The Hand Hygiene Problem

handwashing Hand hygiene as it is understood today requires three to 30 applications of hand rub per hour during patient care, which translates to one hand rub application up to every 2 minutes during intensive care activities.

The reality, however, is that unobserved healthcare workers perform very few hand hygiene actions during their work day. The magnitude of the task of fixing this substandard quality of care has challenged infection control professionals worldwide for many years.

Problem: “Hand hygiene? It’s not a problem here”

One of the biggest roadblocks to improving hand hygiene among healthcare workers is their unawareness of low compliance rates. This lack of awareness can stem from failure to monitor and share hand hygiene compliance rates with staff, or faulty monitoring methods. For example, direct observation in an intensive care unit at North Shore University Hospital in Manhasset, N.Y., showed an adherence rate of 60 percent. When the hospital used an objective monitoring system that provided constant observation and feedback, however, it found the rate to be less than 10 percent.

Even if staff are aware of low hand hygiene compliance rates, they may not feel an urgency to improve adherence because the consequences — infections or death — may not be obvious. “Unless someone dies, [they think] it’s not a problem.

Problem: “I don’t always have time to wash my hands”cdchand

Another common reason healthcare workers cite for low hand hygiene adherence is lack of time. “The problem is certainly not a lack of posters reminding staff to wash their hands. These signs (of varying cuteness or scariness) have been hanging in hospitals for decades. It’s time for hospitals to give up on that as a way of increasing hand hygiene. Staff know they should practice proper hand hygiene. [The issue is] lack of time. [There’s] too much waste in the process.

Problem: “There’s never any soap”

Even when healthcare workers are aware of hand hygiene compliance issues and have time to wash their hands, they may face a barrier of limited resources. If dispensers aren’t always filled with sanitizer and sinks aren’t located in convenient places, the best-intentioned workers will have difficulty complying with hand hygiene practices all the time..

Problem: “I didn’t know we had to wash our hands that way.”handwashing2

While most healthcare workers understand the importance of hand hygiene, they may not be aware of the correct techniques and times for washing hands.

The solution remains instilling behavioral change in health care workers, who don’t want to hurt patients, but are busy and multitasking. If hand hygiene practices are not ingrained and do not prompt an automatic reaction to reach for the hand sanitizer, they aren’t going to happen.

Some hospitals have experimented with positioning non-staff volunteers in healthcare settings to observe and report on hand hygiene compliance. They deliver their reports to clinicians and departmental and hospital leadership.

The difficulties with this technique, however, present barriers:

  • Observation is not conducted on a 24/7 basis, so noncompliance that may be rampant on an overnight shift, for example, or during particularly busy periods may remain undetected.
  • Distinction between compliance and non-compliance may be subjective on the part of the observers unless very specific criteria are set forth.
  • It is unlikely that all hospitals can be staffed with volunteers to carry out observations in every unit at every moment of the round-the-clock workday.
  • Volunteers may be reluctant to point out noncompliance among senior staff members and physicians.


How Sani-Track Can Help

SaniTrackFrontViewAThe patent-pending generic Sani-Track™ universal wall mount, accommodates all models of soap and sanitizer dispensers, with one of the lowest infrastructure/installation disruption room down time in the industry. Sani-Track™ can be easily implemented in any hospital, outpatient clinic, nursing home, dental office or other patient care environment.

Most hygiene verification products depend heavily on calling attention to noncompliance i.e. whether through blinking lights, beeps or vibrations. Sani-Track™ compels compliance through positive reinforcement, behavior modification, and creating healthcare worker efficiency. Sani-Track™ is designed to become a part of the daily activities of caregivers without causing a disruption in workflow or becoming a source of annoyance.

In developing the Sani-Track™ system we incorporated the following capabilities in order to address the budgeting and personnel realities of healthcare operations:

  • Use existing hand hygiene stations and dispenser wall mounts with minimal infrastructure disruption.
  • Designed to adapt to all makes and models of dispenser units.
  • Room install time is 20 – 45 minute installation per unit.
  • Wi-Fi and POE based for access over existing wireless network.
  • The system is internet assessable for service and support room by room if necessary.
  • Benign impact on daily operations.  No verbal prompts, buzzers, alcohol sensors or blinking badge lights.
  • Allows Infection Control department to deal with non-compliance in a private and professional manner, without any in-room disturbances involving the employee and/or patient.
  • The system is scalable into full employee/visitor access control security within hospitals.

The Sani-Track™ system can be implemented in any hospital, outpatient clinic, nursing home, dental office or other patient care environment. Sani-Track™ hardware and software is web based for HELP DESK support, and scalable/expandable enough to meet any number of future needs such as asset tracking, inventory control, temperature monitoring, patient monitoring, alert messaging, and soon to be mandated; visitor tracking and access control.

Hand Hygiene and Infection Control Techniques

Hand Hygiene for Health Care Workers – Germ Smart


Infection Control: Basic Infection Prevention Techniques


Hand Hygiene Save Lives



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