Handwashing instills a good habit

“Foam in, foam out.” That’s the slogan you’ll find School of Medicine and Barnes-Jewish Hospital health-care staff repeating to help prevent infections.

The slogan refers to using alcohol-based foam upon entering and exiting patient and clinic rooms. The foam is an alternative to soap-and-water handwashing.

While it seems that handwashing is something most adults would do instinctively, many people, including health-care workers, don’t wash their hands as often as they think they do. In fact, most estimates show that only about 50 percent of health-care workers are washing or foaming their hands as often as they should.

Keeping hands clean, whether by washing with soap and water or using alcohol-based foams, has been shown to reduce overall infection rates in hospitals, according to the Centers for Disease Control and Prevention (CDC).

Keith Woeltje, M.D., Ph.D., associate professor of medicine and medical director of the BJC Infection Control and Healthcare Epidemiology Consortium, said some interactions with patients are not perceived to require hand hygiene, such as taking blood pressure or even touching a patient on the shoulder. But the CDC’s guidelines call for handwashing or using foam before and after all patient contact and in between some procedures on the same patient, such as changing dressings or emptying drains or catheters.

At the School of Medicine and Barnes-Jewish Hospital, the handwashing or foam use compliance rate is much higher than average at nearly 80 percent and continues to rise, Woeltje said.

“There is a large initiative in the BJC system to increase hand-hygiene, including surveillance in all hospitals and providing feedback rates,” Woeltje said. “The infection control staff uses a standardized form when monitoring handwashing, from which they generate compliance rates.”

“The goals of Barnes-Jewish Hospital and the BJC system promote the use of alcohol-based foam, which workers can do while walking to another task,” said David Warren, M.D., assistant professor of medicine and hospital epidemiologist for Barnes-Jewish Hospital. “For that reason, we have placed foam dispensers inside and outside of each patient room to remind staff to use the foam before going in the room and when coming out.”

The low compliance rate in the past among health-care workers in general has been due to perceived barriers to handwashing, such as accessibility to soap and water or alcohol-based products and the time commitment involved. Guidelines call for washing hands for at least 15 seconds each time, and that can take much of a health-care worker’s time. Using foam can save up to 1 hour out of an 8-hour shift.

In addition, there is a perception that using soap and water is drying to hands. Woeltje said the alcohol foam has emollients that keep natural oils on the skin instead of washing them away. The infection-control specialists have also placed hand lotions that are compatible with the alcohol foams and gloves at nurses’ stations. Gloves are primarily used when there is risk of contact with body fluids and to protect the worker from infectious diseases.

Hilary Babcock, M.D., assistant professor in medicine and medical director of occupational health for Barnes-Jewish and St. Louis Children’s hospitals, said the infection-control team has put together an educational campaign to remind staff to comply with handwashing guidelines. There is an online education module, posters placed around the clinics and hospital, and the slogan “Foam in, foam out,” appears on the screen savers of computers in all patient rooms at Barnes-Jewish Hospital.

But Babcock said educating staff only goes so far.

“These workers are working hard, and many times they are understaffed,” she said. “So we have to make handwashing or using foam part of their routine.”

Infection control specialists at the hospital reward staff when they see someone washing their hands or using foam appropriately with trinkets or verbal congratulations, Babcock said.

“Our long-term goal is to develop a habit,” Woeltje said. “It’s like putting on a seat belt in the car — once you start doing it, you can’t drive without putting it on. We want the same sort of habit ingrained in the health-care staff.”