Resources, implementation and performance of hand hygiene practices and their impact on hospital care: A multicenter cross-sectional survey in Greece

2025-08-01

Our latest research study was published in the American Journal of Infection Control (Association for Professionals in Infection Control and Epidemiology, Inc), July 31, 2025.

Resources, implementation and performance of hand hygiene practices and their impact on hospital care: A multicenter cross-sectional survey in Greece

Eirini Astrinaki, Evangelos I. Kritsotakis, Efsevia Vitsaxaki, Stamatina Saplamidou, Panagiotis Skevakis, Emmanouil Bolikas, Despoina Christofaki, Apostolia Salvaraki, Christos Kleovoulou, Styliani Papathanasaki, Chrisanthi Markopoulou, Evagelia Magouli, Diamantis Kofteridis, Petros Ioannou

Access the full paper via:

AJIC journal website
Science Direct
PubMed
Elsevier share link for free access until October 08, 2025.

Abstract

Background

Limited data exist on hand hygiene practices in Greek hospitals. This study assessed hand hygiene resources, implementation, and compliance in eight public hospitals and their impact on healthcare-associated bloodstream infections (BSIs).

Methods

The World Health Organization's "Ward Infrastructure Survey", "Hand Hygiene Self-Assessment Framework" (HHSAF) and the "5 Moments" concept were employed. Hand hygiene indicators and BSI rates were assessed using Poisson regression.

Results

Hand washing facilities were provided in 87% of patient room toilets. Νearly all sinks (96%) had soap, but disposable paper towels availability was 51%.Alcohol-based hand rub (ABHR) availability at the point of care was 41.8%. Hospitals scored at "Basic" (n=5; 62%) or "Inadequate" (n=3; 38%) hand hygiene implementation level with a mean HHSAF score of 140. Compliance was 58.8% (95% CI 56.9%-60.6%) in one surveyed tertiary hospital but only 9.8% (95% CI: 8.7%-11%) in one secondary. BSI rates in the wards were higher with higher ABHR availability (incidence rate ratio (IRR) 1.09 per 10% increase in ABHR p=0.002) and when powdered gloves were not used (IRR 2.09, p<0.001).

Conclusion

Significant hand hygiene compliance discrepancies and ineffective implementation strategies within surveyed hospitals were determined. Improving hand hygiene infrastructure, education and feedback could foster current scores.

Figure 1. Box-and-whisker plot of overall and component hand hygiene scores based on the Hand Hygiene Self-Assessment Framework survey (N = 8 hospitals)

Table 2. Hand hygiene infrastructure in patient care areas

Table 3. Associations between bloodstream infection rates and ward-level indicators of hand hygiene structures and resources

Notes. Relative incidence rates (IRR) for bloodstream infections were estimated by Poisson regression adjusting for ward specialty (ICU, medical, surgical, other), numbers of nurses, physicians and cleaning staff, and the annual number of patient days in the wards. Only hand hygiene indicators with sufficient variation in at least 20% of the wards (n>15) were examined.

Figure 2. Associations between hand hygiene compliance proportions and bloodstream infection rates in n = 17 high-risk wards at two hospitals