Hand hygiene compliance in healthcare

Greg Whiteley shares his thoughts on a recently published paper in the American Journal of Infection Control on hand hygiene compliance.

Greg Whiteley* shares his thoughts on a recently published paper in the American Journal of Infection Control on hand hygiene compliance. 

Greg Whiteley

In December 2016 members of the infection control community published a paper in the American Journal of Infection Control (AJIC) on hand hygiene compliance.

The findings released in the paper, ‘Automated hand hygiene auditing with and without an intervention’, in my opinion were truly terrifying and tells of the tragedy involving the medical community and its self-monitoring practices.

Now, we know that the nasty germs that live, grow and flourish within healthcare settings, also move about via unwashed hands. Patients are often infected with these multi-drug-resistant microbes, because of medical personnel who do not wash their hands. So, washing your hands turns out to save lives.

One of the authors of the paper is Professor Mary-Louise McLaws, well known for her talks on the importance of washing your hands. Professor McLaws is involved with the acclaimed global hand hygiene initiative known as the ‘5 Moments for Hand Hygiene’.

Anyway, back to the research, and guess what? It turns out that while the hospital wards in the study reported hand hygiene compliance above 85 per cent, as per the Hand Hygiene Australia auditing methods, the real hand hygiene compliance levels were 30 per cent and 49 per cent. The official hand hygiene compliance rates were 55 and 38 percentage points higher than covert automation rates detected and measured during the same period.

Even an intervention during the study failed to have a significant impact on the medical ward (the average compliance didn’t change from the covert rate). While there was marginal improvement in the surgical ward, compared to the covert phase, by 11 percentage points to 60 per cent the hand hygiene compliance fell back to normal levels as soon as the intervention part of the study was completed.

So, if this level of hand hygiene compliance is representative in Australian Hospitals, every clinician or nurse who visits a patient has between a 50 per cent and 70 per cent chance of having contaminated hands. Yuck!

And is there any comment from your local health minister? Of course not. Even the Clinical Excellence Commission has had no response, and they are the group responsible for commissioning and approving the official audit numbers for hand hygiene compliance.

What is also of concern is the lack of mainstream media coverage and commentary on this important Australian research which was quickly dismissed by vested interests in the hand hygiene community.

For any of us that have lost loved ones or friends due to healthcare associated infections, and wondered how this has occurred, perhaps you might want to watch carefully next time you visit your local hospital and see if the friendly staff are among the 30 per cent who do wash their hands? If they are good hand washers, please say thank you. It will reinforce our community view.

But what else can we also do?

Well, this does underscore the importance of firstly washing your own hands regularly, and particularly if you are a cleaner working within a healthcare setting. And secondly, it shows again the importance of good surface cleaning.

If the bugs have been removed from the patient and other surfaces through use of effective hospital grade products and a validated cleaning technique, then you are winning the war slowly.

You can’t control the health care worker’s hand hygiene, but as a cleaner, you can make certain that what they touch within the hospital has been effectively cleaned and disinfected. The bugs are there, you cannot see them, but you can clean and remove them.

The jury is out on whether healthcare workers can lift their game in hand hygiene. The good news is that our cleaning interventions do matter and the cleaning staff can intervene to save lives amid the turmoil of auditing errors and poor hand hygiene from healthcare staffers.

*Greg Whiteley is director of Whiteley Corporation


This first appeared in the May/June issue of INCLEAN magazine. To subscribe, click here. 

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