Sometimes we have to admit our limitations. We hold hand hygiene sacrosanct but knowledge and outcome gaps exist.Here is a critically important article on hand hygiene in the OR published recently in Infection Control and Hospital Epidemiology.
In this randomized, prospective trial using a hand hygiene technology to capture hand hygiene decontamination events (HDE), despite an 8 fold increase in HDE, no improvement in hospital acquired infections outcomes were documented, including surgical site infections. The study was methodologically sound.
Despite the 8 fold increase in hand hygiene, perhaps the HDEs were not the 'right' ones, at the most critical times, such as during induction and emergence of anesthesia. This, however, may be a stretch.
The simple fact is we have yet to prove that heightened hand hygiene in the OR improves outcomes.
With growing pressure to improve safety and reduce hospital acquired infections, we should focus our efforts on high reliability performance of wide scale interventions with the greatest known benefits: safety checklists, central line checklists, hand hygiene in non-OR settings, formalized daily review of urinary catheter use, automatic 72 hour urinary catheter discontinuation orders and chlorhexidine patient bathing, to name a few.
Press on.
