Citing articles
Oliveira MA de, Leuthier RM, Oliveira Filho JR, et al. Hand hygiene: knowledge and attitudes...
J Nurs UFPE on line. 2019;13:e236418
https://doi.org/10.5205/1981-8963.2019.236418
HAND HYGIENE: KNOWLEDGE AND ATTITUDES OF HEALTHCARE PROFESSIONALS HIGIENIZAÇÃO DAS MÃOS: CONHECIMENTOS E ATITUDES DE PROFISSIONAIS DA SAÚDE
HIGIENE DE MANOS: CONOCIMIENTOS Y ACTITUDES DE LOS PROFESIONALES DE LA SALUD Maria Alenita de Oliveira1, Rafaella de Menezes Leuthier2, Josélio Rodrigues Oliveira Filho3, Maria Amanda Pereira Leite4, Larissa Gabriella Alves Fernandes5, Antônio Francisco dos Santos6, Karla Fernandes de Albuquerque7, Karina
Guedes Correia8
ABSTRACT
Objective: to evaluate the knowledge and understanding of health professionals in relation to the practice of hand hygiene. Method: this is a quantitative, descriptive, cross-sectional study, with 56 professionals from a philanthropic hospital. Data collection occurred by means of two questionnaires. The data were entered into a database in Microsoft® Office Excel, analyzing them by means of descriptive statistics. The results are presented as tables. Results: 100% of the professionals consider hand hygiene important and recognize the hands as inducing agent of infection and that the practice of hygiene leads to its prevention; 64% reported carrying out a perfect hygiene before and after patient contact. However, the evaluation of the rate of adherence to opportunities of hand hygiene was low, with the 8.5%. Conclusion: although the team of professionals has an adequate perception of the importance of hand washing and has knowledge about the topic, this is not reflected in the routine. Descriptors: Hand Hygiene; Patient Safety; Cross Infection; Hospital; Health Care; Disease Prevention; Health Human Resources.
RESUMO
Objetivo: avaliar o conhecimento e a compreensão dos profissionais da saúde em relação à prática de higiene das mãos. Método: trata-se de estudo quantitativo, descritivo, transversal, com 56 profissionais de um hospital filantrópico. Utilizaram-se, para a coleta de dados, dois questionários. Inseriram-se os dados em um banco de dados no Programa Microsoft® Office Excel, analisando-os por meio de estatística descritiva. Apresentaram-se os resultados em forma de tabelas. Resultados: verificou-se que 100% dos profissionais consideram importante a higienização das mãos e reconhecem as mãos como agente indutor de infecção e que a prática da higiene leva à sua prevenção; 64% afirmaram que praticam uma perfeita higienização antes e após o contato com o paciente. Observou-se, entretanto, após a avaliação da taxa de adesão a oportunidades de higiene de mãos, baixa taxa de adesão de 8,5%. Conclusão: revela-se que, apesar de a equipe de profissionais ter uma percepção adequada da importância da higienização das mãos e de ter conhecimento sobre o tema, isso não se reflete no cotidiano. Descritores: Higiene das Mãos; Segurança do Paciente; Infecção Hospitalar; Hospital; Assistência à Saúde; Prevenção de Doenças; Recursos Humanos em Saúde.
RESUMEN
Objetivo: evaluar el conocimiento y la comprensión de los profesionales de la salud en relación con la práctica de la higiene de las manos. Método: se trata de un estudio cuantitativo, descriptivo, transversal, con 56 profesionales de un hospital filantrópico. Se utilizaron para la recolección de datos dos cuestionarios. Los datos fueron introducidos en una base de datos de Microsoft® Office Excel, y analizados por medio de estadísticas descriptivas. Los resultados se presentan en forma de tablas. Resultados: se encontró que 100% de los profesionales consideran importante la higiene de las manos y reconocen las manos como agentes inductores de la infección y que la práctica de la higiene conduce a su prevención; 64% dijieron que hacen una práctica perfecta de higiene antes y después del contacto con el paciente. También se observó, sin embargo, después de la evaluación de la tasa de adhesión a las oportunidades de higiene de manos, la baja adhesión, con 8,5%. Conclusión: se revela que, a pesar de que el equipo de profesionales tiene una adecuada percepción de la importancia de lavarse las manos y tiene conocimientos sobre el tema, pero no lo hacen en su cotidiano. Descriptores: Higiene de las Manos; Seguridad del Paciente; Infección Hospitalaria; Hospitales; Atención de Salud; Prevención de Enfermedades; Recursos Humanos en Salud.
