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Hand Washing: What’s It Going to Take to Get the Job Done?

July 10, 2013
Handwashing

Handwashing (Photo credit: kokopinto)

By Shawn Kennedy, AJN editor-in-chief

I took a few days off last week and caught up on some reading. Perhaps the article that struck me most was one from the New York Times on the various methods that many hospitals are using to improve rates of hand washing among nurses, physicians, and other direct care providers. Hospitals are trying everything from buttons that offer gentle reminders to camera monitors to mandating that direct caregivers wear electronic sensors that indicate whether or not they washed their hands.

Perhaps the most disturbing part of the article was the remarks made by Elaine Larson, a nursing professor at Columbia University School of Nursing who had done extensive research on hand washing. She spoke of how some health professionals go out of their way to avoid washing their hands, even ducking under scanners.

A 2009 report from the Centers for Disease Control and Prevention estimated that HAIs (hospital-acquired infections), cost U.S. hospitals between $28.4 to $33.8 billion annually in direct medical costs. Just think about what could be done with that money.

I don’t get it. We all know the importance of hand washing. From Ignaz Semmelweis, who introduced hand washing in obstetrical clinics in 1847 and as a result reduced puerpal fever, to Florence Nightingale, whose insistence on good hygiene and basic cleanliness helped to reduce death rates during the Crimean War, to the extensive body of research conducted by Larson and others—the facts have long supported the critical need for health care providers to wash their hands before patient contact to prevent HAIs.

We’ve also published numerous articles and reports on the topic—original research (“Evaluation of a Hand Hygiene Campaign in Outpatient Health Care Clinics,” March 2013; “Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper to Hands: Preliminary Results,” December 2011); editorials (most recently, “Grandma Was Right—Wash Your Hands!,” December 2011); and many news articles on hand hygiene. (There’s one in our current issue: “The Right Balance Between Hand Sanitizers and Hand Washing,” July 2013.)

There are resources galore to reinforce hand washing—the CDC has a Web page with materials that can be downloaded for free. But it’s obvious the problem is not lack of knowledge, nor is it forgetfulness, given all the reminders and prompts from scanners. What can it be that makes health care professionals continue to knowingly (the most disturbing part) jeopardize the lives of their patients? Anyone have any ideas?

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7 comments

  1. At our hospital the hand sanitizer is in the hall way. Patients and families can not see us “wash” our hands. Getting the message out to the public how important hand washing can be may improve our professional performance and give us a gentle reminder when our patients ask “Did you wash your hands”?

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  2. Hospital staff should be reminded that the regular handwashing protects them, too, as well as the patient.

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  3. Nurse staffing in the form of nurse-patient ratios and hours of nursing care per patient-day have been implicated in the spread of infection.
    Safe Staffing Saves Lives: http://safestaffingsaveslives.org/

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  4. I also agree that staffing and skin breakdown do make hand hygiene a challenge. I’m thinking shock collars may be next… or maybe, just consider that patient could be your mother, sister or child. Would you take more time to do what has been proven to reduce the risk of infection and ultimately death if you were related to the patient?

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  5. I wholeheartedly agree with the first commentor, the second has a good point, too. But I see two other factors, the the old “it won’t happen to me,” prejudice and frankly, boredom. It is tedious and exasperating to wash your hands over and over and over. And if your hands begin to hurt from it, well, forget it.

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  6. Hello,

    In my opinion the solution is simple. If the institutions we work for provide us with genlter soap products and lotions I feel the hand washing percentage will go up. The fact that most end up bleeding from handwashing due to dry hands end up taking shortcuts and don’t wash their hands as they should.

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  7. I have only one explanation for why nurses would avoid hand washing, which is in everyone’s best interests: unsafe staffing levels. Staffing has been routinely the number one issue for the past 20 years. Short staffing is unsafe because it leads to bad practice. Nurses are literally running from patient to patient, are overwhelmed with mandatory scanning, documentation and medication deadlines, monitoring – everything to ensure that they give care, except the resources to give that care. Experienced nurses are frustrated and demoralized and new nurses are unprepared to handle the patient needs and documentation requirements. Alarmingly nurses are now being suspended and fired for not meeting standards that are unrealistic with the staffing levels allowed.
    This is simple physics. One nurse cannot be in nine places at one time. Hand washing takes only a few minutes, but when there are no minutes to take, it gets ignored. Every safety initiative takes time. In a lot of hospitals, nurses have no time. The dollars spent on surveillance cameras, scanners, alarms and GPS locaters, should be spent on better staffing.

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