Need handwashing help !!

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Specializes in ER/trauma center.

Help! We are a busy trauma/ER and have had horrendous compliance with handwashing before and after seeing patients by all staff, from MDs to aides. We have many different types of staff who audit us (secretly or not) and it is now almost a year and we are always the lowest unit in the hospital (avg. 20-30% compliance!) We've had people argue the problems w. the audits and the barriers to washing (phys. set up) but I think its more a habit/culture change issue. I always wash so it can be done. Patients are now on the lookout for this and stats are going to be published. We are immed informing staff who do not wash, sending them an email stating they did not wash, trying to encourage/remind everyone out loud to do it, thank those who do,etc. :confused:

We have put the 'foams' mounted outside each room, etc. We now have a doc who wants to mount a can of foam on the foot of each stretcher ! I think we should just hang them from each doorway so the can hits you on the head on the way in...but I still can't make you rub your hands together. Another doc joked to attach them to each wrist so you can squirt it out like Spidey...

Has anyone had any successful ideas for reinforcing the culture change? We are at our wits end. :banghead:

Thanks-love you guys -and Happy Almost Emergency Nurses Week !! :yeah:

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Specializes in cardiac/critical care/ informatics.

Maybe try doing the black light thing so nurses/doctors that aren't washing their hands can see what is on thier hands. Discipline may be an option if it is blantantly not following handwashing. Other than that it sounds like you are doing things right. probably and handwashing committe or taskforce is needed :}

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Specializes in Emergency.

Define washing hands, do you include use of waterless products? Maybe its the product. Has anyone done a survey of staff or is that just the product that has always been used? There in may be the problem. I have worked at several facilities and I can tell you those canned foams are probably the worst as far as drying on ones hands, I personally prefer the gelled products if given a choice.

Currently where I am at the gel is at the door of every room as you leave the room so one can use it on entering or exiting. We started to audit quarterly, staff know the month, know its someone from the department or they know but not who. We had a significant jump last quarter as we too were not doing to well.

For what its worth our docs are testing a device that looks like a pager that dispenses spray sanitizer. Uses replaceable cartridges. Our medical director likes it with one note, need to wear it at the waist not clip up high as it will make you cough if inhaled.

Rj

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Personally.... I had to make friends with the hand gel. I fought it for a long time b/c I hate the way it makes my hands feel. Despite good intentions I really was only about 50% compliant with washing. Now that I'm using the hand gel I am near 100%.

Often times I grab my goo in one room and finish rubbing as I'm entering the next. Both patients/family get the benefit of seeing their nurse doing hand hygiene and it doesn't take much time, the way handwashing does.

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Specializes in ED, ICU, PACU.

Coming from someone who has had to deal with patient ratios beyond belief: Do you provide a reasonable nurse to patient ratio and space out patients in a way that would give your nurses adequate time to wash their hands?

Although, I am meticulous about handwashing, I have found that the logistics of sinks and foam, together with the frantic pace of having to be in more than two places at one time, makes it impossible to both wash hands as you describe you wish to have done & attend to patients as expected. There has to be some give somewhere to give the nurses adequate TIME to maintain proper hand hygeine.

Now, of course, all bets are off when someone is crashing. Dead people don't have to worry about cross transmission of infection.

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Specializes in Family Practice.

I also have made friends with the handgel- I keep a travel size container in my pocket. But someone (forget who) told me gels are not as good as scrubbing with soap & water.

Any body heard of the effectiveness of waterless gels? I figure they are better then nothing.

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Specializes in ED, ICU, PACU.
I also have made friends with the handgel- I keep a travel size container in my pocket. But someone (forget who) told me gels are not as good as scrubbing with soap & water.

Any body heard of the effectiveness of waterless gels? I figure they are better then nothing.

They are totally ineffective with C-Diff and can only be used a few times before you have to wash the layers of residue off.

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They are totally ineffective with C-Diff and can only be used a few times before you have to wash the layers of residue off.

Quite true. I didn't mean to give the impression that the gel is all I use. I still probably wash my hands about 70 times a day, but that is much less than I previously did, yet my compliance is much higher due to the gel.

I still hate the feel of the gel and washing off the multiple layers. I just don't know a better way.

I've wished for a long time that someone would come up with some sort of ultraviolet light that killed microbs, yet was safe for our skin. That way we could just swip our hands under the light as we entered and left each room!

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Specializes in ED, ICU, PACU.
Quite true. I didn't mean to give the impression that the gel is all I use. I still probably wash my hands about 70 times a day, but that is much less than I previously did, yet my compliance is much higher due to the gel.

I still hate the feel of the gel and washing off the multiple layers. I just don't know a better way.

I've wished for a long time that someone would come up with some sort of ultraviolet light that killed microbs, yet was safe for our skin. That way we could just swip our hands under the light as we entered and left each room!

Oh no, you didn't give that impression at all.

Love that idea of yours about the UV.

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I think we should just hang them from each doorway so the can hits you on the head on the way in.

A great idea! *joking* :wink2: So far I have never seen 100% compliance except with rumor/truth of a serious virus/condition going around, I wish you luck!

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Specializes in ER/trauma center.

Has anyone else tackled this issue with any cute/clever/annoying or whatever tricks to help change the habits/culture?????

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I think you can achieve results with honey not vinegar. I think the black light idea is great....make it a group contest with random testing. You could split it up by shifts, or teams, or positions...but tell them you will have random daily (or weekly) checks....drawn from a hat or something....whatever team wins over the month wins the right to brag or breakfast, or trophy.....something. Everyone loves a great competition and it motivates everyone because they don't want to be the reason their team loses.

just an idea

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