1,2,3,4,5,6,7,8University Center of João Pessoa/UNIPÊ. João Pessoa (PB), Brazil. ORCID : https://orcid.org/0000-0002-1009-6988 Email:
alenitaoliveira@uol.com.br ORCID : https://orcid.org/0000-0002-1744-8691 Email: correiakg@gmail.com ORCID : https://orcid.org/0000-0001-
6229-2932 Email: rafaella.leuthier@gmail.com ORCID :: https://orcid.org/0000-0001-9061-2948 Email: joselio@hotmail.com.br ORCID :
https://orcid.org/0000-0003-1337-6077 Email: amandamapl1997@gmail.com ORCID : https://orcid.org/0000-0002-4750-6602 Email:
larissagabifernandes97@gmail.com ORCID : https://orcid.org/0000-0002-0202-2698 Email: tonnifsantos@gmail.com ORCID :
https://orcid.org/0000-0001-6458-1746 Email: karlaalbuq@hotmail.com
How to cite this article
Oliveira MA de, Leuthier RM, Oliveira Filho JR, Leite MAP, Fernandes LGA, Santos AF dos, et al. Hand hygiene: knowledge and attitudes of healthcare professionals. J Nurs UFPE on line. 2019;13:e236418 DOI: https://doi.org/10.5205/1981- 8963.2019.236418
ORIGINAL ARTICLE
Oliveira MA de, Leuthier RM, Oliveira Filho JR, et al. Hand hygiene: knowledge and attitudes...
J Nurs UFPE on line. 2019;13:e236418
https://doi.org/10.5205/1981-8963.2019.236418
Patient safety in the scientific and care
contexts has been much discussed as a result of
adverse events observed at hospital institutions.
Hospital infections cause many deaths of
hospitalized patients, reaching 15% of hospitalized
patients in Brazil and 10% in the United States of
America and Europe.1 Healthcare-related
infections (HCRI) have increased considerably and
caused great involvement in the life of patients,
being currently considered a public health
problem. They are responsible for increasing
considerably the costs in care of the patient, in
addition to increasing the length of hospital stay,
morbidity and mortality at health services.2
One of the recommended measures to reduce
healthcare-related infections is the hand hygiene.
There are recommendations from normalizing
organs regarding products, technique, frequency,
among other aspects of the disinfection of hands,
to be followed by professionals in the health area,
which are based on the relationship between
adherence to this practice and the decrease of the
endemic rates of infection. However, adherence
to hand hygiene is still low. Therefore, the
information is not reaching its highest goal, which
is changing professionals’ behavior, which has
caused concern.3 The authors of a study carried
out in South Brazil corroborates this opinion when
stating that, although the understanding regarding
the effectiveness of hand hygiene in prevention of
infection is widespread, health professionals
inadequately adhere to this practice.4
Hands are essential tools for professionals who
develop actions at health services. Consequently,
patient safety depends directly on the adherence
to protocols of hand hygiene (HH).1 Moreover, the
behavior of health professionals regarding
microbial hazards associated with non-adherence
to hand hygiene is contradictory, being assigned to
the false perception of a risk, the underestimation
of individual responsibility and the minimization of
the problem. Furthermore, the inappropriate
behavior not always refers to the lack of
knowledge about the dangers and forms of
transmission of micro-organisms.5
Therefore, the non-hand hygiene constitutes a
serious public health problem since it leads to the
resistance of micro-organisms to pharmacological
treatments; increased hospitalization time;
increased costs to health systems and increased
mortality.4
In this context, patient safety represents a
global issue and the theme hand hygiene has been
addressed primarily in relation to attitudes that
contribute to the reduction of nosocomial
infections.1
In this context, the protocol for the Practice of
Hand Hygiene in Health Services was created,
whose purpose is to guide professionals on the
practice of hand washing and preventing the
transmission of microorganisms.8-9 This protocol
aims to advise the correct technique and five
times that health professionals should sanitize
their hands: “before touching a patient”; “before
clean/aseptic procedures”; “after body fluid
exposure/risk”; “after touching a patient” and
“after touching patient surroundings”.6-7 The
deployment of the protocol of hand hygiene is one
of the six goals recommended by the Ministry of
Health to improve patient safety in the hospital
environment.
