hand hygiene
hand hygiene
By Robert Lee
Why is Exceptional Hand Hygiene Compliance Not More Effective in Reducing HAIs ?
Your facility reports hand hygiene compliance of greater than 90 percent , ranked as one of the best by your state for environmental services ( EVS ), and your Leapfrog Group grades are all As . If this is your integrated delivery network ( IDN ) or hospital , one might ask why patients continue to acquire an infection during and after their visit to your hospital . The Centers for Disease Control and Prevention ( CDC ) reports , “ Each day , approximately 1 in 31 U . S . patients and 1 in 43 nursing home residents contracts at least one infection in association with their healthcare , underscoring the need for improvements in patient care practices in U . S . healthcare facilities . While much progress has been made , more needs to be done to prevent healthcare-associated infections in a variety of settings .” 1
There was an increase and then a slight decrease in HAIs the last several years despite our intense focus on universal precautions . Is hand hygiene compliance , environmental cleaning , and other interventions ineffective or is reporting inaccurate ?
Focusing on hand hygiene compliance , the CDC reported that the average hand hygiene compliance in the U . S . is less than 40 percent . 2 The goal of hand hygiene is to eliminate or greatly decrease microorganisms on hands and thereby prevent or significantly decrease the transmission of these potential pathogens to patients . If hand hygiene is performed before entering a patient ’ s room and soon after there is hand contact with a cell phone , tablet , bedrails , etc ., hands can become colonized with microorganisms present on those other surfaces , and , of course , potentially spread those organisms to the patient if no hand hygiene is performed in the interval before patient contact .
Clack , et al . ( 2017 ) found that hospital personnel contaminated their hands by touching surfaces in the patient ’ s room within 4.5 seconds post entry . 3 Therefore , even though compliant with hand hygiene prior to room entry , contamination occurred during non-patient environmental contact prior to patient contact . Returning to the preceding discussion , if your institution ’ s
hand hygiene compliance score is 99 percent but you have environmental contact soon after entering the room before patient contact , what is the efficacy of such exceptional compliance in infection prevention ? Consider behavior in the operating room ; if anyone on the surgical team contaminates their gloved hands , an immediate glove change is required before any further contact with the patient , sterile instruments , or the surgical field . In surgery , hand hygiene guidelines are strictly enforced even after entering the patient ’ s space , in contrast to the behavior that often occurs in other patient care areas .
What steps can be taken to adjust to this data and prevent hand contamination prior to patient contact ? One obvious consideration in measuring hand hygiene compliance at the point of care ( POC ) rather than the doorway . Adding dispensers inside the room and improving training to change behavior to be more consistent with what occurs in the operating room where any break in technique requires re-gloving at a minimum would be a start . A torn or damaged glove in the OR requires repeat hand cleansing and re-gloving ; the same approach to regular patient care would move us closer to more effective hand hygiene where it really matters -- POC -- and potentially enhance the outcome of all these efforts , a decrease in HAIs and improved patient care and outcomes .
Of course , this is not the only intervention or factor impacting HAI rates , but one of the factors within our control . Other considerations to enhance
If hand hygiene is performed before entering a patient ’ s room and soon after there is hand contact with a cell phone , tablet , bedrails , etc ., hands can become colonized with microorganisms present on those other surfaces , and , of course , potentially spread those organisms to the patient if no hand hygiene is performed in the interval before patient contact .”
infection prevention include high compliance with environmental cleaning and disinfection , visitor and patient hand hygiene compliance , and controlling antibiotic use , etc . No single intervention alone is appropriate but rather , as noted by the Society for Healthcare Epidemiology of America ( SHEA ), a global and “ horizontal ” approach to the infection prevention interventions is within our control to achieve the ultimate outcome , reducing HAI . 4
Robert Lee , BA , the CEO and founder of MD-Medical Data Quality & Safety Advisors , LLC , is the senior biologist and performance improvement consultant . MD-MDQSA is the home of The IPEX - The Infection Prevention Exchange , a digital collaboration between selected evidence-based solutions that use big data , technology , and AI to reduce risk of HAIs . Lee may be reached at : medicaldatamanagement @ gmail . com
References :
1 . CDC HAI Progress Report . 2022 . https :// www . cdc . gov / hai / data / portal / progress-report . html
2 . CDC Hand Hygiene Core Guidelines . https :// www . cdc . gov / handhygiene / download / hand _ hygiene _ core . pdf
3 . Clack L , Scotoni M , Wolfensberger A , Sax H . “ First-person view ” of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool . Antimicrob Resist Infect Control . 2017 Oct 30 ; 6:108 . doi : 10.1186 / s13756-017-0267-z . PMID : 29093812 ; PMCID : PMC5661930 .
4 . Septimus E , MD , Weinstein RA , Perl TM , Goldmann DA and Yokoe DS . Commentary : Approaches for Preventing Healthcare-Associated Infections : Go Long or Go Wide ? Infection Control and Hospital Epidemiol . Vol . 35 , No . 7 , July 2014 .
22 • www . healthcarehygienemagazine . com • february 2024