NEW YORK NURSE: October/November 2008
by Gale A. Spencer, RN, PhD, Distinguished Teaching Professor and Decker Chaire in Community Health Nursing, Decker School of Nursing, Binghamton University, and member of the Foundation Center for Nursing Research Planning Committee
Approximately 5% to 10% of patients admitted to acute care hospitals will acquire an infection that they did not have before entering the facility. These nosocomial infections increase patient morbidity and mortality, and lead to additional costs that would not be expected from the patient’s underlying condition alone.
In the United States, one in 136 hospitalized patients becomes seriously ill as a result of acquiring a nosocomial infection during their stay. This is equivalent to 2 million cases each year and results in approximately 80,000 deaths annually (World Health Organization, 2005).
Many of these infections result from poor hand hygiene among healthcare providers, even though evidence-based research on the need for hand washing has been available since the work of Holmes in 1843 and Semmelweis in 1846. Under routine hospital conditions, however, compliance with hand washing protocols is still unacceptably low.
A study, “Handwashing Compliance by Health Care Workers,” investigated the efficacy of an educational intervention and patient awareness program (Bischoff, Reynolds, Sessler, Edmond, & Wenzel, 2000). The researchers compared the acceptance of new and increasingly accessible alcohol-based, waterless hand disinfectant dispensers with the standard sink/soap combination. The study took place in a 728-bed, tertiary care teaching hospital on a medical intensive care unit (MICU) and a cardiac surgery intensive care unit (CSICU) over a period of six months. The intervention consisted of an education/feedback program for healthcare providers, as well as a patient awareness program. Following the educational intervention, an alcohol-based, waterless hand antiseptic agent dispenser system was implemented. At first, a single dispenser was made available per four beds. The ratio was then increased to one dispenser for each bed.
Prior to the intervention, baseline hand washing compliance before and after patient care was 10% and 22% for healthcare providers in the MICU and 3% and 13% for healthcare providers in the CSICU. Hand washing compliance changed very little after the education/feedback intervention program alone (in the MICU, it went from 14% to 25%; in the CSICU, rates went from 6% to 13%). However, observations after introduction of the waterless hand antiseptic revealed a statistically significant change in hand washing rates (p<.05). Compliance continued to improve as the dispensers were made more available (from 19% to 41% with one dispenser per four beds, and from 23% to 48% with one dispenser per each bed) (Bischoff et al., 2000).
The findings of the study indicate that the education/feedback intervention and patient awareness programs alone failed to improve hand washing compliance. Easy availability of dispensers with an alcohol-based, waterless antiseptic, however, led to significantly higher hand washing rates among healthcare workers.
This study clearly identifies the need for and effectiveness of a quick, simple alternative to regular hand washing in the clinical arena. It also supports the findings of the Centers for Disease Control and Prevention (CDC) publication “Guidelines for Hand Hygiene in Health-Care Settings,” which identifies the reasons staff members give for not washing up regularly: not enough time, lack of soap and paper towels, inconveniently located sinks, and patient needs that take priority over hand washing (CDC, 2002). The guidelines point out that not only do sanitizers do a better job of disinfecting hands than soap alone, their use also takes less time and dispensers are more accessible than sinks. According to the CDC, during an average eight-hour shift, a nurse spends 56 minutes washing with soap and water, while hand sanitizer use takes only 18 minutes per shift.
Carefully review the full text of the Bischoff study as well as the 2002 CDC document for the guidance they offer. Implementation of a cost-effective system to increase hand hygiene and assist in the prevention of nosocomial infections can save lives.
Bischoff, W. E., Reynolds, T. M., Sessler, C. N., Edmond, M. B., & Wenzel, R. P. (2000). Handwashing compliance by health care workers. Archives of Internal Medicine, 160, 1017-1021.
Centers for Disease Control and Prevention. (2002). Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002; 51 (No. RR-16): [inclusive page numbers].
World Health Organization. (2005). Guidelines on Hand Hygiene in Health Care (Advanced Draft): A Summary. Retrieved October 1, 2008, from www.who.int/patientsafety/events/05/HH_en.pdf