Hand Hygiene Compliance and Postpartum Infections

Background Hand hygiene (HH) is a fundamental aspect of modern medicine, however there is a paucity of evidence of the benefits of HH in modern maternity care. Aims We aim to examine the association between HH compliance and postpartum infection hospital readmission, and what factors are associated with readmissions. Methods Single centre cohort study of all women birthing at a tertiary hospital in Sydney, Australia between 2017 and 2024. Linked perinatal, hospitalisation and hand hygiene compliance data were used. Modified Poisson regression was used to estimate the association between HH compliance and postpartum infection-related hospital readmission within 42 days of birth. Results Readmission for infection occurred in 220 (1.1%) of 20,195 births. HH compliance increased from 61.0% in 2014 to 86.9% in 2024 (p<0.001). There was no association between hand hygiene compliance and readmission for infection (aRR 1.01, 95% CI 0.99-1.04). Instrumental delivery (aRR 2.00, 95% CI 1.27-3.04) and emergency caesarean birth (aRR 3.28, 95% CI 1.57-6.86) were associated with increased risk of infectious readmission. Conclusion We showed a sustained improvement in HH compliance, yet there was no associated change in postpartum infectious readmissions. Mode of delivery by instrumental or caesarean section was associated with infection. This reinforces the success of the National Hand Hygiene Initiative in Australia and encourages us to look to other strategies to further decrease infections following instrumental and caesarean birth.