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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 withthe draft guidelines for hand hygiene in healthcare settings, our hospital,clinics and long-term care facilities started a trial of alcohol sanitizers. Weinstalled dispensers throughout these facilities and did in-services on how touse the products. Evaluations were done and one product was chosen. Physicianslike the new concept and we have educated our patients and visitors. Our handhygiene has improved. We are planning to put a Joint Commission on Accreditationof Healthcare Organizations (JCAHO) brochure entitled 'Speak Up' in our admitpackets for patients. They are told to observe staff for handwashing or use ofalcohol sanitizers. Staff and physicians will probably be reminded by ourpatients to wash their hands or use the alcohol sanitizers. Handwashing and handhygiene compliance should soar if the staff knows patients are watching.Nonclinical staff has responded to hand hygiene compliance by having dispensersin 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, Iexperimented. I washed my hands perfectly: 20 seconds of good friction on allsurfaces of hands, using warm water and liquid soap. I dried them on dry papertowels and used additional paper towels to open the door. I went to theadministrative suite, dropped off papers and descended five flights of stairs tothe emergency department and lab. There was no patient contact at all. I askedthe lab technician to culture my hand, then washed my hands again and asked fora second culture. The first culture grew Staph aureus coag+ and Group DStreptococcus. Neither was a resistant strain. The second culture grew 'normalflora' proving that handwashing does work. I showed pictures of someone sneezinginto their hands, then shaking hands with another person who then proceeded toeat candy without washing their hands in between. Very effective! We had asurgeon with infection control practices that were so bad, nurses were writingme complaint-filled notes. He finally came around. He had a poor surgicaloutcome that caused a lawsuit after which infection control issues came tolight. 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 handwashing by all hospital staff by frequently reminding them that the mosteffective way to protect themselves, their families, their co-workers, and mostimportantly our patients is to wash their hands. This message is delivered byeducational posters in various areas of the hospital campus including thebathrooms (talk about captive audience). Also, with the advent of alcohol-basedhand disinfectant, it could not be easier. Finally, I remind the staff duringsurveillance rounds that frequent, correctly done handwashing reduces the numberof patients requiring isolation."
Kevin L. Sullivan, RN, BSN, CIC Infection Control Nurse, Mercy MedicalCenter, Springfield, Mass.