According to Dr. Linam, proper hand-hygiene practices for healthcare workers are “the most important behavior to prevent HAIs.” Although guidelines defining proper hand hygiene have been provided by the Centers for Disease Control and Prevention and the World Health Organization, “we don’t do near as good a job as we should.”
Guidelines for hand hygiene among healthcare workers focus on an institutional approach that provides proper education and training, ensures the availability of supplies at the point of care, provides workplace reminders such as signs, and provides feedback to the healthcare workers so that they are aware of what they are doing well in addition to what they should improve on.
“What we’ve seen, through a number of different studies, is that groups that have implemented some combination of these interventions have seen significant improvement in their hand hygiene [compliance rates]. But, often, that improvement is below 90% [compliance].” However, he added, additional studies have shown that goal setting, incentivizing hand hygiene, direct accountability of healthcare workers, and providing real-time feedback “may further increase hand-hygiene compliance.”
Although most children who are admitted into hospitals are hospitalized due to respiratory infections such as bronchiolitis, most guidelines do not require testing to specify the cause of infection. This allows for an umbrella designation of “respiratory syndrome.” Therefore, Dr. Linam recommends taking syndrome-based isolation precautions.
Another imperative practice that can hinder the transmission of respiratory viruses from healthcare workers across the facility is influenza vaccination. Whole facility vaccination can be accomplished through several strategies, including educational campaigns, by providing different vaccination choices—such as FluMist for those who do not like needles for years this method of influenza vaccination is deemed acceptable—or by mandating that healthcare workers who are unvaccinated wear masks at all times. Some healthcare facilities, however, require all hospital personnel, including contract workers, to be vaccinated for influenza. These hospitals have seen an increase of up to 90% vaccination rates among workers. “But, this strategy, as you can imagine, is controversial,” Dr. Linam said.
The final manner by which Dr. Linam suggested healthcare facilities can prevent infection transmission by healthcare workers is to prevent ill personnel from going to work. A mixed-method study published several years ago, said Dr. Linam, looked at why clinicians and advanced practice clinicians choose to go to work sick. The study found that 94% of healthcare workers included in the study “believed that working while sick placed patients at risk.” Nonetheless, this did not stop 83% of these same individuals from showing up to work sick at least once in the past year, and approximately 10% from working while sick at least five times in the past year.