From the Babylonians soaking in baths and Hindu use of ashes and water to Semmelweis with lime and soda, until the present-day CDC and WHO campaigns and National patient Safety goals by The Joint Commission (TJC). In a December 20, 2017 publication, The Joint Commission announced effective 1 January 2018, would cite individual observations of noncompliance with hand hygiene under IC.02.01.01 EP2. Why? Organizations have had ample time to educate and develop programs. Now, TJC will issue requirements for improvement because “(w)hile there are various causes for HAI, The Joint Commission has determined that failure to perform hand hygiene associated with direct care of patients should no longer be one of them.”
Organizations should be continually striving to improve their compliance rates, but we must tackle various entry points to enhance compliance with hand hygiene. Infection control plans must assess the hospital environment as well as the community. When speaking with staff, if they can articulate the methods of hand hygiene and the touchpoints of hand hygiene, it is not the education piece that needs to be enforced, it is the behavior of performing the action that is missed.
What do you do if you are not educating? Empower patients and workers to ask about hand hygiene and engage “offenders” about a missed hand hygiene opportunity. Instruct patients upon admission that they should expect to see healthcare workers engage in hand hygiene frequently. Empower staff to stop colleagues and surgeons when an alcohol-based surgical antiseptic is not used correctly. Often, you may find that sometimes, a person may have simply forgotten, been focused on something else, or just did not know the process. Engagement in communication will help to keep the importance of hand hygiene on the forefront of everyone as the most important step.
Involve the community by teaching or providing information about hand hygiene at your local schools or faith organizations. Perhaps, if healthcare workers engage at a primary level, we can instill the habit and just reinforce when the patient is seen in a weakened state.
Lastly, we must each be accountable for our own personal knowledge and actions. Look at and review policies to make sure up-to-date information is provided and to ensure that you are not holding on to sacred cows that decrease compliance. For instance, it is no longer a requirement to do a three- or five-minute hand scrub before use of an alcohol-based hand antiseptic for surgical procedures (first hand hygiene then the alcohol-based product). Also, the bristle portion of a scrub brush are not recommended to be utilized on arms (can cause irritation/disruption).
Take a look around your organization and begin to empower and engage. You’ve already educated!
Behavior Modification is Key to Boosting Hand Hygiene Compliance, Avoiding Survey Deficiencies