The healthcare hand hygiene challenge
Essity’s Liam Mynes looks at the benefits and pitfalls of various hand hygiene compliance methods, and considers how a mixture of approaches – along with the right products and systems – can help enhance hand hygiene in healthcare.
Hand hygiene is crucial in healthcare, but according to the World Health Organization's (WHO) Clean Hands 2020 campaign, around 70% of healthcare workers worldwide fail to routinely wash their hands.
Hospitals have implemented various systems to address this situation over the years, with the most common being the use of trained observers to assess employees’ hand hygiene practices. This method – considered by the WHO to be the gold standard – involves deploying staff members to scrutinise the habits of healthcare workers. However, human monitoring is not without its pitfalls.
Often considered to be intrusive, live observation is costly in terms of time and labour. It’s also subject to the so-called Hawthorne effect, whereby staff members temporarily adjust their behaviour when they know they’re being watched.
A study at a medical facility in San Jose, California, bore out this theory. Researchers overtly watched a group of healthcare workers while secretly assessing the hand hygiene habits of another group. After collating more than 4000 hand hygiene observations, they concluded that staff members were twice as likely to wash their hands if they were aware of being watched, with compliance rates rising by a further 30% if the operative in question were personally acquainted with his or her observer.
An alternative approach to human observation is electronic monitoring, which uses sensors located in a badge or wristband to detect when the wearer is washing their hands. These systems also have their drawbacks, though. Electronic monitoring can be expensive, inaccurate and unpopular with staff members who may again resent the perceived ‘Big Brother-like’ intrusion on their work practices.
However, in the midst of a global pandemic it seems hard to believe that healthcare staff would resist any efforts to enhance patient safety. Our own research also suggests that employees are keen to improve their hand hygiene compliance.
A 2018 study carried out by United Minds on behalf of Essity revealed that 80% of healthcare professionals claimed to want to improve their hand hygiene compliance, but said they found most traditional training modules to be uninspiring. Six out of 10 said they would like hand hygiene to be afforded a higher priority in their unit, while 40% called for better hand hygiene training.
So, if they are aware of the importance of hand hygiene and are keen to do better, why are some staff members still
56 | HEALTHCARE HYGIENE failing to wash their hands?
Studies show there are several reasons behind poor compliance. Healthcare staff have been rushed off their feet during the COVID-19 crisis which means they have had little time to spare for carrying out the regular 40-60 second hand-washes advocated by the WHO.
Frequent hand washing and sanitising also has a tendency to aggravate the skin, something that can be an ongoing problem for healthcare workers. A Royal College of Nursing survey carried out in December 2019 revealed that 93% of nurses had suffered skin conditions during the previous year, with 46% describing the condition of their hands or wrists as ‘poor’ or ‘very poor’.
Some healthcare workers complain that the products they need to carry out hand hygiene are not always available when they need them because the dispensers are hard to locate or because the soap and paper supply has run out.
It’s crucial that good habits are adhered to in the midst of a global pandemic. So, whether or not staff happen to have sore hands or are rushed off their feet, they still need to be motivated to cleanse their hands thoroughly and frequently. Healthcare facilities should therefore ensure an ongoing supply of user-friendly products and combine these with the provision of engaging hand hygiene training to reinforce the message.
Mild soaps, soft hand towels and moisturisers will all help to alleviate the problem of sore hands. For example, Tork Foam Soap comes in an Extra Mild version which is allergy- friendly certified by ECARF, the European Centre for Allergy Research Foundation, while Tork Xpress Extra Soft Multifold Hand Towels are soft, absorbent and gentle on the skin. A fragrance-free conditioning cream such as Tork Non- perfumed Hand & Body Lotion will help to prevent chapping and soreness when used after hand washing.
Besides being skin-friendly, all hand hygiene products should be easy to use since this will facilitate the process for harassed healthcare workers. The dispenser for Tork Foam Soap has been designed to be particularly easy to use even for people with low hand strength, and the unit
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