Q&A: COVID-19 Elevates Importance of Hand Hygiene To a Whole New Level for Good

The lack of proper hand hygiene among healthcare workers has been a perennial problem. For decades, study after study found that healthcare workers do not practice proper hand hygiene. COVID-19 is almost certainly going to change that, says Deborah Chung, the healthcare marketing manager for Essity North America, a health and hygiene company. Recently Chung talked to Infection Control Today^®about how, even after COVID goes, hand hygiene will occupy a new place of importance in the minds of healthcare practitioners.

Infection Control Today^®:  Hand hygiene has been a problem for decades. People don’t practice it enough. Healthcare workers in study after study-they don’t practice it enough. Do you think COVID-19 is going to change how everybody regards hand hygiene?

Deborah Chung:  Absolutely. Even before COVID-19 there was a study done where eight out of 10 healthcare workers wanted to receive better hand hygiene training. And proper hand hygiene training is the number one way to reduce the spread of illnesses and viruses including COVID-19. And given these unprecedented times, it’s more important than ever to reinforce and control the spread of not only COVID-19, but on any other illnesses.

ICT^®: I looked at the guidelines set out by the World Health Organization about how proper hand hygiene should be done and wonder if that can be too cumbersome in a busy healthcare setting where patients need to be seen right away. 

Chung:  The World Health Organization’s recommendations for hand hygiene is before and after touching the patient, before and after cleaning a procedure, and after bodily fluid exposure. That performance of hand hygiene can incorporate sanitizing or hand washing. So, no and if that means protecting our patients more and reducing the pathogen transmission for up to 50%, I don’t think that 20 to 30 seconds is too much to ask.

ICT^®: And yet, at least until this point, it wasn’t done properly by enough healthcare workers. What do you think’s going on there?

Chung:  Even before COVID-19, proper hand hygiene compliance was very low. When we did a survey a couple of years ago, 40% of healthcare workers wanted better hand hygiene training because we all think we know how to perform it, but are we doing it accurately? No. With the 40% of healthcare workers wanting better hand hygiene training pre-COVID, I can only assume that’s been exponentially surged. There are virtual reality trainings that can help simulate different scenarios of hand hygiene compliance. You can put up signage. You can have optimal dispenser placement of sanitizers to reinforce hand hygiene. But I think right now, more than ever, the education of hand hygiene is very important.

ICT^®: And how you go about educating healthcare workers about hygiene?

Chung:  Virtual reality apps are readily available. They’re very effective in reinforcing the World Health Organization’s five moments of hand hygiene. Also, signage; increasing signage throughout a facility. Studies also show eight out of 10 patients indicate the presence of hand hygiene signage makes them feel more comfortable and safe about the facility’s cleanliness and quality of care. Having signage throughout your facility can reinforce visually to your healthcare workers as well as your patients the importance of hand hygiene.

ICT^®: Are you hopeful a hand hygiene will improve even after COVID-19 goes away?

Chung:  I do believe the world is never going to be the same, whether it’s a good or a bad thing. You know, I can’t predict the future. But even when COVID-19 was surging in North America, people were stocking up on sanitizers, bleach, alcohol. I think hand hygiene will never go away. I think moving forward, it’s going to be more implemented. I think the social distancing aspect and being hypersensitive to hand hygiene is the new norm. 

ICT^®: What role do you think infection preventionists at hospitals have in trying to improve hand hygiene in their particular facilities?

Chung:  I think they have a very important role. Their relationship with EVS technicians and the departments making sure that they have the right tools that they need to effectively keep patients and visitors safe and hygienic. Their role is to inform the team of what solutions best disinfect and surface cleaning; on how to surface clean. But they have a very important role as far as keeping our healthcare facilities hygienic.

ICT^®: Who has the hardest time in hospitals maintaining hand hygiene standards. Is it nurses? Doctors? Environmental services teams? 

Chung:  I haven’t seen any scientific research done around who has, I guess, the hardest time maintaining hand hygiene but it I think they all equally have an important role to play to reduce the spread of illnesses and hospital-acquired infections or healthcare-acquired infections. EVS being on the frontline of our health care workers, I think they do play a significant role and reducing the spread of illnesses as well.

ICT^®: How’d you get interested in hand hygiene?

Chung:  It’s perfect timing right now with COVID-19. But it’s something that we all think we know. We know how to do. We do it multiple times a day. There’s I think a study that said there are five billion hands that needs to be washed daily. But are we doing it efficiently and effectively? I can only assume that percentage is probably not well enough. My goal and mission is to make sure everyone knows how to properly wash their hands, to protect our loved ones and our friends and family. That’s the best way to promote that right now.

ICT^®: Do you see a new technology on the horizon that will help in ensuring that hand hygiene standards are maintained?

Chung:  There are some in the market today and I can only imagine it’s going to be more readily available in healthcare facilities. They have monitoring tools monitoring hand hygiene compliance. So, whether it’s a sanitizer with a monitoring tool to monitor when a healthcare worker goes inside a patient room that they are using the sanitizer dispenser. Whether it’s exiting the room, entering the room, the bathrooms: It’s a hand hygiene monitoring tool, which I think more facilities would implement moving forward.

ICT^®: It seems that when healthcare workers don and doff their personal protective equipment they’re encouraged to disinfect their hands every step of the way.

Chung:  Yes, it’s just like after touching every patient. You are sanitizing or washing your hands donning and doffing PPE as well.

ICT^®: Do you think there are enough sinks and sanitizing dispensers in hospitals now to help in hand hygiene?

Chung:  I think in healthcare facilities right now, that that’s a subjective question, depending on your rural or urban setting. I would have to do a little bit more research. But I think what we have now should be enough to get the job done.

ICT^®: Who sets the benchmark as far as hand hygiene is concerned? Johns Hopkins? The Cleveland Clinic? Anybody come to mind?

Chung:  We usually follow our collaboration with the World Health Organization, and they set the guidelines for the five moments of hand hygiene. And that is before and after touching the patient before, and after bodily fluids, and before and after an aseptic procedure.

ICT^®: Any advice for infection preventionists about how to better spread the gospel of hand hygiene among their fellow healthcare workers?

Chung:  I think just repetitive education and training. Leading with doing. When you are performing hand hygiene in front of your colleagues or coworkers, friends and families, I think that's the best way to set an example. 

ICT^®: Do you think there will be new standards created about hand hygiene as a result of COVID-19?

Chung:  The 22 seconds of hand hygiene or hand washing and hand sanitizing that has shown effective of killing 99% of the germs and illnesses from studies done. I don’t know what type of conversations they’re having at a higher level, but I think that is very sufficient for now.

This interview has been edited for length and clarity.