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Hand Hygiene: Know the Facts

When the latest coronavirus threat, or COVID-19, first emerged in January, the number one recommendation for protecting oneself from the virus and preventing its spread was to wash hands frequently and thoroughly.

Similarly, the best way to prevent healthcare associated infections and the transmission of disease in the operating room and across health care settings is to practice good hand hygiene.

“We all learned in kindergarten and in Health Class 101 how to wash our hands properly,” says Sharon A. McNamara BSN, MS, RN, CNOR. “But proper hand hygiene is probably the most abused and misused preventive methodology in everyday life and, sadly, in health care as well.”

Preventing Disease Transmissions

An estimated two million patients contract a healthcare associated infection (HAI) each year and 99,000 of them die from their infection, according to the Centers for Disease Control and Prevention. Additionally, HAIs cost hospitals an estimated $45 billion annually.

“Practicing effective hand hygiene is the best way to prevent the transmission of diseases in the OR,” says Amber Wood, MSN, RN, CNOR, CIC, FAPIC, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN). “The danger of not performing hand hygiene correctly is that we put our patients and ourselves at risk for acquiring infectious pathogens.”

“Contamination inside the operating suite can lead to surgical site infections,” says Jill Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, manager, infection prevention at Emory University Hospital Midtown in Atlanta, Georgia.

“Good hand hygiene in the OR can assist with preventing contamination of the surgical wound, instruments and skin after sterile prep,” Holdsworth adds. “All of these areas are important when looking at maintaining a sterile environment and preventing surgical site infections.”

According to Wood, hand hygiene compliance is only about 50 percent in the perioperative setting. McNamara confirms this anecdotally.

“My observations of anesthesia providers, nurses and technologists in the OR reveal that they frequently omit proper hand hygiene practices during patient care activities,” she says.

Wood attributes the low hand hygiene compliance rate to the fact that there is a high number of contacts between perioperative personnel and OR patients. “So there’s a high number of opportunities for hand hygiene to occur, especially during induction and emergence from anesthesia.”

David Reinhart, MSN, MBA, RN, CNOR, specialty director perioperative services, blames a lack of availability and/or poor placement of hand sanitizer dispensers. “Conflicting responsibilities in relationship to on-time surgery starts is another factor,” he says.

McNamara concurs.

“I believe that inadequate placement or lack of hand gel dispensers and hand wash sinks is a big factor in low rates of hand hygiene compliance,” she says.

According to Wood, most interactions with the patient occur at the bedside or in the center of the room.

“Sometimes it’s not safe to leave the patient to go over to the wall and perform hand hygiene or into the hallway to wash hands at the sink,” she explains. “Having alcohol-based hand rubs in strategic locations near the bedside or wearing personal dispensers are two strategies to combat this problem.”

Guidance from the CDC and WHO

The CDC and World Health Organization (WHO) recommend that appropriate hand hygiene be performed by health care workers at specific times, including the following:

  • Before and after patient contact.
  • Before performing a clean or sterile task.
  • After risk for blood or body fluid exposure.
  • After contact with patient surroundings.
  • Any time hands are visibly soiled or dirty.

“How often do you see a practitioner complete the positioning of a patient and then go directly to the computer to document?” McNamara asks. “Or see practitioners transporting patients with or without gloves but not gelling or washing their hands before starting the procedure?”

Wood recommends not wearing gloves when they’re not indicated. “When gloves are worn for an extended time, we tend to forget that the gloves do not replace hand hygiene,” she says.

“For example, we often put gloves on in anticipation of needing them, such as when the patient is emerging from anesthesia,” Wood adds. “Then we leave them on while we’re getting ready to transport the patient and forget to perform hand hygiene before touching the patient.”

Technology solutions can also help improve hand hygiene compliance. One example is a group monitoring system (GMS) that electronically monitors, tracks and reports hand hygiene compliance rates in real time.

“Electronic hand hygiene monitoring can be very helpful when it comes to monitoring hand hygiene compliance and accurately recording results,” says Holdsworth. “These types of systems can provide valuable information about areas in the facility that are causing specific issues.”

Wood recommends that an interdisciplinary team carefully evaluate any technology solutions for hand hygiene monitoring. “Perioperative team members should be involved in the selection of technology for hand hygiene monitoring,” she says.

“Many of these systems are set up to capture hand hygiene in and out of a room, but this may have limited benefits for capturing data and improving compliance in the perioperative setting,” Wood explains. “This is because a majority of hand hygiene opportunities in this setting are occurring at the bedside.”

Hand Hygiene TST

The Joint Commission Center for Transforming Healthcare has developed the Hand Hygiene Targeted Solutions Tool (TST) to help boost hand hygiene compliance rates. The Hand Hygiene TST is a web-based application designed to help health care organizations understand barriers to successful hand hygiene while implementing evidence-based solutions that lead to reductions in HAIs.

The Hand Hygiene TST will guide health care organizations through a step-by-step process to accurately measure actual hand hygiene performance and identify barriers to success. It will also direct organizations to proven solutions that are customized to address each organization’s particular needs.

For more information, visit to learn more about the Hand Hygiene TST.



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