in the United States , best practice recommendations include performance of hand hygiene on entering the room and on exiting the patient care area . There is no mention of POC in the CDC Guideline for Hand Hygiene in Healthcare Settings ( 2002 ), and the Joint Commission Center for Transforming Healthcare based the Targeted Solutions Toolkit upon the “ wash in / wash out ” concept . Despite the evidence of POC interventions as an effective strategy to improve hand hygiene , a recent survey indicated that 22.5 percent of U . S . hospitals do not have alcohol-based hand rubs ( ABHRs ) available at the POC . This raises the question of whether different guidelines and national recommendations have resulted in variations in the adoption of POC practices .”
The Core Infection Prevention and Control Practices for Safe Care Delivery in All Healthcare Settings recommendations of the Healthcare Infection Control Practices Advisory Committee ( HICPAC ) include the following strong recommendations for hand hygiene in healthcare settings :
1 . Healthcare personnel should use an alcohol-based handrub or wash with soap and water for the following clinical indications :
• Immediately before touching a patient
• Before performing an aseptic task ( e . g ., placing an indwelling device ) or handling invasive medical devices
• Before moving from work on a soiled body site to a clean body site on the same patient
• After touching a patient or the patient ’ s immediate environment
• After contact with blood , body fluids , or contaminated surfaces
• Immediately after glove removal
2 . Healthcare facilities should :
• Require healthcare personnel to perform hand hygiene in accordance with Centers for Disease Control and Prevention ( CDC ) recommendations
• Ensure that healthcare personnel perform hand hygiene with soap and water when hands are visibly soiled
• Ensure that supplies necessary for adherence to hand hygiene are readily accessible in all areas where patient care is being delivered
• Unless hands are visibly soiled , an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water . Hand rubs are generally less irritating to hands and , in the absence of a sink , are an effective method of cleaning hands .
But how well are healthcare professionals following the guidance for handwashing and POC hand hygiene ? Kirk , et al . ( 2016 ) followed up their 2012 review with a study to compare knowledge , attitudes and practices of U . S . and Canadian frontline healthcare personnel regarding POC hand hygiene . A 32-question online survey was sent to physicians and nurses who were in direct clinical practice at least half of the time . Three hundred fifty frontline caregivers completed the survey . Among respondents , 57.1 percent were from the U . S . and 42.9 percent were from Canada , and respondents were evenly distributed between physician and nurses . Significantly more physicians in the sample were men ( 68.6 percent men ) compared with nurses ( 90.3 percent women ).
The U . S . and Canadian respondents gave identical ranking to their perceived barriers to hand hygiene compliance . Of the eight potential barriers to hand hygiene compliance listed in the survey , participants were asked to select the ones they believed were the most significant deterrents to performing hand hygiene at recommended moments . Canadian and U . S . healthcare workers selected barriers with near identical frequency ; the most frequent barriers were dispenser / sinks not in convenient locations ( 41 percent ), being busy ( 36 percent ), empty product dispensers ( 33 percent ), and products drying out hands ( 32 percent ).
Regarding product placement , about 90 percent of U . S . and Canadian healthcare workers reported that ABHR dispensers are readily available at their hospitals ; however , more than half of the survey respondents from both countries agreed or strongly agreed that they would be more likely to clean their hands when recommended if the ABHR was closer to the patient . In a related question , participants were also asked to select where hand hygiene products would be better positioned . In identical results from the United States and Canada , a wall dispenser within 3 feet of the patient was selected as the most desired position ( 77 percent ), followed by the foot of the bed ( 42 percent ). As the researchers noted , “ Options for wall-mounted dispensers within the patient zone that are truly within the definition of POC placement are limited due to restricted wall space , fire safety concerns , and the need for patient care access from both sides of the bed . However , placing ABHR at the foot of the bed is a promising solution and true to the definition of POC if it provides ABHR within arm ’ s reach without leaving the patient zone . The placement of hand hygiene products within arm ’ s reach enables the caregiver to fully comply with the moments for hand hygiene .”
They add , “ Hand hygiene experts also recommend placing ABHR in convenient locations that are consistent with staff workflow patterns . Even when a hospital ’ s hand hygiene policies are based on WHO moments , hand hygiene products are often not available within the patient zone . There is sometimes a misunderstanding that simply providing ABHR in patient rooms is providing for POC hand hygiene . However , current guidelines are clear that health care workers should not need to leave the patient zone to perform hand hygiene . Placing ABHR in the patient zone within arm ’ s reach of the POC achieves this goal and removes the barrier most frequently identified by U . S . and Canadian healthcare workers .”
Regarding product preference , Canadian respondents indicated a statistically significant preference for soap and water over ABHR , whereas U . S . respondents preferred ABHR . However , in both the U . S . and Canada , more physicians indicated a preference for ABHR over soap and water when compared with nurses . Respondents who identified a reason for preference of ABHR cited taking less time ( 78 percent ) and convenient location of dispensers ( 73 percent ) as the most common reasons .
As Kirk , et al . ( 2016 ) observe , “ Preference for soap and water over ABHR indicates a knowledge deficit and the opportunity for healthcare workers to be educated on specific hand hygiene practices for skin health as well as patient safety . It is the ongoing challenge to infection preventionists ( IPs ), healthcare worker educators , and others to promote improved hand hygiene compliance with the goal of improving patient outcomes .”