Stancill , et al . ( 2022 ) acknowledge that “ During the coronavirus disease 2019 ( COVID-19 ) pandemic , the focus has been on airborne and droplet transmission , but the importance of hand hygiene has also had renewed emphasis .
Severe acute respiratory coronavirus virus 2 ( SARS-
CoV-2 ) can survive on human skin for about nine hours , but it is easily inactivated with an alcoholbased hand rub , reinforcing the role of hand hygiene in limiting the COVID-19 spread .” fewer patient visitors , remote rounding by clinicians , and nurse batching of tasks while in patient rooms . High compliance was not sustained and returned to baseline . As hospitals set hand hygiene goals , this study suggests high compliance is possible , even with automated monitoring , yet difficult to sustain . The recent decline in compliance should be a clarion call to hospitals currently experiencing COVID-19 surges .”
Experts suggest that to be most successful , hand hygiene should be part of a bundle of evidence-based practices .
Investigators in Florida report that they “ rapidly implemented comprehensive practices for enhanced institutional and personal hygiene in March 2020 . Our policy focused on hand hygiene , universal face coverings , expanded environmental services and restriction of non-essential personnel and visitors . With the addition of intensified infection prevention and control ( IP & C ) measures throughout the course of the COVID-19 pandemic , we hypothesized that the hand hygiene compliance at our hospital will have significantly increased and , as a result , the incidence of non-COVID-19-related hospital-acquired infections will have decreased .” While seeing a downward trend in HAIs , Kong , et al . ( 2021 ) discovered a strong statistically significant negative correlation between hand hygiene compliance and the rate of Clostridium difficile hospital-acquired infection . The authors reported that hand hygiene compliance increased from 82.9 percent before the COVID-19 pandemic ( January 2019 to February 2020 ) to 96.4 percent during the COVID-19 pandemic ( March to June 2020 ).
They observe , “ This increase shows that with a strong enough stimulus , particularly such that supports personal safety , providers are likely to focus their attention on the required protocol . This is consistent with psychological theories that personal investment is a stronger driver for action than simply following a protocol . We hope that this change in behavior will persist beyond the pandemic and become a habitual practice that is deeply ingrained as a pattern for every health care provider . It is , however , important to note that even with the pandemic threat , hand hygiene compliance has not reached 100 percent yet . It is possible that the use of personal protective equipment ( PPE ) may be providing a sense of protection that lowers the vigilance of providers for hand hygiene . Also , these results are from a single center , and no external data regarding hand hygiene compliance were available for comparison .”
As Long , et al . ( 2021 ) acknowledge , “ While not ill-intended , hand hygiene is a frequent error of omission . HAI rates negatively correlate with hand hygiene performance rates and are potentially preventable by increasing hand hygiene compliance .”
Also of importance is the connection between hands and surfaces .
Stancill , et al . ( 2022 ) acknowledge that “ During the coronavirus disease 2019 ( COVID-19 ) pandemic , the focus has been on airborne and droplet transmission , but the importance of hand hygiene has also had renewed emphasis . Severe acute respiratory coronavirus virus 2 ( SARS-CoV-2 ) can survive on human skin for about nine hours , but it is easily inactivated with an alcohol-based hand rub , reinforcing the role of hand hygiene in limiting the COVID-19 spread .”
Instead of using an automated monitoring system by which to collect compliance data , Stancill , et al . ( 2022 ) sought to determine whether their institution ’ s Clean-In-Clean-Out ( CICO ) program , a manual method for hand hygiene observations , was sustainable throughout a public health and healthcare crisis . They also wanted to know if the COVID-19 pandemic impacted hand hygiene compliance .
During this evaluation , the researchers pulled CICO hand hygiene metric data regarding engagement , the absolute number of observations performed overall and per 1,000 patient days ; compliance , hand hygiene compliance percentage ; and accountability , the percentage of observations with feedback from January 2019 through December 2020 across inpatient settings . They reported a total of 97,429 observations in 2019 and 74,809 in 2020 . Adjusting for the number of observations per 1,000 patient days showed no statistically significant difference between 2019 and 2020 . They also found that hand hygiene observations followed the same trend ( sharp increase followed by stabilization ) as COVID-19 hospitalizations from March through July 2020 , when the number of COVID-19 hospitalizations reached its first peak . After mid-July , the number of observations stabilized and began decreasing with increasing hospitalizations . Hand hygiene observations never recovered to the spring 2020 level .
The researchers found that “ observations and feedback increased with COVID-19 media attention , prior to cases occurring in North Carolina or at our facility . These increases may reflect staff proactively engaged in COVID-19 infection prevention efforts . Feedback and compliance increased again when our facility began seeing COVID-19 patients , even in the absence of active reminders and campaigns from infection prevention staff .”
They add , “ A statistically significant increase in hand hygiene compliance was observed during one period , March through June 2020 , which corresponded with the admission of the first COVID-19 patient at our facility , shelter-in-place orders community-wide , and low inpatient volumes . In July , patient volumes started to return to pre-COVID-19 levels while our facility also began treating a higher number of COVID-19 patients . In addition , the hospital started experiencing staff shortages . The decrease in engagement observed with higher patient volume and patient-to-staff ratios is further evidence that operating at high capacity is not beneficial for patient safety . This trend was further demonstrated by the decrease in hand hygiene compliance from October through December 2020 , when