Hand hygiene policies

[R5RN, BSN, RN, EMT-P]

I've been working in an ED as a paramedic for about a year. Recently, our hand hygiene policy has gotten VERY intense. Because most of my experience is prehospital (though I graduate nursing school this May), I don't really know what the "norm" is for hand sanitizer/hand washing protocols in hospitals.

My coworkers are being reprimanded on a daily basis. The rule is you wash in and wash out, no excuses. Some examples of when people have been reprimanded were:

- A tech was carrying a used bed pan out of the room to the dirty utility. Our nurse manager stopped him and told him he needed to set the bed pan down (where I don't know), deglove, wash his hands, reglove, and pick it up again.

- A tech was restocking linen in an empty, cleaned room. She washed in and out of the room she was just in with a patient, but was reprimanded for not doing the same in the empty room.

- A nurse washed, stepped into a patient's doorway to answer a questions and as she was still rubbing the sanitizer into her hands, she stepped back out. She was reprimanded for not "washing out".

- A nurse washed out of a patients room and while still rubbing in the sanitizer entered another patient's room (touched and did nothing other than walk from one room to the one next to it) and was reprimanded for not "washing in".

On a daily basis we walk in with our hands full, no free hand at all to get hand sanitizer, and if we enter the patient's room, set our things down, and then use hand sanitizer BUT no one sees us, it's assumed we didn't wash in.

Everyone is exhausted and frustrated at this point. I feel like whoever is making the "wash in, wash out, no excuses" rule has no concept of how infections are actually transmitted. The last two cases I listed I think are prime examples of that.

Does this seem excessive? Or is it on par with where you work? What does your hospital do?

[lilnursey'15]

Foam in Foam out ALWAYS. That's the policy at my hospital.

I think even if nothing is touched this rule is still in place (for good reason) because "better safe than sorry"

:)

Sent from my iPhone using allnurses

[RNewbie]

My hospital has people who do hand washing audits. They lurk around with iPads collecting info on who washes in and out. The problem with this is they look to see if you are sanitizing in from the sanitizer in the quad/pod outside of the pt's room. Most staff don't use that sanitizer because we use the one right in the pt's doorway. The auditor can't always see this and we get dinged for it. Also, a lot of times when I'm in a room depending on what I'm doing I'll wash my hands with soap and water before leaving the room, not touching anything on the way out. Of course the auditor standing down the hall can't see that and I get dinged for not using the sanitizer outside of the room.

[dudette10, MSN, RN]

The examples you gave are ridiculous. This is why we are treated as know-nothings in some environments.

Out of curiosity, what bad thing happened that started all this?

[klone, MSN, RN]

I agree with Dudette. We are VERY militant about foam in/foam out, but the examples you gave are ridiculous. Especially the first one. WTH?

[Anonymous865]

I can make a good guess why the are doing this - If someone does something EVERY. SINGLE. TIME. it becomes such an ingrained habit that you will do it without even thinking about it. If you do something most times, but not if you didn't touch something, or you just sanitized when leaving the last room, it will never become a habit. Then there is a risk that you might forget when you should have sanitized. It removes the need to make a decision.

It's like when I learned to drive, I was required to put my seatbelt on before I even put the key in the ignition. Putting my seatbelt on became such a habit that I put it on even if I'm just moving the car from the driveway into the garage. It's such a habit that the seatbelt goes on then I put the key in the ignition.

Guards at secure sites are required to check your badge every time you enter the facility. It doesn't matter that the guard checked your badge, then you noticed you dropped something and stepped back into the lobby to pick it up. You will have to run your badge through the reader and hand it to the guard again even though he just checked it and you just took one step away from him to pick something up.

For things that are really important you don't want people thinking about whether they need to do it this time. You want it to be a habit that they do w/o thinking. You want people to feel uncomfortable if they don't do it.

[ThatBigGuy]

First, you need to define "reprimanded" for us. Is this reprimand a permanent write up in the worker's file? Or is it more like the manager is keeping an eagle eye out and verbally points out the failure to abide to the letter of the law?

If it's the former, than shame on your facility. If it's the latter, then suck it up, the manager is managing. We recently switched to bedside reporting at shift change. For a month, managers stood in the nurse station and verbally warned us when we were not in the room giving report. It was beyond annoying for the first two weeks, but by the end of the month, it was like getting report anywhere else but bedside was incredibly odd.

Your situation does bring forth the question as to what brought about this particular policy, and why is it enforced in such a stringent fashion.

[Guest03/15/15, BSN, RN]

My husband is a medic/ff I always harass him and ask if he washed his hands before pt contact, after contact, before and after any intervention, then upon ER arrival, before entering pt assigned room, and one more time before leaving. Haha he tells me I've lost my mind.