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Enforcing hand hygiene in the ED: Expert tips

Emergency Management Alert, December 12, 2006

Why won't your employees follow proper hand hygiene procedures? You've tried everything from pleading to cajoling to scolding to joking to get them to wash hands more often. You've threatened to report them-in some cases, have reported them-to administration. You've hosted the last refresher course in the topic you care to host. Still, no improvement.

A few ideas came from the HCPro's December 8 audioconference, "Emerging Diseases in the ED: Strategies for Infection Control Professionals," featuring speakers Douglas Salvador, MD, MPH, and Libby Chinnes, RN, BSN, CIC. The pair suggests the following:

• Observation: Salvador: "The places that are having success outside the ED are using observation. They're taking some measure of whether folks are using their hands or not. They're using surreptitious observation, they're employng sampling, they're feeding back data [to HCWs] in a positive way." If people know that they're being watched, they'll respond better, he says.
• Use of stories: Chinnes and Salvador agree that if an HCW is told a story that has meaning for him or her, preferably a story that could highlight consequences of not washing, employees will listen. Salvador: "Use real-life stories. 'Mr So-and-So came to our hospital for this procedure; he wasn't known to have an infectious organism and he develed ESBL bacteremia. We don't know where he got it, but somewhere it was passed on to HCWs." The hint would be taken, agreed Chinnes.
• Offer of help from the infection control department: Chinnes: An ICP should go to the ER and let staff there know that they can "rapidly become the ED's resource person on infection control and prevention." The idea, she says, is to help the ED see the infection control department as a partner in care. "We can take literature, use different teaching tools [and] remind them, when we're going to do some of the triage training on IC disease," etc. Bring the ED into the process.
• Promise of penalty: Chinnes and Salvador mentioned that in some cases, the hospital would have to make it very clear that they were willing to follow up on threats of penalizing those who did not follow proper hand hygiene procedures.

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