This week Beaumont Hospital received a poor bill of health from HIQA in relation to (among other things) hand hygiene following an unannounced visit on 23rd July 2013. In fact, the HIQA report states that “While a few doctors were compliant with hand hygiene best practice, most were not” and that inadequate hand hygiene and infection control practices at the hospital pose “a risk to patients”.
I know that poor hand hygiene has already been flagged many times in many different healthcare settings all around the world, but I am always absolutely astonished that a simple procedure – that most of us are taught to do as toddlers – now requires funding, education, posters with instructions and external inspections to ensure compliance in modern healthcare settings.
It has been estimated in the US that the average cost of a hospital stay for patients who acquired infections was approximately $50,000 more than for those who did not acquire infections and that annually 99,000 US patients don’t survive from infections picked up in hospital. Source
I trained in Beaumont Hospital from 1988 to 1991. At that time we student nurses were inspected by nurse managers before going on duty. Some complained about this, perceiving it to be an affront to their right to be treated as adult professionals. In a lot of ways the behaviour of nurse managers towards students was nothing short of bullying, but on the issue of hand-washing I always agreed with them, so I actually never minded the inspections because I knew that the underlying aim was patient safety. If I had ever had dirty fingernails or a stained uniform they would have been quite right to prevent me from looking after vulnerable patients. Even nurses who were not compulsive hand washers like me were still very keen to avoid the wrath and gnashing of teeth of those nurse line managers.
Their rules were simple. Hair had to be completely tied back. Uniform had to be clean. Bracelets, wristwatches and any ring other than a wedding ring were forbidden. These were no-brainers for me! I certainly did not want to finish my shifts with a medley of stomach slime, bowel contents, blood and wound sap fermenting under my jewellery! Gloves help to avoid contamination from predictable splashes, but the reality for HCPs is that there are many unpredictable showers of hazardous human juices with little opportunity to take a moment to properly glove up. Hand washing, necessary in everyday life anyway, is an absolute priority in a healthcare setting.
So, why are so many healthcare professionals (HCPs) unwilling to undertake this most basic activity?
- One research paper reveals that HCPs tend to wash their hands after procedures to protect themselves;
- Other studies have found that some HCPs do not believe there is adequate evidence that hand washing prevents infection (here is the WHO’s ‘compelling evidence’ that hand washing does reduce transmission of infection in hospitals!); and that students tend to copy their superiors’ routines during clinical procedures.
- Other studies reveal that dry skin, time pressures and the tedium of hand washing are contributing factors.
- The founder of a US company that produces electronic devices to monitor staff hand hygiene habits has suggested that HCPs who are concentrating and multi-tasking duties that are of life-and-death importance are functioning at a high cognitive level and tend to forget the ‘small’ things such as hand washing.
- Other infection control specialists think that there can also be resistance to authority – proven by the fact that they have observed HCPs swipe their electronic tags near the sensor at the sink and turn on the water to register that they have been there, and then move away without washing their hands!
In May, the New York Times reported that a hospital in Long Island has installed motion sensors in ICU rooms. When the sensor is triggered by someone entering the room, a video camera is turned on and the footage is monitored by workers in India, who watch to check that HCPs are washing their hands. Aside from the need for infection control, a major incentive for this is financial. Under new rules in the US, hospitals will apparently lose Medicare income if patients contract preventable infections.
In many hospitals in Ireland, patients are now urged to ask their HCP if they have washed their hands. This is difficult to do without appearing confrontational. We worry that the HCP will get huffy if asked. I would say to patients, let them be huffy. You have a right to be protected from preventable infections.
Easier said than done, I know. A few years ago I found myself in a paediatric operating theatre, accompanying my child who was having surgery. Just as the anaesthetic was being administered, the theatre nurse dropped a gauze swab on the ground, picked it up and put it back over the I.V. cannula. In a flash, I tried to find an acceptable way to say “Nooooooooooo!” but at that second the anaesthetic took effect and I was physically bundled out by two nurses so that I wouldn’t be there for the intubation. (They didn’t know I was a nurse). As I paced around waiting for post-op return of child, I fretted about the gauze swab almost as much as the anaesthetic. In hindsight I should have said “I’d prefer if you’d use a fresh swab if that’s okay”.
If you are happy to confront outright a HCP who doesn’t wash their hands or does something that puts you at risk, go right ahead. If you prefer a softer approach, keep the phrase “I would prefer if you could wash your hands before doing this” in the back of your mind, ready to be wheeled out when necessary.
Whether healthcare professionals are forced by their employers/insurers to wash their hands or reminded by patients to do so, as a patient it is your right to be treated in a hygienic environment.
You would protest if a shop assistant short-changed you.
Please protest just as much if your healthcare professional doesn’t wash their hands! Tweet this!