Hand Washing: the first line of defence

Each year it is estimated that 300,000 patients (one in 16) acquire a healthcare‑associated infection (HCAI) while being cared for with the NHS in England. Each one of these infections means additional use of NHS resources, greater patient discomfort and a decrease in patient safety.
It is widely recognised within the NHS that hand hygiene is one of the most important factors in the fight against HCAIs. The promotion of good hand hygiene practice has been the subject of various campaigns over the years, in particular the Department of Health’s Clean Your Hands Campaign, which had a significant impact on the healthcare environment. Since 2006 there has been an 18-fold reduction in MRSA (methicillin-resistant Staphylococcus aureus) bloodstream infections and a 5-fold reduction in Clostridium difficile infections.

Hand washing plays a vital role in hand hygiene and alcohol rubs make it easier for healthcare staff to clean their hand quickly when they aren’t able to wash them. A recent British Medical Journal report found that antibacterial hand gel use rocketed by 300 per cent during the Department of Health campaign which led to the introduction of alcohol gel dispensers by patients beds, together with posters reminding staff about hand washing and hygiene compliance checks.
Procurement data from 116 trusts were collected and the results found that increased use of soap significantly contributed to the reduction of Clostridium difficile infection throughout the study and alcohol hand gel had a positive impact on MRSA prevalence.

Framework agreement
The availability of soaps, moisturisers, alcohol based hand rubs and alcohol free products is vital to support trusts, clinicians, end users and the infection prevention and control team professionals. In October last year NHS Supply Chain aligned all their hand hygiene products under one single framework agreement. The range of products and the number of suppliers was extended offering trusts greater choice and significant savings opportunities on a number of product lines.
The specification and process for the tender were put together with input from the Infection Prevention Society and the Royal College of Nursing. Julie Storr, President of the infection Prevention Society (IPS) explains: “IPS supports the new Framework Agreement which constitutes an important component of a multimodal behaviour change improvement strategy.”
“We fully support the development of this framework,” says Rose Gallagher Nurse Adviser for Infection and Prevention Control at the Royal College of Nursing. “It supports healthcare organisations by providing a range of resources needed for staff to perform hand hygiene. We know how important quality products and choice are in enabling hand hygiene and this framework is a positive step forward in assisting this.”
A rigorous process of product evaluation into compliance with standards and toxicology was also carried out by the Health Infection Research Laboratory and the Health and Safety Executive Laboratory.
Nicholas Hutton, Senior Buyer – Healthcare Acquired Infection Control at NHS Supply Chain says: “This contract will make it even easier for NHS trusts to order hand hygiene products, to make savings and will support them in their aim to meet hand hygiene compliance targets. With approximately 250 product lines and three new suppliers on contract, we offer an extensive range of first-line defence products in the fight against infection.”

The range of products on NHS Supply Chain’s framework are available through dispensers, free standing bottles and tottles and are all aligned to trust hand washing and hygiene guidance procedures.
Most HCAIs are preventable through good hand hygiene, cleaning hands at the right times and in the right way, and there are a number of institutions working hard to get this message across. But is the hand hygiene message truly embedded in UK healthcare systems - or can we do better?
The recent launch of a new National Institute for Health and Care Excellence (NICE) quality standard for Infection Prevention and Control stresses the importance of simple steps such as hand washing to reduce infections. The quality standard which features six statements designed to drive improvements was welcomed by the Royal College of Nursing and the Infection Prevention Society.

“It is really positive that NICE have published a quality standard on Infection Control,” said Rose Gallagher from the RCN. “These aspirations will support organisations to go that little bit further in terms of stopping infection and ways of improving infection control.”
However Rose is concerned that the government had not made a commitment to evaluate this quality standard. “At the moment there is no formal mechanism to evaluate impact and inform future practice. It would be very helpful to both infection control specialists and staff working on wards to undertake this evaluation,” says Rose. “We still have a lot of work to do in terms of getting the evidence base much stronger and in terms of understanding why people don’t do things they should be doing,” she said.
Julie Storr, President of the Infection Prevention Society, said: “The NICE standard reinforces the need for action on healthcare associated infection. It is only one part of an overall approach to quality improvement. Constant vigilance is required if basic yet essential actions such as hand hygiene are to be integrated and embedded within care and treatment.”
Procuring hand hygiene products alone will not end the fight against HCAIs. But it is vital that we work with key stakeholders to convey the importance of hand hygiene and the NICE quality standard.

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