Hand hygiene is crucial when trying to prevent healthcare-associated infections (HAIs), which can lead to disease and even death — in fact, each year 100,000 people die of HAIs in the U.S. According to new research from Columbia University School of Nursing and the World Health Organization (WHO), nearly one in five U.S. health facilities don't make alcohol-based hand sanitizer available at each and every point of care. “Embedding hand hygiene efforts in a stronger institutional safety climate is clearly an area for improvement,” wrote the researchers in their published study.

Clean Hands Save Lives

The Centers for Disease Control and Prevention (CDC) have published guidelines for appropriate hand hygiene practices in health settings since 2002, and the WHO has published similar recommendations more recently. Worldwide, however, workers’ compliance with these recommended practices is unacceptably low. Even in high-income countries, including the U.S., where ample resources are available for supplies, training, and promotion, average compliance was only about 40 percent.

To examine whether health employees are currently practicing hand hygiene, a research team surveyed a sample of 168 facilities in 42 states and Puerto Rico from July through December 2011. Led by Laurie Conway, PhD student at Columbia Nursing, and Dr. Benedetta Allegranzi, leader of a WHO infection control program, the team found about three-quarters (77.5 percent) of all facilities reported they made alcohol-based sanitizer continuously available at every point of care. On the positive side, a detailed analysis of 129 public facilities (80.6 percent of the total) showed that most had an advanced or intermediate level of hand hygiene implementation progress. Yet nearly one in 10 facilities reported their senior leaders, such as the CEO, medical director, or director of nursing, had not made a clear commitment to support hand hygiene improvement.

"When hospitals don't focus heavily on hand hygiene, that puts patients at unnecessary risk for preventable healthcare associated infections," Conway stated in a press release. "The tone for compliance with infection control guidelines is set at the highest levels of management, and our study also found that executives aren't always doing all that they can to send a clear message that preventing infections is a priority."

It is important to note that 2,238 U.S. health care facilities were invited to participate in this study, yet only 168 chose to do so (a mere 7.5 percent). This means these self-selective study results are extremely limited since, in all likelihood, only those hospitals already practicing hand hygience chose to take part in the study, while the worst offenders probably opted out. We can only imagine how low sanitary standards may be in many hospitals in the U.S.

"While hand hygiene compliance is the responsibility of every health care worker, U.S. health care facilities would certainly benefit from coordinated national and sub-national efforts aimed at hand hygiene improvement,” said co-author Dr. Didier Pittet, Director, Faculty of Medicine, Geneva, Switzerland.

Source: Conway L, Allegranzi B, Pittet D. Larson E. Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of American health care facilities. American Journal of Infection Control. 2014.