Refining a time-honored principle: Hand hygiene compliance in the critical care unit of an oncology center – A cross-sectional study

Abstract: INTRODUCTION: Hospital-acquired infections (HAIs) contribute to increased morbidity, mortality, prolonged hospital stays, and increased healthcare costs. Despite the effectiveness of hand hygiene in preventing HAIs, compliance remains suboptimal, with significant variation between high-income (64.5%) and low-income countries (9.1%). Studies show that a 30% improvement in compliance can lead to a 41% reduction in infection prevalence. This study aimed to evaluate healthcare workers’ knowledge, practices, and barriers to hand hygiene in an oncology center intensive care unit (ICU) with the primary objective to improve hand hygiene compliance by 30% from baseline. MATERIALS AND METHODS: The National Cancer Grid, in the Enable Quality, Improve Patient care India Project , conducted a single-center and cross-sectional study at a tertiary oncology center ICU (August 2023–May 2024) on hand hygiene compliance of healthcare professionals. Compliance was directly measured using the World Health Organization standard hand hygiene observation form and plotted weekly on a run chart. Process mapping and Gemba walks analyzed the flow of activities. Root causes were analyzed using fishbone method and Pareto analysis. Interventions were assessed for their reliability and maturity. Weekly progress reviews were done to refine the strategies and assess intervention effectiveness. RESULTS AND OBSERVATION: The baseline compliance rate of 40% fluctuated until interventions began. Postimplementation, the run chart showed a steady improvement, reaching 65% by December 2023, approaching the target of 70%. CONCLUSION: A targeted, multi-faceted approach, including workload reduction, personalized monitoring, education, and resource optimization, can significantly improve an oncology center ICU hand hygiene compliance from 40% to 65%.