By Kelly M. Pyrek
If youre a healthcare worker and youhavent been washing your hands, chances are someone at OSF Saint FrancisMedical Center in Peoria, Ill. is watching and making a note of it. This secrethandwashing observation exercise is part of the facilitys larger war on germsand a campaign to increase hand-hygiene compliance among the centers 5,000employees and 750 physicians.
When the epidemiology and infection control department at OSFSaint Francis Medical Center received a $1,000 nursing research grant, itdecided to conduct a house-wide project that would have a broad reach towardachieving an ongoing goal handwashing and healthcare worker/patient safety.
We chose hand hygiene because its something that isimportant but sometimes overlooked, says Patricia Ham, MS, RN. We did ourresearch, wrote up a proposal, and secured money to do some cultures and aneducational campaign. We decided that part of the program would include secretobservers as well as a survey of staff members knowledge about and attitudetoward hand hygiene. We did the observation during the summer, and now welldo education and intervention, and in January 2005, we will resurvey to see ifthe intervention made any difference.
Ham says that nursing students were recruited to serve as thesecret handwashing observers. Before they went onto the floors, the studentswatched a hand-hygiene video so that we were assured that everyone was on thesame page about what they would be looking for. They were assigned differentunits and they picked the times they wanted to go that unit for theirobservation sessions. They wore lab coats and name badges, because they couldntlook like some person off the street. If staff members asked them what they weredoing, they were instructed to say and everything was scripted that theywere conducting research for the epidemiology and infection control department,so that they didnt reveal the nature of the research. If a staff membercontinued to ask, What are you looking at? then they would be instructedto say, The nature of the research is confidential, but your manager isaware of the project, and if you have any questions, you can talk to him or her.
Ham says her department is working with a statistician to helpcrunch the numbers regarding the facilitys current handwashing compliancerate, but observes from an anecdotal point of view, There are missedopportunities.
We have declared war on germs, Ham adds, explaining thatthe idea of a military-themed campaign was borrowed from an infection controlnurse she met at a recent Association for Professionals in Infection Control andEpidemiology (APIC) meeting, and modified to fit OSFs needs. At thekick-off of our campaign, the three of us in our department dressed in fatiguesto get into the combat mindset. Our housekeeping department supervisor actually is in themilitary, so he was the one who did so much to work the crowd, so to speak, andget people motivated.
Ham says that every month, War Games, a one-page factsheet discussing hand-hygiene issues is distributed facility-wide. The reverseside of the fact-sheet has a fun hand-hygiene quiz, ranging from true/falsequestions, to a word-search game, and when the quizzes are completed, staffmembers turn them in and their name is dropped into a hat. Names are drawn, andthe winners receive gift certificates from Wal-Mart. Ham says she ordered 3,500hand hygiene-themed lapel buttons for the 5,000 employees, thinking not everyonewould want to participate, But I was wrong we ran out of buttons, theywere so popular, Ham says. They are embracing the campaign because itsfun. Sometimes we get so bogged down in the have-tos, that its great to dosomething a little more lighthearted yet educational.
Americans are up to their elbows ingrime, and theyre not doing enough about it, according to the Soap andDetergent Association (SDA)s 2004 Clean Hands Report Card. The report cardgives Americans a C for hand hygiene, although many would give themselvesa higher grade. But what is said vs. what is done often differs.
The SDA produced the report card to raise awareness ofNational Clean Hands Week held in September, a national health campaign thattouts handwashing as the easiest path to staying healthy. The report cardsurveyed Americans on basic hand-hygiene practices, such as washing before ameal, after using the bathroom, and after coughing or sneezing. The report cardnot only measured how often Americans wash daily, but for how long, and revealedperceptions of hand hygiene.
Most infectious diseases are spread by contact, eitherperson-to-person, or by touching surfaces harboring germs, said U.S. SurgeonGeneral Richard H. Carmona. Proper hand cleaning is the best preventionagainst communicable illness.
In very simple terms, clean hands save lives, said NancyBock, SDA vice president of education. According to the Centers for DiseaseControl and Prevention (CDC), cleaning our hands is the single most importantthing we can do to keep from getting sick and spreading illness to others.
Among the findings of SDAs latest National CleaningSurvey:
Forty-three percent surveyed seldom or never wash their handsafter coughing or sneezing. One of the most common ways people catch colds is byrubbing their nose or eyes after touching someone or something contaminated withthe cold virus.
Thirty-two percent dont always wash before eating lunch.That means germs that were on the change, the door handle, and the elevatorbutton might find their way onto the midday turkey sandwich.
Fifty-four percent of respondents dont wash their handslong enough to effectively remove germs and dislodge dirt. The CDC and SDArecommend washing with soap for at least 20 seconds.
According to the report card, 90 percent of Americans surveyedsaid they always washed their hands after using the bathroom, while 8 percentsaid they frequently washed, and 2 percent said they seldom or never washed.There appears to be a major gap between what people say and what they do. A 2003observational study by the American Society for Microbiology found as many asone-third of public restroom users did not wash their hands.
The Clean Hands Report Card found a notable gap in thehand-hygiene perceptions and practices of men and women. While 51 percentoverall considered handwashing as a top way to prevent colds and fl u, morewomen (60 percent) thought so than men (42 percent). Both men and women listedother top cold and fl u prevention tactics including healthy diet (23 percent),immunization (11 percent), and proper sleep (8 percent). Women also were aheadin handwashing frequency: they washed their hands an average of nine times aday, while men washed an average of six times daily.
More Americans should know that your health is literally inyour hands, said Bock. She mentioned key instances when handwashing iscritical:
No soap and water? That is no longer a barrier to hand hygiene with the latest portable products. Instant hand sanitizers, gels and foams are convenient and effective in killing germs. Additionally, disposable hand wipes offer a timesaving cleansing alternative for people with active lifestyles.
The Clean Hands Report Card was based on a survey of 1,013American adults. The independent consumer research study was completed in August2004, on behalf of the Soap and Detergent Association (SDA), by InternationalCommunications Research (ICR). The survey has a margin of error of plus or minus3.1 percent.