Headline news -the right way to wash your hands

If Content is King then Context is Queen

In April 2016 a study completed by SHIP (Safeguarding Health through Infection Prevention) researchers at Glasgow Caledonian University (GCU) made the headlines as it produced the first evidence, in a randomised controlled trial (RCT), that the World Health Organization’s (WHO) 6-step hand hygiene guidance is more effective in reducing residual bacterial load on healthcare workers hands than the 3-step technique.

There are two ways to wash your hands?

Yes, there are currently two internationally recommended techniques for healthcare staff undertaking direct patient care reported for hand-hygiene: the 6-step guidance by the World Health Organization (WHO) and the 3-step technique by the United States’ Center for Disease Control and Prevention. However previously, neither technique had a very limited evidence base to support their effectiveness.

And the results are in

This new applied research showed that the 6-step technique was superior to the 3-step technique in reducing the residual bacterial load after alcohol-based hand rub hand hygiene. This reduction was not related to the area of the hands coverage, time taken to perform the technique, type of organism or staff group.

This was an important finding since hand-hygiene is the cornerstone of infection prevention and control and yet very little evidence exists to support the best technique. Therefore the SHIP researchers and GCU felt that it was important to share this information with the world.  The study itself was published in “Infection Control and Hospital Epidemiology”, the journal of the Society for Healthcare Epidemiology of America, and to ensure maximum impact of this publication, GCU send out a press release. This is where it got interesting!

It was headline news

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Media coverage was plentiful and diverse. It featured in nearly 100 news outlets, as well as social media from all over the world (e.g. United Kingdom, Denmark, New Zealand, the United States, Sweden, India, South Africa, Poland, Brazil, Japan) and from a variety of different backgrounds (e.g. medical, infection control, science, lifestyle).

Headlines included, “You’ve been washing your hands wrong” (NY Times); “You’ve been washing your hands wrong your whole life” (IFL Science), “The right way to wash your hands” (Wall Street Journal) and “WHO’s six-step hand hygiene technique superior to CDC’s three-step technique” (Healio).

Just follow the instructions

Most of the publications summarised the paper well and there was also a focus on the interesting finding that only 65% of participants in the study followed the entire 6-step process even though the instructions were in front of them –the focus of a follow-up study we are currently beginning. However this current RCT found that the 6-step technique, even when not performed completely or perfectly, i.e. at 65% compliance, was still superior to the 3-step technique. It could be to do with the sites of the hand more frequently missed by the 3 step (the back of the index and the middle finger of the right hand are significantly less frequently missed by 6 steps compared to 3 steps); however, there is a need for additional research to explore this further.

I simply don’t have the time

However, some took the paper out of context and concentrated on the amount of extra time the 6-step technique took compared to the 3-step. One online science magazine worked out that, as the 6-step technique takes 24% longer to complete, you would spend an extra 7.5 seconds per wash. Therefore if you washed your hands 8 times per day you would spend an extra 6 hours a year washing your hands (IFL science).  In fact we make comment on this in the paper, as those doctors and nurses with 100% compliance with the 6 step technique had a significantly greater reduction in bacterial load, with no additional time or difference in coverage, compared to those with 65% compliance with 6 step technique. This means that it is the technique rather than the length of time that is important, meaning there is real merit in investing effort in further improving healthcare workers compliance with the 6 step technique.

It’s just a matter of opinion

Not everyone saw the importance of the study, both for the prevention of Healthcare Associated Infections (HAIs) and in preventing the public from getting common colds and food poisoning, with one opinion writer in The Sunday Times stating, “Honestly, I wash my hands of these bozos”. The public’s reaction to some of the posts was also interesting. One online commentary forum began with, “This world is doomed. NOW WE NEED SCIENTISTS TO TEACH US HOW TO WASH OUR HANDS????” However these discussions often led to comments about how people are “disgusting” and often don’t wash their hands which then led to discussion about how this could be improved, ending with sentiments such as, surely if it helps then it’s worth the extra time. This debate in itself raised the awareness of hand hygiene.

There’s no such thing as bad publicity

The 6-step technique may be “overwhelming” and “complicated” as quoted within the press but a common sense approach is taken with many of the journalists who featured our study. They recommended, “at the very least you spend 10 or 15 seconds working up a good lather” and “get scrubbin”(Bustle.com) or, as Refinery29 explained, “it’s important to remember though, that even if your bathroom is pretty gross, you’re probably not dealing with hospital-level scary bacteria. So while we should all probably be using the six-step technique to keep as safe as possible (especially if we’re handling food or in the bathroom), we also realize that’s probably not going to happen every time. So wash your hands as well as you can with soap and warm water, but don’t freak out if you’re not hitting every single one of those six steps.”

