In honour of #safesurgicalhands day, I thought I would highlight a shocking fairly recent study of hand hygiene compliance among anaesthetists. The study identified a huge number of hand hygiene opportunities during the delivery of anaesthesia (149 per hour on average) – in fact, it would have consumed more than an hour of each anaesthetists time! Importantly, the observation was done via video camera, so is probably a better reflection of actual compliance. It is little surprise then that the hand hygiene compliance rate was so low (a dire 2.9%). So, before berating our anaesthetic colleagues, we may need to think of some new models of defining critical control points related to hand hygiene for this specialist group. And then berate them (with love and support) for failing to meet them!
Image credit: youtube.
Reflections on Infection Prevention and Control 
I completely support the need to have a new model of hand hygiene for anaesthetists. My own recent observations corroborate this studies findings. If something is unachievable then my own view is that staff’s perception is I can’t achieve that so won’t do anything! We need to work with our colleagues to provide a practical and effective model for hand hygiene during anaesthesia with the backing of the Royal College of Anaesthetists.
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Its all very good to identify such flaws but two thoughts immediately come to mind:
1: If people aren’t complying, as this video strongly supports, then is it a failure on the part of the people involved to comply, OR is there something seriously flawed in the protocol they are being asked to adopt that is impeding them in the performance of their tasks.
All too often it is the latter rather than an adopted attitude of those failing to comply, and as such there is more often a need to adjust procedures than most are willing to admit.
2: It is fine to look at high risk touch points and look to improve the quality of the hygiene / safety of them, but in adopting such a process it is equally important to look at the means by which they are cleaned to provide the safest possible environment.
The philosophy of “kill everything” leaves an unnatural and unsustainable ecosystem on surfaces. Its a void, and Nature abhors such voids. Despite every effort to filter out the presence of planktonic bacteria in healthcare facilities, especially ORs, (and there are some truly exciting and innovative technologies out there now), they are unavoidable and will find such voids and attach.
Antimicrobial surface treatments are one approach to address this, but do we ever go all the way back to the proverbial drawing board and examine the underlying premises of how and what we clean with.
If those two core components of OR hygiene were seriously examined, we would perhaps start to shift our perspectives and look at alternatives to these very basic issues. If the current cleaning products and protocols worked, then a lot of the issues discussed here and other blogs with regard to infection control may be mute.
We need to be open to alternative approaches at the most foundational, basic steps when it comes to issues like hand hygiene. We need to consider whether what we use for hand hygiene is the most effective, from what is used to scrub the hands, to what is used to clean high touch point equipment, to the use of items such as antimicrobial coatings. All these and more are components that need to be addressed in response to the issue raised in this article and its accompanying video.
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I think it’s very wise to develop the most functional way – well adapted to their actual work environment – to ensure good hand hygiene . I am curious about your comment to “berate them with love and support” and I wonder if that would be the same approach you would use for a group of food servers with the same compliance rates.
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Its clear there needs to be a process redesign as spending 40+% of the time on hand hygiene is unsustainable. In the past Anaesthetists made significant advances in patient safety through training and process redesign e.g. http://www.hindawi.com/journals/arp/2016/4237523/ These systems are often designed using the Human Error Template and Hierarchical Task analysis to identify and reduce the potential for error. But was infection control part of that analysis? Is the risk of infection tracked in the simulations / training? It might be an interesting place to start the conversation about process redesign.
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