May 31, 2017

Handshake-free zones: How UCLA Health is targeting the spread of germs

Daily Briefing

    To cut the rate of hospital-acquired infections, Mark Sklansky, a professor at the David Geffen School of Medicine at the University of California-Los Angeles (UCLA), established handshake-free zones at two UCLA hospitals—and initial research suggests the policies have helped curb the practice, Anna Gorman writes for NPR's "Shots."

    Case study: How hand hygiene audits helped reduce C. Diff rates

    Background

    While nearly all medical facilities have strict handwashing policies, not every health care professional follows the policies closely, Gorman writes. In fact, according to a 2010 study, only around 40 percent of physicians and other health care workers comply with their hospital's hand hygiene regulations.

    Meanwhile, CDC reports that on any given day, one out of every 25 hospital patients contracts a hospital-acquired infection (HAI), Gorman writes, and research suggests that providers' hands could be part of the problem.

    Handshake-free zone

    To curb the rate of HAIs, Sklansky in 2015 decided to implement an idea he initially proposed in a 2014 JAMA editorial: Establish handshake-free zones in the hospital.

    The pilot program ran in the NICU at two UCLA hospitals, Gorman writes, one in Santa Monica and the other in Westwood. As part of the pilot program, providers and patients in each unit were informed of the policy and the reasons behind it. The hospitals also posted signs that read, "To help reduce the spread of germs, our NICU is now a handshake-free zone. Please find other ways to greet each other."  Other forms of greeting were encouraged, such as fist bumps, smiles, a bow, or a wave.

    While Sklansky said that the no-handshake rule was not an adequate substitute for handwashing, he thought it could limit the spread of germs throughout a medical facility and cut the overall HAI rate. And the handshakes weren't completely banned, just discouraged, Gorman writes. "We aren't like a military operation," Sklansky said. "We are just trying to limit the use of handshakes."

    Key findings

    While a follow-up survey didn't assess whether avoiding handshakes reduced the spread of disease, it did show that establishing the handshake-free zone cut the number of handshakes—and that providers and families largely support the initiative.

    Specifically, the survey found that nurses and medical students expressed support for the idea, while male physicians were the most likely to express resistance to the policy, mostly because they didn't feel convinced it was necessary to curb infection rates. The patients' families, however, were universally supportive, according to Sklansky.

    Meena Garg, a neonatologist and medical director at the Westwood NICU, said while the policy can feel uncomfortable, especially if a patient's family member reaches out a hand, it remains an easy-to-implement and cost-effective way to cut the infection rate.

    According to Gorman, Sklansky plans to examine whether the policies cut the HAI rate in a future study. In the meantime, the signs remain posted in the two NICUs, and both physicians and nurses continue to discourage handshakes, Gorman writes.

    A step in the right direction—or merely sidestepping the problem?

    Maureen Shawn Kennedy, editor-in-chief of the American Journal of Nursing, said handshake-free zones are an effective way of avoiding the spread of disease. "There are just so many reasons to avoid handshakes, even when people are washing their hands," she said. For instance, she said while health care providers frequently wash their hands, they often don't do it long enough or do it incorrectly. Further, she noted that bacteria still live on computers, medical charts, phones, uniforms, and other places and objects in the hospital.

    But some disease specialists contend that providers don't need to stop shaking hands—they simply need to do a better job washing their hands, Gorman writes. "If we ban the handshake, we might as well ban the physical examination," said Herbert Fred, a Houston physician and associate editor of the Texas Heart Institute Journal. "Both practices can spread germs," if workers do not clean their hands correctly.

    And Sklansky agrees, Gorman writes. Hospitals do need to improve compliance with hand hygiene rules, Sklansky said, but he argued that the no-handshake zones complement and enhance those efforts. "I actually think handshake-free zones will bring attention to the hands as vectors for disease and help" (Gorman, "Shots," NPR, 5/29).

    How hand hygiene audits with iRound helped reduce C. Diff rates

    At Key Health, Mountain hospitals, all hospitals had already instituted "secret shopper" programs, in which regional staff would discreetly observe and record rates of local staff hand washing compliance. However, collecting, analyzing, and reporting data from these hand hygiene audits was time-consuming and limited the number of audits the regional staff could conduct.

    Key Health began transitioning hand hygiene audits from paper to iPads with iRound technology. The local hospitals also began using iRound to conduct regular audits of their staff—typically daily on most units—to prepare for the regional audits.

    Read the Case Study

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