Secret Handwashing Observation is Part of One Hospital’s Waron Germs

Secret Handwashing Observation is Part of One Hospital’s War on Germs

By Kelly M. Pyrek

If you’re a healthcare worker and you haven’t been washing your hands, chances are someone at OSF Saint Francis Medical Center in Peoria, Ill. is watching and making a note of it. This secret handwashing observation exercise is part of the facility’s larger war on germs and a campaign to increase hand-hygiene compliance among the center’s 5,000 employees and 750 physicians.

When the epidemiology and infection control department at OSF Saint Francis Medical Center received a $1,000 nursing research grant, it decided to conduct a house-wide project that would have a broad reach toward achieving an ongoing goal – handwashing and healthcare worker/patient safety.

“We chose hand hygiene because it’s something that is important but sometimes overlooked,” says Patricia Ham, MS, RN. “We did our research, wrote up a proposal, and secured money to do some cultures and an educational campaign. We decided that part of the program would include secret observers as well as a survey of staff members’ knowledge about and attitude toward hand hygiene. We did the observation during the summer, and now we’ll do education and intervention, and in January 2005, we will resurvey to see if the intervention made any difference.”

Ham says that nursing students were recruited to serve as the secret handwashing observers. “Before they went onto the floors, the students watched a hand-hygiene video so that we were assured that everyone was on the same page about what they would be looking for. They were assigned different units and they picked the times they wanted to go that unit for their observation sessions. They wore lab coats and name badges, because they couldn’t look like some person off the street. If staff members asked them what they were doing, they were instructed to say – and everything was scripted – that they were conducting research for the epidemiology and infection control department, so that they didn’t reveal the nature of the research. If a staff member continued to ask, ‘What are you looking at?’ then they would be instructed to say, ‘The nature of the research is confidential, but your manager is aware of the project, and if you have any questions, you can talk to him or her.’”

Ham says her department is working with a statistician to help crunch the numbers regarding the facility’s current handwashing compliance rate, but observes from an anecdotal point of view, “There are missed opportunities.”

“We have declared war on germs,” Ham adds, explaining that the idea of a military-themed campaign was borrowed from an infection control nurse she met at a recent Association for Professionals in Infection Control and Epidemiology (APIC) meeting, and modified to fit OSF’s needs. “At the kick-off of our campaign, the three of us in our department dressed in fatigues to get into the combat mindset. Our housekeeping department supervisor actually is in the military, so he was the one who did so much to work the crowd, so to speak, and get people motivated.”

Ham says that every month, “War Games,” a one-page fact sheet discussing hand-hygiene issues is distributed facility-wide. The reverse side of the fact-sheet has a fun hand-hygiene quiz, ranging from true/false questions, to a word-search game, and when the quizzes are completed, staff members turn them in and their name is dropped into a hat. Names are drawn, and the winners receive gift certificates from Wal-Mart. Ham says she ordered 3,500 hand hygiene-themed lapel buttons for the 5,000 employees, thinking not everyone would want to participate, “But I was wrong … we ran out of buttons, they were so popular,” Ham says. “They are embracing the campaign because it’s fun. Sometimes we get so bogged down in the have-to’s, that it’s great to do something a little more lighthearted yet educational.”

U.S. Gets a “C” for Hygiene in the SDA Clean Hands Report Card

Americans are up to their elbows in grime, and they’re not doing enough about it, according to the Soap and Detergent Association (SDA)’s 2004 Clean Hands Report Card. The report card gives Americans a “C” for hand hygiene, although many would give themselves a higher grade. But what is said vs. what is done often differs.

The SDA produced the report card to raise awareness of National Clean Hands Week held in September, a national health campaign that touts handwashing as the easiest path to staying healthy. The report card surveyed Americans on basic hand-hygiene practices, such as washing before a meal, after using the bathroom, and after coughing or sneezing. The report card not only measured how often Americans wash daily, but for how long, and revealed perceptions of hand hygiene.

“Most infectious diseases are spread by contact, either person-to-person, or by touching surfaces harboring germs,” said U.S. Surgeon General Richard H. Carmona. “Proper hand cleaning is the best prevention against communicable illness.”

“In very simple terms, clean hands save lives,” said Nancy Bock, SDA vice president of education. “According to the Centers for Disease Control and Prevention (CDC), cleaning our hands is the single most important thing we can do to keep from getting sick and spreading illness to others.”

Among the findings of SDA’s latest National Cleaning Survey:

Forty-three percent surveyed seldom or never wash their hands after coughing or sneezing. One of the most common ways people catch colds is by rubbing their nose or eyes after touching someone or something contaminated with the cold virus.

Thirty-two percent don’t always wash before eating lunch. That means germs that were on the change, the door handle, and the elevator button might find their way onto the midday turkey sandwich.

Fifty-four percent of respondents don’t wash their hands long enough to effectively remove germs and dislodge dirt. The CDC and SDA recommend washing with soap for at least 20 seconds.

According to the report card, 90 percent of Americans surveyed said they always washed their hands after using the bathroom, while 8 percent said they frequently washed, and 2 percent said they seldom or never washed. There appears to be a major gap between what people say and what they do. A 2003 observational study by the American Society for Microbiology found as many as one-third of public restroom users did not wash their hands.

The Clean Hands Report Card found a notable gap in the hand-hygiene perceptions and practices of men and women. While 51 percent overall considered handwashing as a top way to prevent colds and fl u, more women (60 percent) thought so than men (42 percent). Both men and women listed other top cold and fl u prevention tactics including healthy diet (23 percent), immunization (11 percent), and proper sleep (8 percent). Women also were ahead in handwashing frequency: they washed their hands an average of nine times a day, while men washed an average of six times daily.

“More Americans should know that your health is literally in your hands,” said Bock. She mentioned key instances when handwashing is critical:

• when preparing food
• before meals and snacks
• after using the restroom
• after touching animals
• when hands are dirty
• when you or someone around you is ill

No soap and water? That is no longer a barrier to hand hygiene with the latest portable products. Instant hand sanitizers, gels and foams are convenient and effective in killing germs. Additionally, disposable hand wipes offer a timesaving cleansing alternative for people with active lifestyles.

The Clean Hands Report Card was based on a survey of 1,013 American adults. The independent consumer research study was completed in August 2004, on behalf of the Soap and Detergent Association (SDA), by International Communications Research (ICR). The survey has a margin of error of plus or minus 3.1 percent.