The Importance Of Being Earnest With Your Hand Hygiene

For my inaugural blog, I wanted to touch on a subject that is so common for each of us in our clinical practice that it perhaps does not get the appropriate attention it deserves: hand hygiene.

While this may seem rudimentary, recent statistics from the Centers for Disease Control and Prevention (CDC) demonstrate that healthcare workers are among some of the greatest offenders when it comes to effectively and consistently washing their hands.1

It is important to remember that nearly 80 percent of all infectious diseases are transmitted by touch.2 As healthcare providers, we can significantly reduce the potential for transmission of pathogens via redoubled efforts at effective hand hygiene paradigms. Now perhaps you are thinking: “I do a great job washing my hands between patient encounters.” Maybe that is true but in a recent poll, pediatric intensive care physicians claimed their rate of hand washing between patients was 73 percent. Yet when researchers followed and observed the polled physicians, the hand washing rate was less than 10 percent.3

Clearly, there is a disconnect between the clinician’s perceived effectiveness regarding his or her hand hygiene and the reality of things. This raises the question: “If that is the case, how do I stack up?”

To be effective, the CDC recommends washing your hands for at least 15 seconds.4 However, recent studies have demonstrated that washing with soap for 30 seconds rather than 15 reduces the bacterial burden on your skin by nearly a factor of 10.5 A recent CDC-funded study to evaluate hand washing by healthcare workers demonstrated an average wash time of only nine seconds.6 We must do better.

It is also important to note that many studies have demonstrated that alcohol-based, waterless hand rubs are more effective than antibacterial soaps unless the hands are heavily soiled.4 Waterless hand rubs are well suited for hygienic hand disinfection for the following reasons:

• optimal antimicrobial spectrum (active against all bacteria and most clinically important viruses, yeasts and fungi);
• no wash basin necessary for use and easy availability at bedside;
• no microbial contamination of healthcare workers' clothing; and
• rapidity of action.

Research has shown that improved adherence to hand hygiene (i.e. hand washing or use of alcohol-based hand rubs) protocols to terminate outbreaks in healthcare facilities reduces transmission of antimicrobial resistant organisms (e.g. methicillin resistant Staphylococcus aureus) and reduces overall infection rates.1

Indeed, according to the CDC, the single most important thing a person can do to keep from getting sick and spreading illness to others, protect patient safety and reduce infection is to keep his or her hands clean by thorough hand washing.4

This is a critical issue. The cost of carelessness is real. There is significant morbidity and mortality associated with the development of nosocomial infections. As clinicians, we are on the front lines of a battle that we simply cannot afford to lose. Lives depend upon it.

As healthcare providers, we are in a unique position to be part of a continuing and growing problem, or part of a solution. However compliant with hand hygiene protocols each of us may be, we must strive to be better and luckily, we can easily be better.

Have you been effective with your hand hygiene today? How will you be better tomorrow?

References

1. Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis. 2001; 7(2):234-40.

2. Available at http://www.med.umich.edu/ice/info.htm [2]

3. Donowitz LG. Handwashing technique in a pediatric intensive care unit. Am J Dis Child. 1987;141(6):683-685.

4. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Morb Mortal Wkly Rep. 2002; 51(RR16):1-56.

5. Pittet D. Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach. Emerging Infectious Diseases. 2001;7(2):234-40.

6. Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356(9238):1307-12.