Hand Hygiene by Healthcare Workers: a neglected practice





Infectious diseases; Virus; Patient safety; Nursing; Biosecurity.


Hand Hygiene (HH) is a simple and essential action in the prevention of infectious diseases. Therefore, the aim of this study was to evaluate the levels of adherence, technique, and knowledge about HH by healthcare workers and perform an educational intervention. We conducted a cross-sectional analysis with 20 professionals, for six months. We observed and categorized the HH opportunities, evaluated the performance of the correct technique, determined the degree of HH compliance (Positivity Index proposed by Carter, IPC) and applied a questionnaire about HH. The data contributed to conduct training and discussion about COVID-19, using a didactic model of virus. We observed N = 791 opportunities for HH, but only N = 128 (16.18%) were performed, with the correct technique in 80.47% (N = 103). The categories with the greatest number of opportunities for HH were “after patient care” (N = 238) and “before patient care” (N = 214). However, HH occurred only in N = 76 (31.93%) and N = 28 (13.08%), respectively. Comparing the categories, the highest adherence was "after removing the gloves" (53.19%). The degree of HH compliance in this study is lower than that recommended by the IPC (70%). In the questionnaires, workers affirmed to have taken at least one course about HH throughout their careers; few of them mentioned virus as a microbe present in the hands; “Lack of time” was the major reason to not HH. The educational intervention reinforced the importance of the correct HH technique, stimulated adaptations in the hospital structure and in strategies for coping with the emergence of the pandemic.


Araujo, M. V. D., Simões, I., & Silva, C. L. (1978). Auditoria em enfermagem. Revista Brasileira de Enfermagem, 31(4), 466-477. https://doi.org/10.1590/0034-716719780004000005

Berardi, A., Perinelli, D. R., Merchant, H. A., Bisharat, L., Basheti, I. A., Bonacucina, G., ... & Palmieri, G. F. (2020). Hand sanitisers amid CoViD-19: A critical review of alcohol-based products on the market and formulation approaches to respond to increasing demand. International journal of pharmaceutics, 119431. https://doi.org/10.1016/j.ijpharm.2020.119431

Chang, D., Xu, H., Rebaza, A., Sharma, L., & Cruz, C. S. D. (2020). Protecting health-care workers from subclinical coronavirus infection. The Lancet Respiratory Medicine, 8(3), e13. https://doi.org/10.1016/S2213-2600(20)30066-7

Dewes, F. (2019). Adesão à higiene de mãos em hospitais: revisão bibliográfica. Porto Alegre: LUME Repositório digital, Universidade Federal do Rio Grande do Sul. https://www.lume.ufrgs.br/handle/10183/201794

Joint Commission International. (2020). International Patient Safety Goals (IPSGs). https://www.jointcommissioninternational.org/standards/international-patient-safety-goals/

Lima, M. L. S. O., Almeida, R. K. S., da Fonseca, F. S. A., & Gonçalves, C. C. S. (2020). The Chemistry Of Sanitizers In Covid-19 Times: Do You Know How It Works? Química Nova, 43(5), 668-678. https://doi.org/10.21577/0100-4042.20170552

Madigan, M. T., Martinko, J. M., Bender, K. S., Buckley, D. H. & Stahl, D. A. (2016). Microbiologia de Brock. (14a ed.), ArtMed Editora.

Massuda, A., Hone, T., Leles, F. A. G., de Castro, M. C., & Atun, R. (2018). The Brazilian health system at crossroads: progress, crisis and resilience. BMJ global health, 3(4). http://dx.doi.org/10.1136/bmjgh-2018-000829

Oliveira, A. C., de Paula, A. O., & Gama, C. S. (2017). Monitoring hand hygiene: direct observation versus self-report rates. Enfermería Global, 16(4), 334-343. https://doi.org/10.6018/eglobal.16.4.277861

Pittet, D. & Boyce, J. M. (2001). Hand hygiene and patient care: pursuing the Semmelweis legacy. The Lancet Infectious Diseases, 1, 9-20. https://doi.org/10.1016/S1473-3099(09)70295-6

Reilly, J. S., Price, L., Lang, S., Robertson, C., Cheater, F., Skinner, K., & Chow, A. (2016). A pragmatic randomized controlled trial of 6-step vs 3-step hand hygiene technique in acute hospital care in the United Kingdom. Infection control & hospital epidemiology, 37(6), 661-666. 10.1017/ice.2016.51

Riou, J. & Althaus, C. L. (2020). Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Eurosurveillance. 25(4), 2000058. https://doi.org/10.2807/1560-7917.ES.2020.25.4.2000058

Santos, T. C. R., Roseira, C. E., Piai-Morais, T. H., & Figueiredo, R. M. D. (2014). Hand hygiene in hospital environments: use of conformity indicators. Revista gaucha de enfermagem, 35(1), 70-77. https://doi.org/10.1590/1983-1447.2014.01.40930

Vasconcelos, R. O., Alves, D. C. I., Fernandes, L. M., & de Oliveira, J. L. C. (2018). Adhesion to hand hygiene by nursing team in intensive care unit. Enfermería Global, (50), 430-445.

World Health Organization. (2020). Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19). Interim guidance. https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf

World Health Organization. (2009). WHO guidelines on hand hygiene in health care: First Global Patient Safety Challenge Clean Care is Safer Care. https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf,jsessionid=9EDBA3F541173B6A541FBEE2697DC4FA?sequence=1

Zhang, S., Kong, X., Lamb, K. V., & Wu, Y. (2019). High nursing workload is a main associated factor of poor hand hygiene adherence in Beijing, China: An observational study. International journal of nursing practice, 25(2), e12720. https://doi.org/10.1111/ijn.12720




How to Cite

FONTANA, L. B.; ROSSATO, J. M.; FERREIRA , L. R.; ZANCAN , S. .; MASSARIOL , A. M.; MORESCO , T. R. Hand Hygiene by Healthcare Workers: a neglected practice. Research, Society and Development, [S. l.], v. 10, n. 3, p. e53510313554, 2021. DOI: 10.33448/rsd-v10i3.13554. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/13554. Acesso em: 16 apr. 2021.



Health Sciences