Improving Compliance with Hand Hygiene in Neonatal Intensive Care Unit of ALZhraa University Hospital

Background: Health care acquired infections (HCAIs) are a common occurrence in the neonatal intensive care unit (NICU) and may be associated with morbidity and mortality. It has also been suggested that the hands of healthcare workers play a significant role in the transmission of nosocomial pathogens.

Objective: 1 - Evaluate the current knowledge of hand hygiene (HH)among the health care workers of NICU of AL Zhraa University hospital using questionnaires.2- Evaluate current practice, behaviour and attitude of hand hygiene among NICU workers of AL Zhraa University hospital by direct observation.  3 - Investigate the factors associated with poor compliance with hand hygiene
Methods: Prospective study, to measure HH knowledge, attitude and practice. It is an interview to the personnel and an audit .Setting: NICU of AL Zhraa University hospital. 35 full time nurses and physicians were interviewed for their knowledge, beliefs and practice regarding HH using designed questionnaire, before and after implementation of the quality improvement project. Monitoring hand hygiene compliance by direct, observations using check list forms, before and after implementation of the quality improvement project. The percent of health care staff in compliance with hand hygiene procedure was calculated . Results: Before implementation of quality improvement project, Knowledge, beliefs, and practices of neonatal intensive care unit HCWs vary regarding different aspects of HH from high to mild. Also study confirmed mild to high levels of compliance with hand hygiene in different aspects among nurses and physicians, while other HCWs were not apply any of the HH guidelines.After the project we found increase in the number of well trained NICU staff on (HH) from 30 % before to 85 % after one year of project implementation.The percent of health care staff in compliance with hand hygiene procedure was increased from 45 to 75%.
Rate of HCAI showed a continuing downward trend in rate of infection in NICU from 29% to 20, 15 % and   5 % by the end of the project.
Percentages of the different species of bacteria before and after project implementation showed that Klebseilla spp was the most frequently isolated micro-organism from blood cultures . After adjusting for other factors that might influence length of stay, we found that average length of stay reduced from 25 days to 11 days. Conclusions: These projects achieved its goals and expected effects, as there is reduction in HCAIs and improve NICU health care workers (KAP) regarding HCAI. Inorder to maintain the gain and to allow for continous improvement ,we recommend  coordinated, multifaceted infection control strategies that include all healthcare staff and hospital authorities.