Hand Hygiene Formula

Hand-hygiene formula: 2 clean hands 4 good health
Excerpted from Healthcare Purchasing News, Nov, 2008 by Susan Cantrell

Hand hygiene is virtually the first chapter and first verse of the healthcare worker (HCW)'s bible; yet it remains an issue. All agree it's a crucial step in preventing spread of infection; yet, compliance is low, an embarrassing overall average of 40% according to the Centers for Disease Control and Prevention (CDC)'s "Guideline for Hand Hygiene in Health-Care Settings."

It's not that HCWs don't want to comply; it's that there are legitimate obstacles, complicated challenges, and valid complaints. Suzanne M. Pear, RN, PhD, CIC, healthcare epidemiologist, associate director for infection prevention practices, scientific affairs and clinical education, Kimberly-Clark Health Care, Roswell, GA, agreed: "Hand-hygiene compliance is more complex than it would seem on the surface. Reported barriers are numerous and seemingly impossible to eliminate completely, but it's a challenge in which we must all continuously engage."

Obstacles, challenges, complaints

The reasons for lack of compliance to such a simple and basic tenet of healthcare are many, noted Alecia Cooper, RN, BS, MBA, CNOR, vice president, clinical services, Medline Industries Inc., Mundelein, IL. "We believe the many reasons can be summed up into three categories: lack of education, behavioral challenges, and poor skin condition."

Indeed there sometimes is a lack of knowledge as to when and how to sanitize hands and the appropriate procedures to follow when hand sanitation is performed; thus the need for constant reinforcement through education. Education is an area in which vendors are investing deeply.

Pear explained that, whereas "a single education Intervention doesn't often sustain behavior change, education is the initiator of behavior change and the foundation upon which conscious behavior changes are maintained. Education about the patient consequences of poor hand-hygiene compliance and the essentials of hand-hygiene technique and frequency are critical components of an ongoing multimodal, multidisciplinary hand-hygiene compliance program. We're learning by trial, error, and methodological research about what works and what doesn't to alter HCW behavior, even adopting industry's social marketing techniques to help effect these critical practice changes."

Kimberly-Clark demonstrates the connection between healthcare-acquired infections (HAIs) and hand hygiene in a very personal way, hopefully making an Indelible impression upon listeners. Pear said: "Kimberly-Clark Health Care's clinical education goals help to put a face on the devastating issue of HAIs by providing grants that fund speakers such as Victoria Nahum, whose life and family were irrevocably damaged by these preventable harms, at clinical education venues such as the 'Safe Care Campaign.' This program has helped healthcare administrators and clinicians connect the clinical dots between non-compliance to evidence-based practices and catastrophic patient outcomes."

Cooper highlighted an appalling obstacle in the category of behavior: "Behavioral challenges include the realization that there are no measurable consequences to the HCW who does not follow procedures." Incredible, but true. Hands harboring pathogens can be lethal weapons but are seldom viewed in that light. This perhaps is due partly to lack of positive examples, of which there is a dearth, noted Cooper: "Physicians are the least compliant, and other HCWs follow their lead."

As for the third category, the CDC's handwashing guideline states: "... approximately 25% of nurses report symptoms or signs of dermatitis involving their hands, and as many as 85% give a history of having skin problems (249). Frequent and repeated use of hand-hygiene products, particularly soaps and other detergents, is a primary cause of chronic irritant contact dermatitis among HCWs (250)."

The more handwashing is performed, the more likely hands become dry, cracked, and painful and the less likely those hurting are to comply. Cooper added: "Healthcare workers may put on and take off gloves as many as 30 times per shift, also leading to skin irritations. All combined effects lead to less compliance."

Other reasons for noncompliance were outlined by Cheryl A. Littau, PhD, senior scientist, skin care innovation, Ecolab Healthcare, Eagan, MN: "For some, it's lack of time due to understaffing or critical patient needs, whereas others do not recognize the situation as an opportunity that requires hand washing. For example, an HCW may touch a piece of equipment that is contaminated, although not visibly soiled, and therefore may not perceive a need to wash his or her hands. Other common reasons include sinks or sanitizer dispensers that are not in close proximity to the patient."

Products offer a helping hand

Hand hygiene is big business. Companies are constantly striving to develop products that offer solutions to the compliance problem. Jeanne Medvick, BAMT (ASCP), MBA, CIC, manager of clinical studies, STERIS Corporation, Mentor, OH, offered advice for purchasers and users of hand-hygiene products: "Hand-hygiene products should be formulated to offer the customer three benefits: clean the hands of visible soil, assure antimicrobial efficacy to kill transient microorganisms, and be mild to the skin so that skin health is not put at risk. In today's world, a hand-hygiene product has to do more than clean skin and kill microorganisms. Healthcare workers who know that a product will cause dryness and irritation will be reluctant to use it and are less likely to be in compliance with good hand-hygiene practices if their skin hurts. STERIS conducts clinical studies to prove both antimicrobial efficacy and mildness." ...