Hand Hygiene

last authored: Feb 2010, David LaPierre
last reviewed:

 

 

 

Introduction

Non-pharmacologic interventions can be extremely effective at preventing transmission and keeping our patients safe. Hospital acquired infections affect 220,000 Canadians yearly, with 8,000 deaths resulting (McGreer, 2008). Pathogens that are spread by the hands include Gram-negative bacilli, S. aureus, enterococci, and C. difficile.

 

Hospital-associated infections affect 5–15% of hospitalized patients in the developed world (Vincent, 2003). The developing world likely has much higher rates due to lack of staff and supplies, substantial numbers of patients, and an abundance of infectious diseases.

 

Infection spreads most commonly via the hands of health care professionals, requiring five factors (Pittet et al, 2006)

• pathogens are present on the patient’s skin, or on objects surrounding the patient
• pathogens are transferred to the hands of HCPs
• pathogens survive for at least several minutes on the hands
• handwashing or hand antisepsis is inadequate or omitted
• contaminated hands of the caregiver come into direct contact with another patient, or with an object that will come into direct contact with the patient

 

Unfortunately, health care provider compliance is <40%, a statistic so dismal that medical schools are now mandated to provide education.

 

Barriers to Hand Hygiene

Observed barriers include (WHO, 2009)

• doctor status, nursing assistant, physiotherapist, technician (rather than a nurse)
• male gender
• working in intensive care, surgical care unit, emergency care, anaesthesiology
• wearing gowns/gloves
• before contact with patient environment
• after contact with patient environment e.g. equipment
• caring for patients aged less than 65 years old
• caring for patients recovering from clean/clean-contaminated surgery in post-anaesthesia care unit
• patient care in non-isolation room
• duration of contact with patient (< or equal to 2 minutes)
• interruption in patient-care activities
• automated sink
• activities with high risk of cross-transmission
• understaffing/overcrowding

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When to Perform Hand Hygiene

Four moments of hand hygiene

• before patient contact
• before aseptic task (often forgotten)
• after contacting body fluids
• after patient contact

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How to Perform Hand Hygiene

should get images from WHO for each tab...

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Barriers to Hand Hygiene

There are many barriers to adequate hand hygiene (WHO, 2009)

Observed barriers include: doctor status, nursing assistant, physiotherapist, technician (rather than a nurse) male gender working in intensive care, surgical care unit, emergency care, anaesthesiology wearing gowns/gloves before contact with patient environment after contact with patient environment e.g. equipment caring for patients aged less than 65 years old caring for patients recovering from clean/clean-contaminated surgery in post-anaesthesia care unit patient care in non-isolation room duration of contact with patient (< or equal to 2 minutes) interruption in patient-care activities automated sink activities with high risk of cross-transmission understaffing/overcrowding

Self-reported barriers include: irritation and dryness from soap sinks are inconveniently located/shortage of sinks lack of soap, water, paper towels too busy/insufficient time hand hygiene interferes with HCW-patient relation low risk of acquiring infection from patients belief that glove use obviates the need for hand hygiene lack of knowledge of benefits and guidelines lack of rewards/encouragement lack of role model from colleagues or superiors forgetfulness scepticism about the value of hand hygiene

 

 

 

Resources and References

WHO - Clean Care is Safer Care

WHO - Guidelines on Hand Hygiene in Health Care

Pittet D et al. 2006. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infectious Diseases, 6:641- 652.

Vincent JL. 2003. Nosocomial infections in adult intensive-care units. Lancet, 361:2068-2077.

McGeer A. 2008

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