Q&A: Hand Hygiene
Surgical Products talks with Joan Blanchard of AORN about the importance of hand hygiene and a new initiative to engage and recognize nurses around the country for exemplary hand hygiene compliance.
To raise awareness of the deadly risks associated with poor hand hygiene and encourage best practices among nurses and other healthcare professionals, the Association of periOperative Registered Nurses (AORN) and 3M Infection Prevention have joined in an initiative to reduce the risk of healthcare-associated infections (HAIs) in the surgical setting. According to the Centers for Disease Control and Prevention, HAIs account for nearly 100,000 deaths each year, nearly six percent of the total HAIs reported annually.
The “It’s In Your Hands” campaign spotlights AORN’s recently updated “Recommended Practices for Hand Hygiene in the Perioperative Setting,” and through new and creative programs will engage and recognize nurses from around the country for exemplary hand hygiene compliance. The campaign will include a YouTube video contest in which nurses will demonstrate the updated hand hygiene protocols through short videos, as well as a recognition program for those who have gone above and beyond to lead their organizations in reducing HAIs through good hand hygiene practices.
Surgical Products caught up with Joan Blanchard, RN, BSN, MSS, CNOR, CIC
Perioperative Nurse Specialist, Association for periOperative Registered Nurses (AORN), to discuss the importance of hand hygiene, what nurses and surgical professionals can do to improve hand hygiene in their facility, and to tell us about the “It’s In Your Hands” initiative.
Surgical Products: Can you please discuss the steps a healthcare professional should go through when practicing proper hand hygiene?
Blanchard: More than any other intervention to prevent and control healthcare-acquired infections (HAIs), hand hygiene remains the most effective and least costly. Hand hygiene helps remove soil, debris and microorganisms from hands and forearms, keeping patients and other healthcare providers safe from bacteria that could lead to infection.
Recently, the Association for periOperative Registered Nurses (AORN) issued its Recommended Practices for Hand Hygiene in the Perioperative Setting,” which define procedures, protocols and evaluation methods for hand hygiene for the perioperative setting, which includes traditional operating rooms, ambulatory surgery centers, physician’s offices, cardiac catheterization laboratories, endoscopy suites, radiology departments and all other areas where surgery and other invasive procedures may be performed
Appropriate hand hygiene protocols begin from the minute a healthcare provider enters the healthcare facility’s perioperative setting to the minute they leave, and at every point in between, including: between patients, before and after putting on or removing gloves, any time hands and forearms have become contaminated, before and after eating, before and after restroom use, before leaving the healthcare facility, and whenever they become soiled.
According to the guidelines, proper protocols in the perioperative area start with the removal of jewelry from hands and wrists. When the guidelines reference hand hygiene in this setting, they are speaking specifically of handwashing, hand rubs and the traditional scrubs.
- Handwashing starts with cleaning underneath the nails with a nail cleaner under running water. It is imperative to follow manufacturer’s directions for application of soap, covering all areas of the hands and arms. Wash for 15 seconds, and then rinse well with water. Dry hands with paper towels.
- If a hand rub is used for a surgical procedure a mask should be worn. Clean nails under running water and apply the hand rubs according to manufacturer’s directions using the correct amount of product, covering all surfaces of the hands and forearms and allowing them to dry.
- A mask should also be worn for a traditional scrub. If soiled, hands and forearms should be washed before doing the scrub; then rinsed with water. A soft bristle brush containing antiseptic product should be used. A three to five minute scrub following manufacturer’s direction for the product should be done starting with the fingers on all four sides, repeated on opposite hand, then scrub the hands and the forearms up to the elbow. Keep hands and forearms elevated. Rinse with water from fingertips to elbows, holding hands higher than elbows and away from scrub attire; then move into the OR and dry hands and forearms with a sterile towel.
Surgical Products: Why might healthcare professionals not be practicing proper hand hygiene—what obstacles are they facing?
Blanchard: There are a number of reasons why compliance among healthcare professionals may be a challenge. The biggest obstacles they face are: pressure for quick turnovers of operating rooms, and a shortage of healthcare personnel, which is systemic across the industry. Other factors include inconveniently located sinks, lack of supplies, lack of education, non-involvement in product evaluation and selection, or the product causes skin irritation. The good news, though, hospitals across the country are more aware than ever about the need for increasing hand hygiene education and compliance and there have been some creative programs implemented that address the issue.
