Achieving Perfect Hand Washing: an Audit Cycle with Surgical Internees

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ORIGINAL ARTICLE

Achieving Perfect Hand Washing: an Audit Cycle with Surgical Internees Ramanuj Mukherjee 1 & Pritha Roy 2 & Madhav Parik 3 Received: 11 May 2020 / Accepted: 29 September 2020 # Association of Surgeons of India 2020

Abstract The aim of this study is to achieve 100% compliance in surgical hand antisepsis along with identification of areas of worst compliance and efficacies of various interventions best suited to deal with them. This audit was performed over 6 days in a tertiary care hospital in Calcutta, India, with 42 surgical internees. Compliance to ideal hand washing technique was recorded after each attempt with the first attempt as baseline. Video demonstration, personal demonstration by a consultant, and individual instruction were used as subsequent interventions to achieve 100% compliance. The baseline level of compliance was found to be 33.59%. A total of 6 attempts was required to achieve 100% compliance, with the increase in compliance being statistically significant (p = 0.0294). Personal instruction was found to be the most effective intervention. Hand washing technique was the criterion that needed the most number of attempts (n = 6) to rectify. This study found video-based instruction and individual guidance effective teaching tools for surgical hand disinfection and gave novel data regarding the reasons responsible for poor compliance to proper hand washing in a general surgical setting. This study demonstrated the efficiency of audit cycles in the improvement of surgical hand washing and can be the preferred mode of intervention in future studies aimed at achieving ideal hand antisepsis. Keywords Asepsis . Hand washing . Clinical audit . Hand hygiene

Introduction In the twenty-first century, hand washing has become an essential practice in the field of healthcare, even though the relationship between hand washing and spread of infections was established about two centuries ago [1]. It is well established in current scientific literature that cross infection of patients from the hands of the care * Madhav Parik [email protected] Ramanuj Mukherjee [email protected] Pritha Roy [email protected] 1

Department of General Surgery, RG Kar Medical College and Hospital Kolkata, 136 Sarat Bose Road, Calcutta 700029, India

2

Department of Radiotherapy, RG Kar Medical College and Hospital Kolkata, AA-85 Block, Saltlake, Calcutta 700064, India

3

Department of Psychiatry, RG Kar Medical College and Hospital Kolkata, Block C-111, Bangur Avenue, Calcutta 700055, India

giver results in healthcare-associated infection (HCAI) [2, 3]. HCAI is a global problem as it leads to increased morbidity and mortality amongst patients and development of resistance amongst microorganisms due to the rampant use of antimicrobials and is a huge economic burden for patients as well as healthcare systems. HCAI is specially challenging to deal with in developing countries due to limited resources and the lack of reliable investigations, monitoring and standardization of medical records. This along wit