Increasing patient hand hygiene by 45.7%

Hand hygiene is well recognised as one of the most effective initiatives to protect patients from healthcare-associated infections (HAIs). Improving patient hand hygiene has been shown to reduce the transmission of harmful pathogens, but while much attention has focused on the role of hand hygiene for healthcare workers, this is not always the case for patients.

The Australian Guidelines for the Prevention and Control of Infection in Healthcare⁽¹⁾ make several recommendations and supportive statements towards the importance of patient hand hygiene to reduce HAIs and the implementation of a patient-centred approach to infection prevention and control.

The guidelines summary of recommendations include:

3.1.1 Hand hygiene - Practice Statement

“It is good practice for patients to perform hand hygiene and be educated about the benefits of hand hygiene for infection prevention and control.

Patients should be involved in hand hygiene and offered the opportunity to clean their hands when appropriate, including before meals and after using the toilet, commode, or bedpan/urinal. Patient preferences for hand hygiene products may differ, and they should be provided with the option of alcohol-based hand rubs, hand wipes or access to hand washbasins, based on any specific needs.”

Antibacterial hand wipes are a safe, cost-effective and easy to establish method to support patient hand hygiene initiatives.

In 2018, Wilkinson et al.⁽²⁾ concluded that an antimicrobial patient hand wipe (Clinell Antibacterial Hand wipes), when applied for 60 seconds, is at least as good as soap and water at removing transient microorganisms from the hands, representing an acceptable alternative to handwashing.

More recently, a study set within six acute elderly care/rehabilitation wards in a large UK hospital reports the impact of a bundled approach to improve patient hand hygiene. Using a multimodal strategy to improve patient hand hygiene - Heather P. Loveday et al.⁽³⁾  aims to establish if providing patient hand wipes, along with a defined protocol for encouraging their use, is effective in improving the frequency of patient hand hygiene.

A baseline audit identified opportunities for patient hand hygiene. These were: before meals, before touching and after touching an invasive device, after using the toilet, after sneezing/coughing, after vomiting. Prior to the introduction of a patient hand hygiene bundle, compliance with these hand hygiene opportunities was measured at 13.2%.

A patient hand hygiene bundle was then introduced. This included:

• Individual patient hand wipe packs
• A patient hand hygiene protocol for staff
• An information card about patient hand hygiene for patients
• Monitoring and feedback of rates of compliance
   

The effect of the patient hand hygiene bundle was then monitored over a 12-week period.

The results were impressive. Following the implementation of this bundle, there was a significant improvement in compliance, with patient hand hygiene increasing by 45.7%.  A key finding was that access to a method of hand hygiene simply by placement of a pack of wipes correlated with an increase in hand hygiene compliance.

Feedback from participating patients and staff showed the majority of patients found the wipes made their hands feel clean and were easy to remove from the pack. Ward managers highlighted that the patient experience was improved, and patient awareness of the need for hand hygiene increased. Overall, the wards wanted to continue to promote patient hand hygiene and felt that patient wipes was a more efficient and practical means of enabling patients to clean their hands with assistance or independently.

This study also affirms that healthcare staff have an essential role in encouraging patients to perform timely and appropriate hand hygiene. Providing patients with packs of hand wipes was found to be a simple, cost-effective approach to increasing patient hand hygiene and reducing the risk of healthcare-associated infections.

References

1) Australian Guidelines for the Prevention and Control of Infection in Healthcare, Canberra: National Health and Medical Research Council (2019).

2)  Wilkinson MAC et al. Assessment of the efficacy of a patient hand wipe: development of a test method. J Hosp Infect 2018; 98. 339-44

3) H.P. Loveday et al.  Using a multimodal strategy to improve patient hand hygiene. American Journal of Infection Control 49 (2021) 740−745