You can lead hands to water, but you can’t make them sink
Hand washing suffers in new, sink-laden hospital
Give health care workers a sink in every room in a brand spanking new hospital, and hand washing compliance is bound to . . . drop? That was the unfortunate finding of surprised epidemiologists who saw workers conditioned to wash in hallway sinks turn up their hands at sparkling new in-room access.
"It was surprising," says Mary Lankford, RN, BSN, infection control practitioner at Northwestern Memorial Hospital in Chicago. "Our study was different in that we built a whole new hospital. Previous studies have looked at two different existing units and sink-to-bed ratios. We had hoped for better hand washing, obviously."
In May 1999, patients at the hospital were moved from a facility with private and semi-private rooms having limited hall sinks to a newly constructed hospital with all private rooms and dedicated sinks. "Our units are set up with the hand-washing sinks right inside the room," she says. "You cannot miss the sink. It’s available, set up with soap, towels, and all of the equipment. It really was better in the new hospital."
To compare hand washing before and after the move to the new facility, Lankford and colleagues conducted an observational study. "We followed them literally into the rooms," she says. "If asked, we said we were looking at infection control measures."
During two separate six-month periods — before and after the transition to the new hospital — weekly observations were done in the medical and surgical intensive care units, hematology/ oncology, and solid organ transplant. Overall, the researchers observed 560 patient/worker interactions, which resulted in 729 hand-washing opportunities. Among those, 305 interactions were observed in the old hospital and 424 in the new hospital.1
"We looked at hand washing before and after," Lankford says. "Hand washing was expected, as well as glove use. These were all high-risk rooms. The hospital has a standard policy that, on entry, you wash your hands and put gloves on before you touch the patient."
Compliance with that policy was poor in both settings, with 12% of observed workers following it in the old hospital and only 6% in the new. Health care workers preferred to wash their hands after patient contact, with 53% doing so at the old hospital and 23% in the new.
"We gave this information to the [unit] managers, and the plan is for us to go back and do an intervention," she says. "One of the things we are going to be looking at is involving these particular units with compliance. Previous studies show that if there is nursing administration support, then the compliance is better. We’re also looking at implementing alcohol[-based], sinkless, and waterless products."
Of interest, when more than one health care worker entered the room, they tended to mirror compliance or lack thereof. If one washed her hands, the other did, and vice versa, Lankford says. "When you move into a totally new facility, I think there is a relearning process," she says. "People had been in this [old] hospital a long time and were used to washing their hands outside the room. We saw people that would get ready to go do something and realize outside of the room that they hadn’t washed. They would look for a place, but there are no sinks in the hallway in the new hospital."
Reference
1. Lankford, MG, Zembower RR, Trick WE. Impact of hospital design on hand washing compliance among health care workers. Abstract 18. Infectious Disease Society of America. New Orleans; Sept 7-10, 2000.
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