Readiness Rounds - Blog , Hand HygieneReadiness Rounds - Blog , Hand Hygienehttps://www.readinessrounds.com/blogs/hand-hygieneWed, 08 Apr 2026 01:50:22 -0700http://zoho.com/sites/<![CDATA[The Dirty Truth of Hand Hygiene]]>https://www.readinessrounds.com/blogs/post/the-dirty-truth-of-hand-hygieneWe know that pathogens causing Healthcare Associated Infections (HAIs) are most frequently spread between patients on the hands of healthcare workers]]>

Wthogens causing Healthcare Associated Infections (HAIs) are most frequently spread between patients on the hands of healthcare workers (HCWs). (1) 

One in 25 hospital patients will encounter a Healthcare Associated Infection and of those, 1 in 9 will die. This equates to approximately 200 preventable deaths per day in the United States' healthcare system. (2)

 

Hospital patients who acquire infections typically require lengthy inpatient stays, are more likely to be admitted to critical care units, are much more likely to be readmitted, and at an increased risk of death. (3)



The human cost alone should be reason enough for a swift call to action!

Who is paying for their treatment?

With multiple studies showing that US hospital healthcare workers perform hand hygiene less than 50% of the time when they should, what is the economic impact to hospitals? (4)

According to the CDC and the US Department of Health and Human Services’ estimates, preventable HAIs cost between $28 and $40 billion per year! (5)

With such significant human and economic loss at stake, why are we, as an industry, tolerating such lackadaisical adherence to a simple process as impactful as hand hygiene? 

We have all read numerous studies telling us that the problem is highly complex and takes a complicated multimodal approach to improve, but at the end of the day, this is a process that takes

less than 4% of our caregiving time, is convenient and easy to perform, and has measurable, significant positive impact on our patient outcomes. (6)

We've helped many clients greatly improve their HAIs and readmission rates by implementing more proactive tools to their hand hygiene program. Contact us here if you'd like to discuss similar tools for your facility.

]]>Mon, 21 Apr 2025 05:47:30 -0600<![CDATA[Are your manicured fingernails spreading infection?]]>https://www.readinessrounds.com/blogs/post/are-your-manicured-fingernails-spreading-infectionBy now, healthcare workers are keenly aware of the recommendations regarding use of traditional nail polish and artificial nails by healthcare workers ]]>

By now, healthcare workers are keenly aware of the recommendations regarding use of traditional nail polish and artificial nails by healthcare workers and workers who are employed in patient care areas. The evidence and guidelines support not wearing artificial nails and either not using nail polish or ensuring the polish is intact. Most hospitals have adopted policies to that effect.


With the newer gel polish products being widely available, many nurses utilize this longer lasting “polish” that stays intact for longer than traditional polish. But...is it safe?

The Association of Operating Room Nurses (AORN) recently made a position statement on the use of gel polish in operating rooms that asserts that gel polish not be worn in these areas. The rationale is that very few studies have been done and evidence doesn’t support its safe use. {1} The Association for Professionals in Infection Control and Epidemiology (APIC) endorses this statement. {2}


The World Health Organization (WHO) states that HCWs who wear artificial nails are more likely to harbor Gram-negative pathogens on their fingertips than those who have natural nails, both before and after hand washing or hand rub with an alcohol-based gel. Additionally, the WHO recommends that HCWs do not wear artificial fingernails or extenders when having direct contact with patients and that natural nails should be kept short. {3}

The CDC concurs with the WHO and recommends keeping natural nails short: less than ¼-inch long. {4} The Society for Healthcare Epidemiology of America (SHEA) & Infectious Diseases Society of America (IDSA) state that, based on a lack of evidence on gel nails specifically, a conservative approach (treating them as artificial nails) should be considered. If this is the case, then at the very least, gel nails should not be worn in high infection-risk areas. {5}

Based on evidence and recommendations, some hospitals are going to a “clean, short, natural nails” policy for all patient care area workers. Given the lack of hospital hand hygiene adherence (as low as 40-50%) {6}, the increased risk of artificial and chipped nail polish harboring bacteria, and the high potential for hospital acquired infection, this stringent approach to nail grooming may be impactful in reducing potential of spreading infection.

