ED hand washing hard to track: Ask patients

Make sure staff wash their hands consistently. It sounds simple enough, and it's necessary to comply with The Joint Commission's National Patient Safety Goal to prevent deadly health care-associated infections due to multiple drug-resistant organisms. But it's anything but easy for most EDs to do this.

"EDs are fast-moving environments, and hand hygiene is still a continual improvement process," says Marianne Fournie, RN, BSN, MBA, corporate director for system ED services at Methodist Healthcare in Memphis, TN.

The ED has more than doubled the number of hand washing cleaning solution stations, and hand washing audits are done by infection control and ED staff on a regular basis. "I also do random checks when I'm in the department. We then post the data on compliance," she says. "But we still are not where we want to be."

The ED is considering a novel approach: having patients "police" compliance. "We are talking about educating our patients and family members so they can be our 'watchdogs,'" says Fournie. "It would require having the right method of hand cleaning solution available at the right place, the right height, and within eyesight of the patient, so they can monitor us."

At Baylor Medical Center at Irving (TX)'s ED, hand hygiene is kept at the forefront, says Michelle Underwood, RN, BSN, MBA, ED nursing supervisor/clinical nurse educator. All patient treatment areas have sinks with antibacterial soap and alcohol-based foams mounted on the walls outside patient rooms to encourage staff to "foam in and foam out."

"We have also been proactive in encouraging patients to utilize hand hygiene stations that have been strategically placed at ED entry points," Underwood says.

Also, environmental services staff are permanently assigned to the ED 24 hours a day. Nurses are able to ensure all rooms and equipment are routinely and appropriately cleaned in between patients by staff specially trained in infection control. "This translates into a decreased risk of infection for not only our patients and visitors, but also our staff," says Underwood. "This directly impacts our ability to decrease the risk of hospital-acquired infection for our clients."

The ED monitors hand washing compliance with direct observation and random audits of staff in patient care areas. "When opportunities are identified, staff are re-educated about infection control policy. Hand washing expectations are formally reviewed by the direct supervisor," says Underwood.