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Ask Me When I Last Washed My Hands

Semmelweis’s run chart showing mortality rate decrease following start of hand hygiene.

Over 150 years ago, physician Ignaz Semmelweis determined that health care workers in a Viennese teaching hospital transmitted hospital-acquired diseases. The odor coming from the hands of doctors and students disturbed Semmelweis. He observed that they were not adequately washing their hands after performing autopsies and before their rounds on the delivery suite. “Cadaverous particles” were transferred from doctors and students to mothers, causing puerperal fever. Armed with a solution, Semmelweis recommended a stricter hand hygiene regimen involving a scrub of chlorinated lime solution after performing autopsies and before any patient contact. Mortality rates declined from 16% to 3%.

While hand hygiene is common language in health care today, it is not necessarily commonly practiced. Baseline hand hygiene rates in hospitals may be surprising to the public, often as low as 30%, but it may not be surprising to those in the organization. Hand hygiene is more than a project or a training module. Hand hygiene is both cultural and behavioral change. It is about accepting this habit to promote both staff and patient safety. There are several avenues where health care organizations influence change, perhaps by taking a TRIP:
 

  • Tone: when you notice someone not washing their hands, remain positive and politely remind your colleague to sanitize or wash their hands. Include a friendly reminder about washing hands for the safety of patients. Leadership should be involved if an unexpected behavior ensues.
  • Respect: perhaps a doctor or a nurse does not like being told what to do in front of patients. Create a signal or point to a picture of hands on the underside of your badge and flash it to your colleague. It will make for a subtle and non-confrontational reminder.
  • Incentives: psychology plays a significant role in behavior change. If your hospital implements an initiative, it might be useful to have positive reinforcement, such as a coffee gift card or recognition in a staff room with a photo of the clinician.
  • Patient awareness: patients can hold their medical staff accountable. A pin to wear on a lab coat or scrubs with the phrase, “Ask me when I last washed my hands” will prompt patients to become involved in the safety of their own care. Be prepared to respond appropriately to your patients.

Dr. Semelweiss’ approach to hand hygiene was filled with challenges even when the discussions were between him and his fellow doctors. He encountered significant resistance and failed to convince most of his colleagues that patients were dying and falling ill due to what was resolved by a simple solution. A hand hygiene agenda item must be integrated into standing meetings and not solely through a program or initiative. Hand hygiene is a continued patient safety and quality issue but achievable with the right attitude, organizational culture and support.

References

Beresford, L. Applied Psychology Improves Hand Hygiene in Hospitals. 1 September 2013. www.the-hospitalist.org/article/applied-psychology-improves-hand-hygiene-in-hospitals

Measuring Hand Hygiene Adherence: Overcoming the Challenges. Oakbrook Terrace: The Joint Commission. 2009. http://www.jointcommission.org/assets/1/18/hh_monograph.pdf

WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care is Safer Care. Geneva: World Health Organization. 2009. http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf

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