Hand hygiene still a challenge

Health care leaders across the nation have instituted hand-hygiene policies to prevent the spread of infections by staff. Compliance with these policies, however, falls woefully short in many facilities.

Case in point: In summer 2014, researchers from the University of New Mexico and the New Mexico Health Department conducted a cross-sectional study of 15 outpatient facilities in that state. Medical student interviews with staff indicated that 93 percent of policies recommended by the Centers for Disease Control and Prevention were in place in the facilities.

But students observed only 63 percent compliance with recommended hand-hygiene practices. According to some experts, the study's 37 percent noncompliance rate still is better than the overall rate at health care facilities nationwide. “Although not 100 percent, hand-hygiene rates in our outpatient facilities surpass average handwashing rates overall,” says James Cheek, M.D., a lead author of the study who teaches in the public health program at the University of New Mexico School of Medicine.

The average handwashing rate for all U.S. health care workers is generally below 50 percent, according to a 2006 report by the Institute for Healthcare Improvement titled How-to Guide: Improving Hand Hygiene. Research by other national organizations has put the compliance rate at 40 percent and lower.

The New Mexico outpatient facility findings were reported in the April issue of the American Journal of Infection Control, published by the Association for Professionals in Infection Control and Epidemiology.

Medical students assessed prevention policies at each facility using an outpatient infection prevention checklist developed by the CDC. In addition to assessing hand-hygiene compliance, the students evaluated injection-safety practices through direct observation. Each student was asked to observe 10 injections and 20 hand-hygiene opportunities at his or her assigned practice.

Of the 163 injection-safety observations, 66 percent of the preparations complied with all of the recommended steps. During the 330 hand-hygiene observations, students reported that proper cleaning supplies were always available.