Nurse Manager Oversight Helps Maintain Hand Hygiene Standards


Not only did nurse managers feel responsible for the levels of hand hygiene adherence on their wards, but that attitude extended to general standards of infection prevention.

Nurse managers play a vital role in ensuring hand hygiene on hospital wards while the insight they have about how best to promote the practice should be taken into account when hospital leadership teams update guidelines. That’s one of the conclusions of a study in the American Journal of Infection Controlundertaken by investigators with Oxford University.

They conducted the study at a National Health Service trust in Great Britain that holds 1300 inpatient beds and employs 1200 healthcare staff. The data were collected in semi-structured interviews in an office near the site of care with frontline managers in 2 wards. Eight of the participants were nurses, 2 were doctors, and 1 was the head of the housekeeping department. The data were collected between January and March of 2019 and during that time the trust recorded 90% to 100% of hand hygiene adherence. 

Not only did nurse managers feel responsible for the levels of hand hygiene adherence on their wards, but that attitude extended to general standards of infection prevention. “They designated tasks to housekeeping staff, especially when cases of infection were detected and used performance feedback to promote high standards,” the study states. 

They also found valuable allies in other healthcare professionals. “Support from the infection prevention nurses was appreciated and nurse managers worked collaboratively with them to identify system failures when adverse events were reported (root cause analysis),” the study states. “Ward managers thought that the infection prevention team was too busy dealing with crises at organizational level to help resolve ward-based issues, however.”

As one of the interviewees put it: “They [infection prevention nurses] come if there’s something specific…. If we get a case of C. Diff … they make sure we know what to put in place. But normally they deal with major infection.” 

The study data were collected a year before the COVID-19 pandemic surfaced and made hand hygiene such a much-discussed and lauded infection prevention process. The study data were also collected in Great Britain by British investigators, but healthcare-acquired infections (HAIs) are a problem everywhere. According to the US Centers for Disease Control and Prevention (CDC), each year there are about 1.7 million cases of HAIs in US hospitals and 99,000 associated deaths occurred. That adds up to about $6.5 billion in extra costs each year. 

The Oxford University investigators note that “although hand hygiene is considered the be the most effective means of breaking the chain of infection and theoretically should be effective, adherence is typically 40% or less and often cursory….”

The investigators realize that the small size of their study might discourage others from extrapolating their findings to other settings. However, they disagree with potential critics who might say that larger studies will be needed, saying that “large scale, randomized studies are time-consuming and challenging to undertake.”


They say that a more practical approach is needed in which individual health providers “review local arrangements for hand hygiene for each clinical setting and the specific groups of health workers involved.”

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