Healthcare organizations have been promoting hand hygiene as a critical weapon against infections for decades, yet compliance rates have remained lower than desired. At the same time, some healthcare workers may be tired of hearing the familiar drone of "Wash your hands," and may be resistant to being taught what they think they mastered at a young age. To move past apathy and resistance, healthcare organizations need a new approach: They need to engage front-line workers in hand hygiene initiatives.
By engaging physicians and staff through a comprehensive hand hygiene education program, Children's Healthcare of Atlanta more than doubled its compliance rates in one year, and has maintained compliance levels of more than 95 percent for several years. Renee Watson, RNC, BSN, CPHQ, CIC, manager of infection prevention and epidemiology at Children's Healthcare of Atlanta, shares five ways she engages front-line workers in hand hygiene.
1. Be passionate. A passionate and engaging leader is important when implementing a hand hygiene initiative. A leader who has a passion for hand hygiene and infection prevention can make a seemingly boring topic come alive, according to Ms. Watson.
2. Ask questions. To hook physicians and staff in hand hygiene training, Ms. Watson asks how many people think they wash their hands for the required 15 seconds. Most trainees answer yes. However, when she then asks staff to rub their hands together as if they were washing their hands, the majority of people stop around seven or eight seconds. "Folks customarily turn around very quickly and listen," Ms. Watson says. This simple, quick exercise raises people's awareness and engages them in learning more about hand hygiene, she says.
Ms. Watson also asks trainees if soap and water or alcohol hand sanitizer is more effective in cleaning hands. Many are not aware that alcohol sanitizers eliminate more pathogens than soap and water except when hands are visibly soiled, when caregivers have blood and body fluids on their hands or when they have worked with specific organisms that require mechanical removal, Ms. Watson says. Asking the question, rather than simply telling which option is more effective, engages physicians and staff and demonstrates their need for hand hygiene education and training. "You want to keep a dialogue, not a monologue," she says. "You want to keep them engaged and participating."
3. Add a personal element. Telling a personal story about hand hygiene adds a personal element to hand hygiene education, and makes the issue more immediate to physicians and staff, according to Ms. Watson. By reading or listening to hand hygiene facts, front-line workers may understand on an intellectual level the importance of hand hygiene; by hearing a story, front-line workers gain a deeper and more emotional understanding of hand hygiene's importance.
Ms. Watson links hand hygiene to front-line workers' day-to-day lives by discussing hand hygiene in the context of the hospital. "Patients' parents trust us with their child. They may have traveled from another state to get lifesaving operation. [Imagine] if they [traveled a long distance] only to have their child get an infection and possibly die. It could have been due to hand hygiene," she says.
4. Empower staff. Healthcare leaders can engage front-line staff in hand hygiene initiatives by giving them the authority to make changes that will effectively help them improve compliance. For example, when Children's Healthcare of Atlanta planned to install more hand sanitizers, Ms. Watson gave staff sticky notes they could place in locations where hand sanitizers would be most convenient for them. "I don't have the context of what the room looks like with all the equipment and patients," Ms. Watson says. Involving front-line staff in decision-making recognizes their experience and their knowledge of what changes would be most useful for them.
Leaders can also engage front-line workers in choosing hand hygiene products and lotions. Getting physician and staff input on the type of soap and sanitizer may increase the likelihood they will use the product. "Involve care-level clinicians at every single angle so they are empowered and less likely to feel the issue has been forced upon them; rather, they are part of the improvement and part of the decision-making and subsequent success," Ms. Watson says.
5. Facilitate communication. Even if a staff member or physician understands and cares about hand hygiene, he or she may be hesitant to remind colleagues or supervisors to wash their hands during patient care. To overcome this barrier, Children's Healthcare of Atlanta developed a catch phrase, "Foam up," to unobtrusively remind people of proper hand hygiene processes. "It's a safe way to communicate with someone who may have forgotten to wash [his or her] hands," Ms. Watson says.
For instance, if a physician approaches a patient without washing his or her hands first, nurses or other staff may feel uncomfortable reminding the physician of hand hygiene in front of the patient. "Saying 'Let's all foam up!' and putting a dollop of sanitizer on everybody's hands," is a more comfortable way of enforcing hand hygiene in that type of situation, Ms. Watson says.
