Long-Term Care Survey Alert

Rein in nosocomial infection rates by using these 5 field-test strategies.

Effective hand hygiene is the linchpin of an infection control plan that prevents transmission of the flu and super bugs. And therein lies the rub for many nursing facilities ...quot; or lack of it, if staff don't cleanse their hands appropriately.

"Staff are supposed to wash their hands with soap and water from 10 to 15 seconds with a good friction rub," says Stephanie Mayoryk, RN, CIC, infection control practitioner at Levindale Hebrew Geriatric Center and Hospital in Baltimore, MD. They must use soap and water if their hands are visibly soiled, she adds.

Otherwise, they should use alcohol-based hand sanitizer to clean their hands before and after caring for patients. "Some studies show the sanitizer is more effective than soap and water," says Mayoryk.

A potential exception:Some hospitals have policies requiring staff to use soap and water to clean their hands when caring for patients with C. difficile, which creates spores, Mayork adds.

Make sure staff use alcohol-based hand gels given that some "waterless" gels don't contain alcohol, advises an article, "Hand Washing: A Simple Way To Prevent Infection," published on MayoClinic.com. The article advises applying about 1/2 teaspoon of the product to the palm of your hand." Then "rub your hands together, covering all surfaces of your hands, until they're dry."

Resource: Read the entire article at www.mayoclinic.com/health/handwashing/HQ00407

Get Staff on the Hand-Cleansing Bandwagon

Knowing when and how to cleanse your hands is one thing but actually doing it each and every time is another. Levindale has significantly improved staff's handwashing compliance by implementing a number of strategies, says Mayoryk. These include:

1. Conducting a "hand hygiene day" with an educational focus. "We brought in a microbiologist who had made cultures plates from staff members' hands," says Mayoryk, adding that the culturing was done without identifying whose hands were contaminated. "The culture plates grew out all kinds of things, ranging from common skin flora to pathogens that could definitely cause disease," says Mayoryk. "When staff sees what grows from their hands, they get the point."

Give out favors: The infection control team gave participants in the hand washing day nail files and small bottles of hand sanitizer with the facility's name on them.

Tip: One hospital system uses pictures of cultures grown from staff's hands to make screen savers for healthcare staff's computers, as a reminder for them to use good hand hygiene.

2. Using fluorescent dyes such as Glo Germ to train staff to wash their hands thoroughly. "We apply [the dye] to a couple of volunteers' hands" during orientation training, says Mayoryk. "They then wash their hands and come back to examine them under a black light to see how well they have washed them."

Mayoryk says the training exercise shows the areas where people most commonly don't do a good job of washing -- that is "between the thumb and forefinger and nail beds and under the nails. Sometimes the exercise shows that people forget to wash their wrists," she adds.

3. Performing discrete environmental rounds to observe whether staff, including physicians, are cleaning their hands appropriately. They also check to see if staff are following the nail policy (artificial nails are forbidden), says Mayoryk.

4. Teaching staff to avoid contaminating their freshly washed hands in the bathroom. At Levindale, infection control personnel teach staff to use the paper towel that they use to turn off the faucet to also open the doorknob, says Mayoryk. The staff person then throws the towel in the nearest trashcan.

5. Putting up flyers and posters to remind people to wash their hands, especially in bathrooms. The posters give a phone number to call if there are no paper towels or soap in the bathroom.

More best practices: As part of future hand hygiene quality improvement efforts, Sheppard Air Force Base's medical group plans to post small posters illustrating hand washing technique in the handwashing areas. And the group plans "to keep tabs on [staff's use of] hand sanitizer use by drawing a line and date on the solution container," Dennis Marquardt, chief of performance improvement/risk manager at SAFB, tells Eli.