Why hand hygiene compliance remains a complex challenge

Whiteley Corporation’s executive chairman Greg Whiteley argues some of the reasons why hand hygiene compliance is still so poor.

Whiteley Corporation’s executive chairman Greg Whiteley argues some of the reasons why hand hygiene compliance is still so poor.

Did you know that in the last 30 years, there have been more than 29,000 published papers on the general subject of hand hygiene? That is a lot of writing, reading and arithmetic. So much research, so much peer review, so many studies…So why is hand hygiene compliance still so poor?

Even the regular observations on the poor compliance with hand hygiene guidelines has been exhaustively studied, written about and published. All it would seem to no avail.

As readers of this publication may remember, a recent study in Australia demonstrated that the published compliance rates of greater than 80 per cent are in my opinion just rubbish. The data used to defend hand hygiene compliance is just a game of the ‘emperor’s new clothes’. It is only a matter of time before there is a general acknowledgement of the falsehood in the reporting system currently used by governments around Australia.

So why is it so hard to achieve compliance? There are of course many reasons. Perhaps the first reason is healthcare workers are too busy. Doctors are busy saving lives, and other healthcare workers are too busy caring for patients.

They are all too busy to wash their hands and prevent transmission of nosocomial pathogens, or to prevent another healthcare associated infection by stopping to wash their hands.

A second problem is the presence of gloves. Many people put on their gloves and imagine the gloves are some sort of ‘force field’ to prevent the bacteria or other microbes jumping on board their gloved hand.

Just another bit of lazy rubbish thinking and behaviour, because it is well evidenced that the bacteria are just as happy on an over-used glove, as on an unwashed hand. Gloves should be changed as frequently as people are meant to wash their hands.

Perhaps a third reason is the risk perception/motivation around hand hygiene compliance is most frequently an inherent response learned as children at the time of toilet training.

You can’t see the germs, but you are taught to wash your hands because of the danger to your health from those unseen microbes.

Dr Michael Whitby and his colleagues investigated the issue of inherent versus elective hand hygiene and risk perception. In a study of more than 750 healthcare workers, it was the inherent behaviour that was a better predictor of compliance with hand hygiene protocols.

So non-compliance might be your mothers fault, due to insufficient training? That is a finding of which Freud would be proud!

So, the message of hand hygiene compliance will continue onward. The ridiculous data collection promoted for measurement will continue to show nothing. Sadly, patients will continue to be unnecessarily infected by the super bugs and all because we don’t wash our hands sufficiently often. Please pass me the alcohol gel, because I need some about now.

www.whiteley.com.au

This first appeared in the May/June issue of INCLEAN magazine. To subscribe, click here

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