N.Y. Times: The Dirty Little Secret of Nursing Homes

Most people learn the importance of washing hands to get rid of germs and harmful bacteria as children in pre-school, but that training wears off for some and it’s starting to show in the nation’s nursing homes, reports the New York Times’ New Old Age blog, citing a rise in deficiencies for ‘hand hygiene.’

This sounds like common sense: If you work in a nursing home, you wash your hands when you start your shift and again before you leave. You wash your hands (or, in some cases, use an alcohol-based antimicrobial) before and after any direct contact with residents. Before you help someone with tooth-brushing, bathing, eating or using the toilet. Before and after handling a catheter or taking a finger-stick blood sample or changing a dressing. Or handling used bed linens. Or blowing your own nose.

In fact, these are not only common-sensical habits; they’re prescribed by guidelines from the Centers for Medicare and Medicaid, part of the process by which the nation’s nursing homes are inspected and certified.


Yet the percentage of nursing homes cited for deficiencies in “hand hygiene” has been rising in recent years. Inspectors found such deficiencies in fewer than 7.4 percent of nursing homes from 2000 to 2002, but by 2009 found them in close to 12 percent. Some states did better: Hand hygiene citations in Pennsylvania in 2009 came from just 6 percent of facilities. Some fared much worse: Michigan that year was at 15 percent.

One reason cited by the University of Pittsburgh gerontologist Nicholas Castle, a veteran nursing home researcher whose team uncovered this trend, was the growing emphasis on infection control, which means that “surveyors are probably looking harder than they used to” — not a bad thing.

But the study, published in the Journal of Applied Gerontology, also indicated that understaffing and insufficient training played a part. “Most facilities understand the importance of hand washing,” Dr. Castle said in an interview. “It’s a question of having the staff and resources to implement what they know they should be doing.”


…You would think the most direct route to improvement would be to add more staff and raise Medicaid reimbursements for nursing homes. But in the current economic and governmental climate, Dr. Castle noted, “they’re unlikely to get either and they have to do more with less,” which may be the most dispiriting element of all.

The trend is alarming considering the “fierce” infections that can lurk in health care settings, says the blog post, especially as the elderly are often more susceptible.

“Infections picked up in health care settings represent their single greatest cause of sickness and death, the reason underlying a quarter of all hospitalizations from long-term care facilities,” it says. 

Read the full piece at the New York Times.

Written by Alyssa Gerace