Improving hand hygiene compliance in Greek hospitals: results of a Nationwide Quality Improvement Program (GRIPP-SNF)

Abstract Objective: Hand hygiene (HH) is the most effective way to prevent healthcare-associated infections (HAIs) and the spread of antimicrobial-resistant pathogens. HH compliance is particularly relevant in Greece, which has among the highest rates of HAIs and antimicrobial resistance in the European Union. The aim of our study was to assess current HH practices in Greece and to improve compliance. Design: Prospective observational quasi-experimental (before-after) study. Setting: Eight public adult tertiary hospitals. Participants: “Physicians, Nurses, and Ancillary Healthcare Workers.” Methods: Three time periods were defined: the baseline period (December 2021–June 2022), intervention period (July 2022–January 2023), and postintervention period (February 2023–May 2024). An improvement bundle was implemented. A minimum of 30 observations per department per month of HH opportunities were required. Trained observers conducted observations using a standardized data collection tool. Interrupted time-series analysis was performed. Results: 38,069 HH opportunities were observed. Overall compliance was 48.5%. Glove use without proper HH was observed in 72.9% of opportunities. Alcohol-based hand rub was used for HH by 57.8% of HCW who conducted HH. Compliance improved from 37.3% in the baseline period to 53.3% after the intervention (16% increase, P < .001). Improved compliance was observed in 9/13 (69%) intensive care units. Of 10 participating medical and surgical wards, improved compliance was observed in 9 (90%) units, and improvement ranged from 7.2% to 28.3% Conclusions: Overall, we found low compliance rates and gaps in HH practices in Greek hospitals. A quality improvement intervention improved overall HH compliance. This is the largest study of HH compliance in Greek hospitals to date.