2 May 2019
A look at hand hygiene in the ER
The emergency room is, understandably, often a hectic, chaotic place. When emergencies strike and lives need saving, clinical staff must move quickly and decisively to action. A recent study published in the Infection Control & Hospital Epidemiology journal found that more detailed hand washing instructions led to decidedly better results when it comes to hand hygiene in the ER. Additionally, a report from The Wall Street Journal analyzing the study explained that while thoroughness pays off, hospitals must be careful in how they go about putting best practices into place.
Looking closely at hand washing best practices
The study compared the six-step hand washing procedure set forth by the World Health Organization with the three-step process in place from the Centers for Disease Control. The core findings were fairly straightforward, including such details as:
● The WHO method led to fewer bacteria remaining on the hands of clinicians after washing was completed.
● The WHO technique took approximately 42.5 seconds on average.
● The CDC procedure generally took 35 seconds to be completed.
● Compliance to the WHO method was 65 percent.
● Compliance to the CDC method was 100 percent.
These results paint an intriguing picture of how the hand-washing methods differ, and you can get the full details, including the differences between the techniques, from The WSJ report here. The key point to note is that the WHO and CDC actually subscribe to the same best practices when it comes to hand washing. The difference is that the WHO steps cover everything clinicians should do when washing their hands in detail, while the CDC provides broader instructions and expects clinicians to fill in the gaps. The CDC is working on revising its set of steps moving forward.
What does this mean in the emergency room?
Which hand hygiene methodology will work best in the ER? Tom Talbot, Vanderbilt University’s chief hospital epidemiologist, told the news source that the few seconds difference between the two methodologies could make a difference in the ER and, even in other situations, careful monitoring will be needed to get staff to comply with a more complicated, six-step hand washing procedure.
Balancing speed with thoroughness is critical when dealing with hand washing in the emergency room.
If there is one clear implication of the study, it is that hand hygiene in the ER is especially complicated. Both the WHO and CDC believe that careful hand washing covering the entire hand is critical, but employees often do not have the time to carefully get to every nook and cranny on their hands. Choosing the best method for your setting, and the optimal way to track compliance, depends on figuring out what is best for your staff.
In the end, saving lives is the priority. Balancing faster hand washing with hygiene methods that are more thorough is critical.
You can simplify compliance with digital tools like real-time location systems for electronic hand hygiene monitoring paired with Bluetooth-enabled hand hygiene sessions. With compliance documentation simplified and streamlined, you can focus on creating policies and procedures that make the most sense for your specific workforce. A few key issues you should consider in this process include:
● Tenure: A long-tenured staff will likely have ingrained processes and best practices, allowing you to simplify the formal training around hand hygiene. A staff with lots of turnover, however, may need more detailed training and signage to keep them focused on proper operations.
● Management: Do you have the management resources to manually stay on top of hand hygiene challenges, or are you better off with more complex training and documentation around hand washing?
The core difference between the WHO method and the CDC procedure is that the WHO tells clinicians everything they should consider, while the CDC instructions assume clinicians understand best practices and provide broad instructions as a reminder. Choosing which is best for your ER is a matter of balancing your operational requirements with your staffing dynamics.