Surgical Products: Can you discuss the consequences of not practicing proper hand hygiene?
- For patients: Healthcare personnel neglecting to use good hand hygiene practices could be transmitting microorganisms that may cause an infection in a patient.
- For healthcare workers: Like provider-to-patient transmission, healthcare personnel can also transmit infections to other healthcare providers. The best way to avoid this is by practicing established hand hygiene practices.
- For the hospital as a whole: Healthcare-acquired infections can result if healthcare personnel are not following good hand hygiene practices. This could result in an escalation of cost, increased patient illness or death, longer stays for patients, as well as pain and suffering a patient may have as a result of a healthcare-acquired infection.
Surgical Products: What are some products or technologies healthcare professionals should be aware of that will help them in practicing proper hand hygiene?
Blanchard: There are a dearth of products available that can be included in proper hand hygiene protocols, including soap and water, alcohol, chlorohexidine, chloroxylenol ,iodine, iodophors, quaternary ammonium, or triclosan. Some of these products may be combined for greater efficacy. Emollients added to some products help protect the hands from becoming dry or irritated.
There have also been some significant technology advances, including automated hand washing stations that read the healthcare personnel’s badge, record time, the name of the person doing handwash, and the unit they are on. Reports can be generated from the information captured during the hand wash and used for performance improvement projects. There are also hand held computers consisting of programs that Infection Preventionists can use when doing observational monitoring of hand hygiene which is less intrusive and quicker.
Surgical Products: What are some strategies or resources you would recommend to healthcare facilities to educate their staff on proper hand hygiene?
Blanchard: Education is key to increasing hand hygiene compliance and adherence to the Recommended Practices. We recommend that facilities provide educational updates on new products and involve healthcare personnel in the trial and evaluation of these products. We also recommend annual, validated competencies on application and purpose of hand hygiene for all staff to ensure ongoing compliance.
Surgical Products: Can you tell us about the “It’s In Your Hands” campaign?
Blanchard: The “It’s in Your Hands” campaign is a collaboration between AORN and 3M to raise awareness of the deadly risks associated with poor hand hygiene and encourage best practices among nurses and other healthcare professionals.
Surgical Products: How is it working to engage nurses in improving hand hygiene?
Blanchard: The campaign wants to engage nurses in creative ways through a video contest to showcase how they follow the Recommended Practices. Early in 2010, we will announce an award program to recognize those who are taking a leadership role within their organization to promote compliance.
Surgical Products: How can nurses get involved?
Blanchard: Nurses can get involved by engaging their colleagues to develop a video showing how they adhere to the Recommended Practices. Potential participants will develop a short, original video that shows the recommended hand hygiene techniques in the perioperative setting in an accurate, creative, educational and informative way.
The contest is currently open and the deadline for entry is January 15th, 2010. A panel of judges from the AORN Recommended Practices Committee will choose three finalists for announcement the week of February 1st. The three finalists will be displayed on AORN’s website (www.aorn.org ) and until February 22, AORN members and other visitors to the site, will have the opportunity to vote for their top video. The winning video will be announced publicly at the AORN Annual Congress in Denver, CO, March 13-18, 2010 and the winner(s) (up to three people) will receive an educational grant from 3M to cover the registration fee to attend an AORN conference of their choice.
For contest rules and instructions after December 1, please visit: http://www.aorn.org/HandHygieneCampaign/ 
Surgical Products: What is the initiative trying to achieve with these efforts?
Blanchard: We want to continue raising awareness of and encouraging adherence to the Recommended Practices, while showcasing nurses and healthcare facilities who demonstrate compliance and can be a model for other facilities across the country.
Surgical Products: What is the one take-away point you would like to pass on to healthcare professionals on the topic of hand hygiene. What should they always remember, no matter what?
Blanchard: Practicing good hand hygiene protects the patient and healthcare personnel, and it may save a life.
Surgical Products: Anything else you would like to add?
Blanchard: This partnership with 3M reinforces hand hygiene standards by helping to creatively inform nurses who are on the front lines of surgical care and giving them tools to inform and engage their peer groups.