Healthcare environments are notoriously chaotic. Hospitals and clinics are bustling with activity, housing both the sick and the immunocompromised, often under the continuous threat of hospital-acquired infections (HAIs). These challenges are further compounded by issues such as short staffing, increasing burnout, and heightened patient volumes.  

In such a setting, aiming for 100% hand hygiene compliance might seem like an impossible standard—and indeed, it is. While some hospitals managed to achieve compliance rates over 90% during the pandemic, research has shown that such high levels are nearly impossible to sustain over the long term. In one study conducted during the pandemic, many hospitals achieved greater than 90% hand hygiene compliance, but within six months, that rate dropped to 51%.

Redefining Success in Hand Hygiene

It’s important to acknowledge that absolute perfection in hand hygiene is unrealistic. Healthcare workers are human, not machines, and expecting robotic consistency under intense pressure is unrealistic. However, this doesn’t mean efforts to improve hand hygiene should be relaxed. On the contrary, even modest improvements can significantly reduce the incidence of HAIs. Recognizing this, the Joint Commission has shifted its focus from stringent compliance targets to fostering overall improvements in hand hygiene practices.

Recent discussions in publications like the Wall Street Journal and Becker’s Hospital Review introduce the "85% rule," suggesting that aiming for this more attainable target might actually be more effective than striving for perfection. This idea is supported by research, including a study published in Nature Communications, which found that optimal learning occurs at about 85% accuracy for humans, animals, and artificial neural networks alike.

Barriers and Solutions for Achieving the 85% Hand Hygiene Target

With this in mind, it's clear that while perfection isn't necessary to make progress, consistent and focused efforts are still required to manage and reduce HAIs effectively. This perspective brings us to explore four common barriers healthcare workers face in maintaining hand hygiene and the practical solutions that can help overcome these challenges. 

Barrier 1: Not Enough Time

Healthcare workers are constantly on the move, attending to emergencies and managing multiple patient needs in often understaffed environments. Despite the best intentions, the sheer unpredictability of the environment can result in missed opportunities for hand hygiene.

• Optimize the Environment: To minimize time spent, healthcare facilities should strategically place handwashing stations and hand sanitizer dispensers at points of care.
  
  
• Portable Solutions: Although healthcare practitioners often have limited control over the placement of handwashing stations, wearable or portable hand sanitizer dispensers can provide the option of hand hygiene, especially in situations such as entering and exiting non-patient areas or accompanying patients between units.
  
  
• Technological Aids: Technologies like SwipeSense monitor and prompt hand hygiene in real-time, helping streamline the process and integrate it into daily routines without adding extra steps.

Barrier 2: Skin Irritation

Healthcare workers frequently suffer from skin irritation due to repetitive hand washing and harsh soaps, which can deter them from adhering to necessary hand hygiene protocols. The constant exposure to chemicals and the physical act of washing can damage skin over time, making it painful and potentially compromising the skin's natural barrier.

• Gentler Hygiene Products: Hand sanitizers and soaps that are formulated to be gentle yet effective can help alleviate skin irritation from frequent use. Products with added emollients and moisturizers can reduce dryness and irritation, encouraging more frequent use.
  
  
• Providing Additional Skin Care: Healthcare workers can carry small moisturizers or have them readily available at workstations, like near computers, to apply after handwashing. This helps to restore moisture and protect the skin’s integrity.
  
  
• Educational Tips: Training on proper hand hygiene techniques is crucial. Healthcare workers should be taught to use lukewarm water instead of hot water, and to gently pat their hands dry instead of rubbing to prevent skin damage.

Barrier 3: Lack of Awareness

A significant barrier to hand hygiene compliance is a lack of awareness. Some healthcare workers may not fully understand the importance of handwashing and its impact on patients. They also may not be aware of the specific times and instances to perform hand hygiene, such as entering or exiting a patient's room or before and after using gloves. 

Additionally, there is often confusion about when to use hand sanitizer instead of soap. It is recommended to use hand sanitizer for quick cleansing when hands are not visibly soiled and to use soap for thoroughly cleaning visibly dirty or potentially contaminated hands.

• Targeted Education Programs: Ongoing education programs can emphasize the importance of hand hygiene in preventing HAIs and include specific training on the times and situations that require hand hygiene. According to Leapfrog's recommendations, effective hand hygiene educational programs should cover six critical topics, from the proper use of gloves to the correct usage of hand sanitizer, among others.
  
  
• Utilizing Technology for Awareness: Technologies like SwipeSense can play a crucial role in raising awareness and improving education about hand hygiene. These systems can provide real-time reminders and feedback, keeping hand hygiene top of mind and removing the guesswork.
  
  
• Visual Reminders and Signage: Visual cues throughout the facility can serve as constant reminders and improve hand hygiene rates. These can include signs about the effectiveness of handwashing in reducing the spread of infections and prompts that indicate the appropriate moments for handwashing or sanitizing.

Barrier 4: Forgetting to Perform Hand Hygiene

Forgetting to perform hand hygiene at critical moments is a common barrier, especially in fast-paced healthcare settings where staff are frequently interrupted or juggling multiple tasks. This oversight can significantly impact infection control efforts.

• Technology for Habit Building: SwipeSense technology can be especially effective in building hand hygiene habits. By providing reminders and tracking compliance, this technology helps healthcare workers internalize the importance of hand hygiene, making it a more instinctive part of their daily routine.
  
  
• Fostering a Team Environment: Encouraging a culture where coworkers gently remind each other to perform hand hygiene can reinforce good practices across the team.
  
  
• Friendly Competitions: Organizing contests between units or departments, with rewards for the highest compliance rates, can create a friendly, competitive atmosphere that motivates staff and improves hand hygiene rates. These competitions can be tracked with digital monitoring systems like SwipeSense, providing real-time feedback and a transparent scoreboard.

Moving Toward Better Hand Hygiene Compliance

By understanding and addressing the common barriers to hand hygiene, healthcare facilities can implement effective strategies to enhance compliance. These solutions include utilizing technology like SwipeSense for reminders and education, fostering a team environment, and implementing strategies to prevent skin irritation.

Ultimately, these efforts not only improve patient outcomes but also protect healthcare workers by reinforcing the critical role of hand hygiene in preventing infections.