Hand Hygiene: Role, best practices and implications in healthcare settings

 

Healthcare providers might need to clean their hands as many as 100 times per 12-hour shift.

 

Filed under
Infection Control
 
February 28, 2023
 
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Hand Hygiene:  Role, best practices and implications in healthcare settings
 

Hand hygiene has been the buzzword for quite some time. During the pandemic, its need was further heightened and as a result, even a common man knows how pivotal it is to control the spread of infection. For hospitals and other healthcare facilities, the need to practice hand hygiene goes a step further. We spoke to 3 leading healthcare hygiene experts to understand how they encourage hand hygiene and reduce HAI’s in their facilities. 

Shazia Irum Mohammed, Infection Control Specialist, King Salman Center for Kidney Disease, Riyadh, MOH - KSA 
Hand hygiene is a general term referring to any action of hand cleaning. It relates to the removal of visible soil and removal or killing of transient microorganisms from the hands while maintaining the good skin integrity resulting from a hand care program. 

Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections (HCAIs). Numerous studies have indicated that healthcare providers clean their hands less than half of the time they should. This leads to the transmission of healthcare-associated infections among hospitalized patients. Typically, healthcare providers are required to clean their hands as many as a hundred times in a twelve hour shift, based on the number of patients admitted and the intensity of care. Therefore, it is extremely vital to follow appropriate technique and correct procedure of hand hygiene in order to prevent the spread of germs, especially, in hospital settings, healthcare-related facilities, such as dialysis centers as well as in nursing homes. 

Hand hygiene is one of the five key initiatives set out by the World Alliance for Patient Safety’s Global Patient Safety Challenge. The World Health Organization (WHO) states: “The goal of Clean Care is Safer Care is to ensure that infection control is acknowledged universally as a solid and essential basis towards patient safety and supports the reduction of health care-associated infections and their consequences”. 

Best Practices and Implications:
In healthcare, the use of effective hand hygiene practice to prevent healthcare-associated infections, cross-infection and reduce the spread of antimicrobial resistance has been common practice for many years. 

There is more than one method available for decontamination of hands such as: 

  1. Hand washing with soap and water (to be applied when hands are visibly soiled).
  2. Hand rubs with alcohol based hand rubs (ABHR).
  3. Surgical hand scrub specially used in operation rooms (ORs). 

Each method has its own requirements and implications. The most commonly used and preferred method of hand hygiene is a hand rub (when hands are not visibly soiled) by alcohol based hand rubs (ABHR) containing 70-90% ethanol or isopropyl as an active ingredient. To select the method of hand hygiene depends on the activity or care which has been implemented on patients or involved in healthcare environmental surfaces. For instance, handling a patient infected with spore forming bacteria such as Clostridium difficle requires to clean the hands with soap and water after patient contact or had contact with the infected environment. The reason is that alcohol based hand rubs (ABHR) are ineffective and have less proven efficacy in reducing or eliminating the burden of these spore forming resistant bacteria. 

HAIs remain a client/patient/resident safety issue and represent a significant adverse outcome of the health care system. ‘’Patients with one or more HAIs during in-patient stay remain in hospital and incur costs on average three times greater than uninfected patients’’

Hand hygiene is the responsibility of all individuals involved in healthcare. A multifaceted, multidisciplinary hand hygiene program (e.g. hand hygiene bundles) that integrates the following elements must be implemented in all healthcare settings:

  • Well written policy and procedure on hand hygiene practices (why, when, how). 
  • Availability of hand hygiene resources, easy access to ABHR products on point of use.
  • Education and training of staff on proper selection of hand hygiene products, correct technique and indications of hand hygiene implementation by following WHO’s 5 moments rule/strategy.
  • Cultural influence by encompassing leadership support.
  • Client/patient engagement. 
  • Comprehensive program to regularly monitor, evaluate and improve hand hygiene compliance along with feedback to individuals, managers and national accreditation organizations. 

Pradeep Ratnagiri, COO, Shifa Hospital, Oman

Health professionals should perform hand hygiene before contact with the patient, prior to sterile handling, after exposure to body fluids of the patient, after contact with the patient as well as after the contact with the patient's immediate environment. On an  average, healthcare providers clean their hands less than half of the times they should. On any given day, about one in 31 hospital patients has at least one healthcare-associated infection.

