A 4-Step Plan to Preventing Sepsis with Proper Hand Hygiene
By Rosie Lyles, MD, MHA, MSc, FACA | May 3, 2018
There’s a concerted effort to raise awareness of sepsis. It affects more than 26 million people and is documented as the largest killer of children.¹ We are now at one year since the World Health Assembly adopted a resolution to improve the prevention, diagnosis and treatment of sepsis. At the heart of this resolution is hand hygiene. This year, there are five calls to action related to hand hygiene.
While hundreds of facilities have made the commitment to the World Health Organization (WHO) campaign, we can’t just look over posters and slogans touting awareness. We need real action.
1. Be Proactive with Touch
We have to be proactive on a daily basis. We don’t touch patients with our elbows and no one has ever heard of elbows transmitting deadly pathogens from patient to patient. As healthcare professionals, besides verbal communication, every action is conducted with our hands. It starts with handshakes as a means of introduction, and transitions into entering clinical information in the electronic medical record (EMR), listening to a patient’s heart with a stethoscope, feeling a patient’s pulse with our fingers, drawing blood for laboratory tests, inserting medical devices and changing wound dressings to surgical procedures. Our hands which start the process of medical treatment can inevitably have an effect on the patient’s outcome. Yet, we are only reminded of the importance of hand washing during seasonal outbreaks, like the flu and an awareness day, week or month. In order to improve, we have to commit to thinking of our actions every day, all day.
2. Create Culture Change
I can recall an event at a long-term acute care hospital in Cook County, Ill., during my time as a physician and clinical investigator for the CDC Prevention and Intervention Epicenter Program. We were collecting clinical specimen for a regional surveillance of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae, a group of emerging highly drug-resistant pathogens. A nurse was assisting me on a vented-patient who was in isolation. After I collected the specimen and said thank you to the nurse, I naturally walked away toward the door removing my isolation gown and gloves. That nurse politely said, “Doctor don’t forget to wash your hands.” I turned around with a surprised look on my face and thanked her for the reminder.
It was an act so small, but this facility had a culture that all nurses (CNAs, RNs, and PCTs) felt comfortable enough to speak up to anyone, even a doctor or supposed superior. This wasn’t the traditional infection preventionist enforcing the policy, it was the entire team. That’s awesome!
3. Recognize Antibiotic Resistance
It’s estimated at least two million people become infected with bacteria that are resistant to antibiotics each year in the U.S.² If your facility can recognize that emerging antibiotic resistance is a global threat, you’ve taken a full circle approach to the hand hygiene conversation. From that piece, your team will quickly recognize the impact of implementing and following proper hand hygiene practices consequently preventing the spread of deadly germs to patients. Medical journals, such as The Lancet, have touted the two go hand-in-hand. No pun intended. Proper hand hygiene can reduce the risk of healthcare provider colonization or infection caused by germs acquired from the patient.
4. Provide Various Hand Hygiene Products
Healthcare providers need to clean their hands as many as 100 times per 12-hour shift, depending on the number of patients and intensity of care. Per the CDC, studies show that some healthcare providers practice hand hygiene less than half of the times they should. Data and real-time feedback is essential to the conversation when determining hand hygiene compliance. To properly measure hand hygiene, every hospital is required to implement a program in accordance with the recommendations of either the CDC or the WHO and set goals for compliance improvement. Hospitals have different options to consider when monitoring compliance. So consider going beyond direct observations and measure the use of hand hygiene products like hand sanitizer because when soap and water aren’t readily available, an alcohol-based antiseptic should always be on standby. Studies have shown they can be very effective for rapidly destroying some pathogens.³
Ultimately our main goals are to: Protect yourself. Protect the patient. Push proper hand hygiene and reduce the number of sepsis cases in your facility.
We can help you with establishing hand hygiene techniques and providing products that reinforce protocols resources that promote a behavior change to reduce infections.
1. Sepsis Fact Sheet 2016. Sepsis Alliance. Accessed April 17, 2018.
2. Antibiotic Resistance Threats in the United States, 2013. https://www.cdc.gov/drugresistance/threat-report-2013/index.html. The Centers for Disease Control and Prevention. Accessed May, 1, 2018.
3. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 10. Alcohol-based antiseptics for hand disinfection and a comparison of their effectiveness with soaps. Journal of Food Protection. November 2010.
Rosie Lyles, MD, MHA, MSc, FACA
Director of Clinicial Affairs
Rosie Lyles, MD, MHA, MSc, FACA is the director of clinical affairs at Medline. She serves as the infectious disease expert and primary medical lead for numerous healthcare businesses, while developing complex clinical strategies and supporting the product life cycle to post market and clinical follow-up. With over a decade of experience investigating healthcare associated infections (HAIs) with a particular focus on hospital epidemiology and prevention of multidrug-resistant organisms (MDROs) infections across the continuum of care, Dr. Lyles has led breakthrough clinical research, changing national guidelines and recommendations that improved patient care and outcomes for the Centers of Disease Control and Prevention (CDC) and the Chicago Prevention and Intervention Epicenter with numerous authored peer-reviewed journal articles related to infectious disease epidemiology. She is an active member of the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). Dr. Lyles is a Board Member for the US Department of Veterans Affairs on the Health Services Research & Development Scientific Merit and for the White House Coronavirus (COVID-19) Commission for Safety and Quality for Nursing Homes, served as Medical Advisory Board for C. Diff Foundation, Co-Chairman of the Association for Health Care Environment (AHE) Industry Advisory Council, an Infectious Diseases Expert for the Florida Health Care Association, and participated in White House Forum on Antibiotic Stewardship (2015) for the National Action Plan for Combating Antibiotic-Resistant Bacteria.