Speaking Out on Hand Hygiene
Q: How can infection control practitioners encourage healthcare workers' compliance with good hand-hygiene practices?
"When the Centers for Disease Control and Prevention (CDC) came out with the draft guidelines for hand hygiene in healthcare settings, our hospital, clinics and long-term care facilities started a trial of alcohol sanitizers. We installed dispensers throughout these facilities and did in-services on how to use the products. Evaluations were done and one product was chosen. Physicians like the new concept and we have educated our patients and visitors. Our hand hygiene has improved. We are planning to put a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) brochure entitled 'Speak Up' in our admit packets for patients. They are told to observe staff for handwashing or use of alcohol sanitizers. Staff and physicians will probably be reminded by our patients to wash their hands or use the alcohol sanitizers. Handwashing and hand hygiene compliance should soar if the staff knows patients are watching. Nonclinical staff has responded to hand hygiene compliance by having dispensers in their areas."
Helen J. Molchan, RN, CIC Director of Infection Control/Employee Health, Citizens Memorial Hospital, Bolivar, Mo.
A: "In addition to the usual preaching about handwashing, I experimented. I washed my hands perfectly: 20 seconds of good friction on all surfaces of hands, using warm water and liquid soap. I dried them on dry paper towels and used additional paper towels to open the door. I went to the administrative suite, dropped off papers and descended five flights of stairs to the emergency department and lab. There was no patient contact at all. I asked the lab technician to culture my hand, then washed my hands again and asked for a second culture. The first culture grew Staph aureus coag+ and Group D Streptococcus. Neither was a resistant strain. The second culture grew 'normal flora' proving that handwashing does work. I showed pictures of someone sneezing into their hands, then shaking hands with another person who then proceeded to eat candy without washing their hands in between. Very effective! We had a surgeon with infection control practices that were so bad, nurses were writing me complaint-filled notes. He finally came around. He had a poor surgical outcome that caused a lawsuit after which infection control issues came to light. He lost his license, in part because of the breach of infection control, specifically not washing his hands when it was appropriate."
Pat Streeter Director of Infection Control, Amsterdam Memorial Hospital, Amsterdam, N.Y.
A: "In my experience, there has been an increase in observed hand washing by all hospital staff by frequently reminding them that the most effective way to protect themselves, their families, their co-workers, and most importantly our patients is to wash their hands. This message is delivered by educational posters in various areas of the hospital campus including the bathrooms (talk about captive audience). Also, with the advent of alcohol-based hand disinfectant, it could not be easier. Finally, I remind the staff during surveillance rounds that frequent, correctly done handwashing reduces the number of patients requiring isolation."
Kevin L. Sullivan, RN, BSN, CIC Infection Control Nurse, Mercy Medical Center, Springfield, Mass.