Increasing handwashing in healthcare workers [June 2001; 88-8]

Increasing handwashing in healthcare workers
Review Results Comment

Washing hands to reduce hospital acquired infection ( Bandolier 73 ) is an important topic examined before ( Bandolier 67 , 82 ). Just to remind ourselves, in the UK hospital acquired infection costs about £1 billion a year, affects 1 patient in 10 in hospital, is responsible for the deaths of many more people than are road accidents, and use the resources of about 27 400-bed hospitals. And that's just the broad picture. At the margins, the effects on healthcare under pressure, as during Winter crises, the effects are much more than these stark assessments.

There's precious little around on handwashing that is easy to find, so when a systematic review about how to increase handwashing in healthcare workers [1] hoves into view it deserves some attention.

Review

The search was through, using four databases, searching the Internet, examining reference lists and attempting to identify unpublished work. Any study that aimed to promote handwashing in healthcare workers as a hospital infection control measure was included. Nearly 3000 citations were identified and examined.

Results

There were 21 studies fulfilling the inclusion criteria. Seventeen were uncontrolled studies and only two were randomised studies. Almost all (20/21) used observation to assess compliance with handwashing.

Handwashing - main themes

Multifaceted approaches combining education, written material, reminders and continued feedback have the most marked and durable effect (see Bandolier 82 ).
One-off educational approaches have a short term effect on handwashing behaviour, and the effect is not large.
Strategically placed reminders have a modest but more sustained effect.
Performance feedback can positively influence handwashing behaviour. Feedback must be repeated if the effect is to be maintained.
Automated sinks can be beneficial, but the additional time involved may deter use.
Moisturised soaps make little difference, but dry hand rubs near patients can give a small increased in frequency of decontamination.

The results of the studies are summarised in the box. Clearly it is the multifaceted approach that does best, as the recent example from Geneva ( Bandolier 82 , not included in this review) showed.

Comment

It is remarkable, given the importance of hospital acquired infection, that more attention has not been given to studies of hand decontamination, so that we know what to do for the best to minimise this important problem. This review is an excellent start for those wanting to reduce our (and their) ignorance. None mentions water at over 60°C without mixer taps, or any other positive barriers to handwashing.

In decent studies ( Bandolier 67 , 82 ) good handwashing initiatives can cut hospital acquired infections by about half. That is a big effect in a big problem. This review will benefit all those in secondary (and primary) care who want to deliver a safer and better service.

References:

S Naikoba, A Hayward. The effectiveness of interventions aimed at increasing handwashing in healthcare workers - a systematic review. Journal of Hospital Infection 2001 47: 173-180.

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