Implementation of multimodal infection control and hand hygiene strategies in acute-care hospitals in Greece: a cross-sectional benchmarking survey

Background: In this first attempt to suggest achievable standards for improvement in hospital infection prevention and control (IPC) in Greece, we assessed main IPC structure and process indicators emphasizing on hand hygiene.

Methods: Acute-care hospitals across the country participated in a cross-sectional survey by completing the World Health Organization Hand Hygiene Self-Assessment Framework (HHSAF) and by providing hospital-level IPC indicators.

Results: Seventeen hospitals completed the survey, comprising 14% of the country’s public hospitals. Median IPC staffing levels were 0.8 nurses and 0.5 doctors per 250 beds, respectively. Few hospitals implemented full multimodal IPC programs. HHSAF indicated that appropriate hand hygiene practices and promotion strategies were in place in most hospitals, but mean HHSAF score (289) was lower compared to studies in Italy (332, p=0.040) and the USA (373, p<0.001). Presence of one additional IPC nurse was independently associated with increases by 53% in the HHSAF median score for training-education (p=0.035) and by 38% in the lower 30th percentile score for safety climate (p=0.049).

Conclusions: Surveyed hospitals are, on average, at an intermediate level in hand hygiene practice but require improvements on training-education, evaluation-feedback and safety climate. Ensuring adequate IPC nurse staffing levels and systematically implementing multimodal IPC programs may lead to substantial improvements.