Credits:

1:  http://www.aorn.org/guidelines/clinical-resources/clinical-faqs/hand-antisepsis-hygiene#gelshellac (link no longer available)


2. http://www.apic.org/Professional-Practice/Practice-Resources


3: http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf


4. http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf


5.  Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., & ... Yokoe, D. S. (2014). Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infection Control & Hospital Epidemiology, 35(8), 937-960. doi:10.1086/677145 http://www.jstor.org/stable/10.1086/677145


6:  Improving Hand Hygiene at Eight Hospitals in the United States by Targeting Specific Causes of Noncompliance. (2015). The Joint Commission Journal on Quality and Patient Safety, 41(1), 4-12. Retrieved August 7, 2015, from https://pubmed.ncbi.nlm.nih.gov/25976719/

]]>Thu, 17 Apr 2025 03:20:52 -0600<![CDATA[4 Most Important Improvements to Your Hand Hygiene Program]]>https://www.readinessrounds.com/blogs/post/hand-hygiene-improvement-solutionsWhat are the 4 things hospitals can implement to improve their hand hygiene?]]>

Is your hospital’s hand hygiene program just going through the motions?


…Or does it provide “on the spot" correction and education?

According to an article recently published by The Joint Commission, lack of “just in time” correction and education is one of the top contributing factors to healthcare workers (HCWs) not performing hand hygiene. (2)


Though it has shown significant positive impact on HCWs, “on the spot” interventions are missing from many hospital hygiene programs. (4)


So why is it that hospitals choose not to implement this method as part of their programs?


Some of these reasons include:

  • Lack of available staff
  • Perception of lack of resources
  • Staff reluctancy to scrutinize and correct peers or supervisors
  • A hospital culture that does not permit peer correction - seeing it as punitive rather than a collaborative effort to improve safety

If hand washing is the most immediate way to prevent the spread of hospital associated infection (3) and lack of “on the spot” coaching is one of the top reasons why healthcare workers do not wash hands (2), doesn’t it make sense to give “real time” coaching serious consideration?

Readiness Rounds' Hand Hygiene electronic rounding solution allows you to perform hand hygiene checklists quickly and accurately.

Sources

(1) Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., & ... Yokoe, D. S. (2014). Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infection Control & Hospital Epidemiology, 35(8), 937-960. doi:10.1086/677145 http://www.jstor.org/stable/10.1086/677145

(2) Improving Hand Hygiene at Eight Hospitals in the United States by Targeting Specific Causes of Noncompliance. (2015). The Joint Commission Journal on Quality and Patient Safety, 41(1), 4-12. Retrieved August 7, 2015, from https://pubmed.ncbi.nlm.nih.gov/25976719/

(3) Mathai, E., Allegranzi, B., Seto, W., Chraïti, M., Sax, H., Larson, E., & Pittet, D. (2010). Educating healthcare workers to optimal hand hygiene practices: addressing the need. Infection, 38(5), 349-356. doi:10.1007/s15010-010-0047-7

(4) Lowry, F. (2015, July 2). On-the-Spot Intervention Improves Hand-Hygiene Practices. Retrieved August 9, 2015, from http://www.medscape.com/viewarticle/847425

]]>Mon, 07 Apr 2025 04:05:00 -0600<![CDATA[Hand Hygiene - Patients Should Not Have to Remind Us to Wash Our Hands]]>https://www.readinessrounds.com/blogs/post/hand-hygiene-patientsHand Hygiene - Should Patients be Reminding us to Wash our Hands]]>

As part of strategies to improve hand hygiene compliance and create a culture of safety, hospitals are asking patients to remind their caregivers to wash their hands or to rewash them within view.

Is this the right thing for our patients?

