Ebola, Other Hospital-Acquired Infections... and Handwashing

Improving hand hygiene helps kill many birds with one stone, from Ebola to MRSA, diarrhea, flu, and the common cold -- and it is everybody's business. For Global Handwashing Day 2014, what is your handwashing commitment?
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As hundreds of millions of people around the world celebrate Global Handwashing Day on Oct. 15, the focus on promoting handwashing comes at a pertinent time for health services. The Ebola outbreak has compelled health facilities around the world to assess their infection control readiness. In the hopefully unlikely event that Ebola virus were to turn up at our local hospital or clinic, would we be prepared? Or would Ebola become the latest hospital-associated infection (HAI)?

The answer is complex -- but part of it lies in handwashing. Ebola virus is certainly not the first organism to present the risk of cross-transmission between patients on the hands of health care workers and carers. It is not the first organism that is highly infectious, that can cause severe illness and death, that can be difficult to treat, and whose spread can be abated by meticulous hand hygiene. Health care facilities contend with these challenges every day. Research tells us over 7 percent of patients in high-income countries acquire an infection while in hospital. Vancomycin-resistant Enterococcus is one. Methicillin-resistant Staphylococcus aureus is another. While a lot of work is going into monitoring and improving rates of health care-associated infection, there is clearly still some way to go in stopping their spread in health care facilities -- and part of that lies in the hands of health care workers.

One of the bedrocks of every health care facility's infection control policy is handwashing. Florence Nightingale's observations are as pertinent today as ever: handwashing with soap (or using alcohol-based hand rub), is an extremely effective way of preventing the spread of infection in health care settings (and elsewhere). And yet research estimates global adherence to handwashing by health care workers to be around 40 percent.

Given the efforts of healthcare workers to improve their patients' health, why do many of us struggle to fully adhere to the World Health Organization's World Alliance for Patient Safety "Five Moments for Hand Hygiene" in health care (before patient contact, before sterile tasks, after body fluid exposure risks, after patient contact, and after contact with the patient's surroundings)? Amidst so many competing priorities, even when health workers know the rationale and protocols, have every intention of protecting their patients from harm, and aim to deliver high quality care, sometimes hand hygiene manages to get lost, particularly during long, intense work days. And this needs to change.

Global Handwashing Day is a great opportunity to remind ourselves that while we worry about the potential risk of Ebola journeying to a health care facility near us, all sorts of other infections have already long arrived, finding their way onto the hands of health care workers during the course of their work every day, threatening the health of hundreds of millions of people in the world, resulting in increased length of stay in hospital, complications, distress, and expense. We can do better.

Educating health care workers about the five moments for hand hygiene is extremely important, but so too is ensuring that we feel motivated, empowered, and supported to take the time to observe these moments. We need committed leaders, teachers, and role models to help embed the handwashing habit in the consciousness of all health care workers and validate the time and effort it takes. We also need ready access to soap and water and alcohol-based disinfectants to ensure we can clean our hands as often as necessary, and as efficiently as possible, as an important, observed component of regular infection control protocols. And we need breaks to combat the fatigue found to be associated with less-frequent handwashing.

Improving hand hygiene helps kill many birds with one stone, from Ebola to MRSA, diarrhea, flu, and the common cold -- and it is everybody's business. For Global Handwashing Day 2014, what is your handwashing commitment?

A version of this article was published in GovToday.