Imagine you saw something disgusting on your hands, such as a bit of feces or blood. You would not hesitate for even a second. You would be at the sink, scrubbing away the yuckiness. It’s gross and seems dangerous – of course you’d want to wash it off immediately. But what if there is something invisible and dangerous on your hands? In healthcare facilities, such as hospitals, invisible germs lurk everywhere, and some can lead to life-threatening infections. Fortunately, regular handwashing in healthcare facilities, by medical staff and patients, can reduce the risk of infection. However, getting everyone to comply with handwashing recommendations is easier said than done.
Where do germs live?
Germs are everywhere! They lurk on hospital surfaces, including floors, bed rails, doorknobs, tray tables, TV remotes, faucets, privacy curtains, and more. Importantly, these germs can easily spread to and between patients.
Doctors, nurses, and other medical staff who don’t wash their hands between patients can easily transfer germs. And patients can get sick from contact with contaminated equipment or surfaces. For more information, read Germs in Hospitals and Doctor Offices – Watch Out!
How common and dangerous are germs in healthcare facilities?
Germs lead to infections. And when patients develop infections at hospitals and other healthcare facilities, the infections are designated as healthcare-acquired infections (HAI). Unfortunately, HAIs are associated with increased patient morbidity and mortality. According to the CDC (Centers for Disease Control and Prevention), in 2015, over 687,000 patients developed a healthcare-acquired infection in an acute care hospital, leading to 72,000 deaths.
Importantly, a lack of handwashing in healthcare plays a large role in the number of these potentially dangerous infections.
There is not enough handwashing in healthcare!
Before I launch into how poorly medical staff follow hand hygiene guidelines, I want to clarify that “handwashing” refers to either washing with soap and water, or using an alcohol-based gel.
Handwashing is a core component of any hospitals’ program to control infections. Researchers report there “is now undisputed evidence that strict adherence to hand hygiene reduces the risk of cross-transmission of infections.”
Simply put, to prevent the spread of germs, medical staff must practice proper hand hygiene, washing their hands before and after tending to patients.
However, as hard as it is to believe, most doctors and other medical providers do not regularly wash their hands.
A review of prior research found a median compliance rate of only 40% among medical staff. Interestingly, the researchers found that compliance rates were lower in intensive care units (30-40%), as compared to other settings (50-60%). Additionally, doctors were less likely to wash their hands (32%), as compared to nurses (48%).
Similarly, a 2014 study found that less than 1/3 of healthcare workers in an intensive care unit always washed their hands.
Unsurprisingly, research found that among hospital workers who interact with patients, handwashing rates decrease as the workday progresses.
Why aren’t medical professionals regularly washing their hands?
It’s likely due to a combination of factors, including forgetfulness, time-related pressures, exhaustion, skin irritations, and apathy.
Hospitals track handwashing habits of staff members.
In order to track compliance rates, many hospitals rely on trained human observers to watch over and track healthcare workers as they wash their hands. Of course, a major drawback from this method is the natural inclination to try harder when you’re being watched.
In the past 10-15 years, companies developed systems for electronic monitoring of handwashing, in which sensors track each employee’s handwashing. However, many hospitals have not adopted these programs because they are expensive, have accuracy issues, and unsurprisingly, staff don’t like being monitored electronically.
But, as with all high-tech products, the technology is improving, leading to improved accuracy and lower costs.
What steps do hospitals take to improve staff handwashing rates?
Hospitals and other healthcare facilities use a variety of approaches to improve handwashing rates among providers. Strategies may include the following steps:
- Increasing the availability of alcohol‐based hand hygiene products.
- Educating staff.
- Providing written and verbal reminders.
- Providing performance feedback.
- Showing administrative support of handwashing.
Interestingly, electronic monitoring might be just what hospitals, and patients, need. In one study, published in 2016, researchers found that electronic monitoring of handwashing led to a 25% improvement in handwashing compliance and a 43% reduction in MRSA infections (methicillin-resistant Staphylococcus aureus).
As the technology improves, perhaps more hospitals will use electronic monitoring and we will finally see higher compliance rates!
How can you improve handwashing in healthcare settings?
There are 2 important ways you can decrease the risk of infections transmitted by a lack of handwashing: ) remind medical providers to wash their hands and 2) wash your own hands.
Make sure your medical providers wash their hands.
Importantly, patients (and families) can significantly impact handwashing rates by simply asking medical staff to wash their hands. Research confirms what one would expect – medical staff handwashing rates increase significantly when patients ask them to wash their hands.
Interestingly, many hospitals now post signs encouraging patients to remind medical staff to wash their hands (and to wash their own hands too).
Unsurprisingly, not all doctors want to hear a reminder from patients. In one study, only 55% of doctors felt patients should remind providers to perform hand hygiene.
In my opinion, I think there is too much at stake here to ignore any situation where a medical provider does not wash his/her hands before touching a patient or medical instrumentation. Of course, I realize it can be intimidating to ask medical providers to wash their hands.
Personally, I have had a few awkward conversations around this topic.
In one case, the hand sanitizing gel dispenser was outside the exam room in an urgent care facility. When I asked the doctor to wash his hands before he examined by husband, he stated he just did so outside the room. I remarked that many sick patients touch the door handle every day. The doctor begrudgingly washed his hands in front of us.
But the doctor’s attitude, and the ridiculous location of the hand sanitizer, has led us to avoid this particular urgent care center.
However, even if you end up in an awkward or unpleasant situation, it’s worth asking medical personnel to wash their hands before they touch you or any medical instrumentation. It might just save your life!
Wash your own hands!
And of course, you should wash your own hands! Patients and visitors can reduce the risk of infection by washing their hands frequently in any healthcare setting, particularly in hospitals and other in-patient facilities. In fact, one study found that the rate of MRSA infections dropped 51% after a program encouraged patients and their families to clean their hands with an alcohol gel rinse twice a day.
Wash your hands properly!
For the best protection, the CDC recommends you wash your hands following these 5 steps recommended:
- Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
- Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
- Scrub your hands for at least 20 seconds.
- Rinse your hands well under clean, running water.
- Dry your hands using a clean towel or air dry them.
If you can’t use soap and water, use a hand sanitizer with at least 60% alcohol. However, it’s important to realize that alcohol-based hand sanitizers will not kill all germs, including C. diff.