Hospital hand hygiene: Where are we at?

Recent news articles show that hospitals in the UK are still failing to reach the ‘Gold Standard’ for reducing infections associated with health care. In one hospital it was found that, out of 60 opportunities doctors had to wash their hands before or after treating patients, only 28 were taken. The medical council are investigating what action can be taken against medical staff for failure to wash their hands after investigations found that a culture of hand hygiene is not thoroughly embedded in some hospitals across the UK.

Patient power

The World Health Organisation has set up a global hand hygiene campaign aimed at encouraging hand compliance, including the more frequent use of alcohol-based hand sanitisers. While some hospitals have even assigned unidentified workers to monitor staff hygiene, others are encouraging patients to be more assertive in raising the question of hand washing with doctors and nurses, by issuing posters, bedside placards and buttons for staff that say, "Ask me if I've washed my hands". 

The Centre for Disease Control (CDC) in America has even provided 16,000 copies of a video called ‘Hand Hygiene Saves Lives’ encouraging patients to question whether staff have washed their hands. A CDC  poster aims to raise patient awareness of the role of hand washing in preventing infection and encourages patients to speak up to hospital staff each time they enter the room.

New technology

In America, electric sensors, thermal imaging and video cameras have been set up to monitor hygiene in some hospitals. The sensor system works by providing a sensor above the patient doorway that tracks entry/exits as hand hygiene "opportunities", while the SMARTLINK Technology in the soap/sanitizer dispensers calculate the hand hygiene "events".  

With Government funding and the support of the SBRI (Small Business Research Unit), scientists are working on the development of a Non Thermal Plasma Hand Sterilisation Unit in which hands are inserted into a machine similar to a hand dryer, and a line of plasma scans across hands to ensure total coverage. 

Being trialled in Dr Grey’s hospital in Elgin Scotland and, developed in conjunction with the NHS Grampian Infection Prevention and Control Team, is a Pure Hold Hygiene Handle that automatically dispenses sanitizing gel ensuring that every person who opens the door cleans their hands. 

Another idea being used is the issue of badges that wirelessly record staffs' use of hand hygiene stations. Staff at SSM St. Mary’s have been monitoring an electronic device which clips onto employee badges and is picked up by an infrared sensor inside and outside the patients room, changing different colours when alcohol rub is used. Some monitoring systems even encourage patient engagement by sounding an electronic alert to remind patients to speak up when staff enter a room. 

NICE Quality Standard

Measures to reduce infection  have been recently been reviewed and highlighted by The National Institute for Health and Care Excellence (NICE) in a Quality Standard on ‘Infection Prevention and Control’. The standard lays out six specific statements for NHS staff on preventing and controlling infections. As well as focusing on hand washing opportunities and procedures, the six statements include:-  the monitoring of the issue of antibiotics in order to reduce antibiotic resistance, NHS organisations sharing information and monitoring infection rates, and the need to follow rigorous sterile procedures for patients who have a urinary catheter, a vascular access device or an enteral feeding tube (including providing detailed information for carers).

For those of us then that might still ask the question, "What is being done to lower the spread of infection in hospitals?", the answer has to be that a variety of different innovations and initiatives are being trialled, both across the UK and worldwide. Some may prove to be more successful than others, and hospital trusts can and should liaise with each other to discuss monitoring the effectiveness of these ideas.  

Hospital and health care staff, patients and visitors all have their part to play in promoting good hygiene practice and developing a culture where we are not afraid to   continually ask the question, "Have you washed your hands?"