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Maintaining proper hand hygiene is crucial in ensuring our safety and that of those around us and is rightly celebrated worldwide.
World Hand Hygiene Day is a reminder that by prioritizing hand hygiene, health care leaders and workers can prevent infections and antimicrobial resistance. This simple action can establish a culture of safety and quality in health care.
To discuss World Hand Hygiene Day and the value of always performing hand hygiene, Infection Control Today® (ICT®) interviewed Marika White, MSN, RN, hygiene advisor, Tork, Essity.
ICT: With World Hand Hygiene Day today (May 5), why is hand hygiene so important?
Marika White, MSN, RN: Hand hygiene is the most effective way to prevent the spread of infection. Throughout the day, we touch various surfaces in the environment, like doorknobs, stair rails, and phones. In health care facilities, we also come into direct contact with residents and staff. Without realizing it, we also touch our mouths, noses, and eyes, so it’s easy to become infected with a pathogen that may be living on the surfaces we’ve touched and spread that pathogen when we touch surfaces in the environment or touch other people. By performing hand hygiene correctly, we remove those pathogens from our hands, thereby breaking the chain of infection.
Right now, hand hygiene is as important as ever as we grapple with the emerging fungal pathogen Candida auris (C auris) that is currently making headlines as it spreads through US health care facilities. C auris can live in a patient’s body without them knowing it or displaying symptoms before becoming ill. Individuals with the greatest risk for contracting C auris include those who are ill, have other medical conditions, are immunocompromised, live in a health care facility for an extended period, or have previously received antibiotics or antifungal medications. Many of these risk factors apply to residents of long-term care facilities, so it’s imperative that we monitor these patients for signs and symptoms of C auris and test them promptly if they develop symptoms. When caring for these patients, the most effective way to prevent infection is to utilize hand hygiene, appropriate personal protective equipment, and surface disinfectants.
ICT: What is the history of World Hand Hygiene Day? How did it come to be?
MW: World Hand Hygiene Day was first launched in 2009 by the World Health Organization (WHO) as part of its SAVE LIVES: Clean Your Hands campaign, which is focused on the importance of proper hand hygiene in health care. More specifically, the observance calls on health care leaders and employees to leverage hand hygiene as a means to prevent infections and antimicrobial resistance and build a culture of safety and quality.
At Tork, an Essity brand, we recognize World Hand Hygiene Day every year because, as a professional hygiene company, we know how powerful clean hands are in building a safe and healthy work environment. As we understand the role of the environment in the transmission of infection, we stress the importance of cleaning both our hands and environmental surfaces properly and in a timely fashion using the right products.
ICT: How can facilities ensure that staff are adequately trained and prioritize hand hygiene?
MW: Training is the most impactful conduit of hand hygiene, and it should start on day 1 for new employees. During onboarding, managers should walk through hand hygiene protocols and then have new employees demonstrate the process in real-time to ensure compliance. That training is repeated on an annual basis. I recommend utilizing a facility-approved skills checklist for return demonstrations of hand hygiene. Keeping a log of trainings and demonstrations is a must for CMS survey compliance.
Throughout the year, managers can reinforce hand hygiene through regular or monthly infection control updates, staff meetings, beginning-of-shift rounds, and as needed when health care-associated infections (HAIs) occur.
Additionally, technology is allowing our field to innovate new ways to train and retrain on the topic of hand hygiene. I’m particularly excited about the advent of virtual reality hand hygiene education, which allows staff the flexibility and autonomy to conduct training when it’s convenient for them and provides real-time feedback. VR training is interactive and engaging, so users are more likely to remember the patient care scenarios they’ve seen and can recall when they should be performing hand hygiene.
ICT: What are the biggest challenges for care facilities regarding promoting hand hygiene?
