I’ve decided to write this blog based on a growing awareness that what once seemed to be automatic and unquestioned is now no longer either. I’m talking about the single most important measure in preventing infection, hand hygiene.
Recent audits of hand hygiene have revealed far lower results and compliance then we have previously seen. In some areas this has been as low as 40%. That means that your loved one could have a 4 in 10 chance of being treated by someone with clean hands. For me that is just not good enough.
Now I’ve been reflecting on why this might be and I do wonder if it is because of the new hospital, busyness or have we simply forgotten its importance as we have reached the lowest levels of healthcare associated infection we have seen.
We know that audit on its own is not sufficient to sustain improvement. What needs to change is behaviour and perhaps environmental things that we now describe as human factors? So I would like to appeal to your yuck factor!
These plates were collected randomly in one ward in DGRI
The ward phone is heavily contaminated, as is the keyboard at the touch down station and yet we may not think of the bugs we have just picked up on the phone when we help ourselves to a biscuit or walking to answer a buzzer without using alcohol hand rub. In that single moment we have transferred those organisms to the buzzer and to the patient or we have eaten them!
What doesn’t kill you makes you stronger?
Well this might be true of exercise but not of infections. Yes, you might gain some immunity but it’s possibly a chancy and painful way of gaining it and in this world of antibiotic resistance it is a growing risk.
Lessons from the past
Semmelweis recognised the importance of hand hygiene in the 1840s when
he noticed an increase in maternal deaths. Even though he reduced deaths
by introducing a hand washing regime which included Chlorinated lime used
after post mortem examinations he was ridiculed for this suggestion and told he lacked evidence and died in 1865 unrecognised in an asylum. https://en.wikipedia.org/wiki/Ignaz_Semmelwei
Florence Nightingale, a hero of mine since my childhood, famously said,
“The first requirement in a hospital is that it should do the sick no harm”.
She set about achieving this by instituting standards of hand washing and cleanliness that brought about her humiliation and ridicule but eventually a sharp reduction in death rates during the Crimean war.
There is a common theme and sadly, it is still a common theme.
When I have asked somebody why they have not performed hand hygiene or not complied with uniform policy and have watches, rings or gel nails, I have been ignored or questioned about the evidence base. I’ve been laughed at on occasion, perhaps nervously in some cases, and often been challenged to discuss other infection related aspects which the challenger believes to be far more worthy of my attention and action.
In 2007 there was a very successful hand hygiene campaign run across the whole of Scotland and this, together with an increased focus on cleaning, produced the lowest rates of healthcare association infection that we have seen at 4.5% HAI in Scottish hospitals in 2016. What has changed?
What’s in it for me?
Social marketing tells us that we that we are selfish animals and if there is a degree of discomfort or effort we make a decision about whether that effort will bring us benefit. I’d like to stimulate your “what’s in it for me?” reflex.
- Self protection
- That feeling of satisfaction at doing the right thing to protect one patient
- The common good and helping others
Our audit results for the last six months are available through Beacon, through the infection prevention and control portal. Your lead for your area will have access to individual audits and detail.
But it’s not about numbers; it’s about making a decision to change your behaviour.
We know how to clean our hands
We know when
We know with what – alcohol hand rub or gel will kill bugs and is better routinely but hand washing will remove organisms mechanically and wash them down the sink.
For further information please look at the National Infection Prevention and Control Manual (NIPCM)
Remember though that for Norovirus and C.diff alcohol isn’t effective so
What we need to do now is make an individual decision to notice each opportunity requiring hand hygiene and take the decision to do it and be prepared to gently challenge others if they miss their opportunity.
As patients and staff remember
And as we enter this season of parties, Flu and Norovirus please remember that we eat more bugs than we ever breathe in so if there’s one thing you can do to protect yourself, please make sure you eat with clean hands.
Elaine Ross is Infection Control Manager at NHS Dumfries and Galloway