New push for clean hands in hospitals

Infection-control experts say that with hand hygiene compliance at less than 50%, it's time to start washing up.

By Damon Adams — Posted May 8, 2006

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Physicians may know that they need to scrub their hands for at least 15 seconds with soap or an alcohol-based rub. But apparently many still are not practicing what's being preached.

That's why the Institute for Healthcare Improvement, Centers for Disease Control and Prevention and two other organizations collaborated on a new how-to guide to improve hand hygiene among physicians and other health care workers.

They say compliance of hand hygiene recommendations at hospitals remains unacceptable -- less than 50% -- and changes are needed to cut health care-associated infections.

The guide's recommendations are pretty basic: conducting demonstrations of correct hand-washing techniques, monitoring how well physicians and others comply, and encouraging patients to remind doctors to clean their hands.

"This isn't magic. Like anything else, it's discipline," said Don Goldmann, MD, senior vice president of IHI and professor of pediatrics at Harvard Medical School, Boston.

Hospital infections affect 2 million patients and cause about 80,000 deaths annually, the guide stated. Hand hygiene is considered a top infection-control measure. But poor compliance continues, and experts say these are reasons why: lack of knowledge about the importance of hand hygiene in reducing the spread of infection; poor access to hand-washing facilities; and little institutional commitment to hand hygiene.

Organizations have tried to inform health professionals about keeping hands clean. In 2002, the CDC published guidelines on hand hygiene in health care settings, noting that alcohol-based hand rubs were preferred in most situations. In 2005, the World Health Organization issued guidelines that stressed multidimensional strategies as the best approach. Meanwhile, the American Medical Association said the CDC and other groups should promote the Association's four principles of hand awareness to the public to help prevent the spread of infectious disease.

Despite such efforts, not enough clinicians are listening. "We still have a long way to go," said John Jernigan, MD, a CDC medical epidemiologist.

Experts said the new guide can help hospitals improve hand-cleansing practices. The "How-to Guide: Improving Hand Hygiene," released in April, said health professionals should have accurate knowledge about contamination and understand the need for good hand hygiene. That can be done through live demonstrations, video presentations and monitoring how well workers clean their hands.

To make it easier for doctors to comply, alcohol-based hand rub dispensers and boxes of clean gloves can be placed next to each patient's bed and near the door to each room. Hospitals also should observe staff to monitor compliance rates.

Dennis S. O'Leary, MD, president of the Joint Commission on Accreditation of Healthcare Organizations, said the guide is an excellent resource for hospitals to make improvements. JCAHO currently requires accredited hospitals to comply with CDC hand hygiene guidelines.

Medical leaders say some hospitals are taking action.

Surveys ask if patients were satisfied with hand hygiene at the University of North Carolina Health Care System, said William A. Rutala, PhD, MPH, director of hospital epidemiology for the system. Infection-control professionals also monitor how well doctors and others clean their hands.

Parkland Memorial Hospital in Dallas has installed more sinks and hand sanitizers during renovations, said Lynne Kirk, MD, president of the American College of Physicians. And leaders at Montefiore Medical Center in New York report they have seen improvement, thanks largely to wall-mounted dispensers.

"It's really kind of revolutionized hand hygiene and our approach to it. Compliance is much better because it's much easier in many ways," said Brian Currie, MD, MPH, senior medical director at Montefiore.

Shands Hospital at the University of Florida in Gainesville monitors if workers comply, and reports are made to a patient-safety committee, said Loretta Litz Fauerbach, director of infection control at the hospital.

"We've had a couple people that we've had to talk to. Usually after that, they straighten themselves out," said Fauerbach, chair of the communications committee of the Assn. for Professionals in Infection Control and Epidemiology, which collaborated on the hygiene guide with the CDC, IHI and the Society for Healthcare Epidemiology of America.

Doctors also need to be careful not to spread germs in other ways, physician leaders said. Research shows that neckties, white coats and computer keyboards are germ nesting grounds.

Family physician Ted Epperly, MD, of Boise, Idaho, stopped wearing ties about five years ago. He washes his hands before and after he uses someone else's computer keyboard. And Dr. Epperly, board member of the American Academy of Family Physicians, practices good hand hygiene in the hospital and at his office.

"I'm constantly reminding myself to wash my hands," he said.

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Hand hygiene quiz

A new how-to guide for improving hand hygiene suggests that hospitals use a questionnaire to survey clinical staff periodically. Here are two questions, with correct answers below:

Question 1: How are antibiotic-resistant pathogens most frequently spread from one patient to another in health care settings? A. Airborne spread resulting from patients coughing or sneezing
B. Patients coming in contact with contaminated equipment
C. From one patient to another via the contaminated hands of clinical staff
D. Poor environmental maintenance

Question 2: Clostridium difficile (the cause of antibiotic-associated diarrhea) is readily killed by alcohol-based hand hygiene products.
True or False?

Answers: 1. C; 2. False

Source: Institute for Healthcare Improvement "How-to Guide: Improving Hand Hygiene"

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External links

"How-to Guide: Improving Hand Hygiene," Institute for Healthcare Improvement, requires registration (link)

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