Artificial fingernails Each facility should have a hand hygiene policy with a statement regarding HCWs wearing artificial fingernails. Several studies suggest that artificial fingernails harbor gram-negative pathogens and have been linked to outbreaks, particularly in neonatal intensive care units (NICU) (WHO, 2009a). Best practice Gloves Gloves are recommended when a HCW anticipates being in contact with blood or body fluids and when handling or touching a contaminated surface (OSHA, 2009). Other indications for glove use are when caring for a patient on transmission-based precautions (i.e., contact precautions) and in an outbreak scenario. Gloves vary depending on the work setting. There are nonsterile and sterile examination gloves, sterile surgical gloves, and Performing hand hygiene To remove transient pathogens, using the proper technique when performing hand hygiene is important (CDC, 2021). To use an ABHR: ● Put approximately a dime size of product on hands and rub together. Factors affecting adherence Depending on the acuity and number of patients assigned, HCWs should perform hand hygiene approximately 100 times in a 12-hour shift (CDC, 2020). As hand hygiene compliance indicates, factors still influence adherence to hand hygiene practices. Many factors have stayed the same: Too busy, understaffing, forgot (Baier et al., 2020; Graf et al., 2011; WHO, 2009a). A recent study in Germany on knowledge about hand hygiene for generation Z dental students, trainee nurses, and medical technical assistants found that the most frequent reasons for noncompliance were “no time” and “forgotten” (Baier et al., 2020). A decade prior, Graf and colleagues (2011) measured the millennial generation’s hand hygiene beliefs by looking at medical students in their first clinical year. The participants were asked about the indications for hand hygiene, and “before preparation of parenteral fluids” and “after removal Continuous education and quality improvement opportunities Hand hygiene practices should be observed as a consistent way to measure infection prevention practices. Along with observing, implementing other multimodal strategies will support sustained improvement. Providing ongoing training and performance feedback to healthcare workers is essential to improving hand hygiene adherence (CDC, 2017; Chavali et al., 2016; Musu et al., 2017; Sasahara et al., 2021; WHO, 2009a). A train-the-trainer model is a practical approach to increasing knowledge and sharing experiences with other HCWs (Tartari et al., 2019). Ackerman and colleagues (2022) used creative video messaging (for 20 seconds) at the sink while HCWs performed handwashing. To help sustain improvements, the authors suggest refreshing training materials every three months to keep HCWs engaged. Healthcare leadership should always strive to ● Cover all surfaces of your hands until dry. ● This process should take about 20 seconds. improve hand hygiene and infection prevention practices. Hand hygiene is a critical part of the essentials of infection prevention and standard precautions. Healthcare-associated
recommendations include no wearing of artificial fingernails or extenders when caring for patients at high risk (e.g., intensive care units and operating rooms) and keeping natural nail tips to less than ¼ inch long (CDC, 2002; WHO, 2009a).
chemotherapy gloves (OSHA, 2009). Gloves do not eliminate contamination of the hands of HCWs and are not a replacement for hand hygiene (Boyce, 2021). As Bingham and colleagues (2016) showed, gloved hands are more contaminated than non-gloved hands, a reminder that overuse of gloves can inadvertently contaminate the environment. The CDC strongly recommends hand hygiene after glove removal (CDC, 2002). To wash with soap and water: ● Wet hands first with water. ● Apply enough soap to get a good lather. ● Rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. ● Rinse hands with water and use a disposable towel to dry them. ● Use a towel to turn off the faucet. of gloves” scored the lowest. Reasons listed for noncompliance were “too lazy to do it,” “forgot to do it,” and “did not have the time to do it.” These results highlight the need to regularly assess hand hygiene knowledge and ensure adequate education in healthcare programs. Other barriers to hand hygiene adherence are frequent entry and exits, continuously wearing gloves and hand hygiene product too drying or irritating to hands (Woodard et al., 2019). Regular training should help to address the other factors, including a lack of knowledge of the guidelines and a perception of a low risk of acquiring an infection from a patient (CDC, 2002; Woodard et al., 2019). Addressing uncertainty and the benefits of hand hygiene will help to improve adherence. infections still occur; however, as hand hygiene compliance increases, HAIs should decrease. Best practice recommendations from the CDC and the WHO describe moments when hand hygiene should be performed to minimize the risk of transmission of pathogens. However, several studies show there are still opportunities for improvement in hand hygiene compliance. Physicians have the lowest hand hygiene adherence, whereas the nurses’ aides have the highest hand hygiene compliance. Regular training, observations, and immediate feedback will help to change behavior. Healthcare Consideration: In any healthcare organization, there is someone in charge of patient safety. If you are interested in being a “secret shopper” to observe hand hygiene adherence, talk with your supervisor or the designated infection preventionist.
Case study #1 Mrs. Grange: Nasogastric (NG) Placement
The nurse enters Mrs. Grange’s room, shuts the door, introduces herself, and shakes the patient’s hand. The nurse explains the procedure to Mrs. Grange and answers her questions. The nurse gathers her supplies at the bedside table, prepares the patient, and dons gloves. The NG is inserted, placement is checked, and
Mrs. Grange is a 69-year-old female admitted to the hospital for bowel blockage after being diagnosed with pancreatic cancer. The nurse needs to insert a nasogastric tube because Mrs. Grange has a firm and distended abdomen and is vomiting.
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