It is regrettable that a global healthcare crisis is needed as a reminder that good hand and other hygiene practices are essential to minimise cross-infection and avoid the spread of pathogens. An outbreak of the new strain of coronavirus Covid-19 has taken hold in Wuhan and Hubei Province and spread widely across China, with some global spread through human-to-human contact. Unsurprisingly, there is concern about how the outbreak may be contained, with the public health agencies in the UK issuing guidance (UK Government, 2020).
Coupled with general guidance, Public Health England (PHE) (2020a) has issued infection prevention and control (IPC) guidance emphasising that personal protective equipment and good IPC practices can minimise risk, although they cannot eliminate it. Careful attention to hand hygiene practices is key, alongside other standard infection control precautions and patient education to adopt good respiratory and cough hygiene to minimise cross-transmission of the virus. Guidance has also been issued for primary care, aimed at identifying potential cases quickly and preventing transmission to staff and other patients (PHE, 2020b).
Gould et al's (2018a) survey of a random sample of 180 qualified nurses’ (72% response rate) understanding of the principles of aseptic technique was not reassuring, albeit the sample comprised nurses working on acute medical and surgical wards. While 65% nurses described aseptic technique in terms of the procedure used to undertake it, only 46% understood the principles of asepsis with the frequent confusion of the related concepts of cleanliness and sterilisation. Surprisingly, 72% nurses reported that they had not received training for at least 5 years, and 90% reported that they had not been re-assessed since their initial training. Thus, knowledge and skills need updating post-qualification, alongside regular audits of practice. It is likely that the understanding of aseptic technique is no better among community nurses, despite the growing prevalence of multidrug-resistant pathogens in the community.
‘Role modelling good hygiene practices to students and others should be part of professional practice.’
A cluster analysis of survey data from 120 critical care nurses (75% response rate) at three NHS trusts revealed three main beliefs surrounding aseptic technique: positive attitudes (enthusiasts), pragmatism (taken seriously but practice could be improved) and scepticism (role of hand hygiene in cross-infection is over-emphasised) (Gould et al, 2018b). These findings suggest that most nurses accept the importance of hand hygiene, but their beliefs may undermine their performance. Thus, different educational interventions are required to change practice. For example, the pragmatists may be susceptible to messages that emphasise professionalism and the need to protect themselves, while the sceptics need to be persuaded that hand hygiene and compliance with guidance are important. Again, this survey did not include community nurses, but these professionals may also hold beliefs that interfere with IPC guidance and best practice.
Role modelling good hygiene practices to students and others should be part of professional practice, including washing hands with soap and water regularly, always between different clients and especially before handling food; showering or bathing, including washing hair regularly; keeping nails short and clean; and washing clothes regularly. Where access to soap and water is limited, an alcohol-based hand rub or hand sanitiser should be used.