Professional Documents
Culture Documents
Hand hygiene is a general term referring to any action of hand cleansing, or any
physical or mechanical action of removing dirt, organic material, and/or microorganisms,
(WHO Guidelines on Hand Hygiene in Healthcare). Different hand hygiene practices
are being utilized. It could either be through hand washing with plain soap or
antimicrobial soap/or an antiseptic and water, requiring drying of the hands with a towel
or any devices, or through application of an antiseptic handrub without requiring any
rinsing.
Plain soaps are detergents that contain no added antimicrobial agents as active
component. It can only remove a certain level of microbes and other contaminants on
the skin with the aid of water. Antimicrobial soaps are medicated detergents containing
an antiseptic agent at a concentration enough to inactivate or inhibit the growth of the
skin’s microbial flora. Its detergent component can remove these contaminants like
plain soap. Antiseptic hand rubs are alcohol-based preparations directly applied to the
skin without requiring any rinsing, to reduce and inactivate and/or temporarily inhibit the
growth of microorganisms.
The direct objective of hand hygiene practices is to reduce the transient microbial
flora without necessary removing the resident skin flora. Indirectly, transmission of
microorganisms to patients, equipment, or another health worker is reduced. Various
hand hygiene studies have provided evidence that adherence to hand hygiene practices
resulted in a decrease in transmission of infection to patients.
The risk of acquiring health care associated infection (HCAI) is universal and occurs
in every health-care facility and system around the world. Overall estimates indicate
that more than 1.4 million patients worldwide in developed and developing countries are
affected at any time. It should be considered as a major problem, and its prevention
must be a priority. The effect of HCAI are prolonged hospital stay, long-term disability,
increased resistance of microorganisms to antimicrobials, massive additional financial
burden, high costs for patients and their families, and excess deaths.
Various studies reported that HCAI rates are higher in developing countries than in
developed countries. HCAI cases were also reported to be more severe in high-risk
populations such as adults in ICUs and neonates. Such infection was found to be more
prevalent in developing countries. Neonatal infections were reported to be 3-20 times
higher among hospital-born babies in developing countries than in developed countries.
A device-associated infection rates reported from multicentre studies conducted in adult
and pediatric ICUs are compared with the USA NNIS system rates in this table:
Unfavorable contributing factors such as understaffing, poor hygiene and
sanitation, lack or shortage of basic equipment, and inadequate structures and
overcrowding, almost all of which can be attributed to limited financial resources;
unfavorable social background and a population largely affected by malnutrition and
other types of infection and/or diseases are considered to contribute to the increased
risk of HCAI in developing countries. Thus, the various preventive measures to reduce
HCAI prevalence have been identified and proven effective, such as hand hygiene, and
WHO recommends that infection control must reach a higher position among the first
priorities in national health programs especially in developing countries.
A. Wash hands with soap and water when visibly dirty or visibly soiled with blood or
other body fluids or after using the toilet.
B. If exposure to potential spore-forming pathogens is strongly suspected or proven,
including outbreaks of Clostridium difficile, hand washing with soap and water is the
preferred means.
C. Use an alcohol-based handrub as the preferred means for routine hand antisepsis in
all other clinical situations described in items D (a) to D (f) listed below, if hands are not
visibly soiled. If alcohol-based handrub is not obtainable, wash hands with soap and
water.
D. Perform hand hygiene:
a. before and after touching the patient;
b. before handling an invasive device for patient care, regardless of whether or
not gloves are used;
c. after contact with body fluids or excretions, mucous membranes, non-intact
skin, or wound dressings;
d. if moving from a contaminated body site to another body site during care of the
same patient;
e. after contact with inanimate surfaces and objects (including medical
equipment) in the immediate vicinity of the patient;
f. after removing sterile or non-sterile gloves;
E. Before handling medication or preparing food perform hand hygiene using an
alcohol-based handrub or wash hands either with plain or antimicrobial soap and water.
F. Soap and alcohol-based handrub should not be used concomitantly;
Hand hygiene technique
A. Apply a palmful of alcohol-based handrub and cover all surfaces of the hands.
Rub hands until dry.
B. When washing hands with soap and water, wet hands with water and apply the
amount of product necessary to cover all surfaces. Rinse hands with water and
dry thoroughly with a single-use towel. Use clean, running water whenever
possible. Avoid using hot water, as repeated exposure to hot water may increase
the risk of dermatitis. Use towel to turn off tap/faucet. Dry hands thoroughly
using a method that does not recontaminate hands. Make sure towels are not
used multiple times or by multiple people.
C. Liquid, bar, leaf or powdered forms of soap are acceptable. When bar soap is
used, small bars of soap in racks that facilitate drainage should be used to allow
the bars to dry.
D.
However, risk factors for noncompliance with hand hygiene have been
determined in several observational studies with an aim to improve compliance. Factors
said to influence reduced compliance are being a physician or a nursing assistant, male
gender, working in an intensive care unit, working during weekdays, wearing gown and
gloves, using an automated sink, performing activities with high risk for cross-
transmission and having many opportunities for hand hygiene per hour of patient care.
In another hospital based survey, variables were identified. These included professional
category, hospital ward, time of day or week, and type and intensity of patient care.
Compliance was highest during weekends and among nurses. Noncompliance was
higher in ICUs than in internal medicine, during procedures with a high risk for bacterial
contamination, and when intensity of patient care was high. Compliance with hand
washing worsened when the demand for hand cleansing was high. Similarly, the lowest
compliance rate was found in ICUs, where indications for hand washing were typically
more frequent. This study confirmed modest levels of compliance with hand hygiene in
a teaching institution and showed that compliance varied by hospital ward and type of
health-care worker. This further suggests that targeted educational programs may be
useful. The study suggested that full compliance with current guidelines may be
unrealistic. However, facilitated access to hand hygiene could help improve compliance.
Monitoring of hand hygiene practices have been a part of hospitals like the Santo
Tomas University Hospital as seen in past studies and the work of the Center (it is
committee ands not center) for Hospital Infection Control (CHIC). In the health care
setting, there is a difference between knowledge of hand hygiene modalities and hand
hygiene habits. Compliance to this is affected by several factors as mentioned in a
review from the International Journal of Infectious Diseases:
Larson E. APIC Guideline for hand washing and hand antisepsis in health-care settings.
Am J Infect Control 1995: 23, 251-269.
World Health Organization. WHO guidelines on hand hygiene in health care. WHO
press 2009, Switzerland.
Ellis M. Hand hygiene: simple and complex. International Journal of Infectious Diseases
2005.