Hand Hygiene in Healthcare settings

Improved adherence to hand hygiene (i.e. hand washing or use of alcohol-based hand rubs) has been shown to terminate outbreaks in health care facilities, to reduce transmission of antimicrobial resistant organisms (e.g. methicillin resistant staphylococcus aureus) and reduce overall infection rates.

The use of gloves does not eliminate the need for hand hygiene. Likewise, the use of hand hygiene does not eliminate the need for gloves. Gloves reduce hand contamination by 70 percent to 80 percent, prevent cross-contamination and protect patients and health care personnel from infection. Handrubs should be used before and after each patient just as gloves should be changed before and after each patient.

Does improved hand hygiene really reduce the spread of bacteria in healthcare settings?

Yes! A scientific study performed in a hospital nursery found that babies acquired staphylococci more frequently when cared for by nurses who didn't wash their hands than babies cared for by nurses who washed their hands between patient contacts with an anti-microbial soap.

Numerous studies show that proper hand hygiene reduces the spread of bacteria in various healthcare settings.

You may not realize you have germs on your hands!

Nurses, doctors and other healthcare workers can contaminate their hands by doing simple tasks, including:

taking a patient’s blood pressure or pulse;
assisting patients with mobility;
touching the patient’s gown or bed sheets; and
touching equipment, including bedside rails, over bed tables, IV pumps.

The photo shows a blood agar plate 24 hrs after an ICU nurse placed her hand on plate.

What kind of contaminants can I be exposed to?

Patients often carry resistant bacteria on their skin. Patients with resistant bacteria like methicillin-resistant S. aureus (MRSA) or vancomycin-resistant enterococci (VRE) often carry the organism on many areas of their skin, even when they don’t have any wounds or broken skin.

Patients often carry the methicillin-resistant S. aureus (MRSA) organism on the skin under their arms, on their hands or wrists, or in the groin area.

When should you wash your hands with soap and water?

Wash your hands with plain soap and water; or with antimicrobial soap and water if:

your hands are visibly soiled (dirty);
hands are visibly contaminated with blood or body fluids;
before eating; and
after using the restroom.

Here are some tips on how to wash your hands effectively with soap and water?

wet hands first with water(avoid HOT water);
apply 3 to 5 ml of soap to hands;
rub hands together for at least 15 seconds;
cover all surfaces of the hands and fingers;
rinse hands with water and dry thoroughly; and
use paper towel to turn off water faucet.

New guidelines recommend frequent use of alcohol-based hand rubs

New guidelines developed by the Centers for Disease Control and Prevention (CDC) and infection-control organizations recommend that healthcare workers use an alcohol-based hand rub (a gel, rinse or foam) to routinely clean their hands between patient contacts, as long as hands are not dirty.

When should you use an alcohol-based hand rub?

Use an alcohol-based hand-rub for routinely cleaning your hands:

before having direct contact with patients;
after having direct contact with a patient’s skin;
after having contact with body fluids, wounds or broken skin;
after touching equipment or furniture near the patient; and
after removing gloves.

DO NOT OPT FOR AN ALCOHOL-BASED HAND-RUB WHEN HANDS ARE VISIBLY SOILED OR CONTAMINATED WITH BLOOD OR BODY FLUIDS!

Here are some tips on how to use an alcohol-based hand rub

Apply 1.5 to 3 ml (about the size of quarter) of an alcohol gel or rinse to the palm of one hand, and rub hands together;

Cover all surfaces of your hands and fingers, including areas around/under fingernails; and

Continue rubbing hands together until alcohol dries (about 15-25 seconds).

Make sure your hands are completely dry prior to putting on gloves.

Wash your hands with soap and water when you feel a “build-up” of emollients on your hands.

Are alcohol-based hand rubs really effective?

More than 20 published studies prove alcohol-based hand rubs are more effective than soap in reducing the number of bacteria on hands.

Several studies show that nurses who routinely cleaned their hands between patients by using an alcohol-based hand rub had less skin irritation and dryness than nurses who washed their hands with soap and water.

Alcohol-based hand rubs contain skin conditioners (emollients) that help prevent the drying effects of alcohol.

Hand Hygiene Guidelines Fact Sheet

Health care personnel should avoid wearing artificial nails and keep natural nails less than one quarter of an inch long if they care for patients at high risk of acquiring infections (e.g. Patients in intensive care units or in transplant units

When evaluating hand hygiene products for potential use in health care facilities, administrators or product selection committees should consider the relative efficacy of antiseptic agents against various pathogens and the acceptability of hand hygiene products by personnel. Characteristics of a product that can affect acceptance and therefore usage include its smell, consistency, color and the effect of dryness on hands.

As part of these recommendations, CDC is asking health care facilities to develop and implement a system for measuring improvements in adherence to these hand hygiene recommendations. Some of the suggested performance indicators include: periodic monitoring of hand hygiene adherence and providing feedback to personnel regarding their performance, monitoring the volume of alcohol-based handrub used/1000 patient days, monitoring adherence to policies dealing with wearing artificial nails and focused assessment of the adequacy of health care personnel hand hygiene when outbreaks of infection occur.

Allergic contact dermatitis due to alcohol hand rubs is very uncommon. However, with increasing use of such products by health care personnel, it is likely that true allergic reactions to such products will occasionally be encountered.

Alcohol-based hand rubs take less time to use than traditional hand washing. In an eight-hour shift, an estimated one hour of an ICU nurse's time will be saved by using an alcohol-based handrub.

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