It’s Time to Tackle 3 Persistent Hand Hygiene Myths

By Madison Pittman

You know that hand hygiene decreases the risk of infection.

Your staff knows that as well.

And yet, if your facility is like most, your hand hygiene rates remain lower than you’d like.

As noted in a 2020 article in The Lancet Infectious Diseases, rates of hand hygiene performance have “remained stubbornly low” despite “huge efforts by local infection prevention and control teams.” Hand-hygiene performance averages 40-50%, and though the COVID-19 pandemic brought more hand hygiene awareness, performance rates quickly declined – in some cases, to lower-than-normal levels.

Reams of data underscoring the importance of hand hygiene and proving the efficacy of hand hygiene interventions and best practices haven’t significantly increased performance rates in most settings. If you want to improve hand hygiene performance rates — and, in turn, decrease healthcare associated infections — you’re going to have to tackle these 3 persistent myths:

Myth #1: Wearing gloves decreases the need for hand hygiene

Gloves are not a substitute for hand hygiene. In fact, they require staff to wash their hands more frequently, says Chris Hermann, MD, PhD, founder and CEO of Clean Hands – Safe Hands.

Gloves can certainly help prevent contamination; because they provide an additional barrier, gloves can prevent the transmission of germs from a caregiver’s hands to a patient wound (and vice versa) during dressing changes, for instance. But if the caregiver simply removes the gloves post-procedure and moves on to the next patient without sanitizing their hands in between, there’s an excellent chance that they’ll unwittingly act as a vehicle of transmission for an infectious agent.

According to a 2015 JAMA Internal Medicine article, nearly 53% of glove removals result in skin or clothing contamination. Other studies have shown that approximately 24% of personnel caring for patients with Clostridium difficile infection had spore contamination on their hands after glove removal. 

Hand hygiene is imperative before and after glove use, and you must share this fact with your staff – including non-clinical staff – often, in simple terms. Electronic hand hygiene systems that include verbal reminders have been shown to effectively increase hand hygiene rates.

Myth #2: Hand hygiene isn’t necessary if you just “pop” into a room

The World Health Organization (WHO) has outlined 5 essential moments for hand hygiene:

1.     Before touching a patient

2.     Before clean/aseptic procedure

3.     After body fluid exposure risk

4.     After touching a patient

5.     After touching patient surroundings

Reviewing those 5 moments, it’s easy to see why staff may think they don’t need to wash or sanitize their hands if they simply “pop” into a room to see how a patient is doing. Yet staff members often underestimate (or don’t realize) the amount of contact they have with patients and their surroundings during quick check-ins. 

A nurse who stops into a patient room to see if the patient needs any pain medication may find themself adjusting the patient’s bedspread or refilling their glass of water. These simple, everyday actions can facilitate the spread of germs, yet these common interactions don’t necessarily register as potential risks.

An article originally published in Infection Control and Hospital Epidemiology noted that busy nurses seemed to “act through a self-developed ‘hierarchy of risk’ to determine when hand washing was necessary,” and that this hierarchy is based on the risk of infection an individual nurse perceives to be associated with an activity. While these decisions are made with good intentions, the individual provider’s subject “hierarchy of risk” is not the best method to determine hand washing protocol.  

Johns Hopkins Hospital (and other hospitals) have successfully used visual cues, including red lines at the threshold of patient rooms, to remind staff to wash their hands each time they cross the threshold. Electronic hand hygiene monitoring systems do the same thing automatically.

Myth #3: We already have excellent hand hygiene!

It’s a universal truth: staff think they clean their hands more often than they do.

Clean Hands-Safe Hands data reveals that approximately 80% of healthcare providers estimate that their hand hygiene performance is between 80-100%. In reality, more than 70% of providers have a hand hygiene rate less than 50% without any feedback. Fewer than 1% of providers have hand hygiene rates that are near what they think they’re doing.

Certainly, most healthcare providers don’t intentionally skip hand hygiene. As a 2015 article published by PLoS One noted, “respondents might not realize how often they intended to but forgot to wash their hands … frequent task interruptions impede remembering and implementing intended behaviors.”

It is next to impossible to improve hand hygiene rates without first taking a long, hard, accurate look at current performance rates. Electronic hand hygiene systems collect and collate real-time data that you can use to encourage and mark hand hygiene improvements.

Which of these myths are impeding hand hygiene improvement efforts at your facility?

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