Many studies have been conducted to improve hand hygiene compliance. However, ICT® decided to go to the source and ask healthcare workers themselves why they don’t always practice hand hygiene.
Every medical professional knows the importance of hand hygiene (HH). It is the first and foremost defense against the chain of infection. So why is it so difficult to maintain HH compliance in healthcare facilities? Myriad methods have been devised to encourage and encourage compliance: mobile phone apps, video cameras, computer programs, stickers and other small signs of positive feedback, and most commonly, infection prevention professionals (IPs) among healthcare workers (HCWs) noting who followed the prescribed HH tours and who didn’t.
But why don’t HCWs, knowing how important it is, follow the appropriate HH procedures every time their facilities approve or require them? Protection against infection today® (ICT®) went to IPs and asked, “What is stopping you from doing HH, and what do you think is stopping other HCWs from consistently adhering to HH requirements?”
Why hand hygiene is important
Leslie Bozigian Curtin, RN, CMIP, former Associate Director of Nursing and Infection Prevention at Sumter East Rehab, has been in the healthcare industry for 40 years. “Breaking the chain of infection requires an infectious agent, a method of transmission, and a susceptible host. Then you must have [a] Method to bring the agent to the vulnerable host. Every time you can break one of these links in the chain, you interrupt the infection process. The easiest way to do that is HH,” she said.
Why is hand hygiene not carried out consistently?
Tracy M. Field, RN, Corporate Infection Prevention Specialist for Ecumen, a long-term care organization, narrates ICT® She sees HH not being implemented, particularly in long-term care (LTC) facilities, despite advances in technology. “Things have come a long, long way. In the 30 years that I’ve been in healthcare, hand sanitizer placement is one of the biggest developments to come about. You have these wall units right in the patient rooms, right in the resident rooms. You have these strategic solution placements all over the place. But even though they are there, I still see them [HCWs] Go past them,” she said.
The first barrier to HH compliance is familiarity with the patient, Field said ICT®. “We live and work with it [patients] who we love very much. We are their family and they are our family. If you feel like you love this [patient], you take care of her every day; They don’t consider them contagious. You could skip [HH] because it’s not like the hospital… and this [patient] in front of you is not super sick. It’s a different situation. In elderly care, HH is just as important: everything we can do for infection prevention. But there’s that sweetness in the care we give [due to familiarity]. I see that as a big barrier,” she said.
Field also explained the second barrier: complacency. In a long-term care facility, an HCW may be thinking, “I’ve been caring for this person every day [in the past] Week; I know they are not sick.” The HCW comes back 2 days later, [and the patient has] COVID-19 or norovirus. And the HCW was already exposed. There’s that kind of complacency where the HCW is like, ‘Oh, I’ll take care of that [patients] the whole time. They’re not sick. “I see that thought as a barrier to elder care,” she said.
Other reasons for improper HH that came up in the interviews with IPs were staffing challenges and lack of time. In these situations, the HCW tries to get everything done, and HH is the easiest and first guideline to overlook. “The staffing shortage is so overwhelming that you’re exhausted and frustrated,” Field said.
However, Field explained that those feelings are not an excuse. “[HCWs] complain that they don’t have time. [However,] I do not think so [HCWs] can argue that they don’t have time to wash their hands or… use hand sanitizer… It’s not that we don’t have time. Our minds are so busy with wearing the mask, wearing eye protection, putting on a gown and so on for these spaces. It’s an overload of intense situations that bogs down HCWs. We’re losing that laser focus, and you’re falling behind and missing some steps,” she said.
Curtin directs their HCWs to perform HH in the following situations:
1. When you put away your purse
2. When you put your coat away
3. Before entering another room of the device
4. If you go into someone’s room and bring a tray
5. Intermediate patient care
6. Before any patient care
7. when you go to the toilet
8th. Before and after a meal or snack
9. After the care that requires gloves, you must remove the gloves and wash your hands again
ICT® also asked Laura Miller, MD, MPH, FAAFP, the main reason she sometimes finds that she is not following HH procedures. Miller is an assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota in Minneapolis. “I think number 1 is time and so many different things in our cognitive spaces. We have been in and out of various locations with patients and care teams. There is a lot going on [and] There’s a lot of moving parts happening,” Miller said.
Miller said another reason for poor HH compliance is lack of access to hand sanitizer. It may not be refilled or in the right place. “That’s a big gap I’ve noticed and it’s certainly something that could be actionable. We have come a long way now as we are in the age of readily available hand sanitizer solutions. We’ve gone into credit [hand sanitizer] next to hand washing stations. It is more practical and useful to have a hand sanitizer solution available than to wash your hands [stations] because it takes so much more time and space [wash].”
Additionally, according to Miller, it can be difficult to just remember to do HH, “especially on more pressing and urgent occasions
Situations when trying to get to the emergency room [because] Your patient is not doing well in the hospital.” She continued, “When you’re an obstetrician and your time is short, it’s difficult to stop when you have something more pressing going on.”
Miller echoed other HCWs who spoke to him ICT® via sticky and/or smelly hand sanitizer or soap. “There were times when a refill pack or something else was different … so I’ll avoid that.” She also mentioned allergies or dermatological effects of hand sanitizer solutions. Because it is alcohol based, it is a drying agent that can cause severe and chronic skin problems.
However, Curtin said there was no excuse for a lack of compliance with HH; Even children know how to wash their hands well and often.
Regardless of their reason for inappropriate HH, their admonition to HCWs is always the same: “You can’t wash your hands too often or use hand sanitizer.”