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Please Wash Me

Created Nov 21 2017, 05:00 PM by Lippincott Solutions
  • CDC
  • Center for Disease Control
  • infection prevention
  • healthcare-associated infections

HygeneYou probably won’t be too surprised to hear that the only thing between you and the transmission of a potentially deadly infection to your patient is proper hand hygiene. But you may be shocked to learn of the less-than-stellar real-world hand hygiene compliance rate of nurses caring for some of the most vulnerable patients in a hospital.

Among 64 ICU nurses at 4 Texas hospitals, the average hand hygiene compliance rate over an 18-day period was just 64%, according to a study published in the August 2017 issue of the American Journal of Infection Control. The hand hygiene compliance rate among male nurses specifically was 67%; among female nurses, 62%.

Researchers identified 4 specific barriers to hand hygiene compliance among the nurses observed in the study: carrying something, using a cell phone, gloving, and pushing or pulling a workstation. Underlying these barriers — or perhaps even a fifth barrier not pinpointed in the study — is perhaps a somewhat casual attitude toward the importance of hand hygiene. Nurses are busy after all. And when things get hectic, the little stuff slides, right?

Little Germs, Big Problem

The problem is, nothing about infection prevention is little. When nurses fail to comply with hand hygiene 100% of the time, they place patients (and themselves) at serious risk of infection. A 2014 report on healthcare-associated infections found that, in 2011, there were about 722,000 healthcare-associated infections in US hospitals — more than half of which occurred outside the ICU. Those infections resulted in the deaths of some 75,000 patients.

To prevent tragedies like this, the Centers for Disease Control and Prevention recommends nurses and other health care providers clean their hands:

  • before and after taking a patient’s pulse or blood pressure, performing exams, lifting a patient, and other times direct contact with a patient’s skin occurs;
  • after contact with blood, body fluids, mucous membranes, non-intact skin, and wound dressings;
  • after contact with medical equipment and other inanimate objects in the immediate vicinity of the patient; and
  • after removing gloves. (That’s in addition to the normal before-eating and after-bathroom guidelines you learned in childhood, of course.)

Antiseptic soap and water are best for visibly dirty hands, after possible exposure to Clostridium difficile, norovirus, and Bacillus anthracis, and before eating or after using the bathroom. In all other instances, alcohol-based hand sanitizer is advised. Hand cleaning via either method should be thorough and take about 20 seconds.

Glove use is not a substitute for hand hygiene. According to the CDC, health care professionals should clean their hands after removing their gloves.

In all, you may need to clean your hands as many as 100 times per 12-hour shift, the CDC acknowledges. Lotions and creams approved by your hospital can help with dry skin.

Making a Difference

Intentional hand hygiene compliance can go far — as can nurse influence. Just 1 issue after the ICU nurse hand-hygiene revelation study, the American Journal of Infection Control published another study. This one focused on patient hand hygiene and C. difficile infection at the University of Pittsburgh Medical Center Mercy Hospital.

Researchers found that after nurse educators coached staff on the importance of hand hygiene for preventing infection and the need to provide more opportunities and encouragement for patients to clean their hands, C. difficile infection rates dropped significantly.

Hand hygiene for patients, they concluded, “should be considered a relevant preventative measure for C. difficile.”

When patients and nurses commit to prioritizing hand hygiene, infection prevention gets a huge boost.