By Sylvia Foley, AJN senior editor
Hand by sochacki.info, via Flickr
The trouble with hands is that they get into everything, and rapidly move between mouths, noses, eyes, and other people’s hands.
So says David Owen in his recent New Yorker article “Hands Across America,” which describes the development of the first gel sanitizer—and of course it’s nothing nurses and other clinicians don’t already know, just as they know that the practice of hand hygiene is crucial to reducing health care–associated infection rates. Yet adherence to hand hygiene guidelines among health care workers remains low. Interventions to improve hand hygiene have been tested in hospitals with demonstrated success, but have seldom been evaluated in other settings. In this month’s CE–Original Research feature, authors Kate Stenske KuKanich and colleagues describe their evaluation of a hand hygiene campaign in an outpatient oncology clinic and an outpatient gastrointestinal (GI) clinic.
The intervention. At each clinic, the researchers observed health care workers for the frequency of hand hygiene (attempts versus opportunities). After compiling baseline data, they initiated an intervention, which consisted of introducing an alcohol-based gel sanitizer and an informational poster to each clinic. (The gel sanitizer was provided as an alternative to foam sanitizer and soap and water.) One week later, interventional data were collected for five nonconsecutive days. Afterwards the posters and gel sanitizers were removed, and one month later, follow-up data were collected. Lastly, three months after follow-up observations ended, workers at each clinic were surveyed to evaluate their perceptions of the campaign.
Some findings. In both clinics, hand hygiene frequency was poor at baseline, just 11% at the oncology clinic and 21% at the GI clinic. But after the intervention it improved significantly, to 36% at the oncology clinic and 54% at the GI clinic—and the improvements were maintained during the follow-up period. Reported barriers to hand hygiene included skin irritation, forgetfulness, and insufficient time. Although a majority of surveyed workers at both clinics said they preferred soap and water, direct observations showed that once gel sanitizer was available, its use predominated. Indeed, when it was removed following the campaign’s end, many workers began carrying their own.
The researchers concluded that “introducing a gel sanitizer and providing informational posters can yield modest short-term improvements in overall hand hygiene performance in outpatient clinics.” They recommend that administrators and influential health care workers
- collaborate in fostering an environment conducive to adherence.
- provide a variety of hand hygiene products, including gel sanitizer.
- encourage workers to participate in creating motivational posters.
For full details, please read the article—it’s free online. We’ve also got an exclusive podcast with the lead author. And as always, please consider sharing your thoughts and experiences with us in the comments.
As an ex-oncology nurse, I find these results dismal. The clinical team should be modeling hand hygiene and best practice for their patients as the risk of these patients dying from an infection is even greater than the general population. I would like to know the CR-BSI rates of these patients and how they compare to national benchmarks.