Hand hygiene is considered one of the most effective ways of reducing healthcare-associated infections (Gould et al, 2017). Worldwide, thousands of people die every day from infections acquired while receiving healthcare, and as many as 1.4 million patients around the world develop a healthcare-associated infection each year. Many of these infections can be prevented by good hand hygiene (Luangasanatip et al, 2015). Hand hygiene can be performed either with soap and water or with alcohol hand rubs, which are now widely available in all healthcare settings (Royal College of Nursing (RCN), 2019). Hand hygiene should be performed at the five ‘moments’ identified by the World Health Organization (WHO) (2009a): before touching a patient, before clean or aseptic procedures, after body fluid exposure, after touching a patient and after touching patient surroundings. Alcohol hand rubs can be used but if your hands are visibly dirty, washing with soap and water is the preferred method (WHO, 2009a)
In my previous role as lead for infection prevention and control for maternity, I worked closely with NHS Trusts' infection prevention and control teams to increase the awareness of the importance of hand hygiene. I educated healthcare workers within the maternity services about effective hand hygiene. I completed audits, delivered training and shared best practice guidelines to improve the health of the patients we cared for. Understanding the importance of handwashing with soap or hand rubs is an effective and affordable way to prevent diseases and reduce healthcare-associated infections in all settings. Direct hand contact between patients and healthcare workers is known to be the primary cause of many healthcare-associated infections and healthcare workers miss opportunities on a regular basis to complete hand hygiene.
In 1847, an obstetrician named Semmelweis observed a higher rate of maternal mortality when women were cared for by doctors. He hypothesised that an increase in death rates was related to doctors not washing their hands effectively. This research had significant findings for healthcare workers because it showed a direct link between handwashing and a decline in infection rates (Best and Neuhauser, 2004). However, it was not until much later that the validity of Semmelweis's research was recognised. Even in today's healthcare settings, many healthcare workers are unaware of the importance of effective hand hygiene. The WHO (2009b) recognised that poor adherence to recommended hand hygiene measures during routine patient care is still an issue, with healthcare workers cleaning their hands less than half of the times they should. The WHO found that the higher the demand for hand hygiene (in areas such as intensive care), the lower the uptake and adherence to the recommendations, putting patients at risk.
There is an increasing demand on nurses and midwives to comply with new guidelines, updated policies and paperwork. Therefore, it is unsurprising that basic measures such as hand hygiene are often forgotten. However, when done properly, good hand hygiene can be one of the simplest and most effective ways to prevent transmission of bacteria and viruses, preventing healthcare-associated infections. Conversations around good handwashing practices with patients and their families is also important. Informing patients when and how to wash their hands will allow them to protect themselves at home and in healthcare settings and will let patients know that it is OK to ask about hand hygiene from those caring for them.
In 2011, the Centre for Maternal and Child Enquiries (CMACE) recognised that sepsis was a leading cause of maternal mortality for the first time (Cantwell et al, 2011). Sepsis should not be a leading cause of maternal mortality in the modern NHS, and it appears that the rate of sepsis-related deaths has decreased, through educating women about washing their hands before and after visiting the toilet, together with making women aware of the signs of sepsis (Cantwell et al, 2011). Globally, infections are still a leading cause of death in neonates and children under 5 years (Kuti et al, 2019). Direct patient contact and contamination from healthcare workers and family members is often a source of infection in the under-5s; education about effective hand-hygiene practices will reduce the incidence of infection and ultimately contribute to ending preventable deaths in this and other age groups, in line with the United Nations (2017) Sustainable Development Goals.
Regular and effective hand hygiene is the single most important thing you can do to protect yourself and others from infection. Healthcare workers play a central role in ensuring that the patients we care for are safe, and that all families have the information needed to prevent the risk of infection. Wash your hands and do not be afraid to ask others to wash their hands too. Together we can reduce the risk of infection and the spread of bacteria and viruses.