Should we routinely audit hand hygiene in hospitals? The crowd say no…!

I had the privilege of participating in the IPS Autumn Webinar series yesterday, in a debate with Dr Evonne Curran on whether we should routinely audit hand hygiene in hospitals. It was good fun – and highlighted some important points about the strengths and limitations of hand hygiene audits – and audits generally for that matter!

Here’s my case for routine hand hygiene auditing in hospitals (you can register (free!) and view the webinars here):

My key arguments were that:

  • Hand hygiene is really important, and one of a range of interventions that we should be routinely auditing to launch focussed improvement work.
  • There are key sources of bias in hand hygiene auditing (see below). However, these can be reduced with optimised methodology.
    • Observation bias (aka Hawthorne effect) – where behaviour is modified by awareness of being observed. For example, if I stand over you with a clipboard and a pen, you’re more likely to do hand hygiene.
    • Observer bias – difference between the true value and the observed value related to observer variation. For example, poor trained auditors will result in variations in reported practice due to observer bias.
    • Selection bias – when the selected group / data does not represent the population. For example, only doing hand hygiene audits during day shifts won’t tell you the whole picture.
  • Hand hygiene audits are a legal and regulatory requirement (in England at least).
  • My own experience is that optimised hand hygiene auditing methodology can deliver a performance indicator that can identify areas of poor performance and drive focussed improvement initiatives.

At the end of the debate, two thirds of the live audience voted against doing routine hand hygiene audits in hospitals. Put another way – I lost! I am taking the view that the audience voted against the concept of inaccurate auditing returning unrealistically high level of compliance, rather than against properly monitored and measured auditing, which can help to fuel improvement.

If nothing else, I hope the debate made the point that poorly planned and executed hand hygiene auditing is doing nobody any good – and may be doing harm. If we are going to do hand hygiene auditing, it should be using optimised methodology to deliver actionable information that is put to work to improve hand hygiene practice.

A hand hygiene cracker from the Christmas BMJ

The annual Christmas BMJ is always good for a laugh. This year, one of the featured articles introduces the idea of using the tune of Frère Jacques to help memorise the WHO’s six-step hand hygiene technique.

And here’s the song in action:

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On the origin of multidrug-resistant Gram-negative bacteria (MDR-GNB)

The colour of the global crisis of antibiotic resistance is red (if te Gram stain is your reference). In rich countries we have ESBL-producing Enterobacterales (mainly E. coli), but the real problem are carbapenemase-producing strains (Klebsiella, Pseudomonas and Acinetobacter) that are already endemic in lower and middle-income countries. The unanswered question is “where did these resistant bacteria come from”? Animals or bathrooms? Continue reading

Bad things happen when you don’t do hand hygiene

This blog is usually concerned with covering the latest developments – but this post features a paper published in 1962! Have you ever wondered what would happen if you didn’t do hand hygiene? Well, this remarkable, shocking, and absolutely unrepeatable study from the 1960s gives us the answer: the result would be transmission of pathogens that can cause HCAI.

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We need to win hearts and minds to improve hand hygiene practice

I listened to Reflections’ very own Martin Kiernan share his wisdom on the challenges around hand hygiene improvement this week, and thought I’d share my own reflections on his talk. The key point seemed to be that we have some way to go in winning the hearts and minds of our frontline clinical colleagues if we are to improve hand hygiene practice across the board.

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Four little words…Clean care for all

Guest bloggers Claire Kilpatrick and Julie Storr (hand hygiene consultants at the WHO, @safesafersafest) post…

Three little words, behind which lay 40 years of a global aspiration. Health for all. Last year the world recommitted to Alma Ata and renewed the global focus on health as a fundamental human right. In 2019, WHO’s 5 May global hand hygiene campaign evokes the spirit of health for all with its own four words: Clean care for all. How is this relevant to infection prevention and control (IPC) on a day to day basis, particularly for the other 364 days of the year?

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“It’s in Your Hands” – time to sing along

Friends and colleagues in Geneva have just released a song written and performed for the upcoming World Hand Hygiene Day. It’s a catchy tune with a nicely produced video – and a strong message in the chorus:

‘Hands are such a simple thing, but our hands can change most everything. Keep care safe and take a stand, clean care for all – it’s in your hands.”

Have a listen and see what you think:

That sinking feeling

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I’m at ECCMID in Amsterdam currently listening to a nice report of an OXA-48 Klebsiella pneumoniae outbreak in Gran Canaria in which sinks were found to be contaminated and replaced. Earlier today I listened to a nice paper on how sinks that drain slowly are more likely to contaminate the local environment for up to 1 metre from Paz Aranega Bou who, together with Ginny Moore and other colleagues has published this nice paper . So many papers on sinks now and I do wonder if we have lost sight of what they do and what they really are.

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“Why Dutch hospitals are so good at beating superbugs”

It is with great pleasure that I ask your attention for this article that appeared in the Economist. Yes, we still have low resistance rates in our hospitals and if you’re interested in how that happened, read it. The prosaic composition contains two parts; a very realistic thriller-like opening, followed by a second part with a rather unrealistic explanation. Both parts are separated by a short sentence of absolute nonsense. Time for a review. Continue reading

Hand hygiene and the courage to challenge: a personal reflection

Allow me to set the scene: I was visiting an elderly relative in an NHS hospital recently (they would deny being elderly – but I’m afraid it is now true). I witnessed a healthcare worker moving efficiently from bed to bed examining each patient (including direct patient contact) to take observations without any hand hygiene between patients and without decontamination of the reusable blood-pressure cuff. I explained to my relative the need to challenge this behaviour. My relative asked – almost pleaded with me – not to intervene saying “you’ll clear off and they’ll be left caring for me overnight”. So, did I have the courage to defy my relative and challenge this behaviour?

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