HOSPITALS & HEALTHCARE FACILITIES
HAND WASHING IN HEALTHCARE – WHAT IS GOING WRONG?
New research reveals that many healthcare workers are still not washing their hands. Following the pandemic, how is this happening? And how can hand hygiene be improved in healthcare settings, asks Essity’s Liam Mynes.
In February this year it was reported that hand-washing in Ireland’s hospitals was now being carried out less rigorously than it was during the pandemic.
The country’s Health and Safety Executive had set a target for 90% hand hygiene compliance across the board. However, the latest audit revealed that only 86.4% of medics were washing their hands at critical points before and after patient contact.
Also in February, new guidance was issued to US healthcare workers as to how they should be washing their hands.
Drawn up by a group of US healthcare bodies, the guidance covered new areas such as glove use and nail polish. According to the collective, all medical workers’ nails should remain unvarnished and their hands should be cleansed after removing gloves.
The group also claimed that only 7% of healthcare personnel were effectively cleaning the entire surface of their hands, adding that there was a clear need for ongoing hand washing training for staff.
And in summer 2022 it emerged that just one in three doctors and nurses in Greek hospitals were adhering to hand hygiene rules before having contact with a patient. The study, carried out in collaboration with the Greek National Health Service, also revealed that fewer than half the nation’s healthcare staff were washing their hands before carrying out any aseptic patient-handling procedure.
These reports seem incredible as we emerge from the shadow of Covid-19 when the need for good hand hygiene – particularly in healthcare – should be top of mind. So, what is going wrong? Why is good hand hygiene compliance so difficult to maintain in this hygiene-critical sector?
According to World Health Organization guidance, staff need to wash their hands before touching a patient, before carrying out any aseptic procedure, after any exposure to body fluid, after touching a patient and after touching the patient’s surroundings. Visibly-soiled hands should be washed with soap and water for between 40 and 60 seconds and then thoroughly dried to ensure a thorough clean. If the hands are not visibly soiled, an alcohol gel may be used instead for a period of 30 seconds.
During the height of the pandemic we were all receiving constant reminders about the dangers of unwashed hands
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and the need for frequent hand washing. But the advent of vaccinations has made the danger seem less severe, and it could be that we have all started to relax – healthcare workers included.
The current staffing shortages are putting increased pressure on medical staff. Most healthcare workers are rushed off their feet which means they have little spare time to carry out the regular 60-second hand-washes the World Health Organization advocates. And in urgent situations, staff members might be forced to choose between washing their hands for the required length of time or delivering life-saving care – a decision that is actually no choice at all.
Frequent hand washing and sanitising has a tendency to aggravate the skin, and this could also be deterring some healthcare workers from washing their hands. A Royal College of Nursing survey carried out in December 2019 revealed that 93% of nurses had suffered with skin conditions on their hands or wrists during the previous year. More than half the people questioned claimed to have experienced redness, itching, dryness or cracking of the skin with 46% describing the condition of their hands as ‘poor’ or ‘very poor’.
And some healthcare workers complain that the products and systems they require to carry out hand hygiene are not always available to hand when they need them. Perhaps the dispensers are hard to access or difficult to locate, or the products may simply be unavailable because the soap and paper supply has run out.
But the global pandemic has alerted us all to the importance of good hand hygiene. So however exhausted and traumatised healthcare staff might be, they still need to be motivated to wash or sanitise their hands thoroughly and frequently – and be given the wherewithal to do so.
Products such as mild soaps, soft hand towels and moisturisers will help to alleviate the problem of sore hands. For example, Tork Foam Soap comes in a Tork Sensitive version which is particularly kind to the hands, while Tork Xpress Extra Soft Multifold Hand Towels are soft, absorbent and gentle on the skin. And the provision of a fragrance-free conditioning cream such as Tork Sensitive Moisturising Hand Cream 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
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