Processes: Optimisation and Solutions

“Disregard for hygiene is no longer acceptable“

How can hand hygiene compliance in hospitals be increased? This is one question that Simone Scheithauer addresses in her studies. Scheithauer is head of the Institute for Hospital Hygiene and Infectious Diseases at the University Hospital Göttingen, Germany. In the interview, she reveals reasons for poor compliance, along with effective approaches for better hand hygiene.

According to various studies, hand hygiene is not always at the top of medical staff’s list of priorities. Why is that?

Simone Scheithauer: There are several reasons for this. One of the reasons is a lack of knowledge. You can address this point with training courses. But knowledge must also be lived, in other words, implemented. Attitude plays a role here. Another reason that is mentioned most frequently by doctors and nursing staff is a lack of time. This shows that medical personnel often regard hygiene as something extra. Infection prevention is an integral part of modern patient care, and not something that comes on top of it. In a study1 we were able to show that there is a connection between workload and compliance, as one would expect – the higher the workload, the lower the compliance. Good compliance is only possible if there are enough hands available that can be disinfected. But that doesn’t justify saying: “We don’t have enough staff, so we don’t do proper hygiene”.

Some hospitals are increasingly using coloured disinfectant dispensers, or dispensers that send data about their use to a computer via WiFi. How would you gauge the effect of technical measures such as these?

Scheithauer: We definitely have to consider various approaches for improving compliance. The coloured dispensers are suitable for this – they serve as a kind of eye-catcher. In one of our studies, we were able to show an improvement in compliance of around six per cent2. We definitely have to consider various approaches for improving compliance. The coloured dispensers are suitable for this – they serve as a kind of eye-catcher. In one of our studies, we were able to show an improvement in compliance of around six per cent3.

How well were the use of WiFi dispensers and feedback rounds received by staff in the patient environment?

Scheithauer: As with all hospital hygiene measures, there was a lot of resentment at the beginning – who likes to be observed at work? You get direct feedback on what you do or don’t do. So, in the beginning we also had to build trust. As hygiene specialists, we achieved this by analysing the data from the WiFi dispensers, and meeting with doctors, nurses once a week. In these inter-professional and interdisciplinary rounds we discussed the results, and established concrete goals. That was very constructive!

Which measures do you consider particularly suitable for improving compliance?

Scheithauer: Process optimisation, of course! We had made an interesting observation during our first studies on compliance with hygienic hand disinfection. For example, when changing dressings, employees often had to get additional materials from the drawer. The calculation is simple. If I create additional necessary moments for hand disinfection for myself, then compliance will get worse at some point. We then carried out interventions in which we didn’t even say “disinfect your hands more often”, but considered in advance how the processes could be optimised. The goal was to achieve higher compliance with fewer hand disinfections – and that worked incredibly well. We have had compliance increases of 100 to 500 per cent4,5,6. We have also shown that these effects are sustainable. In one case, a year and a half later, we looked at the same team and the compliance improvement has still been maintained7.

Are you observing a change in awareness of hand hygiene – and what comes next?

Scheithauer: I think we have a very clear trend that everyone now knows that disregarding hygiene is unacceptable and out-dated. This is reflected in the fact that we usually have well-staffed hygiene teams with the manpower to provide assistance. However, we can only achieve long-term improvement if we get nursing care on board and see the whole thing as an interdisciplinary task in the sense of patient care – and not as a task or idea of external hygiene. In addition, I am sure that a high local presence of hygiene will be able to continually keep this idea up to date. This is certainly a clear trend in the right direction.

Further information

  1. Workload even affects hand hygiene in a highly trained and well-staffed setting: a prospective 365/7/24 observational study, Scheithauer S et al., J Hosp Infect.

  2. Influence of signal colored hand disinfectant dispensers on hand hygiene compliance at a medical intensive care unit, Scheithauer S et al., American Journal of Infection Control

  3. Do WiFi-based hand hygiene dispenser systems increase hand hygiene compliance?, Scheithauer S et al., Am J Infect Control.

  4. Improving hand hygiene compliance in the emergency department: getting to the point, Scheithauer S et al., BMC Infect Dis.

  5. Improving hand hygiene compliance in the anesthesia working room work area: More than just more hand rubs, Scheithauer S et al., Am J Infect Control.

  6. Improving hand hygiene compliance rates in the haemodialysis setting: more than just more hand rubs, Scheithauer S et al., Nephrol Dial Transplant.

  7. Long-term sustainability of hand hygiene improvements in the hemodialysis setting, Scheithauer S et al., Infection



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