The main problem with HAND HYGIENE is not related to the possibility of obtaining only good products, but to the lack of compliance with the norm. Numerous published studies conclude that health personnel wash their hands half of the times they are indicated and in general with less duration than recommended.
The factors identified that influence the reduction of adherence to hand washing are:
1. Categories of workers: technicians, doctors, nurse (in that order), male sex;
2. Hospital area: minor in NICU,
3. Time of day and week: less on weekends,
4. Type and intensity of patient care: the greater the contact the less adhesion,
5. Activities with risk of contamination, use of gloves and nightgown, greater risk less adherence.
6. The reasons of the health staff for low adherence were related to skin irritation, inaccessibility of the dispenser, interference in the relationship with the patient, the patient perceived as a priority, use of gloves, loss of time, ignorance of the guidelines, overwork (inadequate nurse-patient relationship) and insufficient time, ignorance of the impact of proper hand hygiene on nosocomial infection.
Skin irritation is the most important barrier to hand hygiene; the greater the washing, the pH of the skin increases, the lipid content is reduced, the loss of trans-epidermal water and bacterial colonization increases. The use of alcohol gels, which add to the bactericidal power of alcohol emollient substances, are less irritating and better tolerated than soapy solutions, keep the skin protected and reduce bacterial development.
A complex and dynamic change in behavior to achieve greater adherence includes the combination of education, motivation and systematic information coupled with the perception of possible alternatives.