This puts many patients in awkward positions as patients are often in states of vulnerability and don’t want to do anything to negatively impact the caregiver/patient relationship. Patients are no more comfortable today challenging caregiver hand washing than they were 10 years ago and a recent survey revealed that only 2/3 of patients said they would be comfortable reminding a healthcare worker to wash their hands. (1)

When asked, caregivers say they are trained to not take this type of questioning personally, but I have seen the opposite be true on more than one occasion. When polled, less than 1/3 of nurses and physicians preferred that patients remind them to wash their hands, citing among other things that it damages the healthcare worker-patient relationship. (2) For example, it’s possible and even likely that the caregiver applied hand sanitizer before entering the room but since the patient didn’t see it, the caregiver is asked to repeat it. The caregiver feels like the patient doesn’t trust him or her and the patient feels like the caregiver doesn’t care enough to comply. This is a big blow to patient satisfaction & experience.

Also, if the caregiver bristles when asked to comply, the patient feels even more awkward. Recently someone told me that although they were “appalled” at the seeming lack of hand hygiene during a recent trip to the hospital to visit a loved one, they didn’t want to say anything because they didn’t want their loved one to be afraid. After all, the loved one was already sick and in the hospital!

As healthcare providers, we need to change our attitudes. We are all acutely aware of the stats that say we as a whole only comply with hospital hand hygiene guidelines half of the time. We know this is not acceptable, yet we can’t seem to comply. What’s worse is that we cop an attitude when we are reminded.

The Cost of Hand Hygiene

Also, what about the general premise of putting the responsibility for caregiver negligence onto the patient? Of course, patients need to take a collaborative role in their own healthcare and safety; but, as a paid hospital employee, isn’t it on us to adhere to the guidelines to keep ourselves and our patients safe?

We've helped many clients greatly improve their HAIs, readmission rates and patient safety by implementing more proactive tools to their hand hygiene program. Contact us here if you'd like to discuss similar tools for your facility.
]]>Sat, 05 Apr 2025 03:49:00 -0600<![CDATA[Hand Hygiene Compliance Improvement]]>https://www.readinessrounds.com/blogs/post/hand-hygiene-compliance-improvementCareful hand hygiene seems like common sense in healthcare settings, yet the high rates of hospital-acquired infections are still high.]]>

According to the CDC, every year about two million patients get hospital-related infections. An incredible 90,000 of those patients die from the infection. One of the easiest, most obvious standard precautions against hospital-acquired infections is for health care providers and visitors to wash their hands. 


Careful hand washing hygiene seems like common sense. Yet the high rates of hospital-acquired infections suggest that hand-washing hygiene remains an area of concern for many health care facilities.

Many factors contribute to the ongoing problem of hand hygiene


1) Convenience, for example, plays a big role. In some instances, health care providers do not have a nearby place to wash their hands after each patient contact. Given the choice of going out of their way and adding non-productive minutes to the duration of each patient contact, providers may elect not to wash their hands between patients. 

2) Lack of knowledge about what types of hand hygiene are appropriate in various situations may also play a role. For example, visitors may not know that washing with plain, non-antimicrobial soap may not remove infectious agents from their hands. Visitors and care providers alike may be unaware that they should clean their hands not only after touching the patient, but also after touching objects in the patient care area. Some health care workers may not realize they need to wash their hands after removing gloves.

3) Perhaps the biggest challenge is training both health care providers and visitors about proper hand hygiene technique. Do they know how to rub their hands properly and for how long? How many people use their bare hands to turn off the tap after washing with antimicrobial soap, not realizing they’ve just recontaminated their fingers?

The CDC report cites three approaches to improving hand hygiene compliance: education, motivation, and system change.

3 approaches to hand hygiene compliance


1) While it is surprising that a simple activity like hand washing could require training, evidence clearly shows that health care providers who are trained in proper hand hygiene are more likely to clean their hands when necessary and are more likely to use proper techniques. By providing educational materials for both employees and visitors, hospitals may see “increased and sustained adherence to hand hygiene protocols” (Randle et al). In addition, when employees understand the rationale behind specific protocols, they are more likely to comply. Washing your hands after removing gloves may seem redundant until you realize that gloves may have holes too small to see through which contaminants may pass and that it is really quite easy to contaminate your hands inadvertently while removing gloves.

