Nursing Notes

June 7, 2012

Patient location, gloves, worker type predict hand hygiene compliance

Filed under: Nursing — Shirley @ 5:33 am
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Here’s another article on the ever growing battle about handwashing in the hospital.  It is true that strict adherence to handwashing policy will save lives and money, but for some reason we have trouble following this simple policy.  Why is that?  Maybe there is not enough time in a shift to do all the handwashing called for?   I don’t have any answers, but would love to hear your take on this growing concern.

This article is from FierceHealthcare, which is a source I like very much.  I find many interesting articles about medicine and nursing here and you will, too.

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Patients who receive care in a hallway bed are the most likely victims of healthcare workers not washing their hands, according to researchers from Boston’s Brigham and Women’s Hospital in a study to be published in the November Infection Control and Hospital Epidemiology.

In the largest hand hygiene study with more than 5,800 patient encounters in the emergency department (ED), researchers found that bed location, the type of healthcare worker providing the care, and whether the provider used gloves all were predictors of poor hand hygiene in the ED.

“We found that receiving care in a hallway bed was the strongest predictor of your healthcare providers not washing their hands,” said study author Dr. Arjun Venkatesh, an emergency medicine resident at Brigham and Women’s Hospital, in a Society of Healthcare Epidemiology of America press release yesterday.

In addition, researchers found that workers transporting patients were less likely to wash their hands because they likely do not receive as much hand hygiene training as others, according to the press release. They also said that providers using gloves was not a substitute for handwashing in controlling infections.

However, in most cases (90 percent of time), ED workers do wash their hands.

Handwashing could save up to $33 billion, according to a UPI article. In a Health Affairs study, infection control interventions such as handwashing resulted in patients leaving two days earlier and reduced mortality rates by 2 percentage points. Hospital costs also were $12,000 less, according to the article.

For more information:
– read the press release
– here’s the study abstract
– read the UPI article

Related Articles:
Hospital workers comply with hand hygiene signs about patients, not themselves
CDC: Physician offices too lax about infection control
Handwashing more common in public restrooms than in hospitals
Doctors, nurses don’t want patients to bug them about handwashing
Is 100 percent compliance on handwashing possible?

Read more: Patient location, gloves, worker type predict hand hygiene compliance – FierceHealthcare http://www.fiercehealthcare.com/story/patient-location-gloves-worker-type-predict-hand-hygiene-compliance/2011-10-04?utm_medium=nl&utm_source=internal#ixzz1x6O2AD00
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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.

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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; FierceHealthcare.com

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June 3, 2010

Hand Hygiene in Hospitals Not Up to Par

As a working nurse in a psychiatric hospital, I can attest to the fact that handwashing is not always done.  There are many reasons for this omission–lack of time, lack of facilities, lack of interest, etc.  In this day of superbugs and resistant bacteria, it would seem that hand washing would be embraced as a first line of defense.

But, to clarify even more, on my floor there are only three sinks available to actually wash your hands.  One is in the bathroom in the treatment room, which is off the unit and through two locked doors.  One is in the bathroom in the front medication room and accessible only if you have a medication room key.  The last one is in the medication room for the back unit and is off the combined nurses’ station.  Hand hygiene dispensers are everywhere, but not always filled.  After three or four uses of the alcohol rub, your hands become gummy and tacky.  So, hand washing is a real problem for us.

How is hand washing handled in your facility?  Do you think your hospital is better than the average 34%?

Here is another great example of Nursing Research at work.  Please read the entire article and let me know your thoughts.

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By Chris Emery, Contributing Writer, MedPage Today
Published: May 31, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Nurses and other healthcare providers complied with hand hygiene guidelines less than half of the time before participating in medical procedures, results of a new study showed.

Compliance was better after procedures, with 72% following guidelines after procedures compared with 41.7% before procedures, according to a report published in the May issue of Applied Nursing Research.

Overall compliance with hand hygiene guidelines was just 34.3%.

“It is important to note that preprocedure hand hygiene intends to protect patients against infections and maximize risk reduction, whereas postprocedure hand hygiene intends to protect the healthcare provider and other patients who may contract patient-to-patient infections,” wrote Denise M. Korniewicz, PhD, RN, of the University of Miami, and Maher El-Masri, PhD, RN, of the University of Windsor, in Ontario, Canada.

“Thus,” they wrote, “these findings may suggest that healthcare providers are probably driven to wash their hands by their need to protect themselves more than their patients.”

Each year, an estimated 2.5 million patients in the U.S. develop healthcare-associated infections that result in 90,000 deaths and cost the healthcare system an estimated $4.5 to $5.7 billion dollars.

Practices that reduce hand-to-hand or hand-to-skin contamination are considered the most effective way to decrease the risk of healthcare-associated infections, yet previous studies suggest that compliance with hand hygiene guidelines is still poor.

To explore the factors associated with compliance, Korniewicz and El-Masri observed 612 procedures at an academic oncology hospital. Data were recorded for 47 healthcare providers and were collected over a 16-week period from inpatient […more…]

This article was taken from MedPage Today, another wonderful source of great information about healthcare and related subjects.

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May 7, 2010

Real-World Proof of Hand Washing’s Effectiveness

Handwashing
Image by kokopinto via Flickr

Here is an article from ScienceDaily that shows how handwashing or the lack thereof causes problems in the real world as well as in our hospital settings.  When the Infection Control nurse tells you to “wash your hands, please” they are citing from statistical data like that below.

Really, handwashing is such a small thing but this small thing controls many really big things in the medical world.

Please read this article and leave me a comment, won’t you?

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ScienceDaily (May 5, 2010) — Scientists are reporting dramatic new real-world evidence supporting the idea that hand washing can prevent the spread of water-borne disease. It appears in a new study showing a connection between fecal bacteria contamination on hands, fecal contamination of stored drinking water, and health in households in a developing country in Africa.

