Did you grow up with your mother insisting you wash your hands? She was right! As nurses, we all know that the simple act of washing our hands saves lives—and that contaminated hands mean nosocomial infection, and nosocomial infection puts our patients at serious risk. Unfortunately, we don’t seem to be doing enough about it.
In 2005, the Joint Commission on Accreditation of Healthcare Organizations added this item to their National Patient Safety Goals: “a reduction in health care-associated infections.” And no wonder. Here are the numbers:
• 2 million health care associated infections a year
• nearly 90,000 deaths from nosocomial infections a year
• $4.5 billion in medical expenses a year
(Hand Hygiene Resource Center at http://www.handhygiene.org/)
As Dr. Tom Ahrens points out in his article on sepsis in this issue of American Nurse Today, few people actually die from infection itself. They die from the deadly consequence of infection—sepsis. Still, the road from poor hand hygiene to nosocomial infection to sepsis to death can be dramatically short. And as Dr. Ahrens notes, the best and most important therapy for sepsis is prevention.
The Centers for Disease Control and Prevention (CDC) estimates that one-third of all hospital-acquired infections result from a failure to use infection-control practices such as hand hygiene. (http://www.einstein.edu/rx_files/education/cme/hh_cdcguidelines10017.pdf) And study after study shows that healthcare workers follow hygiene guidelines less than 50% of the time, though nurses tend to be the top performers.
To interrupt the transmission of infections by reducing healthcare worker hand-to-patient contact and patient-to-patient contact, the CDC recommends that institutions use these clean-hands tactics:
• Provide more accessible alcohol-based hand rubs.
• Place educational posters and reminders in strategic locations.
• Provide educational sessions.
• Establish an institution-wide strategy to increase compliance.
Many institutions have integrated hand-hygiene goals into their quality improvement and patient-safety programs. All institutions should educate new employees about the importance of hand washing and using products such as alcohol-based gels.
To learn the basics of hand hygiene, read the Fact Sheet on the CDC website:
http://www.cdc.gov/od/media/pressrel/fs021025.htm. The CDC Hand Hygiene Recommendations (available at www.cdc.gov/handhygiene/) provide step-by-step instructions, plus information about hand-hygiene agents, skin care, and other facts and tips.
For nurses, preventing nosocomial infection means being aware. Often, we don’t realize we are touching inanimate objects between patient-focused activities. But during patient care, we must touch dispensing machines, retrieve medications, turn off alarms, answer call lights and telephones, and obtain information from computers. Any of these objects may harbor infectious organisms.
Preventing nosocomial infection also means being compliant. Maintain hand hygiene by washing with soap and water when your hands are visibly soiled. Gloves don’t eliminate the need for hand hygiene, and I worry that the extensive use of gloves as part of universal precautions has made nurses complacent about hand washing and using alcohol-based hand rubs. Gloves are only an adjunct to proper hand hygiene practice. When you move from a contaminated site to a clean one, make sure you change your gloves. And be assertive. If you see other healthcare staff using incorrect practices, speak up.
Those in patient-care areas must also follow simple guidelines, such as having short, natural fingernails and using only hand lotions that are compatible with alcohol-based gels. Healthcare workers in high risk areas without wall-mounted dispensers for alcohol hand rubs should keep pocket-sized alcohol hand rubs with them at all times.
Remember, today’s savvy patients know the role of hand hygiene in preventing hospital-acquired infections. Try Googling “hand hygiene,” and you’ll see how popular the topic is: Over 3 million links pop up!
You should also know this: General-circulation, consumer publications are also addressing the topic, and some recommend that patients make a point of asking their care providers, “Have you washed your hands?”
Pamela F. Cipriano, PhD, RN, FAAN