Promoting hand hygiene to healthcare workers and the public is the real intention of the publicity surrounding this study and that seems to have been achieved.

Here is the link to the actual study:

A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand Hygiene Technique in Acute Hospital Care in the United Kingdom
Jacqui S. Reilly, Lesley Price, Sue Lang, Chris Robertson, Francine Cheater, Kirsty Skinner and Angela Chow June 2016
Infection Control & Hospital Epidemiology, ,Volume37, Issue06, June 2016, pp 661-666
http://journals.cambridge.org/abstract_S0899823X16000519

World Health Organisation’s “Save Lives Clean your Hands” Day

Hi everyone,

Each year the World Health Organisation’s “SAVE LIVES: Clean Your Hands” campaign aims to highlight the importance of hand hygiene in health care and to ‘bring people together’ in support of hand hygiene improvement globally. Hand hygiene is the entrance door for reducing health care-associated infections and so on Thursday 5th May the SHIP team presented a celebration of our past, current and future research.

We displayed posters of our previous research and all the recent headlines this has caused -more information about this in the next blog post! We also showed people what our current and future work is all about and discussed this with people to see if anyone wanted to help with our research.

To support this years WHO campaign we decided to get people to help us sail Glasgow Caledonian University’s SHIP from Land’s End to John O’Groats and spread the message that CLEAN HANDS SAVE LIVES! In order to do this we need people to join our SHIP research group on Facebook (ship GCU) and send us a picture with our SHIP postcard (or just a hand hygiene message if you don’t have one) of your travels. To join us please add us a friend on facebook, Tag us in a post and check-in from anywhere in the UK or beyond and we’ll pin you on our map! By helping us spread this important message you could win a speedboat ride for two down the River Clyde.  Once we have reached 1066 miles (the distance from Land’s End to John O’Groats) we’ll choose a place at random and select a winner.

The “big hand of pom-poms” was also back and again we showed people how to use the WHO’s 6-step hand hygiene technique using the glowbox to see how good they were!hand hygiene day Debbie hand hygiene day Jen

 

Here’s some photos from the day and please watch our playlist above for more information about the WHO’s campaign and also the SHIP journey so far.hand hygiene day Lucy

Another Guinness World Record

Glasgow Caledonian University nursing students attempt record breaking hand wash on European Antibiotic Awareness Day For more details see press release Pic Peter Devlin

Glasgow Caledonian University nursing students attempt record breaking hand wash on European Antibiotic Awareness Day Pic Peter Devlin

 

After the huge success of last year’s world record, it was decided that we should try for another record, still within the theme of hand hygiene since this is the most effective way of reducing the risk of infection in healthcare and the transmission of infection in the wider community.

All student nurses are taught hand hygiene in year one of their nursing programme at Glasgow Caledonian University GCU and so it was felt that student nurses from year 1 and 2 of the programme would be the ideal participants in a world record for “The most participants in a hand sanitising relay”, in partnership with Glasgow City of Science and Health Protection Scotland.

The previous record had been set in May 2014, with 277 participants at the Hong Kong Baptist Hospital. This World Record was beaten by GCU student nurses on November 18, 2015, European Antibiotic Awareness Day, an annual public-health initiative to raise awareness about the threat of antibiotic resistance and the importance of prudent antibiotic use.

417 student nurses undertook the challenge with Professor Fiona McQueen, Scotland’s Chief Nursing Officer, and Glasgow City Council’s Liz Cameron in attendance.

This world record attempt fitted with the SHIP (Safeguarding Health through Infection Prevention) research work streams; research on antimicrobial stewardship, antimicrobial resistance and evidence for infection prevention and control. Every participant, in turn, had to complete the World Health Organisation’s (WHO) six-step hand-hygiene technique with hand sanitising gel and then pass this on to the next person in the relay. One of our most recent studies on hand hygiene technique provided the first evidence for this WHO six-step hand-hygiene technique and will be posted on the blog in the next post.

 

Hand Hygiene World Record. Image: GCU

During the event there was a talk about Antimicrobial Resistance by Professor Jacqui Reilly and participants were entertained with music from the GCUkes (our in-house Ukele band) playing “loosely-based” hygiene and  hand related songs.

The attempt could not have been successful without the help of everyone involved. This included independent stewards and witnesses who volunteered from the wider community and all “hands on deck” from staff within the University.

Professor of Infection Prevention Jacqui Reilly said: “Hand hygiene is one of the most important measures we can all use to prevent infection. By reducing these infections we can reserve the use of antibiotics to those infections which cannot be prevented and support the control of antimicrobial resistance.”

Safe Hands

Well, Tuesday was the World Health Organisations’s global day for action on hand hygiene in health care and we got very involved here at Glasgow Caledonian University.

