Hand Hygiene Ambassadors Welcomed With Open Arms

When investigators with the University of Miami Miller School of Medicine wanted to find out how well “hand hygiene ambassadors” (HHAs) would be received in healthcare settings, they got an unequivocal response. Not one person refused when HHAs stationed in various healthcare settings approached patients, staff, and visitors with alcohol-based handrub (ABHR) and offered to apply it to their hands. 

Further, “When asked whether they think it is a good idea to have an HHA place ABHR on an entrant’s hands, the majority of staff, visitors, and patients agreed,” states the study in theAmerican Journal of Infection Control. 

The use of HHAs has been shown to greatly increase the use of ABHR among patients, but this study probed just how visitors and staff would react as well. 

Investigators looked at 225 encounters with HHAs at 5 lobbies in public and private hospitals, a surgical center, a cancer hospital, and a specialty hospital. The facilities are affiliated with a medical center. 

Lobbies were chosen because everybody passes through them: medical professionals and other hospital staff, patients, and visitors. The HHAs were stationed in the lobbies between 9 am and noon on random days over a 6-month period. The people were asked whether the HHAs could apply ABHR to their hands. 

The HHAs then asked several questions about hand hygiene. When asked whether they liked the idea of an HHA applying ABHR, the majority of staff (85.6%), visitors (93.8%), and patients (80.4%) said yes. At the cancer center, 98% total said they liked the idea, a result that did not surprise the investigators because people there likely have a heightened appreciation of the increased risks of infection in immunocompromised patients. 

There was a statistically significant difference in the sexes regarding HHAs: 91.3% of men liked the idea as opposed to 81% of women. 

“In addition to the direct benefit of placing ABHR on entry to the hospital, the implementation of an HHA may also increase awareness and motivate subsequent hand hygiene in other hospital locations,” the study states. 

There were limitations: There may have been reluctance on the part of participants to say no and to say that they don’t like the idea of HHAs. The study was limited to hospital entrance lobbies. And, as already pointed out, ABHR was “only applied with consent of the entrant. There was no evaluation of those who refused ABHR, as no one did.”

Other interventions to improve hand hygiene in the past have included education, reminder signs and cues, performance feedback and automated systems, facility design, surveillance and video monitoring, portable, mounted, and wearable alcohol-based handrub, and multimodal strategies.

“Nonetheless, a sustained impact on hand hygiene rates varies considerably, and the problem of suboptimal [hand hygiene] continues,” the study states. 

With the growing threat posed by antibiotic-resistant pathogens and the intractable problem of hand hygiene, some hospitals may want to consider innovative approaches such HHAs.   

“Although the cost of such an initiative should be considered prior to implementation, it should be weighed against the annual spending of almost $10 billion in the United States for healthcare-associated infections,” the study stated. “Based on the results of this study, a more targeted approach directed to health care providers in specific clinical areas may be appropriate, and educational programs using HHAs can be tailored to specific areas such as medical and surgical floors and the intensive care unit.”