Healthcare Hygiene magazine January 2024 January 2024 | Page 10

By Shanina C . Knighton , PhD , RN , CIC

For decades now , healthcare-associated infections ( HAIs ) continue to be an unyielding ongoing patient safety concern affecting millions of people and causing hundreds of thousands of deaths globally each year . The approach to preventing HAIs differs from most patient safety issues as it has many factors associated with infection prevention and control especially for multidrug-resistant organisms ( MDROs ), antibiotic-resistant organisms and viruses known as “ superbugs ” that are difficult to prevent and control .

Most innovative strategies to address HAIs focus specifically on antibiotic use , policy , hospital staff practices ( e . g ., not routinely cleaning hands ) and hospital environmental factors ( e . g ., lack of extensive cleaning between patients ). However , an important contributing factor to HAIs has received far less attention and study — the role of patients ’ hands as a source of pathogen transmission in healthcare settings . Uncontended , most would argue that hand hygiene is the single most important practice for anyone to prevent the spread of pathogens that lead to HAIs , however there is less agreement on normalizing patient hand hygiene in healthcare settings . Scientific discovery regarding patients ’ hand cleanliness and pathogen transmission is relatively new and emerging unlike decades of mounting evidence to support the healthcare worker transmission and hand hygiene .

Motivated from earlier science , healthcare staff hand hygiene has advanced immensely in the decades between the 1960s and the 1990s , confirming the carriage of pathogens on healthcare staff ’ s hands . Notably , in some of the same studies that recognized the carriage of pathogens on the hands of healthcare staff , results also showed that patients ’ hands and bodies also tested positive for pathogens ; furthermore , in some cases , patients were found to be the original carrier of these harmful organisms . 1-5

Patients can transfer pathogens to their environment and to healthcare staff , and cross-contaminate themselves as germs are not unidirectional . Therefore ,

they can be transferred in various ways . Documented evidence shows that patients carry one or more MRDOs on their hands , 6-9 proximal areas ( trunk ), and clothing 10 thus increasing the risk of contaminating their environment or cross-contaminating themselves . Once admitted to hospitals , patients are at risk of getting or spreading HAIs simply by inadvertently and unknowingly transmitting pathogens from their hands by making contact with their own devices ( some indwelling ), dressings , surgical wounds , healing and non-healing ulcerations , IV sites , and orifices , including their mouths through making contact with their food .

Furthermore , patients frequently interact with nurses , doctors , visitors , and other patients , which can also increase risks for getting an HAI . While randomized controlled trials that address decolonization and isolation efforts repeatedly and effectively decreased pathogen transmission outside of the patients ’ room and after patients are already infected , 11 evidence supports bidirectional relationships between patients ’ hand contamination and the contamination for high-touch environmental surfaces . 12-15

Surfaces and tools commonly used by staff and patients such as bedside tables , 12 , 16-17 bedrails , 18 medical devices , 12 or call lights contain MDROs . 10 , 16 Contamination of patients ’ personal belongings including cell phones 19 and clothing 10 also increases their risk of contact with MDROs . 20-21 Hence , strategies to prevent growth and colonization of MDROs are needed . Recommendations and conclusions of earlier studies have contended that healthcare staff should clean their hands , but for patients , it was only suggested that patients could be a source of transmission resulting in minimal recommendations for patients to have clean hands . 1 , 5 Accrediting bodies and governing entities acknowledge that patients should have an active role in their care to prevent HAIs ; however , patients ’ role in infection prevention is still passive . For example , patients are encouraged to ask healthcare staff to clean their hands before providing care , but rarely are educated on cleaning their own hands .

Patient hand hygiene as a quality improvement strategy can help prevent the transmission of pathogens that lead to HAIs while simultaneously promoting patient self-management and patient engagement . Furthermore , providing patients with the opportunity to clean their hands is an underutilized approach that can reduce patients ’ hand contamination that can lead to infection . For uncontaminated patients , patient hand hygiene can provide an additional layer of protection for them to prevent predisposition to colonization that leads to HAIs . As viral bacterial and fungal infections increase and we continue to face multi-viral seasons comprised of influenza , SARS-CoV2 , respiratory syncytial virus , pneumonia , and others it is timely to update the growing body of literature on the status of patient hand hygiene in hospitals , which can influence how we integrate or implement patient hand hygiene programs in acute-care settings and long-term care settings .

Shanina C . Knighton , PhD , RN , CIC , is a nurse-scientist , infection preventionist and an associate professor in the Schools of Nursing and adjunct in biomedical engineering at Case Western Reserve University . Knighton was the Inaugural executive director of APIC ’ s Center for Research Practice and Innovation where she championed their transformation to advance science and practice . She is known for being able to take infection prevention science and turn it into practical and equitable tools for improvement in various settings . During COVID-19 , she provided practical prevention tools and guidelines to community members , small businesses , community organizations and public officials including the state of Ohio , the American Nurses Association , the New York State Board of Education , and others . Her practical tips have appeared in media outlets including local news , Forbes , Fox News , Self magazine , and Modern Woman magazine . In 2022 she was recognized as a Case Western Reserve University Faculty Innovator .

10 • www . healthcarehygienemagazine . com • january 2024