While many , if not most , hospitals have been monitoring hand hygiene compliance for years , or at least since the Joint Commission required accredited facilities to start paying more attention to it , there is still the challenge of conducting direct observations of hand hygiene compliance , which is still the most common method and still considered to be the gold standard at the moment .” our facility had high , sustained COVID-19 admissions as well as a normal non-COVID-19 patient volume .”
Confirming what many already suspected , occupational exposure to SARS-CoV-2 drove healthcare personnel illness , not community exposure . The finding underscores the importance of evidence-based interventions such as hand hygiene , to protect healthcare workers and patients alike .
As we know , occupational exposure is not just through respiratory route , or course . While airborne transmission and its subsequent control and prevention has dominated the national scientific discourse for the past several years during the pandemic , the connection between hands and environmental surfaces is essential to explore in any discussion about hand hygiene .
As Gon , et al . ( 2020 ) observe , “ An understanding of surfaces that are safe to touch depend upon assumptions about appropriate cleaning of surfaces , cleaning frequencies , established methods , and sufficient trained cleaning staff . Despite amazing efforts from all staff , including environmental cleaning staff , standards are not always optimal … Surface contamination played a plausible role in SARS , MERS , and pandemic influenza transmission in healthcare settings . Emerging evidence suggests that the virus responsible for the current pandemic ( SARS-CoV-2 ) can survive on common surfaces for days , but viral demographics and characteristics have yet to be sufficiently studied . Recontamination of hands is a consequence and a source of poor surface cleanliness .”
At the onset of the pandemic in early 2020 , it was initially reported that SARS CoV-2 was primarily spread through contaminated objects and surfaces , so the appropriate interventions were suggested . As evidence was amassed , clinical thinking shifted toward airborne transmission , but many experts were cautioning against abandoning evidence-based cleaning and disinfection solely to focus on airborne-centric solutions .
As Gon , et al . ( 2020 ) emphasized at the time , “ We call for greater attention to the risk from hand recontamination and the opportunity for its prevention through empowering healthcare workers and strengthening cleaning of the care environment . For those managing COVID-19 cases , these actions will improve their own and coworkers ’ safety as well as that of all patients and visitors .”
Gon , et al . ( 2020 ) championed a behavioral-change approach to hand hygiene that encompassed the following elements :
• Training , monitoring , and feedback that includes clear guidance for understanding the boundaries of what surfaces are clean , with directions on what healthcare personnel can and cannot touch within the patient zone in relation to hand hygiene , especially before a clean or aseptic procedure .
• Managers and their colleagues should lead by example by demonstrating appropriate hand hygiene , including avoiding recontamination . Hand hygiene protocols should be followed by everyone involved in patient care .
• The importance of recontamination in patient and healthcare personnel safety must be clearly emphasized .
• Replace the behavior to stop the habit : “ Keep hands off unsafe surfaces ” rather than “ do not touch unsafe surfaces .”
• Make it easy to do the right thing . Create a user-friendly environment that facilitates hand hygiene and reduces opportunities for recontamination . The environment needs to account for the workflow for patient management , allowing for minimal opportunities to recontamination when collecting equipment or moving between patients . The environment should also include appropriate cues to remind and trigger hand hygiene , such as strategic placement of handrub dispensers .
Even in the face of pandemics , hand hygiene compliance can be a tough sell to harried healthcare workers .
“ We all know that in the mid-1800s Semmelweiss showed very clearly that hand antisepsis made a difference in reducing puerperal fever ,” Boyce points out . “ His work provided solid evidence , but 150 years later we are still having trouble convincing people to wash their hands . Compliance improved since the Centers for Disease Control and Prevention ( CDC ) guideline came out supporting alcohol-based hand sanitizers , which are faster and more effective , they generally cause less skin irritation than soap and water , and they ’ re much more readily accessible and take less time to use , but it still requires a change in attitudes about handwashing versus alcohol-based handrubs as well as a change in attitude about the importance of hand hygiene overall .”
Boyce continues , “ While many , if not most , hospitals have been monitoring hand hygiene compliance for years , or at least since the Joint Commission required accredited facilities to start paying more attention to it , there is still the challenge of conducting direct observations of hand hygiene compliance , which is still the most common method and still considered to be the gold standard at the moment . However , there ’ s no consistent method of monitoring hand hygiene using direct observations , despite efforts from the World Health Organization ( WHO ) and others . You also can ’ t compare hand hygiene compliance rates from one hospital to another because they ’ re all doing it differently . They use different observers , they use different methods for training the observers , they differ in terms of what they ’ re observing , and they differ in terms of whether they ’ re providing immediate feedback or not .”
Boyce tackled this issue in a paper a few years ago , proposing the idea of combining observations with automated monitoring . “ In that publication I reviewed some of the many problems that are seen with observational methods , and I ’ m not the only
www . healthcarehygienemagazine . com • may 2022
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