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A Moment for Hand Hygiene in the Intensive Care Unit: How Can Compliance be Improved?

Healthcare Associated Infections (HCAIs) such as Methicillin-resistant Staphylococcus Aureus (MRSA) represent the most frequent complications experienced by hospital patients. Effective hand hygiene practices are considered to be the most important strategy for preventing HCAIs. However, compliance with good hand hygiene practices has been historically low, leading to a national and international focus on improving hand hygiene. Although the hand hygiene procedure itself is simple to carry out, the behaviour related to hand hygiene is complex and is not readily understood, explained, or changed. International bodies have made recommendations for how to improve hand hygiene practices, but there are serious weaknesses in the research evidence to guide the implementation of these recommendations. As a result, infection control practices are not based on sound scientific knowledge, may be of limited effectiveness, and resources are not being used efficiently. The aim of the proposed research project is to take a scientific approach to improving hand hygiene in the Irish health service. This research will provide valid and practical methods for improving hand hygiene compliance in Irish Intensive Care Units (ICUs). In order to address the weakness of the research in this area:
• a multi-factorial study involving all of the stakeholders (i.e. patients, nurses, doctors, and regulators) will be carried out to identify the barriers and facilitators to effective hand hygiene practices; and
• based upon this research, all of the stakeholders will be involved in identifying an sustainable intervention that is appropriate for improving hand hygiene compliance in Irish ICUs.
The proposed approach provides direction to regulators, health service managers, and health service providers on ‘how’ standards can be achieved rather than only defining ‘what’ standards must be achieved. This information will be valuable to improving hand hygiene in critical care settings both nationally and internationally.