As the threat of COVID-19 becomes less heavily felt, how can levels of hand hygiene compliance be maintained? Health Europa put the question to Linda Dickey, president of the Association for Professionals in Infection Control and Epidemiology (APIC).
The integral role of hand hygiene has arguably never been so widely acknowledged as it has been in recent years. As we grapple with global public health threats including COVID-19 and antimicrobial resistance, we have seen just how easily insufficient hand hygiene promotes the transmission of infective diseases. Acknowledging and implementing proven hand-hygiene procedures, particularly in clinical settings, is vitally important to reducing the spread of infections, but as we emerge from the pandemic, there is concern that compliance rates may drop. Reflecting on some of the most effective strategies to support hand-hygiene compliance, Linda Dickey, president of the Association for Professionals in Infection Control and Epidemiology (APIC) tells Health Europa why maintaining and building upon an infrastructure that makes hand sanitisation simple is key to protecting both healthcare systems and wider society.
What is the role of the Association for Professionals in Infection Control and Epidemiology within the wider care landscape?
APIC members are by and large infection preventionists. We have a lot of other disciplines and partners that are within APIC, but our collective aim is to prevent infection. We are predominantly focused on the healthcare setting but have a lot of public health partners and as such our remit covers general public health settings, too. In the context of the pandemic, we have obviously all been partnered very closely to not only look at the pandemic response within healthcare but in the broader community setting as well.
How important is hand hygiene as a measure to prevent the transmission of infection? Has the COVID-19 pandemic had a significant impact on public awareness of handwashing as a means of preventing infection?
Hand hygiene is the number-one way that we can prevent the transmission of infection. Around an illness that is primarily droplet spread, our hands are going to be our biggest risk if they have something on them, particularly something wet, and then we touch our nose, mouth, or eyes. We remain very focused on hand hygiene, even with something that is droplet spread, but it is a very difficult behaviour to keep sustained.
At the beginning of the pandemic, there was a lot of focus on hand hygiene, particularly in terms of individual actions people can take like carrying hand sanitiser with them wherever they went. There is more infrastructure out there now in terms of the provision of hand sanitising products and places where you can get hand gel, but in terms of people continuing that behaviour and being as focused on it, I would venture to say it will probably wane. It is just one of those things that when you equate the behaviour with safety, particularly personal safety, the compliance is going to go up but when that equation is not as acute, it will wane. Those of us who are focused on infection prevention are constantly in a position of having to reinforce and try to increase hand hygiene compliance.
There is a risk that as we enter a post-pandemic era people may become complacent about hand hygiene and compliance rates could drop? How could this be averted?
Continuing any kind of public messages that remind people how fundamental hand hygiene is and making it easy for people to clean their hands is important. We need to continue to build that infrastructure in our societies to make it easy for people to sanitise their hands, for instance when attending large events or entering shopping centres. Anything that we can do to make hand hygiene part of our daily life will help reduce the risk of infection; it is just fundamental to reducing the spread of infectious diseases.
What are the key factors affecting low levels of hand hygiene compliance in clinical settings?
It is multifactorial; sometimes we just forget because we have other things on our minds. Operational factors can affect levels of hand-hygiene compliance, for instance, if the sanitising product is not easily seen, or the dispenser has become empty, and sometimes we simply need reminders. Reinforcing those behaviours that make hand hygiene more of an automated action, for instance sanitising your hands whenever you enter a building, is really beneficial.
There are a lot of facilities that try to build their policies and practices around, and drive something that will be very automated so that employees do not even think about it, it is just something they know to do.
During the pandemic, were there any particular methods of communication to encourage hand hygiene that you felt were more effective for both clinical staff and people entering clinical settings?
Although we use signage, the most effective thing, which is hard to do but is truly the most effective, is person-to-person communication. So, if someone actually sees another person miss an opportunity to sanitise their hands they speak up. The other really effective thing and something that we have seen published, is leading by example; when you see your colleague, particularly a colleague that you respect or report to do a certain behaviour, you are more likely to follow suit.
Building a culture where we feel comfortable speaking up and setting an example for one another are the two strongest things that we can do. It is true outside of healthcare as well, if a child sees a parent cleaning their hands and that expectation is set, then a child is more likely to develop that habit. It is no different in healthcare where we set a culture where a patient could speak up and not feel intimidated about speaking up if they see that we miss an opportunity to clean our hands. If they ask care providers to sanitise their hands before a check-up, we need to say absolutely, we appreciate the reminder.
The one thing that has been a huge help in hand hygiene is waterless hand products such as alcohol-based hand gels. These innovations have made hand hygiene practices so much easier and mark a huge step in the right direction to making hand hygiene practices more effective and easier for people to perform.
Association for Professionals in Infection Control and Epidemiology (APIC)
This article is from issue 21 of Health Europa Quarterly. Click here to get your free subscription today.