MW: I find that adherence is the biggest challenge. Hand hygiene comprises relatively simple procedures, so staff can become complacent when valuing the importance of hand hygiene and hand hygiene education. Additionally, staff may cut corners to complete their assigned tasks due to staffing challenges, increased severity of patients’ conditions, and heavy workloads. For example, I’ve found that no matter how much we train, some staff members forget that gloves do not negate the need to perform hand hygiene. This can lead to staff being cited by surveyors for failing to wash their hands when they remove their gloves–and a great deal of time spent by administrators in constructing, implementing, and documenting detailed plans of correction.
While we only celebrate World Hand Hygiene Day for one day each year, it’s an important opportunity for the health care community to pause and be reminded of the role of clean, safe hands in our work and its role in preventing the spread of infection.
ICT: How can they mitigate these challenges?
MW: Hand hygiene education is critical. Staff members can retain a lot from learning why we perform hand hygiene, how pathogens spread, and breaking the chain of infection, but these principles must be constantly reinforced. Some interventions that I’ve found to be helpful include:
Signage: If the reminder is “in your face,” then staff are far more likely to remember to do the act. Hand hygiene reminders should be placed in common areas frequented by staff, including entrances and exits, elevators, bathrooms, breakrooms, and staff lounges.
Professional development: Skills days are good opportunities to reeducate team members on hand hygiene. They include demonstrations of the correct way to perform hand hygiene and return demonstrations of hand hygiene, allowing staff to demonstrate what they’ve learned.
Product placement and availability: Ensuring staff has access to soap, sanitizer, and towel dispensers, along with ensuring the dispensers are full of the products at all times, is critical to promoting hand hygiene. Empty dispensers are an infection preventionist’s nightmare because they often mean that a team member will skip critical hand hygiene processes simply because the necessary products aren’t available. Empty or malfunctioning dispensers can also lead to a facility being cited by government surveyors. For these reasons, implementing a data-driven system across a facility can significantly impact. Such systems monitor dispenser capacity and alert staff when a dispenser requires refilling or is malfunctioning (for example, due to drained batteries).
Culture: Facility-wide, all employees need to understand that hand hygiene is everyone’s responsibility. It’s essential to create a culture in which team members can coach their peers when they observe improper hand hygiene practices or provide positive reinforcement when they follow good hand hygiene practices. They also need to share the responsibility of monitoring dispensers, reporting empty or non-functioning dispensers to the designated person as soon as possible, and alerting colleagues as needed.
ICT: Why must patients in long-term care facilities perform their own hand hygiene whenever possible?
MW: As an RN, I’m passionate about the benefits of having the ability to perform one’s own hand hygiene, even if it seems like a simple task. First, hand hygiene decreases the transmission of HAIs among a fragile population as they frequently interact with one another and environmental surfaces during meals and social and leisure activities in shared spaces.
Second, and perhaps less obvious, hand hygiene plays a pivotal role in delivering dignified, person-centered care. Being able to perform one’s hand hygiene reinforces feelings of independence, dignity, and self-worth—no one dreams of having their personal care performed by another person. Being able to perform portions of their activities of daily living independently improves their self-esteem, but to do so, residents need hand hygiene products or tools (sanitizer, soap, and towel dispensers) that are easily accessible and ADA-compliant. They also need dispensers they can easily manage or handle due to limitations caused by arthritic changes, deformities, decreased range of motion, or pain in their hands or extremities. Giving residents access to dispensers that have an easy-to-use certification and are approved by the Swedish Rheumatism Association (SRA), a non-profit organization advocating for people with rheumatic diseases and chronic pain, allows them to achieve good hygiene and live their lives to the fullest while maintaining their independence.
ICT: Do you have anything else you would like to add?
MW: While we only celebrate World Hand Hygiene Day for one day each year, it’s an important opportunity for the health care community to pause and be reminded of the role of clean, safe hands in our work and its role in preventing the spread of infection. As hand hygiene truly saves lives, I encourage health care professionals and facility leaders to use this moment to evaluate their own hand hygiene protocols and procedures, identify opportunities to build on them throughout the year, and explore how new technology can bring a fresh perspective.