Handwashing: what nurses can learn from coronavirus

It’s not just hand hygiene technique that matters, human factors play a role in compliance too

Picture: Barney Newman

A recent comment on Twitter about an RCNi Learning module on good hand hygiene asked why it has taken the COVID-19 pandemic to remind us to wash our hands properly.

In truth, the pandemic simply refocuses us and reminds us of the key role effective hand hygiene plays in infection prevention and control.

Why handwash for at least 20 seconds?

Compliance with hand hygiene protocols has always been a challenge, with research in this area growing significantly in the past few decades.

The optimal duration of handwashing is hard to pin down, as there have been minimal studies into the impact of different timings.

But adopting best practice by using a structured approach to technique – which can take a couple of rounds of ‘Happy Birthday’ or a minimum of 20 seconds of washing – enables us to focus on areas most commonly missed, such as the fingertips, wrists, thumbs and backs of hands.

It is important to remember that other causes of infection will not have gone on holiday – even if they could get a flight.

Visibly soiled hands need to be washed with soap and running water, never in a bowl of water, with the same approach adopted when caring for patients with vomiting or diarrhoea, regardless of whether you have worn gloves.

Remember that spores such as C. Difficile happily resist alcohol hand rub.

‘Other causes of infection will not have gone on holiday – even if they could get a flight’

One of my favourite articles on hand hygiene is by Heather Gluyas, associate professor at Murdoch University in Western Australia. It explores compliance from a human factors perspective, examining the relationship and interaction between how people think (cognitive processes) and act, the environment they are working in and the tools they use.

A human factors perspective is underpinned by the fact that most nurses want to do a good job, and a simple punitive approach is not the way forward or productive in increasing hand hygiene compliance. 

The human factors that drive non-compliance on hand hygiene 

What are some of the human factors that may hinder us from being able to decontaminate our hands effectively, beyond knowledge and technique? The issue of evaluating risk, for example, is an interesting one in these challenging times. 

Heather Gluyas says we tend to
evaluate the likelihood, rather than the
consequences, of poor outcomes

Professor Gluyas argues that in life and in practice we tend to evaluate the likelihood of poor outcomes occurring, rather than the consequences of a poor outcome.

Examples include choosing to cross the road against the traffic signal or exceeding the speed limit when driving. Most of the time these don’t result in negative outcomes, such as being hit by a car or having a collision.

When this reasoning is applied to hand hygiene, the likelihood of a patient developing a healthcare-associated infection from not following the required protocols may be perceived as low.

COVID-19 crisis brings a heightened awareness of consequences

In a time-pressured, under-resourced healthcare environment, this risk-thinking approach is perhaps understandable, if not excusable.

But heightened awareness of the consequences of coronavirus infections, notably in vulnerable groups, may help change this way of thinking.

Teasing apart human factors can help us strengthen our handwashing compliance, hopefully for the long-term. There is much we can learn in a crisis.

View our COVID-19 resources

Dr Richard Hatchett is senior nurse editor at RCNi, a registered nurse and former principal lecturer