By Jennifer L.W. Fink, RN, BSN
“This? This is a thing for nurses?”
TikTokker @TheNurseErica steps aside, revealing an electronic hand hygiene system. Her skepticism and sarcasm are clearly on display. And you know what? I don’t blame her.
Long-time nurses have seen hospital initiatives come and go, and frankly, many of these initiatives (well-intentioned as they may be) add to nurses’ workloads. Nurses are sick and tired of being asked to do more, and they’re really sick of people who don’t respect their professional expertise.
The last thing nurses need, as NurseErica points out, is another device beeping at them.
I get it. Alarm fatigue is real. It’s been more than a decade since I worked my last hospital shift as a nurse and I still sometimes dream that it’s nearly lunch, I haven’t yet passed all my morning meds, haven’t even assessed one of my patients, and alarms are going off everywhere.
Nurses don’t need another device beeping at them, and they definitely do not need a new system that makes their lives more difficult. Nurses want to be trusted to do what’s best for their patients. They don’t want to risk their emotional or physical well-being in the process.
It is true that some electronic hand hygiene systems audibly (and annoyingly) alarm. Some also interrupt nurses’ workflow. But it’s not fair to imply that the purpose of such systems is to “babysit and police” nurses. The intent is to decrease healthcare associated infections (HAIs), and research shows that use of an electronic hand hygiene system can decrease HAIs by more than 60%.
NurseErica and most of the other nearly 4000 people who commented on her video clearly care deeply about the well-being of nurses and patients. Let’s take a closer look at some of their concerns regarding electronic hand hygiene systems:
Alarm fatigue is all too real for nurses. A 2021 systematic review that examined the effect of alarm fatigue on the work of nurses in intensive care environments found that ICU “nurses think that alarms are burdensome and too frequent, interfering with caring for patients …They feel overburdened with an excessive amount of duties and a continuous wave of alarms.” The authors of the review recommend introducing strategies for alarm management.
The best alarm fatigue management strategy, in my opinion, is to avoid adding additional alarms. Hospitals would do well to steer clear of electronic hand hygiene systems that buzz, beep, or use flashing lights to remind staff to perform hand hygiene. The Clean Hands-Safe Hands system uses a Natural Language Voice Reminder that can be customized to staff needs. Researchers have consistently found that humans respond more quickly to human voices than electronic alarms.
No one wants nurses, doctors, respiratory therapists or other critical personnel to hesitate at the door of a patient’s room for even a few seconds if the patient’s life is on the line. In case of emergency, immediate medical attention takes precedence over hand sanitation. Clinicians should not be “dinged” for failing to sanitize their hands if they were rushing to perform chest compressions.
Some electronic hand hygiene sensors can automatically sense and adjust to the chaos of an emergency situation. “If there’s a code and people are running in and out of the room, our sensors detect that, turn the voice off, and suppresses data recording and reminders until things slow back down,” Dr. Chris Hermann, CEO of Clean Hand-Safe Hands, told me. “The system does the same thing upon admissions and discharge.”
Charge nurses can also adjust the responsiveness of the system using Adaptive Room Modes to allow staff more time to perform hand hygiene before entering isolation rooms, for instance. The system can even be set to silent, if needed – say, if the room is inhabited by a patient who’s been experiencing hallucinations.
Nurses have no patience for anything that disrupts their workflow. In fact, most nurses want hospital administrators to get out of their way and allow them to figure out the best way to manage their work. (Well, that, and extra staffing. A whole lot of people who responded to NurseErica’s video said things like, “literally will do ANYTHING but staff properly….” And “I wish they had the same level of concern over safe staffing.”)
Nursing staff are unlikely to accept an electronic hand hygiene system that requires them to pause even a few seconds to “get credit” for hand hygiene. They simply don’t have time to spend a few seconds (per patient encounter) holding their hands near a sensor. They’d (appropriately!) rather devote that time to direct patient care.
If you’re thinking about installing an electronic hand hygiene system, look for one that facilitates clinical workflow. Involve nurses in the selection process; they are your front-line personnel and can quickly spot the pros and cons of various systems. Do not spring a new hand hygiene initiative on already overburdened staff.
Nurses want to work in safe hospitals with colleagues that clearly care about patients and staff. They don’t need (or want) somebody micromanaging their daily work. Respect them. Listen to them. And address their concerns.