Clinical placements

Good hand hygiene is essential to safe patient care

Observing poor hand hygiene among staff inspired nursing student Shan Moses to step in and introduce new measures to improve patient safety. 

Observing poor hand hygiene among staff inspired nursing student Shan Moses to step in and introduce new measures to improve patient safety


An observation during a ward round helped to influence
staff hand hygiene practice. Picture: iStock

During a second-year placement on a 25-bed medical ward, I attended a ward round with a medical consultant and his team, to observe how they assessed patients and decided on a care plan. The team was made up of seven staff members, including four junior doctors. They saw about 13 patients on our ward before heading to other wards. 

I noticed on several occasions that the medical team did not wash their hands or use alcohol-based hand rub after touching a patient or the surrounding area. 

On average, 4% of patients in Wales pick up a healthcare-associated infection during a hospital stay. Cross-transmission of micro-organisms from healthcare workers’ hands is largely to blame.  

Motivated by support

As a nursing student, I felt nervous highlighting poor hand hygiene to experienced doctors. But when I attended another ward round, I put an alcohol-based hand rub dispenser on the patient notes trolley just as the medical team arrived and asked the doctors to decontaminate their hands. 

I began with the most senior team member, the consultant, reminding him of the importance of good hand hygiene. If I noticed any of the medical team not washing their hands or using the rub, I asked them to decontaminate their hands. I had to remind junior doctors to wash their hands or use the rub three times, but as soon as they realised the consultant was, they followed my instructions. 

I was apprehensive about the response from the doctors and thought they might be patronising or dismissive. To my surprise, the consultant praised my knowledge and congratulated me for highlighting the importance of cross-contamination. This motivated me to carry on, and I always take the opportunity to remind patients and staff of the importance of good hand hygiene. 

Noticing my enthusiasm, the ward sister asked me to carry out weekly hand hygiene audits once I had completed my six-week placement. Audits were already being undertaken monthly, but I carried out weekly spot checks and observed different staff groups, such as ward managers, nursing students, physiotherapists, healthcare support workers and medics. The results were put up on the ward for staff and the public to see. 

Simple step

The different staff groups became competitive, and the audit results showed an improvement in hand hygiene, with a noticeable difference among the doctors. Hand rub on the patients’ notes trolley also became the norm.  

What started as a simple observation on a ward round ended up making a difference to staff hand hygiene practice and, as a result, patient care. I was pleased with the outcome and grateful for the support from ward staff. 

This experience showed how a simple step, such as placing hand rub on a notes trolley, can make a real difference. It also highlighted the importance of not being afraid to intervene.

As a result, I am determined to carry on raising the profile of infection prevention and patient safety throughout my nursing career. 


About the author

Shan Moses is a third-year adult nursing student at Swansea University

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