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Hand hygiene is the most effective way to prevent the spread of infection. Throughout the day, we touch various surfaces in the environment, like doorknobs, stair rails, and phones. In health care facilities, we also come into direct contact with residents and staff. Without realizing it, we also touch our mouths, noses, and eyes, so it’s easy to become infected with a pathogen that may be living on the surfaces we’ve touched and spread that pathogen when we touch surfaces in the environment or touch other people. By performing hand hygiene correctly, we remove those pathogens from our hands, thereby breaking the chain of infection.
Right now, hand hygiene is as important as ever as we grapple with the emerging fungal pathogen Candida auris (C. auris) that is currently making headlines as it spreads through U.S. health care facilities, and has the potential to reach Canadian facilities. C. auris can live in a patient’s body without him or her knowing it or displaying symptoms before becoming ill. Individuals who have the greatest risk for contracting C. auris include those who are ill, have other medical conditions, are immunocompromised, live in a health care facility for an extended period, or have previously received antibiotics or antifungal medications. Many of these risk factors apply to residents of long-term care facilities, so it’s imperative that we monitor these patients for signs and symptoms of C. auris and test them promptly if they develop symptoms. The most effective way to prevent infection is to utilize hand hygiene, appropriate PPE, and surface disinfectants when caring for these patients.
What can facilities do to ensure staff are properly trained and prioritizing hand hygiene?
Training is the most impactful conduit of hand hygiene, and it should start on day one for new employees. During onboarding, managers should walk through hand hygiene protocols and then have new employees demonstrate the process in real-time to ensure compliance. That training is repeated on an annual basis. We recommend utilizing a facility-approved skills checklist for return demonstrations of hand hygiene. Keeping a log of trainings and demonstrations is also a must.
Throughout the year, managers can reinforce hand hygiene through regular or monthly infection control updates, staff meetings, beginning-of-shift rounds, and as needed when health care-associated infections (HAIs) occur.
Photo credit: Essity
Additionally, technology is allowing our field to innovate new ways to train and retrain on the topic of hand hygiene. We are particularly excited about the advent of virtual reality (VR) hand hygiene education, which not only allows staff the flexibility and autonomy to conduct training when it’s convenient for them, but also provides feedback in real-time. VR training is interactive and engaging, so users are more likely to remember the patient care scenarios they’ve seen and can recall when they should be performing hand hygiene.
What are the biggest challenges for care facilities when it comes to promoting hand hygiene?
Compliance is the biggest challenge. Hand hygiene is comprised of relatively simple procedures, so staff can become complacent when it comes to valuing the importance of hand hygiene and hand hygiene education. Additionally, at times due to staffing challenges, increased severity of patients’ conditions, and heavy workloads, staff may cut corners to complete their assigned tasks. No matter how much we train, some staff members may forget that gloves do not negate the need to perform hand hygiene. This can lead to staff being cited by surveyors for failing to wash their hands when they remove their gloves – and a great deal of time spent by administrators in constructing, implementing, and documenting detailed plans of correction.
How can they mitigate these challenges?
Hand hygiene education is critical. Staff members can retain a lot from learning the reasons behind why we perform hand hygiene, how pathogens spread, and breaking the chain of infection, but these principles need to be constantly reinforced. Some interventions that can be helpful include:
- Signage: If the reminder is “in your face,” then staff are far more likely to remember to do the act. Hand hygiene reminders should be placed in common areas frequented by staff, including entrances/exits, elevators, bathrooms, breakrooms, and staff lounges.
- Professional development: Skills days are a good opportunity to re-educate team members on hand hygiene. They include demonstrations of the correct way to perform hand hygiene, as well as return demonstrations of hand hygiene – allowing staff to demonstrate what they’ve learned.
- Product placement and availability: Making sure staff have access to soap, sanitizer, and towel dispensers, along with ensuring the dispensers are full of the products at all times, is critical to promoting hand hygiene. Empty dispensers are an infection preventionist’s nightmare because they often mean that a team member will skip critical hand hygiene processes simply because the necessary products aren’t available. Empty or malfunctioning dispensers can also lead to a facility being cited by government surveyors. Implementing a data-driven system across a facility can make a big impact, as such systems monitor dispenser capacity and alert staff when a dispenser requires refilling or is malfunctioning (for example, due to drained batteries).
- Culture: Facility-wide, all employees need to understand that hand hygiene is everyone’s responsibility. It’s important to create a culture in which team members can coach their peers when they observe improper hand hygiene practices or provide positive reinforcement when they observe good hand hygiene practices. They also need to share the responsibility of monitoring dispensers and reporting empty or non-functioning dispensers to the designated person as soon as possible, as well as alerting colleagues as needed.
For patients in long-term care facilities, why is it important that they perform their own hand hygiene whenever possible?
It’s important to note the benefits that come from the ability to perform one’s own hand hygiene, even if it seems like a simple task. First, hand hygiene decreases the transmission of HAIs among a very fragile population as they frequently interact with one another and environmental surfaces during meals and social/leisure activities in shared spaces.
Second, and perhaps less obvious, hand hygiene plays a pivotal role in delivering dignified, person-centered care. Being able to perform one’s own hand hygiene reinforces feelings of independence, dignity, and self-worth. No one dreams of having their personal care performed by another person. Being able to perform portions of their activities of daily living independently improves their self-esteem, but to do so, residents need hand hygiene products or tools (sanitizer, soap, and towel dispensers) that are easily accessible and ADA-compliant. They also need dispensers they can easily manage or handle due to limitations caused by arthritic changes, deformities, decreased range of motion, or pain in their hands/extremities. Giving residents access to dispensers that have an easy-to-use certification and are approved by the Swedish Rheumatism Association (SRA), a non-profit organization advocating for people with rheumatic diseases and chronic pain, allows them to achieve good hygiene and live their lives to the fullest while maintaining their independence.
