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Clean Hands

Observation protocol “Hand-hygiene in the NICU”

Publication date: 01 January 2013

Students work together on stimulating compliance with hand-hygiene procedures in the Neonatal Intensive Care Unit (NICU), part of the paediatric department at Erasmus MC Sophia Children’s Hospital in Rotterdam.



In approximately 60% of cases as measured in ten hospitals connected with the Collaborating Rijnmond Hospitals Foundation, there is an indication to follow procedures for hand-hygiene according to the Dutch report “Handen Uit de Mouwen” (Rolling Up the Sleeves), based on World Health Organization's My five moments for hand hygiene. Unfortunately, the prescribed hand-hygiene at the NICU’s in hospitals is regularly performed poorly or not at all. The 60% compliance is relatively high compared to other wards. However, poor compliance with hand hygiene is a worldwide problem, leading to many preventable deaths.

Project description

This project focuses on bloodstream infections that often occur in children with an intravenous infusion (IV). These infections can be caused by insufficient observation of the hygienic precautions in the administration of intravenous medicines. Over time, various interventions were implemented successfully to decrease these infections, but there is a great risk that employees relapse into old, less hygienic behaviour. After feedback was given through a survey, the feedback between colleagues about the (un-)hygienic conduct in the preparation and administration of intravenous medicines was evaluated by observation.

Poor hand hygiene increases the risk of bloodstream infections. A hand disinfection feedback system improves compliance to the rules concerning hand-hygiene and improves safety for premature children. Premature children have a great risk of bloodstream infections. Good hand hygiene reduces the risk of infections by approximately 30%, but is regularly forgotten due to the hectic workload. The aim of the project was to develop a technical device, which constantly triggers compliance to the hand hygiene protocol and improves the hygienic conduct around the incubators.

A hand disinfection feedback system has been developed that can be compared to a traffic light that switches to green if the hands have been disinfected properly. The system consists of an electric hand alcohol dispenser with display and a microcomputer with LED lighting and Wi-Fi transmitter, connected to the incubator. The ‘green lights’ on the display and on the incubator door indicate that adequate hand disinfection has been applied and the incubator door can be opened. Data about compliance is transmitted remotely and a dashboard shows the achieved hand hygiene per incubator.