New mothers were dying of sepsis. The year was 1847 and Ignaz Semmelweis, a physician in Vienna, observed that women examined by medical students during childbirth were much more likely to die than those attended by midwife trainees. Noting that the student physicians also performed autopsies and that their hands carried an odor, Semmelweis concluded that they were spreading disease from cadavers. After he introduced the practice of regular hand washing, mortality from puerperal fever sank from 18% to 2.4%.
Today we know that hand decontamination is the number-one way to stop the spread of infection. According to the Centers for Disease Control and Prevention (CDC), nurses lather up more than other health care workers, but all of us wash less than recommended because the practice is time-consuming and inconvenient.
The latest CDC guidelines, issued late in 2002, should lower those barriers to compliance by encouraging you to use an alcohol-based rub rather than soap and water when your hands aren't visibly dirty. The good news is that hand rubs save you a lot of "sink" time-which, by some reports, can amount to 100 washes a day. By using hand rubs, you could gain up to 1 hour per shift. Better adherence by all health care workers will reduce infection, protect patients, and cut costs-and the rubs are easier on the skin than repeated contact with soap and water. (For more on the guidelines, see Combating Infection on page 17.)
But a facility can't just slap up hand-rub dispensers and expect good results. Before choosing a product, employers should ask you to test various types and invite your feedback to encourage use by all the staff. The products should please the senses without drying the skin. Besides rating hand-cleaning products, speak up about where to place them-in wall dispensers near patient beds, for example.
As leading hand washers and patient advocates, we nurses need to be good role models and help move the standard forward. Help shape a culture in your facility that demands optimal practices. For example, ask the staff to come up with reminders, such as catchy slogans, to prod colleagues who forget to clean their hands between patients. Teach your patients about hygiene practices and set a good example for them too. Carry hand-rub packages in a pocket so they can catch you "in the act."
Don't be shy about creating a culture that adheres to the new standards in your unit. Change may take a bit of policing, but preventing just one infection is well worth the effort.
Cheryl L. Mee