• To assess the knowledge and understanding of
health professionals in relation to the practice of
hand hygiene
• To assess the adherence of health
professionals to the five moments of hand
hygiene.
This is a quantitative, descriptive,
observational, cross-sectional study, performed at
a philanthropic hospital in the city of João Pessoa
(PB). The data were collected during the months
of September and October of 2017.
The researchers interviewed 56 professionals
among doctors, nurses, nursing technicians and
assistants, stretcher carriers, cleaning personnel,
dieticians, pharmacists, physiotherapists,
laboratory technician, receptionists and
telemarketing. The instrument used for the survey
about the knowledge in relation to the hygiene of
hands was a self-administered questionnaire.
1 - Questionnaire to assess the knowledge on
hand hygiene.
The participants answered a basic
questionnaire adapted from the questionnaire
recommended by the World Health Organization
about the perception of health professionals about
healthcare-related infections and to hand hygiene
that addressed issues related to the perception
and knowledge of the team related to hand
hygiene, such as its importance, its efficiency and
occasions they practiced hand hygiene.
The questionnaires were applied during the
shift of professionals who were providing care
assistance in the infirmaries, which were randomly
chosen according to the availability in the service
at the application of the same, respecting the
criteria of secrecy.
2 - Questionnaire of observation of hand
hygiene
Concomitant to the application of the
questionnaire about the knowledge, the
questionnaire of observation of hand hygiene of
WHO,10 of blind nature to the team, was used in
METHOD
OBJECTIVES
INTRODUCTION
Oliveira MA de, Leuthier RM, Oliveira Filho JR, et al. Hand hygiene: knowledge and attitudes...
J Nurs UFPE on line. 2019;13:e236418
https://doi.org/10.5205/1981-8963.2019.236418
order to assess the behavior of the team in daily
clinical practice. The observation is carried out for
20 through 30 minutes, without disrupting the
activities of the professionals, registering the total
of opportunities for hand hygiene. The completed
form of opportunities includes the five moments of
hand hygiene recommended by the WHO, as
described below:
1 – Before touching a patient;
2 – Before clean/aseptic procesures;
3 – After body fluis exposure/risk;
4 – After touching a patient;
5 – After touching patient surroudings.
An opportunity of hand hygiene is an
opportunity where one of the indications for hand
hygiene is present and is observed.
The opportunity is a unit that is responsible for
the action. The need to sanitize hands is the
simple or multiple ratio (the indication that leads
to the action). It constitutes the denominator to
measure the rate of adherence to hand hygiene by
health professionals.
For each professional in observation, the
aforementioned opportunities were evaluated,
calculating the rate of compliance as follows: rate
of adherence to opportunities for hand hygiene is
equal to the number of hand hygiene actions
performed by health professionals, divided by the
number of opportunities performed for the hand
hygiene multiplied by 100.
The professionals were approached at the
hospitalization unit and, in case they accepted to
participate in the study, they were invited to go to
a reserved room to ensure privacy. The
participants signed the Informed Consent Form
(ICF), in two copies, before starting the interview,
as advocated by Resolution 466/2012, which
regulates researches involving human beings.11
This study was approved by the Research Ethics
Committee (REC) of the University Center of João
Pessoa, under Consubstantiated Opinion
1.209.075, September 1, 2017.
The collected data were entered in a database
built in Microsoft® Office Excel, analyzing them
later by means of descriptive statistics. The
proportions of affirmative answers in relation to
the total number of responses obtained in relation
to the knowledge on hand hygiene wwre
calculated, as well as the number of adherecence
to opportunities of hand hygiene in relation to the
total number of opportunities observed.
Table 1 describes the questions related to the
knowledge and perception on hand hygiene. It
shows that 100% of the interviewed professionals
considered hand hygiene important and
acknowledged the role of hands as inducing agent
of infection and that the practice of hygiene leads
to prevention of infection. Health professionals’
hands were recognized as route of transmission of
microorganisms by 94.7% of respondents; however,
36% admitted not practicing a perfect hygiene
before and after touching a patient.
Table 1. Knowledge and perception about hand hygiene of the interviewed professionals. João Pessoa (PB), Brazil, 2018.
QUESTIONS YES (%) NO (%)
Do you consider hand hygiene important? 100 - Do you consider hand hygiene efficient in the prevention of infections?
