Understanding hand hygiene compliance in healthcare environments

Healthcare environments can be susceptible to infections due to the high turnover of patients, employees and visitors. Paul Jakeway, Marketing Director here at skin care expert Deb, explains how the introduction of electronic hand hygiene compliance systems can help reduce the incidences of healthcare associated infections (HCAIs) and maintain patient safety.  

In the UK today, the threat of HCAI’s is alarming, with approximately 300,000[1] patients contracting an illness whilst being treated in healthcare premises. That accounts for a cost of around £1 billion to an already financially strained NHS. It has also been revealed that patients are remaining in hospital an extra 3.6 million days a year in the UK due to these infections[2]; meaning healthcare professionals have less time to focus on new admittances.

In a highly sensitive environment such as a hospital, risks can arise from ill patients or from surfaces and medical utensils which contain infectious fluids. We all carry enormous amounts of micro-organisms on our skin and bodies which are invisible to the eyes. Some are good, the ones that live in our gut that assist us to function, but some, such as Methicillin Resistant Staphylococcus Aureus (MRSA) can be bad, and in some cases, life-threatening. Patients who are young, elderly, undergoing treatment for cancer or have undergone an invasive surgical procedure are at the greatest risk of catching infections.

For a hospital to avoid falling victim to HCAI’s, germs and bacteria must be contained. Poor infection control can have a devastating impact. It was revealed earlier this year that in the Neonatal Intensive Care Unit (NICU) of Hull’s Women and Children’s Hospital, a premature baby caught the life-threatening bacterial infection MRSA from “human to human contact."

Chief Nurse Mike Wright commented “we can confirm there was a lapse in infection prevention and control practice, which resulted in likely human-to-human transmission on our Neonatal Intensive Care Unit, and this is deeply regrettable.” Fortunately in this case, the premature baby survived and made a full recovery, but the seriousness of this case conveys how incredibly important effective infection prevention is.

Hands are the principal route by which infections can spread, therefore it is important that this threat is understood. As part of a major global effort to improve hand hygiene in healthcare, the World Health Organisation (WHO) has created the campaign SAVE LIVES: Clean Your Hands, with an aim to galvanise action at the point of care to demonstrate that hand hygiene is the entrance door for reducing HCAIs. It is crucial that healthcare stakeholders are focused on fighting antibiotic resistance in healthcare environments. This can be combatted by effectively cleaning the hands at critical times.

The WHO has recommended that healthcare employees follow its ‘5 Moments for Hand Hygiene’, which outlines that employees must wash their hands before touching a patient, before clean or aseptic procedures, after body fluid exposure or risk, after touching a patient and after touching patient surroundings.

However it isn’t just the amount of times that healthcare employees wash their hands that matters, it is also crucial that employees follow a 3-step hand hygiene and skin care best practice, which should consist of the steps cleanse, sanitise and restore.

Cleansing the skin in healthcare environments is a fundamental step in hand hygiene best practice. Apart from removing any visible soiling from the hands, the physical action of a good hand washing technique will remove high levels of bacteria and viruses also present on the skin. Hand sanitising can reduce bacterial counts on visibly clean hands when access to running water is inconvenient. In healthcare environments, alcohol is the preferred active biocide for skin sanitising without the need for rinsing. Whilst the role of hand washing or decontamination is generally well understood, retaining good skin condition is often ignored. It is vital to regularly replenish the natural oils lost from the skin through frequent hand washing with the use of a reconditioning cream. If the skin is left in a poor condition the likely result will be a reduced level of hand hygiene compliance.  


How should hand hygiene compliance be monitored?

Measuring hand hygiene compliance can be difficult in healthcare environments. New ways of reporting have been developed to ensure that workers are held accountable for delivering the safe, high quality care that the NHS is renowned for worldwide. In many cases, reported hand hygiene rates are much higher than the actual rate of compliance, due to the inaccurate methods of gathering data.

The common method of using direct observation to measure hand compliance is deeply flawed. The information can be subjective, imprecise and prone to false positives. For staff, knowing when they are being watched might make them overplay their regular habits, running their hand under a sanitising dispenser more frequently than they might normally – this behaviour is commonly known as the Hawthorne effect.

The answer is electronic monitoring – a cost-effective method that is considerably more reliable than direct monitoring, and can capture 100% of hand hygiene events, providing operators with precise, quantitative data on actual hand hygiene compliance. The system can also be established into a healthcare environment in a way that bears no detrimental impact to the daily activities of medical staff. State-of-the-art electronic numeration can be incorporated into the dispensers, meaning that a wireless signal will activate any time the dispenser is used and be sent to a tracking server.

It is then possible to monitor what is happening more accurately and determine whether it falls in line with compliance standards. Through having the available numerical data, it means that staff are able to collaborate on compliance improvement plans, set goals and ensure that as a team they are doing everything in their power to improve hand hygiene, and thus patient safety. The difference that hand hygiene compliance can make in healthcare environments is incalculable. The future of hand hygiene compliancy is in the hands of the healthcare employees, patients and visitors.


[1] National Institute for Healthcare & Excellence, 2011

[2] Plowman et al, 1999