Hospitals will have to employ many strategies to ensure good hand hygiene compliance, says Holly Montejano, MS, CIC, CPHQ, clinical science liaison with PDI Healthcare, a company in Orangeburg, NY, that provides infection control services.
The most important elements will be related to education on the process and importance of hand hygiene and glove use for preventing infection transmission, Montejano says. Other important elements include creating a culture of safety within a facility, making hand hygiene a social norm, and hand hygiene campaigns with visual reminders such as posters. Another key is to promote the use of alcohol-based hand rubs (ABHRs) help to improve hand hygiene rates.
“ABHRs are a great alternative to soap and water when hands are not visibly soiled or when not dealing with a spore-forming organism, as they are often less abrasive to the skin,” she says. “Random auditing is a great and inexpensive tool to monitor hand hygiene compliance as well as detect any gaps which may be negatively impacting the hand hygiene program. Keeping hand hygiene a priority within the facility is a key factor in the continued success of a hand hygiene program.”
Montejano recommends the “Sound of Two Hands Washing” program offered by the Institute for Healthcare Improvement. (The program is available online at: https://bit.ly/2RpL9Op.)
It is important to design a hand hygiene program with tailored education for different groups, she says. The education should address the different concerns and abilities of staff, physicians, patients, and even visitors.
Support from the highest levels also is crucial to success, she says. “If leadership does not consider hand hygiene a priority, the staff is bound to overlook the importance of clean hands when providing patient care due to the many competing priorities in the day of a healthcare worker,” she says.
Montejano offers these other tips for improving hand hygiene compliance:
• Have hand hygiene product readily available for use at the bedside and strategically located on the walls and in hallways. For soap and water hand hygiene, make sure that the soap and paper towels remain stocked at the sinks.
• Provide lotions at hand hygiene stations so staff can buffer potential skin irritation from frequent use of ABHRs or soap.
• Staff, patients, and visitors are more likely to perform appropriate hand hygiene when educated on the importance of when to clean their hands and educated on the appropriate technique.
• Hospitals with better hand hygiene rates have invested in a committed program to ensure adequate education and product placement so staff can perform hand hygiene at the appropriate times before, during, and after patient care.
• Transparent sharing of hand hygiene rates also is helpful on a unit as are wall-mounted posters and other visual aids reminding all in the healthcare setting of the importance of hand hygiene.
• Patients who receive education regarding the importance of hand hygiene may report higher patient satisfaction scores as they will perceive staff to be highly engaged in patient well-being and safety. Hand hygiene education creates a very intentional learning moment between the healthcare worker and the patient and often comes at a time when the patient is at his or her most vulnerable.
• For patients who are bedbound or unable to perform soap and water hygiene in a non-outbreak setting, substitute alcohol wipes.
• Remember that hand hygiene product placement also is critical outside of patient care areas. General hallways should be stocked with product, as should hospital entrances and hospital cafeterias. These areas all represent locations that see high volumes of people who are traveling throughout the facility to visit or provide care in units that house the highest-risk patients.