Nursing Notes

July 7, 2010

Is 100 percent compliance on hand washing possible?

Here’s an interesting article about handwashing.  It seems like such a silly little thing to be so controversial.  Everyone’s mother harped on you to “wash your hands” until it became habit for you.  Why, now, is this an issue in hospitals?

To answer this, let me give you an example from my own place of employment.  Since I am a psychiatric nurse, my patients are all up walking around the unit.  Frequently I will have patient contact with all eight of my patients in the matter of just a minute or two because they will come up to me with various requests.

To get to a sink to actually wash my hands, I must reach into my pocket and get my keys to unlock the door to the med room or nurses’ station.  Once inside I still have to get through another door with a door handle.  Now, I am able to wash my hands, open the door again with that door knob and proceed through another door to get back out onto the unit to see my patients.  How did washing my hands do any good?  My keys are probably contaminated, my clothes most definitely are contaminated, the door knobs are contaminated, etc.

There are alcohol handwash dispensers scattered through the nursing station, but there are doors in the way there, too.  So, I am not sure how we can get 100% compliance.  Add to the fact that all of our nurses are so busy that we rarely take a break or eat lunch and only get to go to the bathroom when an accident is about to happen.  This senario does not allow for compliance with hand washing, but I know we all want to try to be compliant.

Does anyone else have such barriers to compliance like ours?  I’d love to hear how the other nurses out there are addressing this issue.


By Sandra Yin

What would it take to move the dial closer to 100 percent compliance on hand washing? And just how realistic is that goal?

“Getting to 100 percent hand hygiene compliance through volunteerism is pretty unlikely,” Dr. William Jarvis, an infection control specialist and president of Jason and Jarvis Associates, a healthcare consulting firm based in Hilton Head, S.C., told FierceHealthcare.

Part of the problem is that most physicians and nurses are not adequately trained in infection control, he said. They may not realize that hand washing is one of the best ways to fight hospital-acquired infections that are behind an estimated 99,000 deaths a year and some $30 billion in excess healthcare spending in the U.S. What’s more, they don’t like to be told what to do. And they don’t understand how easily these pathogens are transmitted. “They just don’t get it,” Jarvis said.

With most hospitals in the 40 to 50 percent adherence range, without a hospital administrator/government mandate or electronic monitoring, it won’t happen, he said. But seatbelt laws and bike helmet laws offer a model to imitate.

A warning for a first violation, a fine the second time, and getting fired the third time would send a clear message, he said. But when the Joint Commission backed off its 90 percent compliance target, hospital administrators stopped caring. If a culture of patient safety were foremost, you wouldn’t see hundreds of doctors or nurses fined, he said, because they would follow the rules.

When asked what it would take to get closer to 100 percent compliance, Vickie Brown, RN, MPH, CIC–a spokesperson for the Association for Professionals in Infection Control and an associate director of hospital epidemiology at the 785-bed UNC Health Care based in Chapel Hill–was cautiously optimistic. “I’m not sure anyone has found the magic bullet,” she told FierceHealthcare. But what took place at UNC was “pretty darn amazing,” she said.

“What happened there holds more promise than anything [else] they’ve tried, short of a miracle.”

People will wash their hands 30 to 40 percent of the time to protect their own health, she said. The challenge is to move people beyond what they learned from their mothers to washing to prevent others from getting infected. Observation, feedback, insuring the right cleaning agents are available, leadership support and role modeling, and encouraging patients to insist that healthcare workers wash their hands can help. But these steps have not pushed the dial to 90 percent compliance. Covert observation can push hand washing to 70 percent, Brown said. But how do you get past that?

At UNC, when 90 nurses became infection control liaisons, ownership of hand hygiene shifted away from Infection Control and became the province of front line providers. They watch each other, provide feedback and correct each other. The liaisons’ work to change the culture of their units helped some reach and sustain 90 percent or greater compliance in hand washing, Brown said.

“To me,” she said, “the key to reducing hospital infections is–whether talking about hand hygiene or ensuring steps are taken to prevent surgical site infections–to ensure the clinicians providing care believe in it and accept infection prevention as a priority.” That’s one way to bring about a complete culture change within an organization. Unlike those infectious bugs, it sounds like it’s worth replicating. – Sandra

From:  The Editor’s Corner;

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