We had a display in the main foyer of the health building on campus to showcase the research we have carried out in this field and to teach the 6 step hand hygiene technique to passers-by. They then got to test their “performance” with the glow box and were then asked to “bin a bug” from the big hand (see photo below). However, most of them didn’t want to bin our pom pom friends and instead took them home.

We also got to show off our official Guinness World Record Certificate and got loads of selfies with the WHO Twitter hashtag, #safeHANDS -go to our Twitter account to see the photos @SHIPGCU

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Daffodils and dirty hands

On the 22nd November last year, Friends of Elder Park, members of staff from the SHIP research group, children involved in the world record, and lots of volunteers planted daffodil bulbs and wild flowers (kindly provided by Glasgow City Council Parks department) in Elder Park as part of a project for Glasgow’s Green Year 2015.

Why Elder Park? John Elder was an engineer/scientist and his wife Isabella Elder a philanthropist and supporter of women in science bought the land and dedicated the park in memory of her husband for use by the local community. She was an great women and in 1892 persuaded Glasgow University to accept women into medicine.

In addition the reason for selecting Daffodils was the link to the Marie Curie cancer care charity and the promotion of women in science – Marie Curie and of course furthering the beliefs of Isabella Elder. Children were therefore also given Marie Curie ‘little pots of care’ (a daffodil bulb, pot and compost) to take home with them.

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In order to promote the science theme we linked the hand hygiene theme to this message. Therefore after the bulb planting, staff from the SHIP research group showed the children how to wash their hands properly using the 6-step technique – a technique supported by evidence from SHIP research.

 

Hand hygiene world record

You’ve got to hand it to Glasgow! GCU student nurses as part of Glasgow City of Science smashes Guinness hand hygiene world record

Glasgow City of Science, with a helping hand from its partners and schoolchildren from across the city, is a world record breaker! The organisation has set a new Guinness World Record for the largest simultaneous hand hygiene lesson at multiple venues and this was celebrated at Glasgow Science Centre on Friday 20th March.

In March last year, Glasgow City of Science coordinated the attempt which saw thousands of primary schoolchildren take part in a simultaneous lesson at Glasgow Science Centre or simultaneously within their schools. Led by 160 student nurses from Glasgow Caledonian University, the 40-minute lesson showed pupils that good hand hygiene is the most effective way to prevent the spread of illnesses. Pupils were introduced to the science of common microbes using versions knitted and donated by members of the public from all around the world and learned how far a sneeze can travel using a ‘snot runway’.

From this event. 3 089 children from 36 Glasgow primary schools were successful in the record attempt, smashing the existing one held by the Health Protection Agency in England of 2,147 children from 21 schools from across the UK.

Legacy packs were left in all schools thanks to funding from the Scottish Government Health Directorate so they can teach every child in their school each year. Thanks to this project, thousands of school children should have a better understanding of good hand hygiene.

Minister for Sport, Health Improvement and Mental Health, Jamie Hepburn joined some record-breaking pupils at a celebration event at Glasgow Science Centre where he collected an official Guinness World Record certificate on behalf of the Scottish Government. He said,

“I am delighted to have been asked to participate in today’s celebratory event  to mark the hand hygiene world record. Tackling and reducing infection in our hospitals and the wider community is a top priority for this Government. “It is vitally important that all children are made aware of the importance and benefits of washing their hands properly and by encouraging them to do so, it will ensure this practice becomes a lifelong habit. We would encourage all children to pass on everything they have learned to their families and friends to spread the word.On behalf of my Ministerial Colleagues and the Scottish Government, I would like to congratulate all the children and organisations who were involved in this project. This world-breaking record has been a fantastic achievement demonstrating again that Scotland leads the way in reducing infections. Today’s award is very well deserved.”

The Glasgow City of Science partnership brings a diverse grouping of over 60 organisations together, from business to government, education and the arts, to work collaboratively on high profile, creative, projects that will raise the profile of Glasgow and the West as a world-class science destination. Several partners including Glasgow Science Centre, Glasgow Caledonian University, NHS Scotland and the Health Protection Scotland worked hand in hand to organise the event.

Professor Jacqui Reilly, Lead consultant, Health Protection Scotland said:

“Hand hygiene is the most important measure we can all take to reduce risk of illness from infections and viruses. Learning when to do hand hygiene, such as before preparing food and after visiting the toilet, together with the correct technique to do it, protects health for a lifetime. HPS is coordinating the implementation of the e bug programme containing the hand hygiene lesson across the whole of Scotland to this end. The programme includes the correct technique for hand hygiene which is based on evidence from research carried out by Glasgow Caledonian University.”
GCU and the Guinness World Record for hand washing presentation at the Science Centre. Image by Guy Hinks.