Improving Hand Hygiene Efforts in Nursing Homes

Hand hygiene is the most basic infection control measure we can take to avoid the transmission of germs. Especially critical in patient care, this staple of infection prevention is frequently neglected and often a challenge. Adherence tends to hover between 30% and 50%, which is astounding considering hand-hygiene’s role in staving off infection.

Whether it is a multi-drug resistant organism like methicillin-resistant Staphylococcus aureus (MRSA), influenza, or even an emerging infectious disease like Ebola, hand hygiene is a critical component to standard and enhanced precautions. Infection prevention and control programs across the United States (and the world) are continually working to improve rates within hospitals and outpatient medical centers, and while some of these interventions work, it can be challenging to maintain long-term hand hygiene adherence.

The truth is that in the United States, we have the resources to be adherent. We have the sinks with soap and water, and the alcohol-based hand sanitizer dispensers, lining the halls and patient rooms in our facilities. The sad reality is that we lack the culture to stay true to hand hygiene adherence—whether it be overworking our medical providers, a lack of education, or simply driving home the culture of adherence in hand hygiene, we’re struggling.

Nursing homes are no exception to this challenge and as the baby-boomer population ages and requires such care, infection control practices in these institutions will need to keep up with the influx of patients. Nursing homes and skilled nursing facilities are sources for transmission of antibiotic-resistant infections, a sobering fact that drives home the importance of even the most basic infection control practice—hand hygiene.

To this end, the authors of a recent study evaluated the impact of a multifaceted hand-hygiene program in nursing homes. Initiating a 2-arm cluster randomized control trial, researchers evaluated 26 nursing homes in France (13 were an intervention group and 13 were assigned to the control group). The intervention group implemented a bundle of hand hygiene related measures to nursing home staff and visitors and outside care providers. These measures included increasing access to hand gel via pocket-sized containers and new dispensers, more informational displays on the importance of hand hygiene, creating local working groups, and staff education through e-learning tools.

The investigators assessed hand-hygiene adherence through hand gel consumption and subsequently evaluated the incidence rate of acute respiratory infections and acute gastroenteritis reported during the study period.

They found that over the 1-year study period, the volume of hand gel being consumed was higher in the intervention group. Interestingly, although there was no difference between the groups in reported mortality rates, hospitalization rates, or antibiotic usage at baseline, over the study period, overall mortality and antibiotic prescriptions were significantly lower in the intervention group.

Although the study period was only 1 year, this is a great example of the changes that can be implemented in a short amount of time to increase hand hygiene and the overall health of a patient population. The relationship between hand hygiene and health is undeniable, and in the case of patient care, we cannot forget that hand hygiene is the most basic thing we can do to keep patients safe. This study provides strong support for a multifaceted approach to addressing poor hand-hygiene adherence across multiple patient care settings. Regardless of location, we can all do better to strengthen infection prevention efforts and patient safety through strong hand hygiene initiatives and adherence.