Hats Off to Hand Hygiene Ambassadors!

February 24, 2020
Saskia v. Popescu, PhD, MPH, MA, CIC
Saskia v. Popescu, PhD, MPH, MA, CIC

Sustainability of high hand hygiene rates is extremely challenging and continuously requires resources and substantial effort.

Hand hygiene. A topic that is often seen as the Everest for infection preventionists. A challenge that requires Herculean effort and success is often momentary. Ensuring people clean their hands is not as easy of a task as many might assume. Sustainability of high hand hygiene rates is extremely challenging and continuously requires resources and substantial effort. 

One tactic in such pursuits though, is the hand hygiene ambassador (HHA). For many hospitals, the entrance is a prime spot for hand hygiene and mask/tissue station. This can act as a helpful reminder for all coming into the hospital, to wash their hands and wear a mask if not feeling well. While it does not guarantee compliance, these stations are great visual cues and are frequently used. What would happen though, if in addition to the hand hygiene station, a hospital also had a hand hygiene ambassador to actively help visitors engage in hand hygiene? 

That’s exactly what researchers from the University of Miami Miller School of Medicine did and they had positive outcomes. For 225 people entering a variety of healthcare settings, those who failed to use hand hygiene (via the alcohol-based hand-gel stations) were offered hand-gel by the hand hygiene ambassador. This proactive approach meant that visitors and even staff alike, were offered hand-gel if they failed to use the stations when walking into the healthcare facility. After this, they were asked their thoughts on the hand hygiene ambassador. 

Overall, the majority of staff, visitors, and patients agreed that the role of the hand hygiene ambassador was a good idea. Even better-no one refused hand-gel when offered. 

This study took place over a six-month period in five lobbies across various healthcare settings. Two trained observers were utilized and placed at the lobbies from 9 am to noon on random days during the study period. The highest rate of people stating that the program was a good idea, was actually visitors. 

Unfortunately, since no one refused the hand-gel, the study was unable to establish why people might refuse. While there are some cost prohibitive aspects of employing hand hygiene ambassadors, this approach may not be possible for some healthcare facilities. The proactive effort though, to catch visitors, patients, and staff alike, and reinforce hand hygiene when they enter the facility, is one infection prevention programs often aspire to. The authors noted that successful and sustainable interventions to increase hand hygiene compliance are often few and far between. “Perhaps the use of a human reminder (such as an HHA) will create awareness in the way that signs and other environmental engineering strategies have failed to achieve.”

As hospitals look to not only improve hand hygiene compliance, but also build more robust programs, perhaps a hybrid role-ambassador and then observer (i.e. secret shopper). Having a volunteer or light-duty worker who can act as both an observer to measure compliance and then ambassador during peak visiting hours, would provide a considerable resource to hospital infection control efforts. The first experience when walking through a healthcare facility’s doors should be one of welcoming, but also a reminder of the role we all have in patient safety and infection prevention. Hand hygiene ambassadors can serve this purpose and help facilitate hand hygiene habits.