Hand Hygiene Compliance

Bacteria are found on everything we touch-a fact that, unfortunately, is forgotten far too often because we can’t see them. So, what would happen if people were shown magnified images of the actual bacteria they encounter on a daily basis?

This is exactly what infection prevention and control specialists Ashley Gregory and Eman Chami did in a study at Henry Ford Hospital in Detroit. Like many hospitals across the country, Henry Ford incorporates hand hygiene as a routine, daily practice and uses continuing education to remind healthcare workers of the importance of cleansing their hands both before and after interacting with patients.Hand Hygiene

“Hand hygiene is important because it is the simplest thing that can be done to help prevent infection,” Gregory said. “It’s something that we all do within our every day, but I don’t think people realize the complexity of it in healthcare. Therefore, it lends itself to increased infection rates within hospitals and can also lend itself to bringing home illnesses that workers might not realize they’ve been carrying on them.”

The ‘Yuck Factor’
For this study, Gregory and Chami wanted to determine whether or not bacteria’s “yuck factor” would influence hand hygiene compliance in four units with low hand hygiene compliance rates. Having a background working in a microbiology lab, Gregory has seen firsthand people’s reactions upon witnessing what bacteria actually looks like up close. “I knew that would often bring up a feeling of disgust, so I thought that would be a good place to start,” Gregory explained.

A Picture is Worth a Thousand Words
Using an adenosine triphosphate (AT) meter, Gregory and Chami swabbed surfaces that are frequently touched by healthcare workers-such as mouse pads, doorknobs, keyboards, and other people’s hands. They then cultured the bacteria and compiled 12 magnified images of the bacterial contamination into a booklet. “They gross you out,” Chami said of the images in a June 9 Henry Ford Health System press release. “They really magnify what people can’t see.”1

Between July and September 2015, Gregory and Chami visited each of the four units 10 times. During each visit, they showed healthcare workers the images to illustrate what the bacteria would look like under a microscope. After seeing the images, several healthcare workers with higher readings of bacterial contamination on their hands were willing to have the AT reading done again after they had washed their hands. This gave the infection prevention team a tangible way to show how hand hygiene helps decrease the amount of bacteria on their hands.

Positive Results
Compliance rates were tested at the mid-point of the study and a second time once all the visits had been completed-and it turns out the “yuck factor” is quite effective. For each of the four units, compliance rates increased 22.9%, 36%, 142% and 37.6%, respectively-improving on average by nearly 24%. Both Gregory and Chami were surprised at the results. “We were expecting a small increase, but we weren’t expecting the extent to which we received the increased hand hygiene rates,” explained Gregory.

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“Bacteria are gross-looking, and I think people constantly hear, ‘Oh, you have to wash your hands from contamination, there could be bacteria on them,’ and it’s all fine when you say it, but until you put a face to it, people don’t realize what you’re talking about,” Gregory said. “I think giving the face to the contamination really helped to increase hand hygiene.”

A New Tool for the Hand Hygiene Toolkit
“The impact of the study is that it gives a new tool for our hospital and other hospitals to use to increase hand hygiene compliance and awareness,” Gregory said. According to Gregory, this method hasn’t been utilized before, but she believes the approach might become implemented throughout other hospitals. In fact, Henry Ford has already received several requests from hospitals across the world for copies of the booklet.

The study was presented at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) in Charlotte, N.C. “Hand hygiene is one of the most important ways to prevent the spread of infection, and yet it can be one of the most difficult benchmarks to improve,” stated APIC 2016 President Susan Dolan, RN, MS, CIC, hospital epidemiologist, Children’s Hospital Colorado in an APIC June 9 press release. “The visual nature of this approach proved successful for the team at Henry Ford Health System, and it may offer an effective strategy for other healthcare facilities that are looking for ways to change behavior and improve hand hygiene compliance.”2

Kirsten Malenke is a staff writer at ADVANCE. Contact: [email protected].


1. Henry Ford Health System. Yuck Factor May Boost Hand Hygiene Compliance. http://www.henryford.com/body.cfm?id=46335&action=detail&ref=2420

2. Association for Professionals in Infection Control and Epidemiology. Seeing is believing: Visual triggers increase hand hygiene compliance. http://www.apic.org/For-Media/News-Releases/Article?id=cfd082bd-7164-4f7c-ada7-6a6572885015


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