Maintaining a habit is always easier than forming a new habit. We should make the most of the high levels of hand hygiene achieved during the COVID-19 epidemic by making 3 key changes to infection control practices in hospitals.
Firstly, we can change the way in which we monitor and audit hand hygiene. Usually, there is just one person appointed per ward to carry out this important task, which results in monitoring and auditing depending on just one person – so if this person is especially busy, or off work for any reason, standards tend to slip. It also means that other members of staff do not feel responsibility for hand hygiene across the team, as they feel that this has been delegated and is no longer something for them to worry about. Also, it is often difficult for the nurse responsible to enforce improvements, especially when this concerns the standards of senior members of staff.
This could be resolved by rotating responsibility for monitoring and audit amongst all staff, from the healthcare assistants to the ward managers. Not only would this build resilience (any staff can assume the responsibility when necessary) but it would also ensure a range of perspectives, it would build a sense of shared responsibility, and would increase awareness of the importance of hand hygiene through all staff being directly involved.
Secondly, the COVID epidemic has led to improved hand hygiene through making the consequences of poor standards in this area more salient. Even those of us outside of the medical profession have become more aware of the importance of washing our hands. We could maintain these levels of awareness in hospitals by regularly publishing figures for interpatient transmission and its consequences (including severe illness and death). This would help remind staff that their actions (or rather inactions, i.e. not washing hands) can have severe consequences down the line that they may not normally be aware of.
Thirdly, and on a more human level, as a practicing nurse I can tell you that following strict hand hygiene standards is not always pleasant. The high alcohol levels in hand sanitizer dry out the skin and can aggravate skin conditions such and eczema. Repeated use, especially in cold weather, can lead to cracked skin and abrasions which are obviously something that should be avoided in a hospital environment. Hand cream is not always supplied to remedy this, and even when it is, this adds further time to the whole process. It is understandable that many of my colleagues (albeit subconsciously) often avoid regularly applying sanitiser to their skin.
To resolve this, the formula for hand sanitizer could be changed to make it more pleasant to apply to the skin. Moisturising ingredients could be added directly to the sanitiser, natural anti-microbial active ingredients could reduce the need for such a high alcohol content, and even options for lotions that smell nice could be made available. We have to remember that hand sanitizer is being applied to a person’s hands, not just a potential transmission hazard. Human hands that go home to care for their loved one and deserve to be treated with a little love in the workplace too.
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