2) Motivation may take several forms. Workers who understand both the physical risks to themselves and patients, as well as the financial implications of hospital-acquired infections may be more inclined to follow protocols. Routine observation, coupled with a system of supportive feedback may increase compliance, as may reminders, such as checklist posters placed in key locations throughout the facility.

3) Systemic changes might include the promotion of a culture of safety overall in the hospital, installation of convenient hand rub dispensers or sinks, making available skin care products to alleviate irritation caused by frequent hand cleaning, a system of rewards for compliance, and ensuring adequate staffing so that workers do not feel so pressed for time that they are tempted to skip hand hygiene. (CDC Hand Hygiene)

Every institution is different, so each hospital must evaluate what combination of educational, motivational, and systemic change strategies will be most effective. Administrators must also be aware that any process improvement plan must be fluid and responsive to feedback from workers and to actual versus projected results.

We've help many clients greatly improve their HAIs and readmission rates by implementing more proactive tools to their hand hygiene program. Get a hold of us here if you'd like to discuss similar tools for your facility.

For more detailed information about indicators for poor hand hygiene and possible strategies to improve protocol compliance, please see the CDC charts appended below.


Sources


Centers for Disease Control. Guideline for hand hygiene in health-care settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Morbidity and Mortality Weekly Report. 25 Oct 2002. Available from cdc.gov.

Randle J, Arthur A, Vaughan N, Wharrad H, Windle R. An observational study of hand hygiene adherence following the introduction of an education intervention. doi:10.1177/1757177414531057

]]>Fri, 04 Apr 2025 23:09:00 -0600<![CDATA[The CDC & the WHO Take on Hand Hygiene... Who Wins?]]>https://www.readinessrounds.com/blogs/post/cdc-vs-who-hand-hygieneHand Hygiene - the 3 step method, or the 6 step method?]]>

Recently in Becker’s Hospital review, there was a great article explaining that the verdict “was in” regarding whether the WHO’s (World Health Organization) 6-step or the CDC’s (Center for Disease Control) 3-step hand washing technique was better at removing bacteria. (2)

Becker’s cites the study done by the Society for Healthcare Epidemiology of America and published in SHEA online April 8, 2016. The study looked at 42 physicians and 78 nurses completing hand hygiene using an alcohol-based hand rub after delivering patient care and determined that the WHO’s six-step technique was better at reducing the median bacterial count from 3.28 to 2.58 versus 3.08 to 2.88 with the CDC’s 3-step technique. (1)


As I read this, I think some of the points of the article need clarified.


First, this is one study in one hospital with statistically few participants. I think we would all agree that this is interesting data, but more studies would be needed to confirm the validity of these results, overall.


Second, although Becker’s response is titled “hand washing,” it is actually not looking at hand washing, by definition, but looking at hand hygiene using sanitizer. This is important to note because both the CDC and WHO say that actually washing hands removes the MOST bacteria over hand hygiene with hand sanitizer.

Finally, the Becker’s review of the study notes that, “incidentally,” the 6-step process was complied with less (meaning the HCWs did not follow all the steps properly). I would contend that, this is one of the overwhelming issues facilities have with hand hygiene in general. It’s nice that the 6-step process removed more bacteria, but if HCWs aren’t complying with the technique, how beneficial is it? (2)

The incidental “compliance with technique” piece of the study brings the question: "how can we improve compliance with hand hygiene technique?"

 

Here are a few suggestions:

  • Training: Ensure HCWs not only attend regular, ongoing training, but that they demonstrate the technique.
  • Culture of accountability: I can remind you, you can remind me and we still like each other because we know it’s best for our health and our patients' health.
  • Personalizing the HAIs: These are people – daughters, fathers, brothers, mothers, etc. The patients are living, breathing humans not just a number of incidences of “infections.”
  • Use real time coaching and education while collecting data: Secret shopper techniques collect data but they allow HCWs to potentially spread infection because the “oopses” aren’t corrected before they cause potential harm to the patient.
  • Sharing the ongoing data trends: Is what we are doing working? If yes, keep reminding, educating, etc. If no, what do we need to change??

