In the midst of what may be one of the worst flu outbreaks in a decade, new research reinforces the importance of proper hand hygiene protocol.
A study published in the February issue of the American Journal for Infection Control found hand washing saves lives — not just in hospitals — but all healthcare facilities, including nursing homes. Researchers looked at 26 French nursing homes from April 1, 2014, to April 1, 2015, discovering consistent measures encouraging staff and visitors to wash their hands reduces mortality and antibiotic prescription rates, according to a news release from the Association for Professionals in Infection Control and Epidemiology highlighting the results.
During the course of the study, which included 13 nursing homes randomly assigned to an intervention group and 13 assigned to a control group, a program was implemented targeting nursing home staff, visitors and outside care providers, the news release said.
As part of the program, hand sanitizer became more readily available in both pocket-sized containers and dispensers and the idea of proper hand hygiene was promoted through posters, events, work groups and education.
The measures resulted in a lower mortality rate of 2.10 deaths per 100 residents, versus 2.65 in the control group, with a notable 30% decrease in the mortality rate during France’s major influenza outbreak in early 2015, according to the news release.
Although the CDC stresses the single best way to prevent the flu is to get vaccinated, proper hand washing and cleansing — either with soap and water or an alcohol-based hand sanitizer if soap and water are not available — also is recommended.
Unique ways to get people washing
One Florida nurse recently took to social media to promote hand-washing, according to The Washington Post. Katherine Smit Lockler’s Jan. 27 Facebook video, in which she uses good-natured humor to encourage the public to wash their hands, along with other measures to prevent the flu, has been viewed more than 5 million times.
In 2016, the Cleveland Clinic’s Lutheran Hospital implemented a program for staff dubbed “SNAP”— Scrub Now and Prevent.
The program uses a secret code, such as snapping fingers in front of patients and visitors to remind a fellow caregiver to clean his or her hands at key times, according to a post on the Cleveland Clinic’s Consult QD blog.
The effort was initiated by Christine Rose, BSN, RN, CIC, an infection preventionist at Lutheran, the post stated.
“While caregivers understand the importance of hand hygiene to patient safety, we all get busy and there is a reluctance to speak up and bring a missed opportunity to the attention of fellow caregivers,” said Rose. “This SNAP intervention promotes a just culture in which everyone, no matter what job they hold, is empowered to discreetly remind another caregiver to wash their hands without fear of retaliation.”
SNAP resulted in 95% hand hygiene compliance at Lutheran, according to Consult QD, and is now being used throughout the health system, with SNAP hand-washing posters displayed at many Cleveland Clinic hospitals and an intervention toolkit available to staff via the system’s intranet.
According to the CDC, healthcare providers clean their hands less than half of the times they should, and one in 25 hospital patients has at least one healthcare-associated infection.
The CDC recommends cleaning hands before and after having direct contact with a patient’s intact skin—this includes taking a pulse or blood pressure, performing physical examinations and lifting the patient in bed. Healthcare providers also should wash hands after contact with blood, body fluids or excretions, mucous membranes, non-intact skin or wound dressings, after contact with inanimate objects—including medical equipment in the immediate vicinity of the patient, after glove removal and if hands will be moving from a contaminated-body site to a clean-body site during patient care.
Infections are common in nursing homes, with 3 million being reported each year in the U.S. alone, according to the French study. The death rate from infections is estimated to be 0.6 per 1,000 resident days.
“This research demonstrates that a sustained educational program focused on hand hygiene can improve practices and may reduce the risk of infection among nursing home patients,” 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC, said in the news release. “It is crucial that we increase efforts to bolster infection prevention programs in nursing homes because residents of these facilities have more underlying health conditions and are more vulnerable to serious complications from infections.”
Courses related to ‘avoiding infection’
CE568: Keep It Clean: Hand Hygiene and Skin Antisepsis (1 contact hr)
Whether at the surgical site or on the hands of the healthcare provider, skin is laden inherently with resident and transient flora. Inadequate hand hygiene allows opportunistic pathogens in varying life stages to transfer between patients and other surfaces during everyday activities. Yet many healthcare workers across various disciplines continue to have poor hand hygiene despite best-practice evidence about microbial transfer between people. Proper preoperative patient skin antisepsis and hand hygiene can minimize surgical site infections, and healthcare professionals across disciplines should collaborate to enhance adherence.
CE453: Noroviruses: The Leading Cause of Acute Gastroenteritis in the U.S. (1 contact hr)
Noroviruses, a common cause of gastroenteritis, generate havoc as the nation’s No.1 cause of foodborne disease and epidemic diarrhea. Acute gastroenteritis is the second most frequent cause of illness in the United States, with only the common cold occurring more frequently. Outbreaks of norovirus gastroenteritis are especially common in closed settings, and have been occurring with increasing frequency in hospitals, nursing homes, day care centers, schools, military bases, prisons and hotels. The viruses have also sickened thousands of passengers on cruise ships and hundreds of restaurant patrons. The sharp increase in norovirus outbreaks has been attributed to a new, more aggressive viral strain designated GII.4. Healthcare professionals across disciplines can limit the transmission of norovirus by paying meticulous attention to handwashing and by encouraging coworkers and visitors to do the same. Healthcare professionals should follow the recommended standard precautions or other specific precautions designated for special populations.
WEB339: Antimicrobial Resistance and Healthcare Acquired Infections (1 contact hr)
Rising trends in antimicrobial resistance is a costly and significant contributor to negative health consequences in the United States and worldwide. The Center for Medicare and Medicaid Services (CMS) recognizes this impact and will now penalize hospitals with high rates of acquired Methicillin-resistant S. aureus (MRSA) and C. difficile infections in an effort to promote proper antimicrobial stewardship and infection control policies. With proper education, development and use of effective protocols, and close monitoring, the interprofessional care team can have a substantial impact on improving patient outcomes and reducing healthcare costs.