Positive Impact of H1N1 Pandemic Influenza on the Adherence to Hand Hygiene and Isolation Precautions among Healthcare Workers

Background: Hand hygiene and isolation precautions prevent cross-infection in hospitals, but their compliance is often low among healthcare workers. During the H1N1 pandemic influenza period in 2009 a massive education intervention was developed around the world. In Chile, the Ministry of Health recommended droplet and contact precautions to all patients hospitalized with suspected or confirmed diagnosis of H1N1 influenza encouraging healthcare workers to comply with these measures.

Objective: To evaluate hand hygiene and isolation precautions compliance among healthcare workers during the pandemic period comparing the results with those obtained during the previous period 2005-2008, in a teaching hospital in Santiago, Chile. 

Methods: Hand hygiene and isolation precautions were evaluated by direct observation of compliance using a check list form. The sampling was proportionally stratified using a 95% level of confidence. In 2009, the supervision was done on July in surgical and medical floors and intensive care units where 53 patients were hospitalized with confirmed diagnosis of H1N1 influenza. Chi square test was used to compare hand hygiene and isolation precautions compliance rates obtained on July 2009 (pandemic period) with the same month of previous years 2005-2008 (pre pandemic period).

Results:

Hand hygiene compliance average rate was 60.2% during the pre pandemic period (range 52% to 73%). In pandemic period the compliance rate was 68.2% (p<0.001). In all the patients admitted with H1N1 influenza virus, droplet and contact precautions were implemented whether the infection was suspected or confirmed. The average compliance with isolation precautions in pre pandemic period was 36.6% and 71.5% in 2009 (p<0.028). The highest compliance rate (100%) was observed in healthcare workers wearing a surgical mask during patient care and the lowest compliance rate (55.4%) in hand hygiene performed before entering patient units.

Conclusions:

The massive and continuous education regarding prevention of H1N1 transmission and the risk of the infection caused a positive change in the healthcare workers behavior focus on prevention with a significant improvement on basic infection prevention practices.