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Since the 2001 release of Centers for Disease Control and Prevention guidelines on hand hygiene, hospitals nationwide have highlighted the importance of hand washing and use of alcohol-based gels in the prevention and control of infections.
Vanderbilt created its own hand washing/hand hygiene campaign in 2004 to educate and raise awareness among its staff and visitors about the regimen that many people take for granted. Staff and visitors are instructed in the why, when, where and how-to of hand hygiene.
"No one maliciously doesn't wash their hands," said Thomas R. Talbot, M.D., M.P.H., assistant professor of Medicine, chief hospital epidemiologist and chair of the Hand Hygiene Task Force. "People are busy and often forget. But that is not acceptable; thus we have found we need to hardwire proper hand washing so that it's an automatic thing, a reflex. We want people to get in the habit and do it with every patient encounter.
"People really have seemed to appreciate the
campaign. Now our biggest focus is rolling it out to every area of the hospital and getting feedback on the adherence data. This is a very basic practice that is also really important for patient quality and safety."
The campaign has been quite effective. Since the start of the program, there has been a 30 percent increase in compliance. The move to educate and increase adherence is not just in medical facilities, Talbot said.
"It's everywhere," he said. "Washing your hands is the No. 1 way to prevent infection whether you are in an office and preventing the flu, or with patients."
The hand washing campaign was launched at the Monroe Carell Jr. Children's Hospital, and soon after, the adult hospital joined the effort. Posters and awareness days are known throughout the Medical Center as effective ways to educate the staff about hand hygiene. As part of the Medical Center training, all staff members must complete the VandySafe teaching on hand hygiene.
Traditionally, the rate of hand washing among the nation's medical staff has been low with the national average between 35 percent and 40 percent. Talbot reports that Vanderbilt was above the national average, but there's room for improvement.
"This has been a multi-disciplinary project," Talbot said. "It has taken the entire institution to make this work. Something that has worked is an incentive called Reward Rounds in which members of the Hand Hygiene Task Force award prizes to Medical Center staff caught in the act of adhering to correct hand washing techniques. We are emphasizing that hand hygiene is important. It is a basic practice that must stay on people's radar to enhance visibility and protection."
Lauran Allen, manager for Performance Management and Improvement at Children's Hospital, started the program and has been happy with the results.
"The campaign has definitely contributed to the overall attitude about hand washing and hand hygiene," she said. "When we first began, people were washing their hands, but they were not doing it correctly.
"Now we have a lot more people doing it the right way and the numbers are increasing. The education piece has really helped. The number of people washing their hands incorrectly has almost been eliminated.
"The program is not just for our staff," she said. "We have events that involve anyone who wants to learn proper hand hygiene. We encourage our patients, especially the children, to participate. We have worked to make this as interesting and fun as possible so that hand washing won't be just another mundane and routine task."
The use of alcohol-based hand sanitizers has proven to be more effective than soap and water in killing bacteria. The task force has dispersed wall-mounted dispensers throughout the Medical Center as another tactic of its campaign.
Although many people have preconceived notions about hand hygiene and hand washing, the task force points out some interesting CDC facts, including that the temperature of water does not prevent infections. There is no way you can get the water hot enough to sterilize your hands. Friction is what is important and disrupts bacteria on the skin.
According to the CDC, a typical person's hands contain millions of microbes. Most of them are naturally occurring and harmless, but some may be disease-causing germs. Every time a person moves from one task to another, touches a surface, rubs his nose or eyes, and interacts with another person, germs spread.
Nearly 22 million school days are missed each year due to the common cold. It has been proven that when children practice healthy hand washing habits, they miss fewer days of school.
Observations in public restrooms show that only about 68 percent of Americans wash their hands before exiting.
Repeated use of reusable cloth towels is not recommended and should be avoided. Recommended drying methods and times: single-use paper towels – dry hands 10 seconds on each towel. The first towel removes the bulk of the water while the second one completes the drying; air dryer – rub hands together under warm air for 30-45 seconds; single-use cloth towel – rub hands for 10 seconds on sections of the towel for a total of 20 seconds.
"This is all something our mothers and grandmothers taught us for good
reason," Talbot said. VM