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Practice comment

'Stay vigilant on hand hygiene or it’s back to the last century'

As the biggest healthcare workforce in terms of sheer numbers, nurses touch the lives of people. Literally.

And, as they touch, treat and care, errors occur in their compliance with the life-saving action of hand hygiene. Each touch not preceded by that action can pose a risk of harm – sometimes death – instead of an assurance of healing and security.

The average nurse in an average hospital with average hand hygiene compliance will clean their hands a lot – but not enough to guarantee patient safety. Nurses should clean their hands over 100,000 times in their working life. Defects in hand hygiene compliance hit around four out of every 10 opportunities, so 40,000 of those 100,000 actions never happen. Yet we are told handwashing is one of the most important actions clinicians can perform for patient safety.

Over the past five to ten years, how hand hygiene is handled, promoted and discussed, along with structures and processes, have been strengthened to make it easier to do at the right time. Within the last two years, international guidelines have been issued, and a World Health Organization day of action ever year on 5 May promotes hand hygiene. So you could be forgiven for asking: isn’t it time to move on?

To answer this, nurses – as potentially powerful leaders and influencers – may want to reflect on whether they understand the dynamics of the transmission of microbes at the point of care. Are you a role model par excellence? Are there any irrational activities taking place in the name of hand hygiene? Claims of 100% compliance, for example, undermine the serious efforts of most sensible nurses, and indicate a failure to understand true compliance.

Distractions, such as implicating patients and visitors in the mass spread of infection, are unhelpful and potentially dangerous. In the 260-page, evidence-based WHO Guidelines on Hand Hygiene in Health Care, there is not one mention of the role of patients and visitors in the spread of infection.

That’s not to say we should dismiss patient hand hygiene – it matters for patients’ dignity, personal hygiene, respect and to prevent self-infection. But this is unlikely to contribute significantly to a sustained reduction in cross-infection.

Nurses should revisit the 80:20 rule. Focus your efforts on the issues most likely to affect patient safety – your hand hygiene and that of your colleagues. Challenge hand hygiene omissions because this will make a difference to patient outcome.

A shift in behaviour, so hand hygiene becomes universal and automatic, is likely to take many years. So, every day, every nurse has a duty to keep hand hygiene on their agenda to ensure we never go back to the last century. Keep talking about it. Do not give colleagues, peers, superiors or subordinates explicit or implicit permission to let it drop.

Is it time to move on from hand hygiene? Not in our lifetime.

Julie Storr is vice-president, Infection Prevention Society; Claire Kilpatrick is board member, Infection Prevention Society

Readers' comments (7)

  • michael stone

    The situation isn't quite back to the observations of Semmelweis's day, pre-antibiotics - but surely clinicians pretty much understand this area, by now !

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  • One would hope so! Haha

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  • Janet Patterson

    Brilliant.

    The basics are the basics because without them, nothing else works.

    From way over here in California, bravo.
    Janet M. Patterson, RN, BSN

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  • Aleksandra Labay

    "The simple thing as -washing hands, may save a human's life". I see on wards a lot of cases, when nurse is forgetting to wash hands. And everytime even if I'm just student, I repeat this sentence.

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  • I train staff in infection control and include hand hygiene in this emphasising resident involvement and hand hygiene as part of this..
    I visited a home today where an 104 year old friend is resident and
    a) her nails were 'disgusting' dirty and too long in my opinion
    b) her fingers are arthritic and contracted and the area between her fingers smelt of 'days of neglect'
    I reported this and 'they are going to do something about it 'this afternoon'
    what happened to hand and nail care as part of personal care for residents!
    This situation highlighted that it is basics and implementation of good practice that is lacking.

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  • To Aleksandra above I would say keep highlighting bad practice - lack of hand hygiene, you as a relatively new person on the scene will probably pick up things that are not being done.

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  • 100,000 hand cleanings in a career?
    Over a 47 year span this equates to 1.23 times per hour...

    Nowhere near enough to be clean between patients.

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