Winter 2002, Vol. 8, No. 4

How Clean Are Your Hands?

The following Article origionally appeard in the The Alert, Winter 2002, Vol. 8, No. 4

The Centers for Disease Control and Prevention (CDC) recently released a Guideline for Hand Hygiene in Health-Care Settings. The full document can be accessed at www.cdc.gov. Some of the highlights follow.

Proper hand hygiene (hand washing or use of alcohol-based handrubs) has been shown to reduce transmission of antimicrobial resistant organisms and to reduce overall infection rates in health care facilities.

The CDC released these guidelines in an attempt to improve hand hygiene in health care settings. In addition to traditional handwashing with soap and water, the CDC recommends the use of alcohol-based handrubs by health care personnel for patient care. However, if hands are visibly soiled, they should be washed with soap and water.

Glove use does not eliminate the need for hand hygiene. In addition, proper hand hygiene does not eliminate the need for gloves. Gloves reduce hand contamination by 70 to 80 percent, prevent cross-contamination, and protect

patients and health care personnel from infection. Alcohol-based handrubs should be used before and after each patient, just as gloves should be changed before and after each patient. However, the CDC recommends that nonlatex gloves be worn when there is minimal risk of exposure to infectious materials, and reduced protein, powder-free latex gloves when there is such a risk (http://www.cdc.gov/niosh/latexalt.html).

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.

When applying an alcohol-based handrub to the hands, rub hands together, covering all surfaces of the hands and fingers until dry. Alcohol-based handrubs significantly reduce the number of microorganisms on the skin, are fast acting, and cause less skin irritation than soap and water. However, the volume needed to reduce the number of bacteria varies by product.

When evaluating hand hygiene products for use in health care facilities, administrators and purchasing departments should consider the efficacy of antiseptic agents against pathogens, as well as the willingness of personnel to accept the products. Product characteristics that affect acceptance include smell, consistency, color, and resultant hand irritation.

The CDC is asking health care facilities to develop and implement a system for measuring adherence to these hand hygiene recommendations. Suggested performance indicators include: periodic monitoring of hand hygiene practices and providing feedback to personnel on their performance, and assessing the adequacy of health care personnel hand hygiene when infection outbreaks occur.