It seems common sense that anyone in the medical field would have good hand hygiene, both for their own well being and the patients they work with. Keeping your hands sanitized is the easiest way to prevent the spread of many common communicable diseases. However, there has actually been an increase in the amount of hand hygiene citations in nursing homes in recent years. Can the lack of proper sanitation be the cause for patients who have infection outbreaks?
Hand Hygiene Statistics
Medicare and Medicaid guidelines include hand hygiene (HH) expectations and are part of the criteria nursing homes are graded on when inspected. In between 2000-2002, the compliance rate for HH was 7.4%. In 2009 it had increased to almost 12%. This means that more than 1 out 10 inspections are finding substandard hand hygiene practices in these nursing homes. Keep in mind that the numbers are based on “observed” lack of HH, meaning even with inspectors watching, the staff did not wash their hands. It can only be assumed that these numbers are low in comparison to the actual compliance when no one is looking.
In a study published in the Journal of Applied Gerontology, that detailed the above statistics, there was a connection made between the lack of staffing and Medicare reimbursement and the HH violations. Overworked, under-trained staff may either not feel they have time to wash their hands as often as they should or are not properly trained to do so.
Infectious Disease Control
The Center of Disease Control is also concerned about the lack of HH in long term care (LTC) facilities and the medical industry in general. According to the CDC, they put lack of hand washing in the medical field at 50%, citing that the facilities more than the workers are to blame for this phenomenon. They point to several factors:
- Lack of convenient washing stations
- Insufficient staffing or overload of duties-CDC estimates 90% of LTC facilities are understaffed
- Empty soap, towels or hand sanitizer containers
- Lack of knowledge and training
- Institutions not making HH a priority
The CDC is specifically concerned about nursing homes and LTC facilities. According to their numbers, the rate of infections in particularly high among residents in these types of facilities, which they attribute in part to the lack of HH.
- Facilities report at least 1 infection per resident per year
- Infections are the leading cause of death in long term care patients
- Residents can have an average of up to 9.4 infections per 1000 days (that is about three per year)
These infections not only are costing the residents of nursing homes their health and their life, they cost billions of dollars in medical costs. It is estimated that $1.4 billion is spent each year in the U.S. on infection cost. Add to that fines and penalties paid by nursing homes for HH violations (about $1000 per violation and up to $10,000 a day), and it seems to make financial sense that nursing homes would make HH a high priority. If they wont comply with HH regulations just to reduce infections and increase the health of their patients, maybe they will if they add up the costs.