A shift routine of 12 hours or longer is not only linked to work fatigue and burnout – but, it is also associated with adverse effects on the nurse’s health. Additionally, it poses a safety risk for patients. A study published in 2014 discovered that prolonged working hours affected nurses and other healthcare workers’ compliance to hand hygiene.

Employing more than 4,100 healthcare workers in 35 hospitals in the United States from three years’ worth of hand washing data, this study showed that hand hygiene compliance has dropped by almost 8.7% over the course of a 12-hour shift.

Furthermore, Hengchen Dai from the University of Pennsylvania, who led the research, added that “the more intense the workload, the greater the decline in compliance with hand hygiene standards”.

Examples of malpractices/negligence due to poor compliance in hand hygiene

1. Skill-based errors

Nurses and other care providers might not be aware of medical malpractices done when they do not properly follow the hand hygiene guidelines. The most common negligence is skill-based errors, also known as slips and lapses in the performance of tasks. These are errors that occur when nurses miss a step or forget to do something in a procedure, such as skipping the hand hygiene practice when administering drugs to patients.

2. Rule-based errors

Another malpractice due to the poor compliance of hand hygiene is rule-based errors, which are errors that have occurred due to the wrong application of the rule to undertake the task at hand. Sterile hand wash is mandated for all nurses and healthcare workers who perform aseptic procedures. If sterility is compromised due to wrong hand hygiene practices – such as upon inserting the indwelling urinary catheter – this is referred to as a ‘rule-based error’, which implies incorrect rules that will place patients at high risk of infection.

Both types of errors exacerbated by poor hand hygiene practices may eventually introduce microorganisms and pathogens to patients. This may in turn cause the transmission of healthcare associated infection (HAI), or sometimes called as nosocomial infection, which is ‘any infection that a person develops as a result of treatment in hospital’.

Reasons for reduced compliance in hand hygiene

There are many factors that result in the poor hand hygiene adherence of healthcare workers. As the shift progresses, the intensity of the workload drains nurses’ energy, which causes their self-regulatory capacity to gradually diminish.

Often, they feel that hand hygiene takes up precious time while working hard to commit to the abundance of tasks. Misconceptions about hand hygiene, such as the belief that gloves can be used as an alternative to hand washing, or the notion that skin irritation arises from frequent hand hygiene practice impedes the compliance of hand hygiene. Even when the gloves have been removed, only 20% of nurses actually clean their hands.

What nurses can do to improve hand hygiene compliance?

Nurse Managers can provide more time-off between shifts as a way to let nurses adhere to hand hygiene practices, even towards the end of their working shift. This idea would rectify the problem as giving more time off appears to be a restorative method, as this also associated with greater hand hygiene compliance on a nurse’s next shift. The researcher said “In particular, more time off is associated with greater improvements in compliance rates when caregivers exhibited lower hygiene compliance rates at the end of their previous shift”.

Preventing nurses’ fatigue is fundamental. As it is linked to the lack of compliance of hand hygiene, there should be a collaboration from staffs to improve the work scheduling that promotes optimal rest to every nurse who works long hours, particularly 12-hour shifts.

However, nurses are professional caregivers who are ethically accountable for the care and safety of their patients. Therefore, adherence to hand hygiene practices should not be neglected by anyone who works within the healthcare environment.

It is hoped that nurses and other care providers will maintain hand hygiene compliance, which will in turn increase patient safety by reducing the likelihood of infection transmission. MIMS

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Mercier. C., & Thornes, N. (1997). Infection Control: Hospital and Community. Health and Fitness.
Collins, F., & Hampton, S. (2005). ‘Hand-washing and methicillin-resistant staphylococcus aureus’, British Journal of Nursing 14:13, 703-707