96 4.0
Are professionals’ hands routes of transmission of microorganisms?
94.7 5.3
Do you practice a perfect hand hygiene before and after touching a patient?
63.5 36.5
Does the use of na alcoholic solution (alcohol gel) facilitate hand hygiene in the work routine?
87.5 12.5
Is it necessary to sanitize the hands after touching patient surroundings?
92.5 7.5
The general rate of adherence to hand hygiene
was 8.5%, while the lower adherence observed was
the hand hygiene after touching a patient (2.1%)
(Table 2).
RESULTS
Oliveira MA de, Leuthier RM, Oliveira Filho JR, et al. Hand hygiene: knowledge and attitudes...
J Nurs UFPE on line. 2019;13:e236418
https://doi.org/10.5205/1981-8963.2019.236418
Table 2. Percentage of adherence to opportunities of hand hygiene of observed healthcare professionals. João Pessoa (PB), Brazil, 2018.
Opportunities
Adherence to hand hygiene
(N) Yes No Total
Adherence (%)
Before touching a patient 4 24 28 14 Before an invasive procedure 4 24 28 14 After fluid exposure 3 20 23 13 After taking off the gloves 2 33 35 5.7 After touching a patient 1 45 46 2.1 After touching instruments 2 42 44 4.5
Total 16 188 204 8,5
Despite the dissemination of the understanding
about the effectiveness of hand hygiene in the
prevention of infections, the adherence of
healthcare professionals to this practice is still
insufficient.4
Therefore, the deployment of protocols in the
care process becomes importante, which passes
through the follow-up of recommendations and
standardization of procedures aiming to increase
patient safety. Hand hygiene constitutes the
measure of greatest impact and proven efficacy in
the prevention of infections, and its deployment is
associated to reduced rates of infections at health
services.2
This work shows that, although the team of
professionals has an adequate perception of the
importance of hand hygiene and has knowledge in
relation to the basic concepts of hand hygiene,
this is not reflected in their work routine. One of
the great challenges in the implementation of the
protocols is the adherence of the team to the
change of the work process.
The rates of adherence to HH at health services
are low, because the general rate has been around
40%, with a variation of 5% through 81%.12-3-4
This work showed a rate around 8.5 % prior to
the implementation of a structured program of
hand hygiene. At university hospital, a research
observed a compliance rate of 27%, with the
emergency room as the area with the lowest
adherence, with a rate of 9.4%.12
The low adherence of professionals to perform
hand hygiene may not be directly associated with
the theoretical knowledge of such action, but,
rather, with the inclusion of this knowledge in
daily practice and in the daily habit of the
professional.4
In this perspective, the development of actions
aiming to continuously foster the knowledge and
practice of HH becomes important, by means of
constant educational campaigns and mobilizing
actions, being important in the perspective of
providing instruments for the health work, in order
to avoid the illness due to exposure to biological
hazards.13,15
Although the procedure of hand hygiene is
simple and low-cost, the incorporation in the daily
practice of professionals was not observed.
Nevertheless, the adoption of this practice by
health professionals is extremely important. The
change of culture relates to the offer of training,
allied to the support of the managers to this
practice.
In addition to the permanent education,
understanding and knowledge of the
organizational culture of the institution are
fundamental for adherence to protocols, since the
adherence goes through the greater involvement
of people and teams and the responsibility of each
one in the work process, facilitating change and
demonstrating improvement in the work process
and the results expected by the implementation of
protocols.12
The results show that 100% of the professionals
consider the practice of hand hygiene important,
64% stated practicing a perfect hand hygiene
before and after thouching a patient, but the
assessment of the adherence rate to hand hygiene
opportunities showed a low rate of only 8.5%.
This study shows the need for a training
program directed to professionals, which will
allow improving the knowledge about the theme,
promoting changes in habits, which, in turn, lead
to a reduced number of hospital infections.
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Oliveira MA de, Leuthier RM, Oliveira Filho JR, et al. Hand hygiene: knowledge and attitudes...
J Nurs UFPE on line. 2019;13:e236418
https://doi.org/10.5205/1981-8963.2019.236418
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Submission: 2019/05/10 Accepted: 2019/04/17 Publishing: 2019/06/27
Corresponding Address
Maria Amanda Pereira Leite
Email: amandamapl1997@gmail.com
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