivastava VK, Aneeshamol P P, Prakash C. Hand hygiene: From semmelweis to present!. J Patient Saf Infect Control [serial online] 2016 [cited 2023 Mar 30];4:22-4. Available from: https://www.jpsiconline.com/text.asp?2016/4/1/22/203537

  Introduction Top

'When I look back upon the past, I can only dispel the sadness which falls upon me by gazing into that happy future when the infection will be banished. The conviction that such a time must inevitably sooner or later arrive will cheer my dying hour.' These are the words by Ignaz Semmelweis, who advocated the use of chlorine lime solution to wash hands after examining and to change clean laboratory coats before examining the patients. That time, people disagreed, and he was sent to a mental asylum where he finally died of sepsis, mainly, the same disease which he fought throughout his life to save the mothers from childbed fever.[1]

With the same concept and having knowledge of clean hands practice, today, after 168 years, hand washing is promoted in every hospital and health-care services. WHO patient safety launched the first global patient safety challenge; Clean Care is Safer Care in 2005.[2] In 2009, WHO launched extension to this program; Save Lives: Clean your hands,[3] and again in 2015, WHO global annual campaign is Save Lives: Clean your hands. It advocates the need to improve and maintain hand hygiene practices among healthcare workers (HCWs) in the right way and at the right times to help reduce the spread of infections in healthcare areas.

Millions of patients are affected every year by healthcare-acquired infection (HAI) which is considered as the most undesirable outcome in healthcare field. Due to difficulty in gathering data, the global burden remains unknown. Bedside hand hygiene practices are considered as one of the factors for the improvement of HAI and control.[4],[5]

Good hand hygiene practices have demonstrated a reduction in HAI. Even though the hand washing procedure is simple and easy to perform, adherence to hand washing recommendations is inappropriately low around 40%–50%.[6]

The present study was done to assess the compliance and to establish hand hygiene practices in our hospital.

  Materials and Methods Top

The study was done in our 250-bedded tertiary care hospital from January 2013 to December 2014. Hand hygiene practices in the emergency and critical care areas (medical, surgical, neurosurgical, neuromedical, neonatal Intensive Care Units and high dependency unit [HDU]) were monitored. Data of 2 years were compared and analysed.

Infection control nurses (ICNs) were instructed to train and educate HCW in these locations. A checklist [Table 1] was prepared which included location, type of HCW and opportunities observed. The opportunities observed covered all the five moments of hand hygiene as per the WHO guidelines.
Table 1: Opportunities observed and monitored during study

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ICN used to monitor opportunities and actions performed for 1 h per location per day in each of the critical areas and emergency. Randomly selected HCWs in that particular area were observed for hand hygiene. ICN used to note all the opportunities for that HCW and write 'Y' (Yes) if hand hygiene was performed and 'N' (No) if not performed in the relevant opportunity rows. Chi-square test was used to test the significance, and a P< 0.05 was considered statistically significant.

  Results Top

[Table 2] shows number of actions performed, total number of opportunities and compliance in 2013 and 2014, respectively. It was noted that there was an increase in the observation of ICN for opportunities, and at the same time, there was an increase in compliance. Compliance was statistically significant in HDU and Intensive Cardiac Care Unit and borderline significant in Neonatal Intensive Care Unit. The compliance rate seen in different locations varied from 53% to 66% in 2013 and 56% to 71% in 2014.
Table 2: Actions performed (Y), total opportunities (T), % compliance (%C) and P value

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  Discussion Top

The major hindrances in practicing hand washing are the issues of mind set and behaviour amongst HCWs. There are various factors which contribute to poor compliance in hand washing; these include lack of knowledge among HCWs about the importance of hand hygiene in reducing the spread of infection, understaffing, overcrowding, poor facilities hand washing, lack of following of correct hand hygiene technique, irritant contact dermatitis associated with frequent exposure to hand wash and lack of institutional commitment to good hand hygiene.[7]

Hand hygiene compliance can be improved by introduction of alcohol-based hand rub, reminders in the workplace, educational, behavioural, administrative support and motivation.[8],[9]

