








key: cord-333840-r5bfebsp
authors: Alzyood, Mamdooh; Jackson, Debra; Aveyard, Helen; Brooke, Joanne
title: COVID‐19 reinforces the importance of handwashing
date: 2020-05-14
journal: J Clin Nurs
DOI: 10.1111/jocn.15313
sha: 
doc_id: 333840
cord_uid: r5bfebsp

nan

are not available is the first line of defence in stopping the spread of infection (CDC 2020) . There is ample evidence, however, that many years before the epidemic handwashing among healthcare workers (HCW) remained an area that needed improvement (CDC 2019, Erasmus et al., 2010) .

Our hands are a critical vector for transmitting microorganisms (Edmonds-Wilson, Nurinova, Zapka, Fierer, & Wilson, 2015) . The cross-transmission of these organisms to others occurs when we fail to wash hands effectively. Within healthcare systems and services, there have been almost continual awareness campaigns in place to encourage handwashing among health service personnel, patients and visitors. For instance, the international campaign, "My five moments for hand hygiene" defines the key moments at which HCWs should comply with hygiene rules while making contact with patients or their surroundings (Sax et al., 2009) . The "Cleanyourhands campaign" was a national campaign launched in the UK aiming to reduce the risk associated with hospital-acquired infections via enhanced hand hygiene compliance among HCWs (Stone et al., 2012) . The campaign included a message "It's OK to ask" to encourage patients to ask HCWs to wash their hands (Stone et al., 2012) and supports patient involvement to prompt handwashing and to work together with nurses and other HCWs to reduce the transmission of infection (Alzyood, Jackson, Brooke, & Aveyard, 2018) .

The current COVID-19 pandemic has seen a focus of education and information on handwashing aimed both at people working within the health sector as well as to the general public. There has been a proliferation of public health messages through various sources about the importance of handwashing, and the correct techniques for handwashing. Memes and short videos aimed at reaching people on their handheld devices, as well as through social media, and mainstream television, radio, print ads and billboards are all in use, and all with the same message that effective handwashing is crucial to stopping the spread of COVID-19.

In addition to a greater presence on social media platforms and other advertising outlets, the importance of handwashing is now frequently seen on daily news reports, as handwashing initiatives are taken on by service users, politicians, public figures and many others. It is commendable to see greater and more widespread efforts to raise handwashing awareness and a notable increase in people speaking up and talking about the importance of handwashing.

As nurses, we are aware that handwashing has not always been taken as seriously as it should, with compliance and adherence in clinical settings far from optimal over time (Bezerra et al., 2020; Pittet, 2001) . Multiple reports from different countries have shown that hand hygiene compliance rate has been estimated at only 40% (Erasmus et al., 2010) while the rate of adherence in critical care units was only 46.25% (Bezerra et al., 2020) . Although this is a simple and lifesaving task, it is not, regrettably, always undertaken (Doronina, Jones, Martello, Biron, & Lavoie-Tremblay, 2017) . The current pandemic has made handwashing the focus of attention. We must now ensure that this focus continues.

Once this pandemic is over, nurses must continue to promote handwashing with the same enthusiasm and commitment not only within the healthcare arena but widely throughout communities and populations. The significant growth of interest in promoting handwashing behaviours since the start of COVID-19 pandemic should be harnessed and continued well after this outbreak is contained. Thus, nurses can support the protection of their communities against this and the many other infectious agents that pose a threat.

An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting

Adherence to hand hygiene in critical sectors: Can we go on like this

Hand hygiene in healthcare settings

COVID-19): FAQ on Hand Hygiene

A systematic review on the effectiveness of interventions to improve hand hygiene compliance of nurses in the hospital setting

Review of human hand microbiome research

Systematic review of studies on compliance with hand hygiene guidelines in hospital care

Improving adherence to hand hygiene practice: A multidisciplinary approach

The World Health Organization hand hygiene observation method

Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: Four year, prospective, ecological, interrupted time series study



