perspectives
By Robert P. Lee; Francis X. Blais, DO, MACOI; and Eleanor Savariau, MBA, BHSA, RN
Could Adherence to Proper Hand Hygiene by
Healthcare Professionals, Commercial Players and
the General Public Mitigate the Spread of COVID-19
or Other Pathogens?
V
iruses do not spread without hosts who participate,
inadvertently carrying the pathogen to others.
Most people define hand hygiene as handwashing, but
hand hygiene is more than just handwashing. Whereas
handwashing is our everyday routine of washing our hands
when soiled or after using the restroom, hand hygiene is
designed to significantly reduce the microorganisms present
on the hands to prevent the transmission of hand flora to
others during patient care. In the healthcare arena, hand
hygiene is a science of protocols; for example, performed
before and after patient contact, utilizing either soap and
water or alcohol-based hand sanitizer for a specific minimal
time interval. Another example is the significant difference
in surgical hand hygiene prior to operative procedures and
basic hand hygiene in routine healthcare activities.
The Centers for Disease Control and Prevention (CDC) and
World Health Organization (WHO) note that healthcare hand
hygiene compliance is around 40 percent. 1-2 Hand hygiene
in the commercial and public sector is around 6 percent
to 20 percent. 3 Physicians, compared to other healthcare
personnel, have the lowest hand hygiene compliance, at
approximately 30 percent. 4
Surface cleaning and hand hygiene work in tandem
to prevent cross contamination. COVID-19 is an invisible
enemy, and consequently, prevention of transmission requires
discipline, improved training and education, and technology
to enhance compliance and improve and sustain maximum
adherence. Studies demonstrate that technology can
improve hand hygiene compliance by 50 percent in the short
term. 5 Busy healthcare personnel require subtle reminders,
reinforcement and feedback to sustain high compliance,
similar to seatbelt reminders, back-up alerts, etc. Without
discipline, proper education and training, and technology to
monitor adherence and provide feedback, are we neglecting
to adhere to the critical measures that can ameliorate and
hopefully prevent transmission of COVID-19 in both our
communities and our healthcare facilities?
Are we underselling the simplicity of proper hand
hygiene as an essential and critical intervention to control
pathogen acquisition and consequent transmission to
people and surfaces? We are in a war with microbes and
our major preventive weapon, hand hygiene, is employed
at a suboptimal rate in the healthcare sector as well as
in the commercial and public sphere. Consequently, are
we providing the general public with the most accurate,
evidence-based information and data that they can employ
to avoid COVID-19 infection as well as prevent transmission
to others, including the most vulnerable?
8
In addition to readily available personal protective
equipment (PPE), healthcare workers also need to both
understand and employ hand hygiene based on the most
effective method to avoid not only the acquisition but also the
transmission of the virus to others, both within and outside
the healthcare arena. The loss of healthcare personnel to
a COVID-19 infection results in one less critical member of
the team essential to dealing with this global pandemic as
cases progressively increase in the U.S.
Can technology and training help? It is well documented
that the current manual method of measuring and reporting
hand hygiene compliance is less than ideal, fraught with
errors, is time-consuming, expensive and probably outdated. 6
Are we providing our healthcare personnel with the latest
and most effective tools to help them do their jobs? It
often seems that infection prevention and environmental
services (EVS) departments rank the lowest when assessing
the need for funding until we find ourselves amid a crisis.
Technology has shown 50 percent improvement in hand
hygiene compliance with a correlation with consequent
decreases in hospital-acquired infections of 50 percent to
65 percent. 7
As technology is employed in many everyday functions,
the same technological solutions could help to address the
COVID-19 pandemic and probable future crises. We should
not underestimate the value of the dedicated infection
prevention and environmental services groups and should
facilitate success through recognition of their critical role
in addressing our current crisis as well as potential future
events to protect patients and our healthcare personnel.
For healthcare personnel, deploy or revisit enhance
training and education using the WHO 5 Moments approach
to hand hygiene. As noted above, currently education and
training is often inconsistent, confusing and focused on
the wrong approach to hand hygiene. The Association
for Professionals in Infection Control and Epidemiology
(APIC) blog suggests the same issue, addressing confusing
and inconsistent standards. The most effective approach
is standardized training employing the WHO 5 Moments
approach to hand hygiene.
The current standard of care to monitor hand hygiene
compliance in most healthcare facilities is the secret shopper
approach, providing compliance data for only 0.4 percent of
hand hygiene opportunities. This is far from ideal compared
to 24/7 assessment of hand hygiene compliance with
electronic monitoring. Technology can enhance adherence
and provide accurate data regarding areas of needed
retraining and reinforcing hand hygiene success. Reminders
april 2020 • www.healthcarehygienemagazine.com