By Peggy McDaniel, BSN, RN
by sergis blog/via Flickr
If I knew then what I know now. In my current nursing role I promote best practices, particularly around reducing bloodstream infections and preventing intravenous medication errors. When I was at the bedside, I did not know what I do now. I now read many articles and studies around infection control and am much more aware of what can be done to reduce risk and improve quality of care. I wonder how many bedside nurses understand the “why” behind the mandate for hand hygiene compliance?
Thirty-four percent compliance. A recent study (here’s a useful summary, and here’s the study abstract) published some dire statistics that only confirm what other studies have shown in recent years: during routine care, clinicians (nurses and doctors) only followed hand hygiene compliance guidelines 34% of the time. Some additional details should not be overlooked as well. Clinicians tended to perform hand hygiene more often after procedures or when exposed to blood. This implies that clinicians are much more concerned with protecting themselves than their patients. Even with much focus on increasing hand hygiene compliance and many dollars being spent on technology to monitor and promote compliance, the statistics reveal that we have a long way to go.
Does our training instill in us the respect we should have for microbes and transmission of microbes? Does theory taught in microbiology classes today take the next step to connect the idea that the “bugs” that cause infection can often be stopped dead by just not passing them along? What do you think? I’d like to know. I went to school over 25 years ago and while I was a staff nurse I always heard the call to wash my hands—but I will admit that the call did not always translate into action. I was busy, there was always one more task to do, and after all, hadn’t I just put on or removed some gloves? Didn’t all of that count?
The answer is a resounding “no!” Although many projects underway across the country and worldwide are reducing infections, the overall rates for the five types of hospital-acquired infections (HAIs) tracked in adults have continued to rise.
Watch that dial. Read this study detailing just how contaminated many surfaces in hospitals really are and the next time you gel in to enter a patient’s room, adjust the volume on the TV remote, apply your gloves to draw up an IV med, and then drop the side rail to access the patient, you may just think twice—and take additional steps to protect that person in the bed, along with yourself.
What will it take to get health care providers to perform hand hygiene consistently? Why does it take any more motivation than the idea that you are protecting your patients and providing excellent care? I believe that clinicians, for the most part, do not seek to harm their patients—but when data like this once again is published, how else do we explain our lack of compliance? It’s unacceptable.
In response to the above post, when visiting hospitals I often observe much higher compliance to hand hygiene than this study discusses. However, I do often see nurses move from what we would consider clean procedures to administering IV medications without doing another “dose” of hand hygiene or donning gloves. I applaud your unit’s nurses! That is awesome. I hope you share your successes and encourage other units to do the same or even better. Your team is exceptional.
Wow! You paint a bleak picture. I don’t know where you worked, but in our unit, nurses are over 90% compliant with hand hygiene protocols. Docs, on the other hand, were about 40% compliant. And these data come from an unannounced survey, during which employees had no idea we were being observed. Excellent hand hygiene is part of our unit culture. In fact, if somebody sees a staff member NOT wash, that person gets reminded, big time. And we do it for the patients. In fact, most of us have very dry, cracked, even bleeding hands because of our extremely frequent hand-hygiene. And by the way, we read journals, understand how essential hand hygiene is, and it’s more than a little insulting for you to presume otherwise.