Are healthcare staff washing their hands?
October 1st 2007

Good hand hygiene has been heavily re-emphasised in recent years. So when SCA Tissue Europe's healthcare market manager Jenny Turner went to hospital as an emergency outpatient, did she discover if the message has been getting through?

Much has been written over the past few years about the importance of hand hygiene in healthcare environments.

Most are agreed on the vital role that handwashing plays in preventing the spread of hospital-acquired infections.

I was recently unlucky enough to witness first-hand the level of hand hygiene compliance in a hospital environment after fracturing my wrist in a horseriding accident. I was taken to A&E and treated by a series of medical personnel including nurses, doctors and a radiologist. In the course of my ongoing treatment I have also seen an orthopaedic specialist and a physiotherapist.

It was obviously a pressurised environment and everyone was attempting to provide the best possible care in the fastest possible time.Despite this fact I found the hygiene standards were often either overlooked or not sufficiently visible to me as the patient.

On arrival at A&E my right wrist was in pain and my actions clumsy when attempting to use my left hand, so the nurse assisted by administrating painkiller tablets directly into my mouth. Before doing so she put on gloves in preference to washing her hands, even commenting that this was for hygiene reasons.

However, gloves provide a warm, damp environment in which micro-organisms can breed. Furthermore, if they have any punctures or tears – and studies show that up to 80 per cent of gloves do so – these micro-organisms could then be transferred to the patient.

Therefore gloves should only be used on hands that have been thoroughly cleaned and dried first.

At one stage during my treatment, an orthopaedic consultant needed to examine my elbow to establish if there were any additional arm injuries.My elbow was badly cut and grazed and I was shocked to observe that the consultant failed to wash his hands before repeatedly touching the open grazes on my skin.

Later in the course of my treatment I was sent to the 'plaster room' where a fitted splint needed to be prepared for my arm post operation.

Here I noticed that the couch roll had not been changed since the previous occupant and was also covered in small pieces of plaster and plastic.As I needed to rest my wrist – which had an uncovered stitched wound – on the couch roll, I pointed this out to the technician and she willingly provided a fresh sheet.However, her oversight left me feeling uneasy about the hospital's hygiene standards in general.

In fact, the only member of staff who clearly demonstrated washing and drying her hands properly was a young physiotherapist who did explain that she was following the guidelines of the infection control manager.

Hygiene pressure groups are repeatedly calling for improved hand hygiene compliance in healthcare environments. They are also constantly urging patients to prompt the medical staff to wash their hands.

But the reality of the situation is that medical staff are often under constant pressure as they hurry from one emergency patient to the next. And the patients are usually frightened, unwell or in pain – or all three – which means they are in no frame of mind to confront the professionals about their hygiene standards.

We at SCA have been stressing the need for good hand hygiene practices for many years and have played our own part in helping to improve the situation.

Besides manufacturing user-friendly, soft hand towels that help improve hand hygiene practices,we also produce educational stickers and posters to help get the message across. In February we will be the main sponsors of the national Infection Control 08 event which aims to disseminate the hand hygiene message to an even wider healthcare audience.

But can the healthcare environment be changed to improve the situation even further? We believe that wash stations must be provided in every treatment room and cubicle so that handwashing between patients becomes a matter of routine.

Soft hand towels such as our Tork Premium Interfold or Tork Premium hand towel rolls should be provided to encourage frequent handwashing among staff. And handwashing posters or stickers such as our own should be prominently displayed in all treatment areas. Patients may not feel up to confronting their doctor or nurse, but a poster will hopefully jog the memory of the healthcare professional at the point of care.

My experience in A&E and subsequent treatment departments taught me that proper hand hygiene in a hospital has two important effects. The obvious one is that handwashing can reduce bacteria and lower the risks of catching a hospital-acquired infection. But the second effect is much more difficult to quantify.

I was surprised by the "feel good" factor generated by the actions of the young physiotherapist whose hand hygiene compliance greatly increased my confidence in her capabilities.

By washing and drying their hands properly in full view of the patient, medical staff are perceived to be much more professional and the level of care they provide is considered that much higher.

It is not clear whether medical staff are aware of the psychological effects that handwashing can have on their patients over and above the physical ones. But this is yet another powerful reason why healthcare professionals should take the time to wash and dry their hands thoroughly between patients. Every individual involved in my treatment was a highly skilled professional, but it is important that this professionalism is reflected in their every action.

And as the arguments for hand hygiene compliance mount up, there is even less excuse for medical staff to ignore them.

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