Prevention agenda in hospitals and healthcare

The need for hand hygiene and prevention is universal all around the world. Even patients in the most high-tech hospitals are at risk from infections while receiving healthcare. Illnesses caused by healthcare-associated infections (HAIs) result in illnesses and long-term health impacts for hundreds of millions of patients around the world.11 They occur in all countries but are several times higher in low and middle-income countries than in high-income ones.

According to the WHO12, HAIs are directly attributable to 99,000 deaths annually in the US and 37,000 deaths in Europe. In high-income countries, 30% of intensive care unit patients are affected by at least one HAI.

In England, HAIs are estimated to annually cost the National Health Service (NHS) around GBP 2.7 billion by taking up 7.1 million bed days each year.13 To put this into perspective, HAIs bears about the same cost to the NHS as smoking. Furthermore, the number of beds HAIs take up equates to 21% of NHS bed capacity, which is equivalent to 38 average size hospitals in the UK.14

What is a healthcare-associated infection?

Healthcare-associated infection (HAI), also referred to as ‘nosocomial’ or ‘hospital’ infection, is an infection occurring in a patient during the process of care in a hospital or other healthcare facility that was not present or incubating at the time of admission. Patients may also be infected in nursing homes, elderly facilities or doctor’s offices.

Hand hygiene is the first line of defense

“Hand hygiene is the patient’s first line of defense because if we can prevent bacteria getting into the patient’s body in the first place, then we don’t need to deal with infections,” explains Dinah Gould, Professor of Nursing at London City University. “It is also affordable compared with other interventions and it is something that anyone can do.”

On the World Hand Hygiene Day in 2020, the WHO designated 2020 as the “Year of the Nurse and Midwife”. The importance of hand hygiene for nurses, midwives, as well as all front-line healthcare staff is an integrated part of their everyday work. However, studies have shown that healthcare professionals non-compliance with hand hygiene routines is a major problem in a hospital setting, often due to stressful situations or lack of hand sanitizer products nearby.

Help is available to empower and support healthcare staff. Actionable recommendations and guidelines can contribute to elevating overall hygiene, such as toolkits that include proper handwashing, hand sanitizing procedures and downloadable instructions.15

“Hand hygiene is the patient’s first line of defense to prevent bacteria getting into the patient’s body in the first place.”

Dinah Gould, Professor of Nursing at London City University

Dinah Gould

Dinah is Professor of Nursing at London City University, London, UK. She has specialized in the role of hand hygiene in preventing infections since the 1980s. Her work has been important in raising the profile of hand hygiene as an essential solution to prevent infections – both in the UK and beyond.

Studies show that manual observations of hospital hand hygiene behavior can serve as a physical reminder and educational opportunity, but the fact that people tend to change their behavior when being observed makes it difficult to draw conclusions on hand washing compliance from manual observation.16

Following routines is key

Knowledge, training and culture are key to improving hand hygiene routines in a hospital environment. As in other areas of society, digital solutions can play an important role. More specifically, electronic monitoring systems (EMS) are one potential solution that can help provide more accurate monitoring of hospital hand hygiene practices.

Dinah Gould supported Essity with the development of the Tork Hand Hygiene Compliance Monitoring System and their observational studies at a hospital in UK. This involved advising on how the system should work and helping to define compliant and non-compliant hand hygiene events to ensure the right things are done by healthcare professionals at the right time.

Studies have shown that electronic monitoring systems can provide healthcare professionals with more accurate data that can be presented to staff in real time to help with awareness and improve hand hygiene compliance.

Hands with soap (photo)

Tork Hand Hygiene Compliance Monitoring System

Essity, together with studies and learnings from an acute medical ward in a NHS trust in London, UK and Sahlgrenska University Hospital in Sweden, has tested and developed the automatic hand hygiene monitoring system (Tork Hand Hygiene Compliance Monitoring System). The system measures individual hand hygiene compliance automatically, objectively and continuously in clinical practice in one ward. The measured results have been fed back to the nurses in real-time, both individually and as a team. The preliminary results from Sahlgrenska University Hospital in Sweden show that the compliance at the ward has more than doubled. This is a significant achievement of the ward and a strong indication that the Tork Hand Hygiene Compliance Monitoring System can inspire a ward to more than double their compliance rate.

The entire care environment matters

Methods and techniques to reduce the spread of viruses and infection in hospitals and long-term care facilities do not just apply to healthcare professionals. Both patients and visitors are also important, along with cleaning staff that have a special role to play.

“It’s not only about everyone working conscientiously with hand hygiene, the entire hospital environment needs to be clean too,” says Gould. “Hospital cleaning staff play an essential role in infection control by keeping surfaces clean and following stringent routines, and we have seen issues arise when cleaning contractors do not adequately train their staff.”

It is well known that implementing infrastructure or solutions without proper training and information can jeopardize investments. A hand hygiene compliance system takes this one step further by reassuring the return on investment. Moreover, it helps and empowers staff in their everyday efforts to advance care and secure a safe hospital and long-term care environment, both for patients and visitors, as well as cleaning and healthcare staff.

“I think hygiene will become an even more important part of the solution in the future,” concludes Gould. “With COVID-19, we have recently seen that people are very interested in how the virus spreads, and people are much more aware of their own hand hygiene as a result of this – both in hospitals and in everyday life.”

Hospitals should provide a safe and hygienic environment both for receivers and givers of care. Even before the world was hit by the COVID-19 pandemic, 57% of people were worried about getting sick from hospitals according to the Essity survey. These are global issues close to people’s hearts and it is time to accelerate action. There are opportunities to promote more hygiene prevention measures and empower healthcare professionals – all in order to improve healthcare outcomes and save lives.

11 WHO. Health care-associated infections FACT SHEET. Visit source

12 Ibid.

13 Guest JF, Keating T, Gould D, et al; Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England; BMJ Open 2020;10:e033367. doi: 10.1136/bmjopen-2019- 033367 // Visit source

14 Ibid.

15 For example: WHO Guidelines on Hand Hygiene in Health Care: a Summary Visit source and The Safe at Work COVID-10 Healthcare Toolkit Visit source

16 The so-called Hawthorne effect is explained in several articles, such as: Guest JF, Keating T, Gould D, et al. Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England; BMJ Open 2020;10:e033367. doi: 10.1136/bmjopen-2019-033367 // Visit source