The Importance of Hand Hygiene on the Surgical Unit

One of the National Patient Safety Goals, put in place to improve patient safety, is to ‘prevent the spread of infection’. The Center for Disease Control advises that on average, healthcare providers clean their hands less than half of the time that they should, and, on any given day, about one in 25 patients acquires at least one healthcare-associated infection. That statistic is alarming, and although all patients are vulnerable to being another statistic, this author believes that one of the most vulnerable populations in the hospital is housed on the surgical unit.

The research collected for this paper compared and contrasted a combination of interventions laid out in three separate studies, which consisted of: education and feedback, visual feedback and electronic reminders, and a cluster of education, reminders, feedback, and collaboration with unit leaders.

The first study, consisting of education and feedback, was conducted on a 12-bed ICU, where data was recorded for 18 nurses. The study conducted 14 weeks of baseline interventions, followed by two four-week interventions, which included four 15-minute classes taught within a 1-week period .

A second intervention was then incorporated into the study, which provided feedback in the form of a poster revealing results of audits of hand-hygiene compliance. This particular study revealed that the education session alone increased compliance from 81% to 94%, but then declined after 3 weeks; however, after the addition of the informational posters, compliance increased to 92%, which was maintained for four weeks. This study clearly showed that the addition of the informational posters was more successful is improving hand hygiene compliance.

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Another study focused on visual feedback and electronic reminders, conducted on a 24-bed ICU. The intervention included a hand hygiene system that would use a flashing light to illuminate the entire hand hygiene dispenser located near the patient, whenever a nurse’s badge would come into close proximity of the dispenser. The results showed a consistent increase in sanitizer use four months after the end of the intervention. The control group had a median usage of 9,250 mL of hand sanitizer, compared to 7,035 mL in the control group. This result clearly showed that this particular intervention was capable of achieving lasting results, even after the study was completed. Lastly, and most successfully, a study was performed that consisted of a cluster of education, reminders, feedback, and collaboration with unit leaders.

The control group received state-of-the-art strategy, which included education, reminders, feedback, and targeting adequate products. The experimental group received the same strategy, plus interventions based on social influence and leadership. The study lasted 13 months, which included 1 month of baseline, 6 months of interventions, and 6 months of follow-up, which included no interventions. The compliance in the control group increased from 23% to 42% in the short-term and to 46% in the long run, and the experimental group increased from 20% to 53% in the short-term, and remained 53% 6 months post-intervention. As this study shows, compliance rates increased in the group that received interventions based on social influence and leadership. This author believes that leadership in the healthcare community plays a vital role in achieving and maintaining high hand hygiene compliance rates.

As shown from research, multimodal, single‐component, or dual interventions to improve hand hygiene compliance in nurses have all been demonstrated to be effective to some extent. High rates of hand hygiene compliance and longest sustainability were found with a multimodal and team leader–directed strategy that incorporated education, reminders, feedback, changes in facility layout, product availability, and the support of a team leader or manager. The study that proved to be the most sustaining was the first study introduced, which consisted of education and feedback over the course of 14 weeks. So, what can the nursing community do to maximize and maintain compliance? What interventions should be?

The author believes there are a number of interventions, that when combined, will show the great success. First, managers and healthcare providers should continue to promote hand hygiene compliance using the World Health Organization’s recommendations for performing hand washing, which include before patient contact, before an aseptic technique, after exposure to bodily fluids, after patient contact, and after contact with a patient’s surroundings. Interventions should also include easy accessibility to antiseptic pumps, frequent reminders and educational seminars, visual reminders to sanitize one’s hands, goal setting both by nurses and management, rewards and incentives for high compliance participants, and accountability among nurses.

Together, the nursing community is far more powerful than one may believe. By joining together, nurses were able to persuade legislators in California to limit nurse to patient ratios. With this much power, it should not be difficult for nurses to change policies within their own hospitals. By asking for better practices, more availability to antiseptic pumps, and recognition for a job well done, the safety of patients will drastically improve. Although this author is referencing evidence-based data gathered on various floors of the hospital, it is this author’s hope that the surgical unit could start to see a great shift in hand hygiene compliance. The surgical unit houses some of the most vulnerable patients in the hospital.

The average patient on the floor is elderly, is on several medications (which can weaken your immune system), is most likely living an unhealthy lifestyle, and quite possibly has a condition that compromises the immune system. We know that surgery and anesthesia medications given to help the patient sleep can be hard on the body, and it can take weeks to months for the immune system to fully recover. Surgery also includes breaks in the skin and underlying tissues, which leaves the body vulnerable to the invasion of bacteria and germs . The patient is then admitted to the surgical unit for post-operative observation and to aid in recovery. This author believes that healthcare staff on the surgical unit should be held to a high standard in regards to hand hygiene, as their patients are extremely vulnerable to hospital-acquired infections.

Hand hygiene compliance may never reach 100% in the healthcare industry. To be realistic, it most likely will never occur. However, the current compliance rate is just unacceptable. While all units in the acute-care setting are prone to infection, the author believes that the surgical unit serves some of the most vulnerable patients in the hospital, for the reasons previously addressed. Physicians, nurses, nurse managers, and assistants must all get on board to fight in raising the standard. It’s life-saving!

References

1. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/
2. Chassin, M. R., Mayer, C., & Nether, K. (2015). Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance. Joint Commission Journal on Quality & Patient Safety, 41(1), 4–12. doi:10.1016/s1553-7250(15)41002-5.
3. Doronina, O., Jones, D., Martello, M., Biron, A., Lavoie-Tremblay, M. (2017). A systematic review on the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting. Sigma Global Nursing Excellence, 49, 143-152. doi:10.1111/jnu.12274
4. How surgery affects the immune system, (2014). Breastcancer.org, Retrieved from www.breastcancer.org/tips/immune/cancer/surgery
5. Joint Commission focus on hand washing puts pressure on facilities. (2018). Briefings on Hospital Safety, 26(4), 7–9. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128488040&site=ehost-live
6. Pronovost, P. (2015). Editorial: toward more reliable processes in health care. The Joint Commission Journal on Quality and Patient Safety, 41(1), 3. doi:10.1016/s1553-7250(15)41001-3