Hand hygiene opportunities and consumption of alcohol-based handrub across nursing homes of canton of Vaud, Switzerland.

BACKGROUND

Optimal hand hygiene (HH) is necessary to prevent healthcare-associated infections among nursing home (NH) residents. We aimed to quantify the number of HH opportunities per resident-day in NHs and assess institutions' alcohol-based hand rub (ABHR) consumption based on the HH needs of their population.

METHODS

Cross-sectional study between 2022 and 2024 with the participation of 117 NHs (95%) and a random sample of 1633 residents. For each resident we accessed the daily care schedule, attributed 2-4 HH opportunities per nursing activity and collected the care dependency score. We estimated the average number of HH opportunities per resident-day across NHs using linear mixed-effects modeling. We also compared theoretical and observed ABHR consumption on an institutional level.

RESULTS

The average amount of HH opportunities was 21.65 per resident-day and the need was highly dependent on the care dependency score (β = 2.93; 95% confidence interval: 2.77-3.10, p < 0.01). Median ABHR was 9.43 L per 1000 resident-days. Overall, across all institutions ABHR consumption was 24% of the expected as most institutions consumed up to 25% of the expected amount of ABHR.

CONCLUSIONS

In this setting, HH opportunities are higher than previously assumed and significantly associated with care dependency. Most NHs perform poorly and should be prioritized in HH improvement actions like education and auditing with direct feedback.