Healthcare Hygiene magazine December 2019 | Page 24

Progress Still Needed
in Advancing Patient
Hand Hygiene
By Sue Barnes, RN, CIC, FAPIC
patient morbidity and mortality. 4 Hand hygiene is commonly
part of C. diff prevention bundles, although typically focused
primarily on healthcare workers.
Patient hand hygiene can significantly impact the rate
of other types of HAI as well. For example, in 2013 on a
cardiothoracic postsurgical step-down unit, patients were
provided bottles of hand sanitizer and information, and infec-
tion rates were tracked. Vancomycin-resistant enterococcus
(VRE) infections decreased by 70 percent in a 19-month
period after the intervention. MRSA infections decreased
by 63 percent in a 19-month period after the intervention. 5
In another hospital intensive care unit (ICU) in 2014, a
protocol was introduced which involved 2 percent chlorhexi-
dine (CHG) wipes applied to patients’ hands three times a day
as a method of reducing HAIs. The mean monthly catheter
associated urinary tract infection (CAUTI) rate decreased from
9.1 to 5.6 per 1,000 catheter days, and the mean monthly
central line-associated bloodstream infection (CLABSI) rate
decreased from 1.1 to 0.50 per 1,000 catheter days. 5
The outcomes of these studies make good sense, as
contaminated patient hands can inadvertently inoculate
their own lines, drains and airways.
A
ccording to the latest Centers for Disease Control
and Prevention (CDC) Healthcare-Associated Infection
(HAI) Progress report, we are seeing a significant reduction
in HAIs, although we have not achieved zero preventable
infections. 1 Hand hygiene is widely known as the single
most important infection measure. Consequently, great
focus, effort and success has been seen relative to healthcare
worker hand hygiene over the past decade, with the aid
of innovations including alcohol-based hand sanitizer and
electronic hand hygiene compliance tracking systems. Yet,
although studies have proven that most HAIs occur as a
result of bacteria present on the patient’s skin and surfaces
within the near-patient environment, there has not been
the same focus or level of improvement regarding patient
hand hygiene. 2
While the rate of healthcare worker (HCW) hand hygiene
compliance is now a common quality metric in hospitals,
there are very few studies that have measured patient hand
hygiene. One study published in 2014 assessed patient hand
hygiene using an ultrasound-based real-time location system
over several months. The study found that most ambulatory
patients did not clean their hands before, during or after
entering the patient pantry area. In addition, there was less
than 35 percent patient hand hygiene compliance after using
the bathroom and prior to eating a meal. 3
Insufficient patient hand hygiene is of greatest concern
relative to HAI transmitted via the fecal-oral route such as
Clostroides difficile (C. diff). C. diff infection occurs when
a patient’s bowel flora becomes disrupted, generally by
antibiotics or by peptic ulcer prevention medications, in
combination with ingestion of C. diff spores via their own
contaminated hands. C. diff is the pathogen of greatest
concern in today’s healthcare setting, causing significant
24
89
out of 106 patient
mobile phones were found to
be contaminated with bacteria.
One potential source of patient hand contamination
are cell phones. Patients’ devices are no less contaminated
than healthcare workers’ phones. In a study by Kumar and
team in 2014, 89 (83.9 percent) out of 106 patient mobile
phones were found to be contaminated with bacteria. The
bacteria identified were 49.0 percent coagulase-negative
Staphylococcus, 11.3 percent Staphylococcus aureus, 6.6
percent Enterobacter cloacae, 2.83 percent Pseudomonas
stutzeri, 2.83 percent Sphingomonas paucimobilis, 1.8
percent Enterococcus faecalis and 9.4 percent aerobic
spores. All the isolated bacteria were found to be resistant
to various antibiotics. 6
And yet, while there is a trend toward addressing health-
care worker cell phone cleaning, there is rarely mention of
patient cell phones and the associated contamination risk.
Based on the few published accounts regarding patient
hand hygiene compliance, this represents a significant per-
formance improvement opportunity which could significantly
december 2019 • www.healthcarehygienemagazine.com