Hand Hygiene Saves Lives, But Is It Realistic For All Nurses?

[TheCommuter]

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.

[multi10]

My hands look much older than my face because of years of being a nurse and washing my hands before and after each patient.

[multi10]

I just returned from my first cruise. There were folks outside each restaurant offering hand sanitizer. Question: Does hand sanitizer make one more vulnerable to disease in the long run? Does it set you up to make you more susceptible to resistant bacteria?

[Barley]

it is statistically easier on your hands, as well.

("it" being foam/alcohol)

I'd be interested in a link to studies to support this idea that alcohol is statistically easier on the hands. When I went to my employee health center for red, dry cracked hands, they told me to avoid the alcohol based products and opt for soap and water (which, incidentally, is difficult at our facility since the only employee sinks are far down the hall from most of the patient rooms).

Now I do a mix of both - soap and water when I'm not far from the sink or have time to walk to the sink, and alcohol gel or foam when I'm in a rush. My hands seem to do better when I can avoid the alcohol more.

[Barley]

The original post makes me wonder about more than hand hygiene - if someone has to make two visits to 68 residents in 8 hrs, that's an average of 3.5minutes per visit - what does one reasonably expect to get accomplished in 3.5minutes? And that's assuming there are Zero activities besides these visits during the 8hr period. Sounds like unsafe conditions and ineffective care would be the norm at such a facility, regardless of whether HH were done.

[BrandonLPN, LPN]

The original post makes me wonder about more than hand hygiene - if someone has to make two visits to 68 residents in 8 hrs, that's an average of 3.5minutes per visit - what does one reasonably expect to get accomplished in 3.5minutes? And that's assuming there are Zero

activities besides these visits during the 8hr period. Sounds like unsafe conditions and ineffective care would be the norm at such a facility, regardless of whether HH were done.

I'm guessing you never worked in LTC. In a nursing home, most of the residents are relatively stable. All some residents might need from a licensed nurse in any given shift are some meds and a eyeballed once-over-lightly visual assessment. On third shift (the shift where you'd have 68 residents) you should really just let them sleep unless absolutely necessary. To do an actual full blown nursing assessment on every resident every shift is not only unnecessary, it would be a violation of the resident's right to peace and privacy.

[BostonTerrierLover, BSN, RN]

Powdered gloves? I had no idea they still made those! How horrible!

If you saw our 1943 Infant Incubator, that should be in a museum, you would understand:(

[Sadala, ADN, RN]

I'm a student so perhaps unqualified to respond. But... seriously? I know the logistics of an in and out complete sink wash may not work in some roles (myriad patients, unsanitary community health conditions), but what is the difficulty of carrying around a small bottle of hand sanitizer in one's pocket? And then doing the complete wash when necessary for patients with c diff, etc? I'm practically compulsive about using sanitizer at this point. They could do one of those reality shows about me because I find myself constantly pulling the bottle out and using it, even between between patients. Hey, I've got a low wbc count. So I figure if I'm concerned for my own safety, shouldn't I be equally or doubly concerned for the next patient who may even be more immune compromised? And what about my family? Don't want to bring anything home to them. They aren't all in the greatest of health. I strip at the door and launder as it is.

I think in one country (Sweden maybe?) they don't even let you bring your scrubs home. The hospital launders your gear and you change AT work. And... they have lower infection rates.

I have always either worked with the public (i.e. with people in compromised situations) or in food processing (commercial), so... I guess I've always been hypersensitive about the hand hygiene.

[brandy1017, ASN, RN]

I'm sick to death of all the hand washing slogans. That is not the problem you wash your hands but there are germs everywhere in the hospitals. If the hospitals wanted to lower infections they would have dedicated equipment vitals, computer for every patient and cleaning would include using a UV radiation device that cleans a room between patients.

We can wash our hands till their raw but if the cleaning of the hospital surfaces and equipment isn't meticulous it makes no difference! Cleaning is not what it used to be at least where I work! Cutbacks on housekeepers, rushing, cheaper products washing my hands isn't going to fix that or sharing equipment from room to room because the hospital is too cheap to provide dedicated equipment for each patient!

[MedChica]

If I'm playing mednurse for the day then hand sanitizer/wipes are the only way to perform hand hygiene between EVERY single pt.I

have to put my meds away... clear my cart... locate a bathroom because the one closest to the dining hall (employee bath) is broken, etc....

I don't have time for that.

We have sanitizer dispensers installed...and 1/2 are usually empty because house-keeping is lazy about filling them.

I have to pull meds as quickly as possible:

- I usually have between 40-42 residents to administer meds to.

- SEVERAL people (para schizo, manic) must have their medication added to their food or they won't take them and they'll start getting out of hand...before you know it, they're raging and we're having to send them out to bring them down. I have one little lady who just got back. They readjusted her meds. DC'd one and put her on a benzo (can't recall the name). It's working. She's calm. Talkative, even. Still very delusional but more...'normal'. You can almost see the REAL her peeking through sometimes. Almost.

We need to keep her that way. She canNOT afford to be allowed to skip meds. I try my d*mndest to beat the food trays to her in order to keep that woman regulated. Etc....

- I need to get the meds out 'on time'. I need to pass the meds at the times when the residents are most likely to congregate in one spot.

I'd like to mention that I don't touch the meds. Since I cut corners on the hand hygiene...I try to, at least, not handle the pills with my hands.

Other than that - if I'm just a regular nurse for the day? Yes - I wash hands between each and every pt. Its not like I'm doing in-depth assessments on all 40+ pt's. Pass a few meds. A treatment here. Some woundcare there. A little suctioning as needed.

The time crunch comes with the paperwork/charting, mostly.

I hate charting.

[BostonTerrierLover, BSN, RN]

Yay! We got tablet and keyboard covers today!!! We just might catch up with the 20th century soon!:)

[wooh, BSN, RN]

I'm sick to death of all the hand washing slogans. That is not the problem you wash your hands but there are germs everywhere in the hospitals.

Our hospital fixed that. Now the nurses have to clean all the high-touch areas. Because well, housekeeping cleaning the high-touch areas would be crazy...

[hippey12]

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.

I have to say I work for a wonderful Homecare agency. They provide us with liquid hand soap, alcohol based hand sanitizer, hand lotion and paper towels. When we run out we just go to the office and get more. I work in an urban area and some places you don't even want to stand in let alone find somewhere to wash your hands. It really is tough out there and more agencies need to do what mine does.