Hand Hygiene Saves Lives, But Is It Realistic For All Nurses?
Is proper hand hygiene possible in all healthcare settings? What about the countless nurses, nursing assistants, home health aides, and volunteers who work in long term care, private duty, home health, and community-based settings? Ensuring good hand hygiene for nurses and other healthcare workers who are employed outside the hospital is a complex problem with no easy resolution.
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As healthcare workers, we all know that proper hand hygiene saves lives because it greatly helps to prevent the spread of microbes that cause lethal diseases. Reputable entities such as the Centers for Disease Control and Prevention, the World Health Organization, and numerous other health-promoting groups all extol the benefits of good hand hygiene.
Is proper hand hygiene achievable in all healthcare settings?
I know that the knee-jerk reaction to this question from many people would be a resounding "Yes!"
However, I suspect that the vast majority of those who believe it is possible to maintain proper hand hygiene in all types of locales have never worked outside the acute care hospital. Proper hand hygiene is very much doable when a nurse is caring for five to seven patients on a medical/surgical floor, has alcohol foam pumps in every room, and abundant sinks throughout the hospital.
But what about the nurses who work in long term care, home health, private duty, or community health settings?
I worked in long term care (a.k.a. nursing homes) for more than six years. During the night shift at one particular facility, I routinely cared for 68 residents with the help of three nursing assistants. The infection control staff at most healthcare facilities recommend that workers perform hand hygiene before entering every single patient room and upon leaving each room.
Let's assume that I entered each resident's room twice during the course of a routine shift. This would amount to four occurrences of hand hygiene per resident. Four hand-washings or alcohol gel rubs multiplied by 68 residents would equal 272 instances of hand hygiene. In case you're wondering, this was not feasible during the course of one 8-hour shift due to time constraints combined with the skinned, painful hands that would have resulted.
Nurses who work in home health and private duty also face some of the same challenges, even if they only provide care to one patient at a time. Some patients cannot or will not keep hand soap and paper towels inside their homes. In these cases, it is up to the home health nurse to supply his or her own soap, towels, and hand sanitizer to maintain proper hand hygiene.
Once in a blue moon the home health nurse may encounter a patient in a rural area who has no running water. On occasion they might be assigned to a patient whose dwelling has no hot or warm water due to the natural gas or electricity having been disconnected. In these instances the nurse would need to use alcohol gel rub, hope for the best, and wait until they leave the house to perform a complete hand-washing at a venue with a public restroom such as a gas station or restaurant.
Achieving proper hand hygiene for nurses who work outside the traditional acute care hospital is a complex challenge with no simple solutions. However, healthcare workers who work in other settings can do the best they can with limited resources. Increased staffing and thorough education on infection control practices are helpful in long term care settings such as nursing homes and assisted living facilities.
Home health companies and private duty agencies may consider providing detailed infection control education and supply employees with kits that include anti-microbial soap, paper towels, and alcohol-based gel rub or foam.
Hand hygiene prevents illness, injury, and death. With appropriate education, adequate staffing, and abundant supplies, proper hand hygiene can become a reality in all types of healthcare settings. Hand washing protects us and our patients. Let's step up to the challenge.