Hand hygiene engagement
Leading with enthusiasm, asking questions, making the topic personal, empowering staff and facilitating communication can engage front-line staff in hand hygiene and help prevent the spread of infections.
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By engaging physicians and staff through a comprehensive hand hygiene education program, Children's Healthcare of Atlanta more than doubled its compliance rates in one year, and has maintained compliance levels of more than 95 percent for several years. Renee Watson, RNC, BSN, CPHQ, CIC, manager of infection prevention and epidemiology at Children's Healthcare of Atlanta, shares five ways she engages front-line workers in hand hygiene. 1. Be passionate. A passionate and engaging leader is important when implementing a hand hygiene initiative. A leader who has a passion for hand hygiene and infection prevention can make a seemingly boring topic come alive, according to Ms. Watson.
2. Ask questions. To hook physicians and staff in hand hygiene training, Ms. Watson asks how many people think they wash their hands for the required 15 seconds. Most trainees answer yes. However, when she then asks staff to rub their hands together as if they were washing their hands, the majority of people stop around seven or eight seconds. "Folks customarily turn around very quickly and listen," Ms. Watson says. This simple, quick exercise raises people's awareness and engages them in learning more about hand hygiene, she says.
Ms. Watson also asks trainees if soap and water or alcohol hand sanitizer is more effective in cleaning hands. Many are not aware that alcohol sanitizers eliminate more pathogens than soap and water except when hands are visibly soiled, when caregivers have blood and body fluids on their hands or when they have worked with specific organisms that require mechanical removal, Ms. Watson says. Asking the question, rather than simply telling which option is more effective, engages physicians and staff and demonstrates their need for hand hygiene education and training. "You want to keep a dialogue, not a monologue," she says. "You want to keep them engaged and participating."
3. Add a personal element. Telling a personal story about hand hygiene adds a personal element to hand hygiene education, and makes the issue more immediate to physicians and staff, according to Ms. Watson. By reading or listening to hand hygiene facts, front-line workers may understand on an intellectual level the importance of hand hygiene; by hearing a story, front-line workers gain a deeper and more emotional understanding of hand hygiene's importance.
Ms. Watson links hand hygiene to front-line workers' day-to-day lives by discussing hand hygiene in the context of the hospital. "Patients' parents trust us with their child. They may have traveled from another state to get lifesaving operation. [Imagine] if they [traveled a long distance] only to have their child get an infection and possibly die. It could have been due to hand hygiene," she says.
4. Empower staff. Healthcare leaders can engage front-line staff in hand hygiene initiatives by giving them the authority to make changes that will effectively help them improve compliance. For example, when Children's Healthcare of Atlanta planned to install more hand sanitizers, Ms. Watson gave staff sticky notes they could place in locations where hand sanitizers would be most convenient for them. "I don't have the context of what the room looks like with all the equipment and patients," Ms. Watson says. Involving front-line staff in decision-making recognizes their experience and their knowledge of what changes would be most useful for them.
Leaders can also engage front-line workers in choosing hand hygiene products and lotions. Getting physician and staff input on the type of soap and sanitizer may increase the likelihood they will use the product. "Involve care-level clinicians at every single angle so they are empowered and less likely to feel the issue has been forced upon them; rather, they are part of the improvement and part of the decision-making and subsequent success," Ms. Watson says.
5. Facilitate communication. Even if a staff member or physician understands and cares about hand hygiene, he or she may be hesitant to remind colleagues or supervisors to wash their hands during patient care. To overcome this barrier, Children's Healthcare of Atlanta developed a catch phrase, "Foam up," to unobtrusively remind people of proper hand hygiene processes. "It's a safe way to communicate with someone who may have forgotten to wash [his or her] hands," Ms. Watson says.
For instance, if a physician approaches a patient without washing his or her hands first, nurses or other staff may feel uncomfortable reminding the physician of hand hygiene in front of the patient. "Saying 'Let's all foam up!' and putting a dollop of sanitizer on everybody's hands," is a more comfortable way of enforcing hand hygiene in that type of situation, Ms. Watson says.
Hand hygiene engagement
Leading with enthusiasm, asking questions, making the topic personal, empowering staff and facilitating communication can engage front-line staff in hand hygiene and help prevent the spread of infections.
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Hand Hygiene Should Be Patient Safety Priority: Q&A With Premier Safety Institute's Gina Pugliese