Hand Hygiene: Achieving
Consistent Compliance is Complex
By Loretta Litz Fauerbach, MS, FSHEA, FAPIC, CIC
O
ver the last decade, environmental microbial
contamination has led to increased health-
care-associated infections (HAIs). The presence
of multidrug-resistant organisms contributes to
the microbial load in the patient environment.
Improved environmental hygiene through
cleaning, disinfection and sterilization is essential
to reducing the bioburden in the environment.
The other key intervention for reducing the
bioburden and preventing transmission to the
patient is hand hygiene.
Hand hygiene includes both cleaning of hands
by traditional handwashing or the use of alcohol
based handrub (ABHR) and the appropriate use
of gloves.
There are three categories of products for
hand hygiene: 1. Non-mediated plain soap; 2.
Medicated/antiseptic soap for antiseptic and
surgical handwash; 3. Alcohol-based handrub
which is used for hygienic and surgical hand
disinfection that is applied and remains on the
hands. In spite of established guidelines published
by the Centers for Disease Control and Prevention
(CDC) and the World Health Organization (WHO),
many challenges remain related to understanding
the practices that are necessary for maximum
reduction of microbes on hands and how to
assure compliance with recommendations for
hand hygiene.
Optimal hand hygiene practices depend on
many complex and confounding factors:
• Agent(s): Type, efficacy against microbial
pathogens and skin sensitivity
• Location and accessibility of product and
dispenser design and ease of use
• Methodology used: Handwashing or ABHR
• Culture of the setting/workplace: unit,
hospital, profession
• Technique used and the duration of the
procedure
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• Knowledge of healthcare provider and belief
in appropriate practices/procedures
• Compliance measurement and monitoring:
Initial measurement involves competency of the
practice and must be verified by instructor; for
ongoing measurement,methods used include
direct observation, electronic and product usage
• Measurement done based on an ap-
proved schedule via trained observer using
monitoring tools
• Feedback: Individual or group; immediate
or delayed
• Education: Type and frequency
• Residual contamination after hand hygiene:
Measure intermittently not continuously via dyes,
markers such as fluorescent, or microbial culture
To assure appropriate hand hygiene practices,
all these contributing factors must be addressed
when developing a comprehensive and effective
hand hygiene program in the complex setting
of modern healthcare. The importance of hand
hygiene has been recognized for centuries and
yet many opportunities remain to assure safe
practices. Administrative support of the hand
hygiene program via resources (human, materials
and computer) and leadership involvement is key
for success. Infection preventionists and hospital
epidemiologists have recognized the importance
of human factors engineering and behavior health
models in improving hand hygiene compliance.
Facilities should seek to use these techniques in
developing a successful hand hygiene program
that addresses the uniqueness of their setting.
Human factors engineering can be applied to
study the interactions of the healthcare worker
and the healthcare system, including device use,
the built environment and the patient. A team
of healthcare providers, materials management
and environmental services should evaluate
the system’s factors impacting hand hygiene
compliance. Important questions related to
Improved
environmental
hygiene
through
cleaning,
disinfection
and
sterilization
is essential
to reducing
the bio
burden in the
environment.
may 2020 • www.healthcarehygienemagazine.com