The general public has never been more aware of handwashing, thanks to the COVID pandemic. We all got a glimpse into the world of the healthcare worker as we washed our hands or used hand sanitizer every time we left a store or got home. Healthcare workers live this life daily, with protocols set to remind them to take every handwashing opportunity in an effort to protect patients (and themselves) from disease. In today's post, we will explore how the pandemic impacted hand washing, called hand hygiene, during the pandemic and beyond. Did the pandemic increase or decrease hand hygiene?
In a recent study from Denmark, researchers compared healthcare worker (HCW) hand hygiene before and during the COVID pandemic. They predicted that HCW would engage in more hand hygiene opportunities in order to help protect themselves and their patients from the novel coronavirus. In reality, hand hygiene compliance went down overall, except in the departments facing active COVID cases. The researchers propose that hand hygiene rates improved "with a fear of acquiring infection (self-protection) and with risk to take the infection home to one's family." This finding is supported by similar research.
In another study using data from 9 US hospitals, results were similar. Hand hygiene compliance was relatively high in the 10 weeks leading up to the first COVID school closings, and sustained high levels during the first months of the shutdown. In total, the study captured over 35 million hand hygiene opportunities via an automated monitoring system. While HCWs "reached higher than typical levels during the initial period of pandemic-related hospital and public health prevention measures" the results indicate that it is "difficult to sustain improvements in hand hygiene performance." The study concludes that the decrease in workload during these first months of the pandemic (due to the cancellation of elective surgery and the overall decrease in medical emergencies due to lockdowns) resulted in more time to take advantage of those opportunities to wash hands. As with the study from Denmark, these researchers also saw "heightened perception of risk to healthcare workers themselves and their families."
As possible further support for the theory behind self-protection and hand hygiene compliance, a study demonstrated that HCW hand hygiene on room entry decreased, while increasing on room exit. The authors concluded that "HCWs modified their behaviors to face the risk propensity of the pandemic," that is, they increased their compliance when they believed their personal risk to be greater.
What can we do about this well-supported theory of hand hygiene compliance and perception of personal risk? The last study we will cover in this post compared two possible approaches to improving hand hygiene. One approach, "nudges," are "subtle interventions that alter the decision environment, aimed to help individuals make better decisions" in environments where there are time constraints. The other approach studied was "boosts," which "aim to improve the decision process of the individual," that is, helping the individual make better choices by improving their competence. The researchers found that both are effective methods of improving hand hygiene, but that "boosting" remained effective for a week, even after the boost was removed. This means that sustained hand hygiene compliance depends on the individual getting an informational "boost" alongside reminders to "nudge" them in the right direction.
Hand hygiene depends - and always will depend - on each individual's compliance. Until there is a hand sanitizers that remains on HCWs hands and actively and continuously kills pathogens throughout the day, we have to rely on interventions that support hand hygiene. Since there is a material that continues to kill pathogens through the day - copper alloys and copper-infused polymers - we should take steps to make sure that these preventive biocidal surfaces get installed in all medical facilities. We ask a lot of healthcare workers under difficult conditions such as severe time constraints, heavy workload, and understaffed facilities. One of the infection prevention measures that fail under these conditions is hand hygiene. Having a biocidal material on bed rails, overbed tables, and workstations reduces the available bioburden, thereby reducing the risk that a dangerous pathogen will be picked up by a HCWs hand and transmitted to a vulnerable patient. These surfaces provide a necessary safety net that protects patients regardless of hand hygiene compliance.