The effect of merging two infectious disease units on hand hygiene adherence in Italy

Background: Healthcare-associated infections (HAIs) are common and harmful to patients. Effective hand hygiene can help prevent HAIs, however, suboptimal healthcare worker hand hygiene remains problematic across the globe. This study analyses the impact of organisational changes on hand hygiene. Methods: This observational study assessed hand hygiene by different professions before and after a merger of a recently combined infectious diseases (ID) unit coupled with a qualitative study about barriers to optimal hand hygiene. Direct observations were compared with previous data collected on both units before they merged. We also conducted focus groups with the doctors and nurses about hand hygiene. Results: After two ID units merged in 2013, we observed 681 provider–patient interactions. We compared these with a previous observation period in 2012. Hand hygiene adherence among nurses significantly declined after the merger (from 36% to 24%, P <0.001). However, adherence among doctors increased from 51% to 63% after the merger (P = 0.004). Data from the focus groups revealed a gap between doctor and nurses perceptions of education and goal adherence rates. Conclusions: Our findings underscore the important role played by effective unit leaders to prevent infection. We found long-term sustainability of hand hygiene practices among doctors. However, adherence among nurses was substantially lower.