Healthcare Hygiene magazine May 2020 | Page 25

hand hygiene include: location of the sink and soap; the type of sink and faucets; the type of paper towels for drying hands or automatic hand dryers; location and ease of use of the ABHRs dispensers; the products and whether the staff likes it or not; application time required by manufacturers’ instructions for use; and the patient’s complexity and the patient’s need for transmission based precautions. Understanding human behavior via behavioral health models is another process to identify the key element for improving compliance with recommended infection prevention strategies. One early example was the use of multi-faceted bundles of care to prevent central line-associated bloodstream infections (CLABSIs) via improve compliance with recommended practices. Hand hygiene and use of sterile techniques were some of the prevention strategies included in the bundle. This national project also focused on institutional culture and feedback to clinical teams and required leadership support for the prevention program. Implementation of the CLABSI bundle in hospitals across the country has resulted in significant reductions in this type of healthcare-associated infection. Subsequently, hand hygiene programs have used behavioral health models to identify and address barriers to compliance. Building a successful hand hygiene program requires intentional work and the use of imple- mentation science to establish a program that addresses the key factors related to appropriate hand hygiene. Important steps include: A. Establish a system that teaches the proper steps for hand hygiene to all new employees and measure competency by demonstration after ini- tial training and then at least annually thereafter. The employee should be able to vocalize when hand hygiene should be performed and be able to demonstrate proper handwashing and also the application of AHBR to clean their hands. B. Use creative ways to demonstrate the impact of proper hand hygiene in the removal of bacteria found on the skin. ➊ Culturing of hands: There are several ways to do it: the bag-rinse method by putting hands into a bag with media and then culturing the fluid; swabbing hands and then plating on an agar plate; and finally, culturing the hand on a large agar plate. Culturing the hands by placing a dirty hand on an agar plate and then clean hands on another plate and incubate for 24-48 hours is very effective. After incubation of the plates, each person should be shown their before and after results. Although the results are not immediately available, the realization of what effective hand hygiene does in reducing the microbial load is “a picture is worth a thousand words.” www.healthcarehygienemagazine.com • may 2020 ➋ A variety of dyes or markers such as fluorescent dyes are available to mimic the removal of the bioburden on hands after hand hygiene. A black light will be needed to show the fluorescents dye. Feedback to the healthcare worker is immediate with these markers and some consider it is advantageous to see the results in close proximity to performing hand hygiene procedure. B. Monitoring of hand hygiene practices should be done consistently via an established schedule. C. The monitor should note that the appro- priate supplies are available at the point of care including alcohol-based handrubs, soap and paper towels plus gloves. D. Provide feedback of monitoring results per protocol to staff individually or to the group/unit and to infection prevention program, quality committees and leadership. E. The monitor should be trained on how to provide individual feedback should include scripting of messages and when to do it in order to how to create a positive culture of patient safety. F. Keeping hands healthy without redness, cracks, rashes, etc. is also key to decreasing the microbial load on hands. Facilities should provide hand lotion that is compatible with their hand hygiene products and gloves. If the healthcare provider has extensive skin breakdown of their hands, occupational health services should see the person and make appropriate recommendations of care to heal the skin. The challenge with hand hygiene protocols is to achieve compliance 100 percent. Reductions in HAIs have been reported in multiple studies when compliance with hand hygiene protocol increased. Healthcare facilities must ensure that each healthcare worker is appropriately performing hand hygiene to reduce the risk of transmission of microbes. In that light, the Joint Commission -- to emphasize the importance of hand hygiene in preventing infections -- has begun to cite non-compliance with hand hygiene when it is observed. Previously when non-compliance was observed the Joint Commission would evaluate compliance monitoring activities, improvement strategies and compliance rates and not cite unless there was a significant breach in practices. According to the CDC Guideline for Hand Hygiene in All Healthcare Settings 2002, han- washing should be performed when hands are visibly soiled. Handwashing is also recommended when spores are the suspected pathogen such as Clostridioides difficile or Candida auris. Spores are not killed or removed from hands by ABHR hand hygiene products. Therefore, handwashing is recommended because it removes and dilutes the presence of the spores by friction and rinsing Understanding human behavior via behavioral health models is another process to identify the key element for improving compliance with recommended infection prevention strategies. 25