Healthcare Hygiene magazine May 2020 | Page 6

h ealthcarehygienemagazine from the editor COVID-19 Places Renewed Emphasis on Hand Hygiene of First Responders O ne of the most written about topics in healthcare is also one of the least practiced, if the less-than-40 percent average is to be believed. Hand hygiene is a cornerstone of infection prevention and control, remains the object of scrutiny by accreditation surveyors, and yet performance remains suboptimal in the healthcare environment and in the general public. That may change in the wake of the COVID-19 pandemic, until complacency sets in during what will become our “new normal” in the healthcare sector and life in general. With COVID-19 putting our beloved first responders in the spotlight, a recent study’s findings remind us they are not immune to poor hand hygiene practices – at least before the novel coronavirus outbreak. Paramedics’ compliance with hand hygiene standards seems to be “remarkably low,” found an observational study of ambulance staff practice in four countries and published online in Emergency Medicine Journal last year. Importantly, an over-reliance on the use of gloves indicates that first responders may be more aware of their own infection risk rather than that of their patients, suggest the researchers. The study authors assert that researchers have paid relatively little attention to hygiene issues in emergency care, as most studies have focused on bioterrorism and disaster preparedness, rather than on basic infection control. They wanted to assess how well paramedics in different countries complied with recommended hand and basic hygiene standards, including the use of gloves, to protect themselves and their patients from the risk of infection. Compliance with World Health Organization guidelines on the five triggers for hand hygiene using either antiseptic rub or soap and water was assessed. These triggers were: before touching the patient; before any ‘clean’ procedure, such as an injection or cleaning a wound; after contact with bodily fluids/wounds; after touching the patient; and after handling the patient’s belongings or anything in the immediate vicinity, such as the stretcher harness. In all, 240 hours of observation were clocked up between December 2016 and May 2017 in Finland, Sweden, Denmark and Australia during which time 77 paramedics dealt with 87 patients. Compliance with basic hygiene standards was high: short, clean nails (83 percent); hair short or tied back (99 percent); and no jewelry worn (62 6 percent). But compliance with hand hygiene was poor. In all, 1,344 hand hygiene triggers were recorded during this period, but complied with in only 15 percent of instances. When broken down separately by trigger, compliance was just 3 percent before touching a patient and 2 percent before any ‘clean’ procedure. This rose to 8 percent after contact with bodily fluids, 29 percent after touching the patient, and to 38 percent after touching belongings, etc. Paramedics used gloves in just over half (54 percent/720) of the recommended instances, with new gloves worn before touching patients around half the time (48 percent), but in only 14 percent of ‘clean’ procedures. There was a tendency to wear the same pair of gloves throughout different indications; for example, after touching a contam- inated site and touching the patient for the first time (21 percent) or before a ‘clean’ procedure (64 percent). Gloves were also worn when there was no obvious need/no risk of bodily fluids, for example. And hand hygiene was less likely when gloves were worn. Proper hand hygiene was observed in 2 percent of such instances, and in 30 percent of the indications when no gloves were worn, suggesting an over-reliance on gloves to ward off the risk of infection, say the researchers. “Hand hygiene compliance among [emergency medical service] providers was remarkably low and higher after patient encounters compared with before patient encounters,” they write. “In addition, there was an over reliance on gloves, indicating a tendency toward self-protection instead of patient protection.” This is an observational study, and it is very likely that behaviors might have been influenced by the presence of the observers, say the researchers. As such, no firm conclusions can be drawn about the findings, they add. Nevertheless, their findings indicate that further research is warranted on the barriers to good hand hygiene and how healthcare providers understand its value. As the conduit between the community and the hospital, it is essential for infection preventionists to continue to observe the hand hygiene behavior of first responders and course-correct as warranted, to protect everyone along the healthcare spectrum. Until next month, bust those bugs! Kelly M. Pyrek editor & publisher [email protected] A.G. Hettinger, CPA president & CFO Patti Valdez art director Mary Johnson sales and marketing specialist [email protected] Linda Lybert business development consultant J. Christine Phillips customer service manager Send inquiries to: [email protected] Healthcare Hygiene magazine is published monthly by Keystone Media Inc. 8925 Ridgeline Boulevard, suite 106, Highlands Ranch, CO 80129. Free digital subscriptions available at www.healthcarehygienemagazine.com for U.S., Canada and other foreign subscribers. Copyright © 2019 Keystone Media Inc. All rights reserved. The publisher reserves the right to accept or reject any advertising or editorial material. Advertisers, and/or their agents, assume the responsibility for all content of published advertisements and assume responsibility for any claims against the publisher based on the advertisement. Editorial contributors assume responsibility for their published works and assume responsibility for any claims against the publisher based on the published work. All items submitted to Healthcare Hygiene magazine become the sole property of Keystone Media Inc. Editorial content may not necessarily reflect the views of the publisher. No part of this publication may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher. Kelly M. Pyrek Editor & Publisher [email protected] may 2020 • www.healthcarehygienemagazine.com