Resources, implementation, and performance of hand hygiene practices and their impact on hospital care: A multicenter cross-sectional survey in Greece - 31/10/25

Doi : 10.1016/j.ajic.2025.07.013

Eirini Astrinaki, RN BSN, MSc ^a,^b, Evangelos I. Kritsotakis, BSc(Hons), MSc, PhD, CStat, FHEA, MRSPH ^c, Efsevia Vitsaxaki, RN BSN, MSc ^b, Stamatina Saplamidou, RN BSN, MSc ^b, Panagiotis Skevakis, RN BSN, MPA, MPH ^d, Emmanouil Bolikas, RN BSN, MPH ^e, Despoina Christofaki, RN BSN, BSc in Health Visiting ^f, Apostolia Salvaraki, RN BSN ^g, Christos Kleovoulou, BSc, MScM, ICN-CCRN, MSc Infection Med ^h, Styliani Papathanasaki, RN BSN, MSc, MPH ⁱ, Chrisanthi Markopoulou, RN BSN, MSc ^j, Evagelia Magouli, RN BSN ^k, Diamantis Kofteridis, MD, PhD ^a,^b, Petros Ioannou, MD, MSc, PhD ^a,^b,^⁎
^a Division of Internal Medicine, School of Medicine, University of Crete, Heraklion, Greece
^b Infection Control Committee, University Hospital of Heraklion, Heraklion, Greece
^c Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Greece
^d Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
^e Infection Control Committee, “Venizeleio-Pananeio” General Hospital of Heraklion, Heraklion, Greece
^f Infection Control Committee, Organic Unit of Agios Nikolaos, General Hospital of Lasithi/General Hospital, Health Center of Neapoli “Dialinakio”, Agios Nikolaos, Greece
^g Infection Control Committee, General Hospital of Rethymno, Rethymno, Greece
^h 7th Health Region of Crete, Heraklion, Greece
ⁱ Infection Control Committee, Decentralized Unit of Sitia, General Hospital of Lasithi/General Hospital, Health Center of Neapoli “Dialinakio”, Sitia, Greece
^j Infection Control Committee, Decentralized Organic Unit of Ierapetra, General Hospital of Lasithi/General Hospital, Health Center of Neapoli “Dialinakio”, Ierapetra, Greece
^k Infection Control Committee, General Hospital-Health Care of Neapoli “Dialinakio”, Neapoli, Greece

^⁎Address correspondence to Petros Ioannou, MD, MSc, PhD, School of Medicine, University of Crete, Heraklion, Crete 71003, Greece.School of Medicine, University of CreteHeraklionCrete71003Greece

Résumé

Background

Limited data exist on hand hygiene practices in Greek hospitals. This study assessed hand hygiene resources, implementation, and compliance in 8 public hospitals and their impact on health care-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

Handwashing 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 the “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 1 surveyed tertiary hospital but only 9.8% (95% CI: 8.7%-11%) in 1 secondary. BSI rates in the wards were higher with higher ABHR availability (incidence rate ratio 1.09 per 10% increase in ABHR, P = .002) and when powdered gloves were not used (incidence rate ratio 2.09, P < .001).

Conclusions

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.

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Highlights

•	Hand hygiene indicators are underevaluated in Greek hospitals.
•	Significant gaps in hand hygiene resources, policies, and compliance were revealed with this survey.
•	The impact of these gaps on hospital care needs further research.

Le texte complet de cet article est disponible en PDF.

Key Words : Hand hygiene, Hand hygiene infrastructure, Hand hygiene compliance, Bacteremia

Plan

Background

Methods

Study design and setting

Hand hygiene surveys

High-risk impact assessment

Statistical analysis

Results

Study sample

Hand hygiene infrastructure

Hospital-wide hand hygiene assessments

Hand hygiene compliance rates

Impact assessment

Discussion

Conclusions

Conflicts of interest: None to report.

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Vol 53 - N° 11

P. 1148-1154 - novembre 2025 Retour au numéro

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Resources, implementation, and performance of hand hygiene practices and their impact on hospital care: A multicenter cross-sectional survey in Greece - 31/10/25

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Background

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Results

Conclusions

Highlights

Plan

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