Hand Hygiene

Scrub a dub dub...While the FDA says hand washing is key for health in the general population, and posits new restrictions on antimicrobial hand soaps, the need for proper hand hygiene to reduce health care acquired infections continues to be of vital importance for health care workers both in and out of a hospital setting.



In fact, health care related infections make up about 80,000 deaths every year in the U.S. alone. Hand hygiene reduces the capability of transmission for healthcare associated pathogens and infections substantially. It’s not hard to do - it just has to be done.

Complying with hand hygiene standards is vital for health, for safety, and to prevent the enormous costs related to these infections. In fact costs for hospitals ranged upward of $33.8 billion, yes billion dollars in 2007.

What does this mean for you? It means, simply, clean up your act, and that of your practice or hospital. Hand hygiene isn’t something to shrug off - it’s something to scrub up.


The vital importance of hand hygiene is recognized by organizations like the Joint Commission, World Health Organization (WHO) and Centers for Disease Control (CDC). There’s no question of value, necessity, or implementation need - there’s the simple business of establishing the right interventions, training, and protocol to ensure compliance.

Compliance with hand hygiene practices among health care workers is surprisingly low, historically speaking - a 2001 review found poor compliance documented across the board, with average hand hygiene compliance at less than 40%. Why?

Basically, healthcare workers tend to feel invincible. They know so much about health care. The often underestimate the importance of compliance itself or they overestimate their own hand hygiene compliance. This is an unhealthy - literally - combination.



So what is Hand Hygiene Compliance? It means removing  microorganisms from your hands with a disinfecting agent like alcohol or soap and water. Using these disinfecting agents should take place:

*Before seeing patients
*After contact with bodily fluids
*Before invasive procedures
*After removing gloves.
*After contact with any patient surroundings

The National Quality Forum's “Safe Practices for Better Healthcare 2010 Update” believe that monitoring healthcare worker compliance with these hygiene practices must be accomplished to successfully evaluate compliance rate.



But how to evaluate? Direct monitoring, patient observations, measurement of hand hygiene product consumption, or electronic surveillance monitoring. This is a lot of evaluation, and the bottom line is to educate, train, reinforce, rather than police. That means intervention - the kind of training and education that MedTrainer can offer.

Educating your staff can result in far fewer sick days, in cost savings in terms of fines, lost work, and over all health impact. Training properly means that there’s more involvement, feedback, and  organizational skills employed. The bottom line is cost savings, proper compliance, improved health, reduced incidence of death and disease, and a healthier happier workplace and general population.

Social media can also a play a role in encouraging proper hygiene, as can the installation of more convenient sinks, alcohol dispensers, or all of the above.

Educate, train and - motivate. Empower patients to speak up. Have the proper staff organization in place to offer feedback, observe, and constructively reinforce training.



A good training program, such as the kind that MedTrainer can offer, provides information for health care worker education and motivation. The reason for hand hygiene in terms of health impact, hand hygiene methods, the best ways to maintain healthy skin, and the indicators to observe regarding glove use should all be presented o staff. Additionally, instruction in how to properly clean hands is key. Using demonstrating posters and signage in the work place can also reinforce the importance of hand hygiene guidelines in the workplace.

The over-all goal here is to improve understanding of hand hygiene practice, demonstrate how to do so, and have available alcohol based rub, gloves, and sink access at the point of patient care. Then: verify, monitor, and offer feedback as appropriate. That’s a complete hand hygiene program.



Over all government recommendations assert that providers should wash their hands wheneer they are visibly dirty, and use alcohol based hand rub thoroughly both before and after patient contact, contact with a contaminated surface, or with medicine.

Additional compliance measures must also be applied: health care workers should not, for example, wear artificial nails. Staff should be given information about hand-hygiene practices that will reduce skin irritation - such as offering lotions or creams to minimize irritation. When designing an intervention to increase hand hygiene, practices should be monitored, and feedback loops implemented.

Naturally, having the right products available in order to achieve compliance is necessary. That means alcohol based hand rub, as well as or in addition to a sink with running water at point of care is necessary, as is proper stocking of gloves.



Awareness of monitoring and feedback loops should also be established - this awareness alone is key in improving adherence to hand hygiene standards.
MedTrainer know that a successful hand hygiene program must include a number of features such as:

* reinforcement of hand hygiene messages
* knowledge of health care workers attitudes toward hand hygiene importance
* understanding among works regarding hand hygiene and the prevention of infections
* monitoring and feedback
* practical education

Also important: having a role model. That’s right, staff that sees senior staff practicing correct hand hygiene is more likely to use these techniques. Supportive management interventions and teaching should include priorities and resources.

To make healthcare safer for staff and patients, we have to BE safer. And essentially that goes back to the very most basic scrub-a-dub-dub adage. Educate on the importance of hand hygiene. Demonstrate what it means in terms of hand washing, alcohol rubs, glove usage. Offer feedback. Make certain that there are enough sinks, alcohol based solutions, and gloves at convenient locations. Observe compliance, give feedback, and reinforce usage.

Studies undertaken since 2001 reveal that there is a statistically significant compliance increase with these methods employed. Improvement means improved health. A 2008 review compiled evaluation of hand hygiene techniques and reported in 58% of studies that there was a significant reduction in healthcare associated infections when intervention and training were undertaken.

Encouraging patients to become involved in these healthy hand hygiene practices is also key to success.



So keep it clean. There is no short cut to hand hygiene, and yet hand hygiene is not a time consuming practice. Establishing the guidelines for proper hygiene, encouraging and demonstrating them, training staff in the proper techniques, and then providing access to the appropriate tools for hand hygiene - none of these steps involve complex processes to utilize effectively. However, they should also include monitoring and feedback. Hand hygiene is too important an issue to just assume compliance is being followed rigorously. Feedback will reinforce. Reinforcing means practice. Practice makes perfect.



A variety of interventions to improve hand hygiene are being suggested, implemented, and promoted in the U.S. and abroad. Health care administrators know just how vital this paradoxically simple yet hard to encourage task is. They’re aware that part of the training process includes not just knowledge, but awareness of beliefs and experience by healthcare workers that may contradict or subsume the knowledge. Strategies for changing behavior in the work place need to be designed to meet each provider and health care situation. Changing up strategies such as the introduction of encouraged patient intervention are emerging as key. What leads to success? Encouragement, training, practice, observation, and feedback.

Even today, with the frankly terrifying rise of super bugs that conventional antibiotic treatment is helpless to treat, there remains a cavalier attitude toward hand hygiene among some healthcare staff. A lack of awareness is part of this and so is an ingrained belief in invincibility or healthcare knowledge that may seem to preclude or supersede the hand hygiene techniques mandated by the government.

Too many healthcare workers think they “know it all” when it comes to hygiene, or that safety practices do not apply specifically to them. The first step is in education on the importance of these standards. After all, even the healthcare workers who consistently believe that the practice is important can be low on implementation. Haste makes more than waste in this situation. Reduce healthcare related infections and comply - train, have the proper “tools” in place for hand hygiene, monitor, and reinforce. It’s that simple and that important.



May 5th is hand hygiene day - make it count this year!