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2006 Infection Control Guide
Hand hygiene is
everyone’s responsibility
Take 15 seconds for life…
If it only takes 15 seconds then why
aren’t all health care workers washing their hands like they should?
Multiple studies show that the simple act of handwashing is one of the
single most effective things we can all do to help limit the spread of
contamination. According to a recent report by the Institute for
Healthcare Improvement (IHI), "compliance by health care workers with
recommended hand hygiene procedures has remained unacceptable, with
compliance rates generally below 50% of hand hygiene opportunities."
To help address the issue, the IHI published a "tool kit" for hospitals
and healthcare workers in conjunction with the Centers for Disease
Control and Prevention (CDC), called the "How to Guide for Improving
Hand Hygiene" that provides practical tips and resources for
implementing an effective hand hygiene program in any hospital.
Key points extracted from the Guide include:
• Waterless, alcohol-based hand rubs
(liquids, gels or foams) are the preferred method for hand hygiene in
most situations due to the superior efficacy of these agents in rapidly
reducing bacterial counts on hands and their ease of use.
• Key to ensuring the use of
alcohol-based hand rubs is placing dispensers in enough key locations
throughout the facility and in particular at the point of care.
• Multi-dimensional strategies are the
most effective. Key elements include staff education and motivation,
adoption of an alcohol-based hand rub as the primary method for hand
hygiene, use of performance indicators, and strong commitment by all
stakeholders, such as front-line staff, managers and health care
leaders, to improve hand hygiene.
• Wearing gloves during patient care
is an additional intervention to help reduce transmission of infectious
agents in high-risk situations, but is not a replacement for proper hand
hygiene practice.
 The
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
also now looks at how hospitals comply with the CDC’s "Guideline for
Hand Hygiene in Health-Care Settings" as part of JCAHO’s 2006 National
Patient Safety Goal 7 to reduce the risk of health care-associated
infections.
According to JCAHO, "Compliance with goal #7 a will be surveyed through
interviews with caregiver staff and direct observation. Caregivers
should know what is expected of them with regard to hand hygiene and
should practice it consistently. It is expected that noncompliance will
be quite low, so that any pattern of noncompliance, i.e., more than a
sporadic miss, will be scored as noncompliance. During tracer activity,
if surveyors observe 3 or more instances of non-compliance, either
through observation of practice or staff interview, a Recommendation for
Improvement (RFI) will result."
Included in IHI’s How-to Guide are
several tools for monitoring hand hygiene compliance including a
knowledge assessment questionnaire, and monitoring checklists.
Medline Industries also introduced a
hand hygiene compliance tool at the APIC conference last year with its
continuing education DVD program, "Innovations in Hand Hygiene,"
featuring infection control expert, Denise Korniewicz, D.N.Sc., RN, FAAN.
The DVD demonstrates the root causes of noncompliance specific to each
facility and gives practitioners a convenient way to self-assess. Dr.
Korniewicz’s assessment tool allows practitioners to immediately attack
problems causing noncompliance including poor skin condition which is
often a major barrier. The hour-long DVD will provide one hour of
continuing education credit.
 "I
think hand hygiene has crept up to number one on the list for all
healthcare facilities from hospitals to nursing homes and assisted
living, now that JCAHO is looking at the CDC hand hygiene guidelines,"
said Linda Spaulding, RNC, CIC, CEO and International Infection Control
Consultant, InCo and Associates LLC. "It’s always been number one from
the infection control standpoint," she added.
"One of the biggest lifesavers for
hand hygiene and infection control is the new alcohol-based hand
sanitizers. We’re seeing more compliance with hand hygiene because of
that. It makes it easier to comply with handwashing policies because as
you’re walking, you squirt some of it on your hands, and you’re washing
your hands while you’re walking down the hall to the next room. I’m
seeing a lot more compliance with handwashing among all medical
personnel."
"I’d say there’s a big increase in handwashing compliance, but I don’t
think it’s still good enough," concluded Spaulding. "And I’m not sure
when and how we’re going to get it as good as we want it to. You get so
busy and you think of the tasks you have to do for the patient first,
and you think of washing your hands second. I just hope that all the
focus on handwashing does not detract from other infection control
measures that should be in place such as proper procedure for IV
insertion, etc."
Spaulding believes that educating the public on hand hygiene and
encouraging patients to ask their caregivers if they’ve washed their
hands will also go a long way towards increasing compliance.
For more hand hygiene resources, see our
our
Hand
Hygiene Glossary, and our
Hand Hygiene Tool Box.
HPN |
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June
2006
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