Nurses — The closest thing to a silver bullet in boosting hand hygiene compliance

If there is one group of clinicians that is particularly pivotal to the success of any quality improvement initiatives — including though regarding hand hygiene compliance — it's the nurses who work on the front lines of patient care.

Involving nurses has been a core tenant of the hand hygiene efforts at Mayo Clinic Florida in Jacksonville for years. Based on internal hand hygiene audits at the institution, compliance tends to hover between 95 and 100 percent, according to Deb Harrison, DNP, RN, who has served as CNO of Mayo Clinic Florida for nearly a decade.

According to Dr. Harrison, nurses are critical because they tend to be patient advocates; they are expected to engage and empower patients to speak up on their own behalf, while also stepping up and enforcing hand hygiene measures with colleagues from all levels of the hospital hierarchy.

"Nurses play a huge role because they are the ones working at the point of care and they are the watchdogs of patients," says Dr. Harrison. "Getting nurses to take responsibility for hand hygiene compliance means creating buy-in, so that should be the goal of any hospital."

Encouraging nurses to empower patients

​To engrain hand hygiene compliance into the hospital's culture, Mayo Clinic Florida has several initiatives in place to help nurses make patients feel confident improving hand hygiene themselves and among the medical staff.

For instance, the hospital nurses ask patients to conduct hand hygiene audits by filling out questionnaires regarding the compliance of their care providers. The data from the surveys is reported on a quarterly basis.

When the nurses provide the patients with the audits, they frequently explain to them what to look for and how to speak up for themselves if they notice an incident of noncompliance.

The hospital also began stocking hand hygiene wipes in patient rooms, so nurses can show patients where they (and their visitors) can wash their hands.

Supporting nurses to speak up to other clinicians

To help nurses feel more comfortable preventing incidences of noncompliance in someone higher on the chain of command, Mayo Clinic Florida coached nurses as part of its "Commitment to Safety" program.

Part of the program involved cultivating a sense of duty in nurses to advocate for patients, even if that means preventing hand hygiene breaches among higher-ups.

To make confronting a colleague or superior easier on nurses, Mayo Clinic Florida provided the workers with a phrase they can use — "I need a little clarity" — that all parties understand to more or less mean "Stop what you are doing, you've missed an important infection prevention step," according to Dr. Harrison. The phrase also helps nurse avoid a confrontation in front of patients.

That said, some nurses feel so comfortable that they don't even feel the need to use the agreed-upon code — something Dr. Harrison experienced firsthand.

"I was so pleased a couple of weeks ago, when I was going to visit a patient in protective isolation and asked a couple of nurses about what protective personal equipment I needed and they said, 'None, but you need to do your hand hygiene,'" she says. "I thought it was great that the nurses had no problem speaking up to the CNO."

Hand hygiene improvement initiatives are bound to vary from hospital to hospital, based on each institution's needs and resources. Nevertheless, every organization should consider taking a page from Mayo Clinic Florida's book and be sure to involve their nurses in the process.

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