We spoke to 2 nurses about the simple, but critically important practice of cleaning hands and found out why hand hygiene is so important in the health-care environment.

Miranda’s perspective

“As health workers we do almost everything with our hands, yet hands can also be centres for germs and one of the easiest ways that infectious diseases can be spread to vulnerable patients.”

Miranda is a staff nurse working on a medical ward in the West Midlands, in the United Kingdom. Her role is very much “hands on” – every day she meets patients, old and young, many of whom have just had surgery. Being in hospital, these patients need extra protection from a range of diseases that can easily spread through touch, from Clostridium difficile, which causes diarrhoea, to Methicillin-resistant Staphylococcus aureus (MRSA), which can lead to skin infections and pneumonia, to COVID-19.

“At our hospital we practice good hand hygiene at every point of our care – from before we go to see a patient to after we have left them,” says Miranda. “As soon as you enter the hospital there are signs telling staff and visitors to clean their hands – with hand sanitizer gel dispensers in every ward, in all the ancillary rooms and at the end of each patient’s bed. The message to clean your hands to stop the spread of infection could not be clearer.”

The importance of thorough handwashing was impressed on Miranda as a student nurse: “During my training, we used ultraviolet light to visualize the germs left on our hands after half-hearted handwashing – it was frightening! Only after washing them properly did they almost completely disappear”.

By following her hospital’s handwashing protocol, Miranda models the importance of handwashing for student nurses and visitors to the ward.

“We can put all our protective gear on, but if we haven’t washed our hands, we can still transmit infection. Just because we have access to sterile gloves, it doesn’t do away with the need for handwashing. Hand hygiene is one the best ways to protect yourself, and protect others,” she says.

Emma’s perspective

Emma is an advanced nurse practitioner working in a paediatric intensive care unit in the north-west of England, United Kingdom. The seriously ill children and babies in her care, many of whom are suffering from heart disease or cancer, often need a “central line”, a tube that goes directly into a vein. This poses an infection risk.

“Before touching a patient, I make sure that I’ve cleaned my hands with alcohol-based hand rub solution first. And afterwards, I make sure I wash my hands too. I probably wash or clean my hands over 100 times a day. Because I’m a senior staff member, I’m very visible. That means I am a role model for the younger nurses.”

Emma explains the importance of hand hygiene to every parent who visits a child. All the nurses on the unit have yearly refresher training. She also audits the unit’s hand-hygiene practice, noting on a daily basis who is – and is not– cleaning their hands correctly, and feeding this back to staff. Last month, her unit achieved 95% compliance.

“Hand hygiene is the simplest thing we do, but done badly, it can have a catastrophic impact, not just in terms of the financial burden on the health system, but also on rates of morbidity and mortality for our patients from hospital acquired infection.”

During a busy 13-hour shift, even Emma, as an experienced nurse, has to consciously make time for thorough hand hygiene. “If I’m in a rush, I find myself back-tracking, thinking ‘did I do that properly?’. The thought that stops me is not wanting to be responsible for causing harm to any child in my care. Even in the winter, when my hands can become really sore, that’s what motivates me.”

Simple hand hygiene, through frequent cleaning, is critical in reducing avoidable harm and infections. Cleaning hands at the right time, with the right products, takes less than a minute, and protects individuals, patients and our health systems. Hand cleaning is also at the heart of our emergency responses to many infectious diseases, such as COVID-19 and hepatitis – being both a key protective measure and helping prevent further transmission.

So, for this World Hand Hygiene Day and beyond, let’s unite, talk and work together on hand hygiene for high-quality, safer care everywhere.