In this study they looked at the barriers in hand hygiene compliance at 6 nursing homes with between 80 and 130 residents. Study was conducted with a mixed method. They surveyed or interviewed the CNA’s, RNs and nurse managers in these nursing homes. The survey had questions with correct/wrong option or the always, often, sometimes, rarely or never answers. The interview allowed for open ended questions. If less than 80% of questions were answered those studies were thrown out. Scored by the answers on survey and then interviews were put into categories to look at pattern. 165 nurses and 27 nurse managers were the sample at theses nursing homes. The main factor found to decrease compliance was not having the hand hygiene supplies available in the direct nursing care areas.
Hammerschmidt J, Manser T. Nurses’ knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC Health Services Research. 2019;19(1):N.PAG. doi:10.1186/s12913-019-4347-z.
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4347-z
Journal Club Critique Form-J. Younkman
I find it very shocking to find that 1 in 5 nurses had correct knowledge about proper hand hygiene! Unfortunately that seems to be a universal problem in healthcare. A study found that EMS providers are no better, with only 24% performing hand hygiene between patients. (Teter, 2014).
Teter, J. (2014, November 21). Hand Hygiene in Emergency Medical Services. Retrieved July 05, 2020, from https://www.tandfonline.com/doi/abs/10.3109/10903127.2014.967427
I have read so many studies on hand hygiene and am always surprised by the lack of compliance. Luckily at my place of work, we have fairly high compliance based on our secret shoppers who do audits. It would be interesting to audit out EMS service but also difficult when not owned by hospital and most of the staff is tied up at the time EMS services being there.
There is also a very high compliance rate of hand washing at my workplace. It seems to be the urgent situations that I do not see a 100% hand wash compliance. It is hard to hit the hand sanitizer before entering a room to assist a choking newborn. I do it though. Sometimes I don’t see hand washing as a secret shopper but if you interview the people, some wash before and after patient contact in the room. I have not had any experience with EMS but I do hope they know the very best way to protect their health is to wash their hands.
Jessica, I cringed before opening your hand hygiene compliance Journal review. I just do not understand why all nurses do not wash their hands every time it would be advised. I am a hand hygiene compliance officer where I work and I get the opportunity to track hand washing every month. I find that it is not the nurses whom are generally the non-washers. I certainly can understand that a nursing home is a much different environment than an acute care hospital but was surprised that hand hygiene supplies were not readily available for use by all. I am glad the situation on supplies has been rectified where you work.
Supplies for hand hygiene have never been an issue where I work until recently. With the COVID, our hand sanitizers in bottles at the nurses stations and at charting stations have all disappeared! I am not a fan of hand sanitizer although I use plenty of it. The CDC recommends using hand sanitizer over soap and water when hands are not visibly dirty because it more effective at killing germs than soap, is easier to use, and improves skin condition with less irritation and dryness than soap. A simple fix to having enough hand sanitizing supplies. At least hand washing is the in thing now!
Centers for Disease Control and Prevention. (n.d.). Hand Hygiene
In Healthcare Settings.
https://www.cdc/handhygiene/science/index.html
I have also had nurses tell me that they hit the hand sanitizer in the patients room on the way in and out so the secret shopper doesn’t catch them because they aren’t necessarily following them into the room. Cant fault them for doing it in the room though in front of the patient.
Hospital Acquired infections are a major problem for health care systems around the world. Appropriate hand washing is the most effective way for preventing these infections. It is amazing to read that many staff members don’t perform hand washing properly. Studies have shown that in addition to training staff on hand washing techniques , reminder mechanisms such as posters, more hydro-alcoholic solution dispensers and reminder beeps to wash hands increased hand washing compliance from 60%-70% before patient contact and 20%-70% after patient contact.
Martos-Cabrera, M. B., Mota-Romero, E., Martos-García, R., Gómez-Urquiza, J. L., Suleiman-Martos, N., Albendín-García, L., & Cañadas-De la Fuente, G. A. (2019). Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review. International journal of environmental research and public health, 16(17), 3039. https://doi.org/10.3390/ijerph16173039
HAIs are not a good thing for the patients or the hospitals. I have worked very hard to make sure education is done at my place of work to increase hand hygiene compliance and decrease HAIs (not that we had that many to begin with)
Hand Hygiene is very important in this line of work. It is so important to wear gloves and wash hands after each patient you take care off. It would be interesting to check the cleanliness of people hands after going into a room and not washing hand. Staff needs to be trained and taught and reminded to wash hands appropriately. This study that I found they are testing the effects of changing the Reminder Signs to wash your hands. I also believe that it helps to have alcohol dispensers outside every room.
Vander Weg, m., Perencevich, E., O’ Shea, A. aet. al. (2019).Effect of Frequency of Changing Point-of-Use Reminder Signs on Health Care Worker Hand Hygiene Adherence
A Cluster Randomized Clinical Trial. JAMA Netw Open. 2(10):e1913823. doi:10.1001/jamanetworkopen.2019.13823
Hi Jessica, I enjoyed reading your Journal Club post. I chose your article review to reply to because this is very relevant to my nursing practice and the article sparked my interest. I work in a long-term care and skilled nursing facility and to protect our vulnerable residents proper hand hygiene is very important. It surprised me that so few nurses had the knowledge needed to implement hand hygiene training concepts. At my facility the DON appoints one person each week to be the hand hygiene inspector. The person can be from any department and they operate covertly. It is kind of a fun way to promote quality hand hygiene. I think this tactic of including all employees in efforts to promote infection control and proper hand washing is very smart and it works! One study found that a comprehensive hand hygiene program showed a significant reduction in catheter associated urinary tract infections (CAUTI) in patients with long-term urinary catheterization (Meddings et al., 2017). UTIs are the bane of a long-term nurses existence! With the recent changes by CMS for antibiotic stewardship, long-term care nurses have been scrambling trying to figure out new and better ways to prevent UTIs for our residents. Thanks for sharing!
References
Meddings, J., Saint, S., Krein, S. L., Gaies, E., Reichert, H., Hickner, A., . . . Mody, L. (2017). Systematic review of interventions to reduce urinary tract infection in nursing home residents. Journal of Hospital Medicine, 12(5), 356-368. doi:10.12788/jhm.2724
I think our nursing staff does a good job of hand hygiene where I see the biggest deficiency is in our non-licensed personal. I know of a few house keeping staff that have been turned in for wearing the same gloves over and over which they defend by saying they wash the gloves between locations. I think hand hygiene is essential not only for us to know how to wash our hands but how to educate our patients to properly do so to prevent the spread infections and illnesses. You did a great job.
Oh you are so right! It is hard to get housekeepers to understand the why behind hand washing and mask wearing. It doesn’t seem to make sense to them. They are all so kind hearted. Not so good at speaking english, which unfortunately is the only language I know, so its hard to get the hand washing high five reminder to wash hands across to them. Our housekeepers seem to be on a task timer and I know they find it stressful to get the work done fast. I think they cut corners the best way they know how. It is so important to also teach our patients to hand wash, I agree.
According to the Centers for Disease Control (CDC), “washing hands can keep you healthy and prevent the spread of respiratory and diarrheal infections from one person to the next”. A lot of hospital-acquired infections are known to come through healthcare workers transmitting from one patient to another. I have seen a lot of facilities that do not have hand sanitizer in patient rooms or hallways. Lack of supplies is one of the reasons healthcare workers sometimes are not able to be in compliance with hand hygiene protocol.
https://www.cdc.gov/handwashing/when-how-handwashing.html