Guest Author – Elaine Larson, RN, PhD, CIC, FAAN
Associate Dean for Research and Anna C. Maxwell Professor of Nursing Research
Columbia University School of Nursing
Editor, American Journal of Infection Control
Over the past few decades, especially since the ‘antibiotic era’ and the advent of increasingly technologic and sophisticated interventions, there has been less and less attention paid to simple hygiene measures in the curriculum of healthcare professionals. In fact, I recall in the 1980s reading that the age of infections was coming to an end because we had conquered germs. Confident that the ‘battle against germs’ was won, hand hygiene, isolation practices, and personal protective equipment took a back seat to fancier therapies. Educators of physicians and nurses seemed to assume either that everybody knows how to wash their hands (or perhaps that it wasn’t really that important?). Hence, because many effective barrier practices are also rather simple, they have received little, if any, attention in healthcare curricula.
In the September issue of The American Journal of Infection Control, Gould and Drey reported on student nurses’ experiences with infection prevention and control during their clinical placement. Almost 500 students from England, Wales, Scotland, and Northern Ireland responded to a survey placed on the website of The Royal College of Nursing. More than three-fourths reported that they had seen clinicians failing to perform hand hygiene before patient contact, and more than half reported deficiencies in other infection prevention practices such as ‘sharps’ disposal, changing personal protective equipment between patients, or failure to apply isolation precautions.
Even though the study was biased by a low response rate and by the fact that nursing students who respond to such surveys may have characteristics and attitudes different than those who do not respond, the findings are very consistent with what others have reported from both nursing and medical students. That is, when students observe infection prevention practices, they can and do identify frequent breeches in themselves and others.
So what do these findings mean for educators and for clinicians working with ‘newbies’? Clearly, the problem does not seem to be lack of knowledge, since students can identify deficiencies. But we know that infection prevention practices and habits don’t just happen, even when people know what to do! Having students be observant of practice increases their mindfulness and can help translate the ‘book learning’ into actual practice. Such ‘mindfulness’ ultimately is what will be required of all staff members to build the kind of safety and patient-oriented culture for which we are striving. So, we need to support students and staff to increase their mindfulness and take ownership of their own infection prevention practices.