Fran Lowry

July 02, 2015

Intervening immediately after a lapse in hand-hygiene practice is an effective way to correct bad habits and can help achieve greater compliance with best practices, according to results from a new study.

"Hand hygiene is the single most important and easiest thing we can do to reduce healthcare-associated infections," said Jorge Parada, MD, from the Stritch School of Medicine at Loyola University Chicago.

However, "compliance with hand hygiene practices is commonly suboptimal, with rates from 30% to 60%," he told Medscape Medical News.

The achievement good hand hygiene is problematic for many reasons. "Quite simply, I believe that very often healthcare workers underestimate the impact and importance of hand hygiene," Dr Parada said. "Despite over a century of evidence showing the effectiveness of hand hygiene, many healthcare workers don't really get it."

"Many believe they do not need to do hand hygiene if they have no intention of examining the patient, forgetting that they are touching bed rails and so on and contaminating the environment, as well as themselves," Dr Parada explained. "Or they believe that the use of gloves supersedes the need for hand hygiene."

To improve the hand hygiene of hospital personnel, his team implemented a program called Just-in-Time Coaching.

Just In Time

Dr Parada presented the study results at the Association for Professionals in Infection Control and Epidemiology (APIC) 2015 Annual Meeting in Nashville, Tennessee.

Over a 3-month period, the researchers clandestinely observed nearly 6000 hand washings at their hospital. If a person did not comply with best hand-hygiene practices, he or she was asked in an open-ended nonconfrontational manner why they did not clean their hands.

Common responses from noncompliant personnel were that they forgot, the alcohol gel dispenser broke, their hands were full, and they had gloves on, Dr Parada reported.

After that discussion, the Just-in-Time Coaching crew reviewed best hand-hygiene practices with the offenders.

There was a significant improvement in hand-hygiene compliance after the coaching program was implemented. With oversight, the hand-hygiene rate rose from 26% to 78% (P < .001).

The intervention effectively improved compliance and gave us a "better understanding of barriers to best practices," Dr Parada explained.

"For example, some coaches found that many staff believed that hand hygiene was not required if they were entering a room but not planning to have direct patient contact. Others believed that gloves were an acceptable replacement for hand hygiene," he said.

This shows the importance of feedback to healthcare workers to improve infection prevention practices.

"Our aim is to leverage our results and permanently change the culture at Loyola," Dr Parada said. "We need to work at making these best practices our new default behaviors." The aim is to achieve hand-hygiene compliance rates of more than 90%.

"I hope our example will help inspire other organizations to launch hand-hygiene improvement programs. If they do, then what really matters might occur — we will help keep our patients and ourselves safer and healthier by avoiding healthcare-associated infections," he said.

"Dr Parada researched the impact of immediate intervention on hand-hygiene compliance and had statistically significant improvement," said Laura Buford, RN, from St. David's Medical Center in Austin, Texas, who is the APIC communications committee chair.

"This shows the importance of feedback to healthcare workers to improve infection prevention practices," Buford told Medscape Medical News. "Hand hygiene is the most important way to prevent the spread of infection and, at times, reminders to do it are needed."

Dr Parada and Ms Buford have disclosed no relevant financial relationships.

Association for Professionals in Infection Control and Epidemiology (APIC) 2015 Annual Meeting: Abstract 81062 Presented June 26, 2015.


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