12 Questions to Ask to Ensure an Effective Hand Hygiene Program

Bernard McDonnell, DO, a retired physician and current surveyor for Healthcare Facilities Accreditation Program, identifies 12 critical questions ambulatory surgery centers and other providers need to ask themselves to help ensure an effective hand hygiene program in their institution.

 

1. Are you washing your hands? "Cut things to the core — that's the first thing to look at," Dr. McDonnell says. "Does your staff know about the importance and need for handwashing?"

 

2. Does your program include hand hygiene policies? "What's in place at your ASC?" he says. "You need to have some guidelines, some policies. You just can't go out and say 'wash your hands.' You have to look at what you're doing. Are you doing hand antisepsis? Are you allowing artificial nails in the OR — I hope you're not. [Do your staff members] have their nails clipped no more than ¼ of an inch? Are you changing gloves and using alcohol-based sanitizers? Have you addressed surgical scrubs?

 

"Now, do you have all of that in your policies?" Dr. McDonnell says. "These are basic things you should do but sometimes for the basic things you have to state the obvious and you should address these in your [policies]."

 

Think about the signs you see in restaurants reminding employees about the requirement to wash their hands before exiting a restroom, he says. You not only might want to use similar signs (see question #9) but you may also want to consider having a policy stating that after staff members use the bathroom in your facility, they have to wash their hands.

 

3. Do have a surveillance program in your ASC? Just as important as having hand hygiene policies and a program is to ensure staff members, including physicians, are following your rules. "Are you watching to see if people doing it?" Dr. McDonnell says. "Are they doing it more than 80 percent of the time? 90 percent? Close 100? Someone needs to be monitoring that."

 

4. Are your people empowered to identify deficiencies? There needs to be a policy in your facility stating anyone can and should share their observations when someone fails to follow your hand hygiene program. "I always say the cleaning person can say to the surgeon, 'You need to wash your hands,'" Dr. McDonnell says. "There has to be that kind of a culture where people are empowered to say that."

 

5. Have you considered a quality program for hand hygiene? Hand hygiene compliance makes a terrific quality program, he says. "It can be all-encompassing of the institution — every part of the institution," Dr. McDonnell says. "The PACU, the OR, recovery. Even things like registration. Make it a quality project, report on it every month. Do graphs on it and figure out if you are getting better or getting worse, and if you're getting worse, figure out why."

 

Such a quality program must include the surveillance element asked about in question #3. Consider trying the "secret shopper" approach where you choose someone to observe your team on hand hygiene compliance without staff members knowing the person has this responsibility. "Even with this [surveillance approach], everyone should still be empowered to watch each other — empower everyone," he says.

 

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6. Do you know the proper guidelines for placement of alcohol-based hand rub sanitizers? You can receive this information from your local fire marshal and some of them you can obtain from the National Fire Protection Association. "Make sure they are installed in accordance with state and local codes," Dr. McDonnell says. "They're afraid the alcohol is going to be set on fire."

 

The CMS Condition of Participation for hospitals, per the Federal Register, is found under standard 482.41(b)(9), which can be viewed here. You can also find guidelines in the CMS "State Operations Manual — Appendix L - Guidance for Surveyors: Ambulatory Surgical Centers" (pdf).


"The most important thing is you have them and do you have them in the right places," he says.

 

7. Does your staff know about the need to do alcohol rubs going in and out of rooms? "The hardest thing to remember is you have to do [alcohol rubs] going into the room and going out of the room, and that's what should be done by everybody," he says. "People forget that, especially when going in — it needs to be done both going in and out."

 

8. Have you reviewed the CDC's and WHO's guidelines for hand hygiene? Both the CDC and World Health Organization have published hand hygiene guidelines, and they are worth reviewing. You can download the CDC's "Guidelines for Hand Hygiene in Healthcare Settings" (published in 2002) by clicking here (pdf). You can download the WHO's "WHO Guidelines on Hand Hygiene in Healthcare" (published in 2009) by clicking here (pdf).

 

9. Do you use visual reminders? A good hand hygiene program will use posters and other visual reminders that address the issues of proper hand hygiene, Dr. McDonnell says. You will want to make sure these displays are changed on a regular basis to ensure staff members do not become accustomed to them and ignore their messages. Editor's note: If you are looking for new poster designs or other hand hygiene tools to use in your facility, visit the hand hygiene section of Becker's Operating Room Clinical Quality & Infection Control's "Database of Downloadable Safety and Quality Tools & Resources" by clicking here.

 

10. Are disposable gloves readily available? Make sure disposable gloves are available to everyone on your team, Dr. McDonnell says.

 

"And make sure they change their gloves," he says. "Don't try to save money and use the same gloves. Always change them after you finish a task. And be sure to wash you hands after removing gloves."

 

11. Include patients and their families in hand hygiene education. Educating patients and their families on proper hand hygiene not only when they are in your facility but also when they leave can help prevent post-surgical infections, spread of disease, etc.

 

"It could be part of your pre-op and post-op instructions," Dr. McDonnell says. "And remind them that since they're going to have surgery, they should get cleaned before they come in. Do you have instructions for these people before they arrive? You're still going to perform a surgical cleanse on them but they should come in clean."

 

It is worthwhile to not only have hand hygiene posters and signs in the staff bathrooms but it is worth including them in patient and visitor bathrooms as well.

 

12. Do you cater to the needs of your customer? "Make sure you have your [hand hygiene] information posted in a language your patients and employees understand," Dr. McDonnell says. "Know your customer."

 

Learn more about HFAP.

 

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