Can I Ask You a Favor? Wash Your Hands!
“Can I ask you a favor? Would you please wash your hands?” It does not sound like a question that would insight irritation, annoyance or even anger, but I have found this question can unnerve even the most professional health care provider.
Recently I have had to get blood tests taken myself and also took my mom for blood tests. Each time I have found something very important missing. The clinicians who are piercing our skin, drawing our blood and bandaging our wound are not washing their hands before they put their gloves on to treat patients. The Center for Disease Control (CDC) states that wearing gloves does not take the place of washing your hands. This can put EVERYONE including the patient and the clinician at risk for diseases including HIV, AIDS, Hepatitis and many other diseases. This is especially true those who are immunocompromised or have conditions like my mother.
Statistics on hand hygiene really are not on the patient’s or clinician’s side. A variety of studies that were put together for the World Health Organization (WHO) and The CDC show that the current rate of hand washing compliance in the medical setting is 40 percent. None of the healthcare professionals I encountered during my personal experiences during the past month complied with the basic need to wash your hands before you touch a patient. They gave me excuses from “I am wearing gloves” to “I washed my hands after the last patient” and my favorite “this only takes a minute to do this procedure”. It is important for every clinician to wash their hands before and after every patient and anytime there is debris on the hands.
All phlebotomist are trained on the concepts of hand hygiene before they are certified. WHO Guidelines for phlebotomy called Best practices in phlebotomy states that you must practice hand hygiene:
1 • Before patient contact. Before touching a patient, when approaching him/her
2• Before an aseptic task. Immediately before any aseptic task.
3 • After body fluid exposure risk. Immediately after an exposure risk to body
fluid and after glove removal.
4 • After patient contact. After touching a patient and her/his immediate
surroundings, when leaving the patient’s side.
5 • After contact with patient surroundings. After touching any object or furniture in the patient’s immediate surroundings (even if the patient has not been touched).
Hand Sanitizers can be used if water is not available or is there is no debris present (this very seldom occurs). It is that simple yet it is not happening. In my cases there was no hand sanitizer or hand washing done.
There is an interesting study on hand hygiene with health care providers and what motivates change. Health care providers may think they are washing their hands just to keep themselves safe. Many of the campaigns focus on keeping staff safe. “There’s this perception among some health care providers that ‘I’m around sick people all the time and I don’t get sick very often, so my immune system is extra strong,’” shared David Hofmann, an author of a study on hand hygiene compliance. http://pss.sagepub.com/content/early/2011/11/10/0956797611419172.abstract“But if you go back to the Hippocratic Oath that all doctors adhere to, it’s ‘First do no harm’. So if you have a sign that says ‘Hey, look, here’s a really vulnerable person you’re about to walk in and see,’ then maybe a sign focused on that person will cue this larger core value in the physician to protect the patient.”
This is such an important point and can make such a huge difference! In the study Hofmann conducted, researchers put up posters in healthcare setting that had messages focused on the benefits hand washing has on the patient rather than on the clinician. The patient-centric posters that focused on keeping the patient safe had a 33% higher increase in soap consumption compared to the clinician-focused signs.
One thing is known for sure, when hand hygiene goes up in the medical setting the rate of infection goes down in patients. That is what I want for my family. So you may wonder what I am going to do from now on? How am I going to get people to wash their hands and not insight riots in the medical setting?
Yesterday when I took my mom into the lab for a blood draw, as I sat down in the chair, I said out loud in front of the clinician, “mom, sit back and relax a minute, with what you have going on health-wise I know the clinician will want to wash her hands to keep you safe and it will take a minute or 2.” The clinician put down her gloves she was donning and went and washed her hands. Sometimes it is not what we say it is how we say it. Keeping everyone safe in the medical environment means sometimes we remind everyone of the importance of hand hygiene.
The plot thickens:
I thought about this situation a lot over the past few days. Not everyone has a daughter to advocate for them. Not everyone knows that phlebotomists are required to wash their hands before and after patients and any time there is debris present. This bothered me so much that I felt a need to do something about it. I called the Labs person in charge several times and never received a reply. I decided because of repeated experience this lapse in infection control this needed to come to the attention of someone that can do something about it.
I called my local health department and they referred to their Environmental Health Division. This department was very concerned, but let me know that they had no jurisdiction or program that oversees area. They referred me to the California Department of Public Health- Clinical Laboratory Field Service. I spoke to them and they shared that I could file a complaint but that they did not have the staff to really investigate complaints like this that involve the consumer and not the staff in the lab. I asked who oversees these dangerous situations. It was explained that the owner of the business was to assign someone within the company. The fox is not overseeing the hen house very well and the system needs to be revamped. I am so concerned for the millions of people in my community and state that are going into labs. There is no checks or balances to make sure they are safe in the area of infection control. We all need to ask our health care providers to wash their hands and to comply with basic infection control.