Wisdom Teachers: Hand hygiene: Larson took the challenge
Hand hygiene: Larson took the challenge
Leading research must fight 'human nature'
Perhaps no American in medicine is more synonymous with hand hygiene than Elaine Larson, RN, PhD, FAAN, CIC, associate dean for research at the Columbia School of Nursing in New York City. Larson has authored scores of papers on the cardinal principle of infection prevention.
Why hand hygiene? The career-changing moment occurred back the 1970s when as a nurse in critical care unit, Larson found that hand washing did not improve even in a new unit designed specifically to make sinks more accessible. Infection rates were similar to those in a unit with architectural barriers to hand washing areas.
"I went to the director of the unit and told him that people weren't washing their hands," she recalls. "He said, 'So what? What is the evidence that hand washing really does make a difference?' I realized maybe we didn't really know the evidence. We were just told [that it reduced infections]. So, that's how I got interested. I went back to get my doctorate to study what was on health care workers' hands. I found that there [was transient colonization] on their hands that was causing infections in patients and it went from there."
While Larson is confident that there is no question about the relationship between hand washing and infections, she concedes the issue still is dogged by the lack of compliance she reported decades ago. Even after the Centers for Disease Control and Prevention — with input of Larson and other expert consultants — tried to attack the problem by recommending in 2002 the use of alcohol hand gels now ubiquitous in health care settings. Compliance may have improved, but IPs know all too well it varies by the culture of the hospital and the motivation of any given worker walking into a patient's room.
"I'm not really frustrated because it's not a bit surprising," Larson says. "It's just human nature. Something like that that you have to do multiple times every single day and there's no immediate feedback about it."
That said, Larson says she has been in hospitals lately with a family member and noticed surprising compliance to hand hygiene. "Every time the staff came in, they put on hand sanitizer," she recalls. "It was pretty impressive. Clearly, it can be a lot better than it is, but it really increased my trust in the place."
The quest to improve and measure compliance continues, with IPs "walking a fine line between monitoring and being a 'spy,'" Larson says.
"There's a feeling, I think, among health care workers that there might be a little resentment about the 'secret shoppers,'" she adds. "They stay secret for about three minutes. But you can make an argument that the Hawthorne effect of observing is not bad. Because people know they're being observed and change their behavior and that's exactly what you want. Sometimes, it takes some external motivation and then it becomes internalized."
Despite the impact of the recession, Larson thinks this is actually a golden time for infection prevention. "I think with the CMS changes in reimbursement and so forth, hospitals are going to have to find ways to increasingly support the infection prevention staff."
In that regard, The Joint Commission continues to make hand hygiene a National Patient Safety Goal. The problem many infection preventionists have, however, is meeting this 1A recommendation in the CDC guidelines: "Monitor health care workers' adherence with recommended hand-hygiene practices and provide personnel with information regarding their performance." To improve the situation, The Joint Commission sought out proven methods and strategies for monitoring hand hygiene compliance. The result is the recently issued report: "Measuring Hand Hygiene Adherence: Overcoming the Challenges."
"The first thing people have to do is decide why they are monitoring hand hygiene," says Larson, who chaired the expert panel that produced the 262-page document. "Just doing it to be in compliance with Joint Commission isn't a good reason. What are you going to do with the information?"Perhaps no American in medicine is more synonymous with hand hygiene than Elaine Larson, RN, PhD, FAAN, CIC, associate dean for research at the Columbia School of Nursing in New York City. Larson has authored scores of papers on the cardinal principle of infection prevention.
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