Hand Washing: What’s It Going to Take to Get the Job Done?July 10, 2013
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?