05/05 was the “International Day of Hand Hygiene”. This was launched in 2009 by the World Health Organisation (WHO) in order to make medical personnel aware of the importance of hand hygiene, because the hands are the major route through which the transmission of pathogens occurs in health care. If hand hygiene is carried out properly, it can prevent microbial pathogens – in particular bacteria and viruses – from being passed via the hands of medical personnel from one patient to the next. Hand hygiene therefore prevents infections and in addition also protects the health of doctors and nurses.
Beyond the boundaries of medical facilities, washing hands with soap and then drying is sufficiently effective; for medical personnel however, disinfection is a mandatory necessity. Sometimes mechanical barrier measures (gloves) can be useful supplementary measures.
Hand disinfection then …
How important a good hand hygiene routine is, particularly when it involves disinfection, was something discovered by gynaecologist Philipp Semmelweis more than 150 years ago. At that time it was common practice by doctors to wash their hands after a postmortem with soap – at best. Following this they would then head off to a childbirth and examined the patient. The result was, of course, that infectious material of the dead body was transferred to these women. The number of cases of puerperal fever was accordingly high. Midwives however did not come into contact with deceased women. At the Vienna General Hospital at that time, in the department in which doctors and medical students – including Semmelweis – worked, about ten percent of births ended up being fatal. In the second section on the other hand, in which student midwives were trained, only about three percent of patients died. Semmelweis examined the many deaths, but only on account of the unexpected death of a colleague, who had injured his hand during an autopsy and died by way of a blood poisoning event, did the gynaecologist recognise that the doctors’ hands were the reason for the many cases of puerperal fever. Semmelweis thereafter introduced hand-washing using chlorinated lime water, whereupon the mortality rate dropped to about two percent.
… and today
The main problem today is not that effective disinfectants don’t exist on the market – it’s rather an issue of compliance on the side of the user. This is because hand hygiene is often not carried out quite as it is prescribed. The causes here are varied. An inappropriate sense of certainty which comes with the use of gloves, or a lack of role models, for example for the medical personnel, or high workloads, can have a negative impact on compliance. How well medical personnel perform hand hygiene is ascertained by so-called direct or open observation. Employees are observed here during their daily work by a third person. The disadvantage of this open observation is that the employees know that someone is watching. As a result, it may be that they change their natural behaviour, whereby better outcomes are aimed for. This phenomenon, also known as Hawthorne effect, is necessarily factored in when, for instance, conducting drug trials by way of placebo administration. With hand hygiene though, eliminating such a bug in the process is not possible. Moreover, only a very small sample group of all performed ablutions and disinfections is documented by the open method of observation. Another possibility exists with the use of hand sanitiser, effectively dispensing a surrogate parameter.
Electronic hand hygiene monitoring systems – always ready
It’s here that the Electronic Hand Hygiene Compliance Organization (EHCO) comes into the picture. This is a consortium of eight US companies, namely Airista, BioVigil, CENTRAK®, Clean Hands Safe Hands, DebMed, Hill-Rom, Inc., SwipeSense and Versus Technology, which all produce electronic hand hygiene monitoring systems. These devices measure the dispensing of disinfectant around the clock. This can be determined – without there being any Hawthorne effect – and on this basis measures such as training in actual hand hygiene behaviour can be carried out.
In addition, some devices have a memory and control function or specify whether only hand washing with soap or a disinfectant is necessary. The seven hospitals within the scope of Greenville Health are already equipped with electronic hand hygiene monitoring systems. “We were able to record a constant double-digit increase in hand hygiene compliance and a reduction in hospital-related infections. These positive changes have been accompanied by cost savings which justify the cost of systems”, says Connie Steed, Director of Infection Prevention at Greenville Health System.
Objective: raise awareness
“All those who have joined EHCO have acceded to the philosophy to transcend commercial and competitive interests, and to believe in this cooperation for the common good. […] Our members have agreed to place the aim of enhanced patient safety and better results ahead of their commercial interests,” says Paul Alper, CEO of EHCO and vice president, Strategy for Patient Safety, DebMed, in a press release. While making these assurances it is to be assumed that the EHCO members hope to improve not only patient safety but also their sales. That being said, electronic devices would be able to help in raising awareness of hygiene as a problem area among hospital staff.
At medical universities as well there are already seminars in which students learn the proper disinfection of hands. Instead of using germs, the students practise their handshake using a fluorescent cream. This “germ infection” then goes from hand to hand – in the end the hands are properly disinfected and checked with a black light. These seminars are part of the basic study and repeated again and again as part of the main study.