Hand hygiene during extraordinary times

Welcome to 2021. 

In what feels like a fresh start to many, begins in the midst of over 85 million devastating global cases of sars-cov-2 (COVID-19) infections. 

Infection prevention groups are tirelessly researching and making adjustments to local, regional, and more far seeking public health strategies, as vaccines are being distributed predominantly to healthcare workers on the front lines of this gruesome virus. 

At the Hygiene and Infection Prevention Network, we have taken a deeper dive into the trends, the perceptions, and the approaches that have shaped infection control in 2020, as we brawl with the most prominent viruses to impact the globe in most of our lifetimes. 

As the general public has become increasingly inundated with messages about social distancing and hygiene improvement efforts, perception about hygiene has become a measure of increased focus. In fact, some people have gone as far as to say that 2020 has turned them into germaphobes with a poll of 2,000 American’s stating that 80% of them are washing their hands more frequently than ever before.  Yet on the reverse, the year has also included the public’s growing questioning of evidence-based regulations, prioritization in healthcare, and the role of digitization have become influencers of the state of healthcare today. 

Perceptions of technologies influence in healthcare

One of the earlier trends to emerge during COVID-19 is the use of advanced digitization technologies for its management. From telemedicine and mobile care, electronic hand hygiene systems, UV robots for cleaning, 3D PPE and printed swabs with AI technology, and mobile apps for contract tracing and social distancing monitoring, it has been a time for accelerating innovation. Technologies limited human touch and manual methods, increased oversight, and protected healthcare workers and their patients.  

Seeing as our primary focus is on hand hygiene, technology has greatly reformed conversations around hand hygiene compliance and cleaning. Perceptions of technology’s influence can be seen across many clinical works, including a study published in the Journal of Hospital Infection aimed to investigate the attitude of healthcare workers in Sweden towards behavior modifiers in a multimodal hand hygiene improvement strategy. In this case, where a system was implemented with intent to improve, train, evaluate, and provide feedback, there were some clear considerations around this topic. The healthcare workers showed positive attitudes towards using electronic hand hygiene systems, and they perceived the systems as having a clear ability to change behaviour. The findings include acknowledging that individual integrity needs to be considered and that some hospitals might prefer to receive feedback on group level rather than on an individual level. 

Another study in the American Journal of Infection Control finds that hand hygiene levels of doctors and nurses can be significantly improved with light-guided nudging and data-driven performance feedback using an automated hand hygiene system as an effective auxiliary tool. Automated systems are fast becoming a preferred measurement tool, ensuring that the IPC teams can focus their time for more complex cases. Once considered the highest technical system, video monitoring found issues with limited implementation possibilities due to privacy, which the automated systems can now circumvent through anonymous reporting making them superior. 

As technology advances, both the measures to protect privacy and the accomplishment of their goals will increase support for the healthcare need. 

Societies approach to hygiene reform 

Outside of healthcare organizations, 2020 saw a shift in public understanding, awareness, and approach to hygiene. As healthcare workers, we know the importance of hand hygiene in preventing HAIs, but the public, seemingly, is still learning. 

“Even Denmark’s finest virologist says that the ten top causes of spreading the virus are sitting on your two hands, because of your ten fingers,” shared Else Smith while discussing how revolutionary transformation in healthcare takes time on the popular Hygiene and infection prevention podcast. 

If we apply the perceptions of risking privacy and fear of regulation to general society and the case of the Coronavirus, we seem to have a lot of common parallels. There seems to be growing societal displeasure across regulatory environments and control strategies. Acceptance, not excitement about access to new hand washing and sanitizing areas in our communities has led to conversations with researchers and healthcare professionals about the future of hygiene practices and the retention of new best practices. One of the best practices to approaching this, lies in education. 

More joyful education in hand hygiene, especially to men and young adults is needed 

study published in June of 2020 of 4,817 adults in the United States found that 85% of them engaged in either handwashing or using hand sanitizer after contact with high-touch public surfaces and that male and of younger age reported less frequent handwashing and hand sanitizing. he authors explored how hygiene-related prevention behaviors aligned with risk perceptions in infection prevention. 

The researchers of the study suggest that  to motivate hand hygiene behavior, health promotion messaging could focus on addressing risk perceptions of COVID-19, which might have shared benefits to promote engagement in additional COVID-19 prevention measures. Finally, increasing visibility and accessibility of handwashing and hand sanitizing signage and materials in public settings could encourage and facilitate hand hygiene to prevent the spread of COVID-19.”

Hand hygiene in healthcare settings 

With the World Health Organization (WHO) stating that 1 in 10 patients get an infection while receiving healthcare, and more during surgical practices, it is crucial that medical practitioners most importantly, and the general public alike, know the importance of Hand Hygiene as a top strategy alongside these other key hygienic practices. While improvement systems are rooted in anonymity, their technologies should be embraced as a tool to help personal improvement, then as a monitoring tool with repercussions. If all of us hygienically improved our day-to-day behaviors, we would have less infections, less sick leave, and a generally better quality of life. 

Hans Jørn Kolmos, professor of clinical microbiology at the University of Southern Denmark, discussed hygienic cleaning in healthcare saying “The crucial thing for the quality of the cleaning is that you have a well-trained staff. The notion that you can take people in from the street and clean hygienically is completely wrong. You can only clean if you have a proper education. Over time, I have been concerned about whether the staff is well trained. It is both about cleaning technique, but it is also about some insight into basic hygiene. It is a problem that you focus on cleaning aesthetically instead of hygienically clean, where you, among other things interrupt transmission routes. Staff should be trained to remove infection instead of just making it look nice. And it is also an educational issue. ” Hans shares more on this topic in the popular podcast on why in healthcare, first, we do no harm

Another consideration about hand hygiene is to make education and the practice of hand hygiene joyful. In 2020 Apple added a function to its devices that counted or provided a song for hand washing situations. Their Apple iWatch provides timely alerts for hand hygiene- 

Education, digitization, and adoption of innovation are all tools that we should consider for the betterment of healthcare and society upon entering 2021. As the coronavirus begins to be vaccinated against, we should take the lessons learned from these trying times and apply them to our larger fights against HAIs into the future.

If you are curious to know more about infection prevention and how to avoid spread of pathogens, do not hesitate to contact the Sani nudge team.

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