During the study period, overall hand hygiene
compliance improved gradually from 48% to 75%.
The PHHP was an effective quality improvement
strategy in the ICU and was associated with reductions
in HAIs and improved hand-washing compliance
by nurses. Patients and their families were eager
to participate and have their hands washed 3 times
daily. Many patients commented on this being the
first time their hands were washed in a hospital.
Simply stated, “if a patient cannot reach the sink,
the sink must be brought to them.” Patients’ hand
hygiene is simple, potentially lifesaving, and often
overlooked by HCWs.
The adoption of a PHHP was structured to
include adequate preparation, training, and validated
competency by the ICU nurses. The 10-week
protocol phase-in period required return demonstration
training of all nursing staff. Compliance
auditing showed that 96.5% of 2326 patients’ hand
hygiene was sustained for 12 months. With the direct
observation and 1-on-1 training, compliance with
the protocol was 100% during the training period.
A decision was made to observe nurses during the
study protocol period biweekly in order to validate
adherence to the protocol.
The use of CHG as part of a PHHP had not been
reported before and therefore required vigilance to
observe concerns and side effects. Patients’ hands
were assessed before each application by the primary
ICU nurse as well as twice a week by a member of
the study team. CHG exposure to mucous membranes
may cause tissues to become red and irritated.19
Two cases of mucous membrane irritation due to
patients touching their eyes before their hands were
dry that resulted in mild eye irritation were observed
by an ICU nurse. Following these 2 episodes, the
entire ICU team was reeducated on the need for CHG
to dry before touching the face. Another CHG concern
was reported by an ICU nurse, who observed
an elevated glucose result after performing a bedside
glucose test on a patient who had just had his hands
cleansed with CHG. The patient’s glucose level was
checked again after the finger was cleaned with
alcohol and revealed a value near the patient’s