Hand hygiene compliance in companion animal clinics and practices in Switzerland: An observational study

Abstract

Background: Hand hygiene (HH) is one of the most important measures to prevent healthcare-associated infections. Data on HH compliance in companion animal veterinary institutions in Europe are sparse.

Methods: This observational study assessed HH according to WHO standards in three large and two medium-sized clinics and two primary care practices in Switzerland. Associations with HH indication, professional group, clinical area and institution were determined using a generalized linear mixed effects model.

Results: Based on 2056 observations, overall HH compliance [95% confidence interval] was 32% [30%-34%]. HH compliance was highest in the consultation area (41% [38%-45%]) and after contact to body fluids (45% [40%-50%]), and lowest in the pre-OR area (20% [15%-24%]) and before clean/aseptic procedures (12% [9%-15%]). Veterinarians showed a higher HH compliance (37% [34%-40%]) than veterinary nurses (25% [22%-28%]). HH compliance was lower before clean/aseptic procedures compared to all other indications (all p < 0.015 except 'before touching a patient' in medium-sized clinics/practices, p = 0.095) and higher in the consultation area compared to all other areas in large clinics (all p < 0.04).

Conclusion: Effective HH training should urgently be promoted for all veterinary personnel with special emphasis on the importance of HH before clean/aseptic procedures.

FIGURE 1

(a) Distribution of HH observations among different clinical areas in Clinics/Practices A‐G. Percentages of HH observations per clinical area are indicated for each institution and for all institutions. (b) Distribution of HH observations among different professional groups in Clinics/Practices A‐G. Percentages of HH observations per professional group are indicated for each institution and for all institutions. (c) Distribution of HH observations among different HH indications in Clinics/Practices A‐G. Percentages of HH observations per HH indication are indicated for each institution and for all institutions Abbreviations: ICU, intensive care unit; nurse, veterinary nurses; others, working personnel not allocated to veterinary nurses or veterinarians (i.e. students, technicians and cleaning staff); pre‐OR, pre‐operating preparation area; ward, animal housing area.

FIGURE 2

Conditional inference tree for HH observations obtained in Clinics A‐C. A conditional inference tree for the binary outcome HH compliance (1: successful, 0: unsuccessful) and the predictors (indication, area, profession, institution) based on 1505 HH observations is shown. At each predictor node, the p‐value (Bonferroni adjustment) indicating the strength of the statistical association is displayed. In the boxes the proportion of the successful HH procedures is colored in dark grey (left side ‘1') and of the unsuccessful HH procedures in light grey (left side ‘0'); the scale on the right side represents the proportion. With n the number of observations in each terminal branch is indicated Abbreviations: abf, after body fluid exposure risk; apt, after touching a patient; bpt, before touching a patient; as, after touching patient surroundings; bc, before clean/aseptic procedure; cons, consultation area; ex, examination area; IC, intensive care unit; nurse, veterinary nurses; other: personnel not allocated to veterinarians or veterinary nurses (i.e. students, technicians and cleaning staff); pO, pre‐operating preparation area; wd, ward (animal housing area); vet, veterinarians

FIGURE 3

Conditional inference tree for HH observations obtained in Clinics/Practices D‐G. A conditional inference tree for the binary outcome HH compliance (1: successful, 0: unsuccessful) and the predictors (indication, area, profession, institution) based on 551 HH observations is shown. At each predictor node, the p‐value (Bonferroni adjustment) indicating the strength of the statistical association is displayed. In the boxes, the proportion of the successful HH procedures is colored in dark grey (left side ‘1') and of the unsuccessful HH procedures in light grey (left side ‘0'); the scale on the right side represents the proportion. With n the number of observations in each terminal branch is indicated Abbreviations: abf, after body fluid exposure risk; apt, after touching a patient; bpt, before touching a patient; as, after touching patient surroundings; bc, before clean/aseptic procedure; cons, consultation area; ex, examination area; nurse, veterinary nurses; other, personnel not allocated to veterinarians or veterinary nurses (i.e. students, technicians and cleaning staff); vet, veterinarians; wd, ward (animal housing area)