Hand Hygiene: Don’t Forget the Patient!

Of all the studies done regarding hospital-acquired infections (HAI), I wonder if anyone has studied the incidence of HAI related to patient hand hygiene. The study wouldn’t be that hard to carry out.

I always offer hand sanitizer to a patient after assisting with toileting and am dismayed when the patient replies,

“You are the only one who has done this.”

Since the patient’s hands may be contaminated as they may handle their intravenous lines (etc., etc.), I wonder what impact this has on infection rates. I would like to compare the infection rates in a unit who implements a strict patient hand hygiene program with a unit who observes the standard practice.

Even without this study’s potential results, it seems that common sense would point to the patient’s hand hygiene as being just as important as the healthcare providers’ hygiene!  After all, it seems we nurses wash our hands ENDLESSLY, and still HAIs get passed around like chocolate in a nurses’ station!

Let’s explore what a study of this nature would involve:

1. (Time and Timing) This should be minimal. Basically staff on the selected unit would offer hand sanitizer to the patient after toileting if the patient is not able to wash their hands.
2. (Availability of study participants) This practice would be standard on the research unit with a “control” unit who does not alter their current practice.
3. (Cooperation of others) This would require the cooperation of the staff and family, anyone who assists the patient with toileting.
4. (Facilities and Equipment) The only equipment required is hand sanitizer or soap and water.
5. (Money) This project would increase the amount spent on hand sanitizer but should be feasible.
6. (Researcher experience) All health care workers are educated in hand hygiene as well as the patient and family upon admission at my facility. Staff with clerical/research experience could help train staff in the selected unit on data collection and monitoring.
7. (Ethical considerations) Since the comparison is with current behavior and does not encourage withholding hand hygiene, no special safeguards are required. Staff will not and can not force hand hygiene on patients and should document if patient refuses for comparison.
8. (Availability of study participants) Participants would consist of any patient admitted to the selected unit.
9. (Researcher interest) Hospital administration may be quite interested in supporting this study as this simple intervention may prove to save the hospital significant sums spent on HAIs annually!

How about you? Is patient hygiene emphasized in your facility? Have you had inservices or education about patient hygiene?

Polit, D. F., & Beck, C. T. (2008). Nursing research: generating and assessing evidence for nursing practice (8th Ed.). Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

What Do You Think?