Who would think that hand washing requires even a thought process let alone education in today’s world? Signs are everywhere in restaurants and in the hospital. Commercials are on the television. There is no ignoring the message; however, folks still are not practicing proper hand hygiene. According to the Center for Disease Control (CDC) and Prevention, proper hand hygiene by healthcare workers is the most important practice for preventing healthcare-associated infections (HAI). CDC data suggests that compliance is below 50% by healthcare workers.
Per ECRI Institute, each year, about 2 million individuals develop a healthcare-associated infection, about 90,000 of these individuals die. According to the Pennsylvania Health Care Cost containment council, in 2006, the average cost for a patient with a healthcare-associated infection was $175,964, compared to an average cost of $33,260 for a patient without a healthcare-associated infection.
CDC recommends the use of an alcohol-based handrub for routine hand decontamination when hands are not visibly soiled, after “clean contact” with patient’s intact skin, and after touching inanimate objects that could be colonized with pathogens.
CDC recommends the use of nonantimicrobial soap and water or hand antisepsis with antimicrobial soap and water when hands are visibly soiled or contaminated with blood or other body fluids. Soap and water hand washing should be performed when caring for patients with spore-forming bacteria, i.e., C-diff.
CDC also provides recommendations regarding fingernails: avoid artificial nails and keep fingernails shorter than one quarter inch in length.
Various survey teams come through the hospital and all have regulations addressing infection control and hand hygiene. Education and policies have been developed to comply with the standards and evaluation tools have been developed to monitor compliance. However, adherence to policies should not be focused on regulatory requirements, but should be focused on patient safety. While there may be excuses for improper hand hygiene, there really should not be barriers. Everyone has a responsibility to promote hand washing and enforce the practice. Everyone has a responsibility to properly wash their hands prior to entering and after exiting a patient room, before aseptic task and after body fluid exposure.
Proper techniques for hand hygiene are critical or the act is in vain as poor hand washing and hand-rubbing may leave hands contaminated with pathogens. The World Health Organization recommends the following directions for proper hand hygiene:
1. Hand Hygiene Technique w/Alcohol Base Formula
a. Apply palm full of product in cupped hand and cover all surfaces.
b. Rub hands palm to palm.
c. Right palm over left dorsum w/interlaced fingers and vice versa.
d. Palm to palm with fingers interlaced.
e. Backs of fingers in opposing palms with fingers interlocked.
f. Rotational rubbing of left thumb clasped in right palm and vice versa.
g. Rotational rubbing backward and forward w/clasped fingers of right hand in left and vice versa.
h. Once dry, hands are safe.
2. Hand Hygiene Technique with Soap and Water
a. Wet hands with water and apply enough soap to cover hand surface.
b. Rub hands palm to palm.
c. Right palm over left dorsum with interlaced fingers and vice versa.
d. Palm to palm with fingers interlocked
e. Back of fingers to opposing palms with fingers interlocked
f. Rotational rubbing of left thumb clasped in right palm and vice versa.
g. Rotational rubbing of left thumb clasped in right palm and vice versa.
h. Rotational rubbing backward and forward with clasped fingers of right hand in left palm and vice versa.
i. Rinse hands with water.
j. Dry thoroughly with a single-use towel.
k. Use towel to turn off faucet.
l. Hands are safe.
Tips to remember: when using soap and water- wash for at least 15 seconds. When using an alcohol based hand sanitizer- wait till it is dry. And don’t forget your thumbs.
Proper hand hygiene saves lives, saves money, saves embarrassment, and saves unnecessary time/energy caring for avoidable injuries/disease. If you are aware of any barriers to proper hand hygiene, speak up and call administration. We are committed to patient safety.
“CLEAN HANDS SAVE LIVES.”