 

What is your hospital doing to ensure compliance with hand hygiene technique? Readiness Rounds offers a robust Hand Hygiene checklist, contact us for a free sample.

]]>Thu, 03 Apr 2025 01:35:00 -0600<![CDATA[NOROVIRUS - The Gift No One Wants!]]>https://www.readinessrounds.com/blogs/post/norovirus-the-gift-no-one-wantsThis is the time of year when it seems that everyone is sick, some with cold and flu, but many with gastrointestinal illnesses.]]>

Not As Funny In Real Life


This is the time of year when it seems that everyone is sick, some with cold and flu, but many with gastrointestinal illnesses. These are the types of diseases that are spread from person-to-person via the dreaded fecal-oral route (YUCK) and require actual hand WASHING with soap and water to best prevent the spread of infection.

Soooooo, ever see hand sanitizer in a public restroom????

To illustrate a point, do you remember the movie “Stand By Me” in which the main character, Will Wheaton tells a story about a “complete and total barforama” during which “girlfriends barfed on boyfriends, kids barfed on their parents, moms barfed on dads”, etc.? (1)

Recently watching this again and laughing, I was reminded of a time when I got to witness a “complete and total barforama” first hand, and it wasn’t so funny.


A few years ago, I had the privilege of chaperoning a high school band field trip. On our last night, all 150 or so of us ate dinner then boarded the four busses to make the 24-hour trip home.


Unfortunately, it was only a couple of hours before several of the students and some of the parents were stricken with stomach cramps, vomiting, and diarrhea.


As the night and next morning unfolded, seemingly half of the people on the trip were violently writhing, puking, and pooping.

This continued to the point that we stopped at a small community hospital in Pennsylvania and were treated somewhat like a mass casualty!


Almost a third of the trip participants were admitted to the ER and given IV fluids and/or antiemetics.

After a six-hour delay, the hospital sent us home armed with sublingual zofran to be given hourly at the first sign of vomiting, and a large stack of basins in case the zofran didn’t work.


The local big-box store donated Gatorade, and we were finally on our way, still ill, but at least making progress toward home.

You have probably already guessed that the diagnosis was norovirus, picked up somewhere during the trip and easily spread based on the close quarters in the hotel and bus.


Assumedly, a food preparer at one of the restaurants we visited along the way was sick and didn’t wash hands properly and— BANG!—just like that, the trip crumbled into insidious illness that wreaked (and reeked) havoc on the ride home.


After this experience, I began to notice the large number of public restrooms that had hand sanitizer hanging on the walls, including restrooms in hospitals.

Although continual improvements to hand sanitizer effectiveness are being made, the current CDC recommendations are clear about what constitutes acceptable hand hygiene: sanitizer vs. actual hand washing.

The CDC asserts that soap and water are more effective at

removing/inactivating germs such as Cryptosporidium (2), norovirus (3), and Clostridium difficile (4), (to name a few) all of which are spread via the fecal-oral route necessitating that individuals WASH hands after using the restroom.

The CDC does say that if soap and water aren’t available, hand sanitizer is the

next best thing. Which leaves me to ponder, in the icon of hand sanitizer bottle with a red cross through the middlecase of public restrooms, especially those in hospitals, aren’t we giving healthcare workers, patients, and visitors misinformation by even having hand sanitizer available inside the restroom?

It’s not that all cases of norovirus will cause the proverbial “complete and total barforama,” but don’t we want to protect our patients and ourselves from even a SINGLE horrible episode? 

Shouldn’t we keep the hand sanitizer OUT of the bathrooms so that staff and visitors remember to WASH their hands after using the restroom?


References:
  1. Reiner, R. (Director). (1986). Stand by Me [Motion picture]. United States: Columbia Pictures
  2. http://www.cdc.gov/parasites/crypto/index.html
  3. http://www.cdc.gov/norovirus/index.html
  4. http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html

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