The study is in ACS’ Environmental Science & Technology, a semi-monthly journal.

Alexandria Boehm, Jenna Davis, and their students note that almost half of the world’s population — over 3 billion people — have no access to municipal drinking water supply systems. They obtain drinking water wells, springs, and other sources, and store it in jugs and other containers in their homes. Past research showed that this stored water can have higher levels of bacterial contamination than its source. But nobody knew why.

The scientists found a strong link between fecal contamination on the hands of household residents and bacterial contamination in stored water in Dar es Salaam, Tanzania. Stored water contained nearly 100 times more fecal bacteria than the source where it was collected. “The results suggest that reducing fecal contamination on hands should be investigated as a strategy for improving stored drinking water quality and health among households using non-networked water supplies,” the report notes.

Here’s the link to the original article and links to many similar stories

Story Source:

Adapted from materials provided by American Chemical Society, via EurekAlert!, a service of AAAS.


Journal Reference:

  1. Amy J. Pickering, Jennifer Davis, Sarah P. Walters, Helena M. Horak, Daniel P. Keymer, Douglas Mushi, Rachelle Strickfaden, Joshua S. Chynoweth, Jessie Liu, Annalise Blum, Kirsten Rogers, Alexandria B. Boehm. Hands, Water, and Health: Fecal Contamination in Tanzanian Communities with Improved, Non-Networked Water Supplies. Environmental Science & Technology, 2010; 44 (9): 3267 DOI: 10.1021/es903524m
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November 21, 2009

When Viruses (Including H1N1) and Bacteria are as Close as your Fingertips; VirWall’s New Innovation Can Disarm Killer Keyboards

Muller Hinton agar with 4% NaCl showing a lawn...
Image via Wikipedia

As hospitals push staff more and more about hand-washing and aseptic technique, I believe that we also need to beef up our “housekeeping” abilities.  I know that as a microbiology student, I had to swab various places touched daily by others and then see what I could grow in the petri dish.  I was amazed, but the worst offender was the telephone that was used in the offices.  Now, with the big push toward computerized health data, nurses find themselve frequently using computer keyboards in common areas.  These items are not touched by our housekeepers, just like the phones and doorknobs are not sanitized.

With the growing problem of pandemics, maybe we all need to just go back to basics and remember how to really clean things.  This article is just a springboard on this topic.  It is interesting that someone was able to take our lack of cleanliness and create a marketable item for sale.  Nurses, put on your thinking caps!

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NEW YORK, Nov. 17 /PRNewswire/ — Engineer/pilot/attorney Jon Roberts, PhD, has dozens of inventions to his credit. They include technology that thwarts piracy in movie theatres, gadgets that track important items inadvertently left behind, devices to enhance airport security and even an electronic matchmaker that alerts two nearby individuals with similar interests that they have, indeed, found their match. Now, as Chairman and VP R&D of VirWall Systems Inc., he’s introducing a keyboard sanitizer that uses UV-C light to eradicate bacteria and viruses on computer keyboards in about 45 seconds, for under a hundredth of a penny per exposure. The invention is featured in the November issue of the New Jersey Technology Council’s LifeSciTrends, an update on important health and technological advances.

“I started studying patterns of infection transmission years ago when my son started bringing home a never-ending series of bacteria and viruses from kindergarten. I don’t think we’d ever had as many colds or coughs in succession,” explains Dr. Roberts.

Today Dr. Roberts has parlayed his study of vectors of disease transmission into the design of a streamlined, efficient keyboard sanitizer that stops 99.99+ percent of bacteria and viruses before they can become hitchhiking pathogens. It is effective against influenza A (the family of which H1N1 is a member), staph, strep, salmonella, MRSA, E. coli, norovirus, Avian flu, the common cold and more.

“When you consider that the average computer keyboard can harbor as many as 3000 microbes per square inch, you’ve got a real problem on your hands – literally,” notes Dr. Roberts. In 2008 the CDC reported the first documented case of norovirus transmitted by computer keyboards and peripherals in a school system. In other settings – such as hospitals — contaminated keyboards can pose significant threats to patients and healthcare professionals alike since the resident pathogens may be more virulent and patients are less able to ward off such infections.

“Anywhere you have shared computers,” explains VirWall’s President/CEO, Donald S. Hetzel, PhD, “you also have shared germs. When people eat near their computers, the problem is compounded. Bacteria love to feed and breed on our crumbs.”

The VirWall KBS-1 is a lightweight, high tech lid that fits over a standard-size keyboard and uses 254-260 nanometers of UV-C wavelength to deactivate potential pathogens. The sanitizer provides uniform coverage in killing microbes, unlike disinfectant sprays and wipes that are user-dependent. The invention recently earned a medal for innovation in healthcare devices and the Yankee “Green” Award for its ability to kill germs with a novel mechanism that avoids the use of chemical disinfectants which some believe to pose environmental damage over time.

The sanitizer will retail for about $100. VirWall also holds patents for a portfolio of additional protective products including a bio-waste sanitizer/receptacle; a pen sanitizer for use at retail checkouts; and a smart-phone recharger/sanitizer.

“That keyboard in front of you is far more than a keyboard,” explains Dr. Roberts. “It’s a germ factory that can cause a relentless series of illnesses and infections. The good news is that some simple precautions can neutralize its potential to sicken.”

For more information on VirWall, the KBS-1 keyboard sanitizer and to see a demo video, visit www.virwallsystems.com.

(Dr. Roberts is senior partner with The Marbury Law Group in Reston, VA; Dr. Donald Hetzel, PhD, is the former head of R&D for several multinational pharmaceutical companies.)

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