Hand hygiene: facilitators and barriers

Although there are many papers on hand hygiene, this new one in American Journal of Infection Control caught my eye. In this study 3,260 hand hygiene opportunities among 64 ICU nurses in 4 hospitals were overtly observed. When HH noncompliance was observed, the reason was documented. Nearly 20% of missed opportunities were accounted for by 4 activities: carrying something, even as small as a syringe or 4x4 (9%), donning gloves or PPE (6%), pushing or pulling a work station (2%), and using a mobile device (1%).

The investigator observed that nurses who were super compliant (90-100% compliant) found ways to deal with the barriers. For example, if they were carrying something, they shifted the object to one hand and reached for gel with the other. They were positive deviants.

The high performers were asked to explain why their compliance was high and four themes emerged: (1) they had internalized standard precautions; (2) they had experienced a previous exposure and were determined to not allow it to occur again; (3) bonuses and pay raises were linked to compliance; and (4) pregnancy and concern for their unborn child.

A better understanding of the barriers and facilitators may allow us to move the needle a bit on one of the most perplexing problems in infection prevention.