Hand hygiene compliance surveillance is essential to understand the current practice among HCWs and to measure the impact of interventions. This can be done by direct observation by ICN, product consumption, automated monitoring and self-reporting by HCW.[10]

Our study is a direct observation study which is considered as the gold standard.[11] The drawbacks associated with this type of study are observation bias (Hawthorne effect), observer bias and selection bias. It is time-consuming and continuous monitoring is not possible. In our study, only two ICNs used to monitor randomly selected HCW which reduces observer and selection bias. Observation bias was there. Indirect observation includes product consumption and electronic monitoring of hand rub and hand wash basins which are less time-consuming and overcome the direct observation drawbacks but are resource demanding.[12],[13] Observation bias can be overcome by behavioural change in HCW. Continuous training and education are imparted in our hospital to address this lacuna.

Although the compliance rate in our study was low as compared to other studies, it was found that with continuous monitoring and education, it increased significantly.[13],[14],[15]

  Conclusion Top

Thist study thus shows that with regular training and education there can be an increase in practice hence compliance of hand hygiene. Training, education along with motivation together forms an important part of infection prevention and control.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Rodriguez LA, Kachala SS, Adusumilli PS. Doctor, did you wash your hands? Natl Med J India 2010;23:111-2.  Back to cited text no. 1
WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft): A Summary. World Health Organization; 2005. Available from: http://www.who.int/patientsafety/events/05/HH_en.pdf. [Last accessed on 2015 Apr 16].  Back to cited text no. 2
Storr JA, Engineer C, Allan V. Save lives: Clean your hands: A WHO patient safety initiative for 2009. World Hosp Health Serv 2009;45:23-5.  Back to cited text no. 3
World Health Organization. Report on the burden of endemic health care-associated infection worldwide. Geneva: World Health Organization; 2011.  Back to cited text no. 4
Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis. Lancet 2011;377:228-41.  Back to cited text no. 5
Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med 1999;130:126-30.  Back to cited text no. 6
Pittet D, Boyce JM. Hand hygiene and patient care: Pursuing the Semmelweis legacy. Lancet Infect Dis 2001;1:9-20.  Back to cited text no. 7
Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000;356:1307-12.  Back to cited text no. 8
Magiorakos AP, Suetens C, Boyd L, Costa C, Cunney R, Drouvot V, et al. National hand hygiene campaigns in Europe, 2000-2009. Euro Surveill 2009;14. pii: 19190.  Back to cited text no. 9
Consensus Management in Hand Hygiene Project Expert Advisory Panel. Measuring hand Hygiene Adherence: Overcoming the Challenges. Oakbrook Terrace IL: The Joint Commission; 2009. Available from: http://www.ihi.org/knowledge/pages/Publications/MeasuringHandHygieneAdherenceOvercomingtheChallenges-appex. [Last accessed on 2015 Mar 05].  Back to cited text no. 10
WHO Guidelines on Hand Hygiene in Health Care, 2009; 11th September, 2014. Available from: http://www.whqlibdoc.who.int/publications/ 2009/9789241597906_eng.pdf. [Last accessed on 2015 Apr 29].  Back to cited text no. 11
Srigley JA, Furness CD, Baker GR, Gardam M. Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: A retrospective cohort study. BMJ Qual Saf 2014;23:974-80.  Back to cited text no. 12
Lund S, Jackson J, Leggett J, Hales L, Dworkin R, Gilbert D. Reality of glove use and handwashing in a community hospital. Am J Infect Control 1994;22:352-7.  Back to cited text no. 13
Albert RK, Condie F. Hand-washing patterns in medical intensive-care units. N Engl J Med 1981;304:1465-6.  Back to cited text no. 14
Raman S, Meenakshi S, Vipin K. Hand washing compliance among healthcare staff in Intensive Care Unit of a multispecialty hospital of North India. J Hosp Adm 2012;1:27-33.  Back to cited text no. 15


  [Table 1], [Table 2]


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