The WHO Guidelines on hand hygiene in healthcare provide health-care workers (HCWs), hospital administrators and health authorities with a thorough review of evidence on hand hygiene in health care and specific recommendations to improve practices and reduce transmission of pathogenic microorganisms to patients and HCWs.

Patiens should ask: 

As a patient in a healthcare setting, patients are at risk of contracting an infection while they are in treatment. Patients and their attendants can play a key role in practicing hand hygiene  and reminding healthcare providers to clean their hands. 

Technique matters

Use the right amount of alcohol-based hand sanitizer to clean your hands. The efficacy of alcohol-based hand sanitizer depends on the volume applied to the hands

Time is very important

Studies show that some healthcare providers practice hand hygiene less than half of the times they should. Healthcare providers might need to clean their hands as many as 100 times per 12-hour shift, depending on the number of patients and intensity of care. 

Dr. Neesha Nair, AGM Quality & Patient Safety, Medical Affairs, Aster DM Healthcare

Throughout the healthcare system, hand hygiene plays a crucial preventative role. This simple act of cleaning hands has been instrumental in preventing the spread of germs, including those resistant to antibiotics.

Research studies mention that only 7% of healthcare personnel effectively clean the entire surface of their hands. Thumbs and fingertips are most frequently missed. Below are a few best practices based on evidence-based guidelines.

Care for the caregiving hands

According to WHO, any skin damage may lead to bacteria colonizing the skin and possible spread of blood-borne viruses as well as other microorganisms. 

To encourage compliance and promote healthy skin and nails, facilities should include healthcare professionals in the selection of hand sanitizers and moisturizers while assuring compatibility with antiseptics and gloves used on-site.

Pre-operative brushing can be harmful to the skin and should be avoided if at all possible. Remember maintaining healthy skin is an essential aspect of hand hygiene.

Say NO to ALL nail lacquer before scrubbing

The recent guidelines published in the journal of Infection Control & Hospital Epidemiology mentions short, natural nails with normal or no polish are the easiest to clean; however, healthcare personnel scrubbing for surgery or working in high-risk areas should maintain short, natural fingernails-free of polish and nail extenders.

Vigilance over your hand-washing stations

Hand hygiene programs in healthcare care facilities usually focus on technique and compliance monitoring. The latest literature suggests programs should also take into consideration:

  • Placements of alcohol-based sanitizer dispensers in facilities 
  • Hand rubs must be within one meter of where care is delivered.
  • Maintaining alcohol-based sanitizer dispensers and sinks – conduct regular audits for oversight
  • Single-use sanitizer dispensers shouldn’t be refilled.
  • Provide dedicated basins for hand-washing, with no other fluids being dumped into them, to avoid infectious germs splashing onto the counter or becoming aerosolized.
  • Ensuring products used for cleaning sink drains are capable of removing biofilm.
  • Antimicrobial soaps containing Triclosan should be avoided. 
  • Use creativity to enhance hand hygiene compliance


Tips for the safe use of alcohol-based hand sanitizers (ABHS)

ABHS contains ethyl alcohol which readily evaporates at room temperature into an ignitable vapor, and is considered a flammable liquid. Although the incidence of fires related to ABHS is very low, it is vital that ABHS is stored safely and that bulk dispensers are installed and maintained correctly. Hand rub solution must contain at least 60% alcohol and not exceed 95% alcohol content by volume. The maximum dispenser fluid capacity recommended is 1.2 liters (41 ounces, 0.32 gal) for dispensers in rooms, corridors, and areas open to corridors.

As stated by CDC, “hand hygiene protects you and those receiving the care you provide. The simple act of cleaning your hands can prevent the spread of germs, including those that are resistant to antibiotics. Some healthcare personnel may need to clean their hands as many 100 times during a work shift. Keeping the skin on your hands healthy and clean is a challenge that requires all healthcare personnel to be knowledgeable about how to care for their hands and when hands should be cleaned.”