Hand Hygiene: A Back to Basics Global Health Initiative
The keynote address of a mother's story at the annual Solutions for Patient Safety Spring National Learning Session1 highlighted the tragic impact of 3 hospital-acquired conditions (HACs) on a 4-year-old little boy and his family—reminding attendees that HACs are more than mere numbers or control charts but rather they affect human lives. This mother highlighted the opportunities for better and more consistent hand hygiene than what she observed during her child's hospitalizations, and how better hand washing might have helped save her child's life. Many of us have similar stories within our own organizations and neonatal intensive care units (NICUs). Hospitals across the country continue to work on reducing preventable harm, focusing on getting to zero. Since the To Err Is Human2 report in 1999, hospitals have had significant reduction in infection; even so, more work is still needed. Reducing HACs, such as central line–associated blood stream infections (CLABSIs), is a global health initiative.3 While many centers have significantly reduced their CLABSI rates over the past few years, consistent and sustainable reduction is difficult to achieve. Central lines are necessary for many infants in the NICU, and insertion and maintenance of these lines require consistent meticulous care. CLABSI prevention is vital, yet not straightforward, due to the complexity of the environment and the biology of the neonate. While many NICUs continue to apply and monitor CLABSI prevention bundles and evidence-based strategies, reduce the number of central lines days, implement standard prepackaged central line kits, and reduce line entries, it may be possible that something as simple as basic hand hygiene is being overlooked.
Hand hygiene has reemerged as a top priority due to the emerging multidrug-resistant organisms (MDROs) and invasive candidiasis, caused by the use of broad-spectrum antibiotics for unproven infections, including the most recent strain of yeast—Candida auris.4Candida auris has caused severe illness in hospitalized patients worldwide and, more recently, has been identified within the United States. The alarming attributes of some strains of Candida auris include their resistance to all 3 major classes of antifungal agents and their ability to persist on surfaces and spread between patients, unlike most other Candida species. Hand hygiene and environmental cleanliness are effective foundational strategies to limit the spread of MDROs.