Posts Tagged ‘hand washing’


Time to Get Serious About ‘Handshake-Free’ Health Care?

June 2, 2014

By Shawn Kennedy, AJN editor-in-chief

Tombstone handshake, from Mel B, via Flickr.

Tombstone handshake, from Mel B, via Flickr.

Last month in JAMA, Mark Sklansky and colleagues wrote a Viewpoint column, “Banning the Handshake From the Health Care Setting.” The article explored the idea and its feasibility, while acknowledging the importance of such rituals as handshakes in human interaction. In the end, the authors argued that it’s an idea we might need to start taking more seriously.

Is this an antisocial idea? That’s debatable, but it would certainly be a good step towards reducing transmission of infections—and one that’s probably long overdue.

It’s well known that pathogens are easily transmissible from health care workers’ hands, even if they practice hand hygiene in between seeing patients. But as the authors remind us, heath care workers are notoriously bad at doing so—they cite research showing that “compliance of health care personnel with hand hygiene programs averages 40%.”

And it’s no better in ambulatory care settings—an original research article we published in March 2013 that measured hand hygiene compliance by health care workers in an ambulatory care clinic found that, even after a campaign to improve adherence, compliance (as measured by direct observation) had only improved to between 32% and 51% at one-month follow-up. The introduction of alcohol-based hand sanitizers helped, but they aren’t effective against all pathogens, including C. difficile and some noroviruses

Bacteria have been shown to live on many surfaces—computer keyboards, telephones, uniforms, and even paper (see our December 2011 research article, “Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper to Hands”). If a conscientious nurse charted on a paper chart or entered a patient’s vital signs into the electronic record after providing care but before washing hands, bacteria could be transmitted to whoever next picked up the chart or used the keyboard. Then that person might shake hands with a family member or colleague, and so on, and so on . . .

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

July 10, 2013

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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That Acute Attention to Detail, Bordering on Wariness…

November 21, 2011

via Wikimedia Commons

By Kinsey Morgan, RN. Kinsey is a new nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA. Her last (and first) post at this blog can be found here.

It seems that nursing schools across the world subscribe to certain mantras regarding the correct way to do things. Different schools teach the same things with utmost urgency. Hand washing is one of the never-ending lessons that comes to mind. How many times do nursing students wash their hands while demonstrating the correct way to perform a procedure? I vividly remember actually having to be evaluated on the skill of hand washing itself.

Another of the regularly emphasized points of nursing school is double-checking. One of my first clinical courses required students to triple-check patient identification before giving medications. We were to look at the medication administration record, the patient’s wristband, and then actually have the patient state their name.

As a new nurse learning several new computer systems for charting, etc., I’ve noticed that the old attention to detail, ground into my soul during my school days, now seems easy to overlook, since computers do so much of the work. Of course, computer charting and electronic MARs* have simplified tasks and made time management much less daunting. But sometimes I worry about the hidden cost of such improvements.

I intend, vow, resolve to make an effort to remain aware of how easily errors can happen when we don’t double- and triple-check things. I want to always retain that astute attention to detail, bordering on wariness, so that I can practice as safely as possible, even with the advent of electronic methods.

*MARS = medication administration records

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