When Hand Hygiene Isn't Second Nature, the Machines Do the Work

A good portion of our publication deals with hand hygiene... how to do it, how to convince people to do it, and why it’s so critical. Yet this fundamental step in infection prevention seems to be ignored so often in hospitals, it’s epidemic. There are some marvelous new products, technologies and educational programs out there designed to boost hand hygiene compliance, so why are the average reported compliance numbers still hovering around 30 percent?

That’s not to say there aren’t numerous hospitals around the country making great strides to change that alarming statistic; in fact, I was delighted to learn about the great success that Maureen Spencer, RN, MEd, CIC, the infection control manager at New England Baptist Hospital has achieved in terms of boosting her facility’s handwashing compliance rates. Spencer was a presenter at this year’s annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC), discussing creative hand hygiene programs to motivate staff, patients and visitors. I was glad that Spencer addressed aspects of human behavior relevant to handwashing compliance, as we all know that social mores figure prominently into the equation. Spencer explained the general principles of the social learning theory, which holds that people can learn by observing the behavior of others and the outcomes of those behaviors; people can learn through observation alone, however, learning may or may not result in a behavioral change; and that cognition plays a role in learning, in that awareness and expectations of future reinforcements or punishments can have a major effect on the behaviors that people exhibit. Spencer pointed to the work of Dr. Albert Bandura of Stanford University, who first explained that people learn behaviors, emotional reactions and attitudes from role models whom they wish to emulate. Bandura notes, “Most human behavior is learned observationally through modeling from observing others one forms an idea of how new behaviors are performed, and on later occasions this coded information serves as a guide for action.” Essentially, it’s monkey-see, monkey-do, to borrow a phrase much less academic in nature but no less accurate in describing how humans mirror each other’s behavior.

Spencer reminded the audience of several key issues related to boosting hand hygiene compliance:

• Cultivate strong role models who can demonstrate model hand hygiene practices

• Identify champions throughout the hospital who can help you assist with hand hygiene compliance-enforcement efforts, such as a nurse manager or a physician

• “Call out” staff members when they do well or mess up — empower patients and staff to breaches in practice and non-compliance, supported by administration.

• Encourage staff to model good hand hygiene, engaging them in fun and educational activities (don’t forget the food and the freebies!), and rewarding them for good hand hygiene protocol

Spencer also recommended the added steps of creating an infection control liaison program (especially helpful in smaller hospitals with stretched manpower and resources); conducting regular hand hygiene campaigns in which staff can actively participate; conducting environmental rounds to ensure proper infection prevention strategies are being employed in all departments; and conducting direct observational studies.

When bribery through food, fairs and freebies isn’t enough to make hand hygiene second-nature, the industry serving infection prevention has created a number of innovative ways to facilitate handwashing and sanitizing, through touchless technology, automated handwashing machines, and even monitoring systems steeped in biometrics and RFID. In the August issue of ICT we explore this world of cross-contamination prevention (beginning on page 12); I hope you’ll take the journey with me.

Until next month, bust those bugs!

Kelly M. Pyrek

Editor in chief

kpyrek@vpico.com