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Int J Infect Dis. 2013 Sep;17(9):e729-32. doi: 10.1016/j.ijid.2013.02.025. Epub 2013 Apr 16.

Hand hygiene non-compliance among intensive care unit health care workers in Aseer Central Hospital, south-western Saudi Arabia.

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Department of Family and Community Medicine, College of Medicine, King Khalid University, PO Box 641, Abha, Aseer, Saudi Arabia.



Hand hygiene is the undisputed single most effective infection control measure. The purpose of the current study was to measure the degree of compliance with hand hygiene practices among health care workers in intensive care facilities at Aseer Central Hospital (ACH), south-western Saudi Arabia.


Data were collected by direct observation of health care workers in intensive care units delivering routine care, using the standardized World Health Organization method for direct observation "Five moments for hand hygiene" approach. Observations were made during February-April 2011, by well-trained infection control nurses during their routine visits to the units. The moment the observer identified an indication, it was counted as an opportunity to which there should be a corresponding positive or negative action (hand washing).


The present study included 536 opportunities (observations) collected from the intensive care unit (ICU), intermediate care unit (IMCU), cardiac care unit (CCU), and pediatric care unit (PICU) of ACH. Observations covered 179 nurses and 34 physicians working in these units. Overall, hand hygiene non-compliance was observed in 41.0%. The study showed that events before contact with the patient (adjusted odds ratio (aOR) 6.575, 95% confidence interval (CI) 4.461-9.691), being a physician (aOR 1.712, 95% CI 1.126-2.989), and work in the IMCU (aOR 2.140, 95% CI 1.202-3.811) were significant risk factors for hand hygiene non-compliance in the hospital.


The observed high figures of hand hygiene non-compliance warrant intensifying education to promote local hand hygiene and training programs to help embed efficient and effective hand hygiene into all elements of care delivery in the intensive care units of ACH.


Five moments; Hand hygiene; Non-compliance; Saudi Arabia

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