World Hand Hygiene Day 5.5.2021 
Improve hygiene at the Point-of-Care

The saying "Out of sight, out of mind" is far more than a truism. The realization that absence leads to forgetfulness can certainly lead to important problem solutions. In infection prevention, for example, to better hand hygiene in patient care.

Hygienic hand disinfection is intended to ensure that no pathogens are transmitted in infection-critical situations. A high risk exists during patient care, at the so-called point-of-care. And it is precisely at this point that the WHO wants to increase patient safety with its campaign for International Hand Hygiene Day on 5.5.2021
 

Definition of Point-of-Care (POC)

The point-of-care (POC) defines the place where three elements come together in healthcare: The patient, the staff member, and the care or treatment [2]. The point-of-care is where most of the indications for hand disinfection occur: The 5 moments of hand hygiene - including the moment of aseptic activities, which is particularly critical for patient safety.
 

Hand hygiene before aseptic activities 

A long-term study in German hospitals with more than 3000 wards shows that compliance with hand hygiene is often low or difficult to increase, especially at moment 2 - before aseptic activities [3]. According to current reference data of Clean Hands Save Lives, compliance before aseptic activities is the worst among all 5 indications for hand disinfection.

The 5 moments: 

• Before patient contact
• After contact with infectious material
• After patient contact
• After leaving the direct patient environment
   

While during these 5 moments compliance rates of 70 % and higher are achieved, hand disinfection prior to infection-critical moments such as the placement and manipulation of accesses, dressing changes, ventilation and the administration of intravenous drugs is not given the importance it should have, at just over 60 %.
 

Hygiene-Tipps for the Point-of-Care

Although increasing hand hygiene compliance is by no means trivial, simple improvements can achieve success at the Point-of-Care:

• Increase visibility
  A lot does not necessary help a lot: hand disinfectant dispensers that are always in view of the staff during treatment increase the willingness to disinfect hands more than simply increasing the number of dispensers [5].
   
• Ensure availability
  Hand disinfectants should be available wherever patients are cared for. Minimum requirement in the patient room: one dispenser per bed in the ICU, one dispenser per two beds in normal wards. 25% of ICUs and 40% of General  Wards have a backlog demand in this area [2, 6]. Providing staff with gown bottles can increase compliance at the POC.
   
• Allow easy access
  No long distances and no short ones either: the hand disinfectant should be just an arm's length away from where the patient is being treated [2].

What could optimal dispenser placement look like, for example, in Operating Theaters, the Central Emergency Room, Intensive Care Units and General wards? Dr. Schumacher's graphic checklists provide suggestions.
 

References:

1.    World Hand Hygiene Day 2021. Seconds save lives – clean your hands! https://www.who.int/campaigns/world-hand-hygiene-day/2021. Letzter Zugriff 30.04.2021.
2.    World Health Organization & WHO Patient Safety. (2009). WHO guidelines on
hand hygiene in health care.
3.    Kramer T S et al. (2020). Journal of Hospital Infection; 106 (1): 71-75
4.    Aktion Saubere Hände. Institut für Hygiene und Umweltmedizin Charité Universitätsmedizin Berlin. Compliance Beobachtungen – Referenzdaten (2020). Berechnungszeitraum: Januar 2019 bis Dezember 2019. 
5.    Thomas BW et al. (2009). JAOA; 109 (5): 263-267
6.    Azim S et al. (2016). American Journal of Infection Control; 44 (7):772-776