Hand hygiene is the single most important step caregivers can take in preventing hospital-acquired infections. Yet nurses and other clinicians often don’t follow recommended guidelines for hand hygiene.
One of the common barriers to better compliance is a lack of knowledge of the results of poor hygiene and the research that supports its effectiveness. To keep your patients safe, it’s important to know the basics of infection prevention, and to understand that hospital policies about hand hygiene are evidence-based and exist for a reason.
Even in normal, healthy people, the skin is colonized with microorganisms. These fall into two categories: transient and resident.
- Transient flora are found on the outer layers of skin and are fairly easily removed by handwashing. They are the organisms most likely to result in hospital-acquired infections.
- The resident flora are more deeply attached to the skin and are harder to remove. When they are disturbed through handwashing or through antibiotic use, they usually reestablish themselves quickly. Your diet, environment, and hygienic habits influence which species make up your resident flora.
Many of these microorganisms are fairly benign while others are pathogenic – capable of causing disease. Pathogens can be transmitted from patient to patient, or from an inanimate object to a patient, by way of a provider’s hands. When objects in a patient room are contaminated, the risk of infection increases – for example, a provider may wash hands upon entering the room, and then re-contaminate them by touching the bedrails or a bedside table. Sometimes a pathogenic organism may even become part of the resident flora on a provider’s hands.
Studies have found that the area under the fingernails is likely to harbor large amounts of bacteria. That’s why WHO guidelines urge hospitals to create policies that require nurses to keep fingernails short and to avoid artificial nails. The area under rings may also harbor bacteria, and WHO guidelines discourage jewelry in high-risk settings like the operating room.
Hand hygiene products
A large body of research has compared the effects of cleaning hands with plain soap and with antibacterial agents. Soap has a detergent action that will remove soil and organic substances like blood from the hands. Although soap has no antimicrobial activity – meaning it won’t kill or inhibit the growth of pathogens – the act of handwashing, when done properly, can loosen pathogens and rinse them down the drain. Handwashing with soap depends on friction from rubbing, as well as copious amounts of running water, to be an effective strategy in infection control.
Antiseptic agents are favored by many health care providers over soap and water. There are several types available, although they vary in their effectiveness against pathogens and the amount of irritation they are likely to cause to the skin.
The most common antiseptic agent is alcohol, which is often used in the familiar hand-sanitizing rubs that don’t require water. Research shows that solutions containing 60-95 percent alcohol are the most effective – they have excellent antimicrobial activity against gram-positive and gram-negative bacteria, as well as against many of the viruses that are of concern in health care (HIV, hepatitis B and C, influenza, etc.) The bad news is that alcohol has no activity against bacterial spores, like those responsible for the spread of Clostridium difficile, or certain classes of viruses. While alcohol is rapidly germicidal upon application, it has no persistent antimicrobial activity so regrowth of bacteria occurs quickly on the skin.
Other common antiseptic agents include chlorhexidine, triclosan, and the iodophor preparations that have replaced iodine.
WHO guidelines for hand hygiene state that health care providers should:
• Use soap and water to wash hands whenever they are visibly soiled with dirt, blood, or other body fluids.
• Use soap and water when there is an outbreak or suspected contamination from spore-forming pathogens like Clostridium difficile.
• Use an alcohol-based handrub in most other clinical situations. This is the preferred means for routine hand cleaning when the hands are not visibly soiled.
• Practice hand hygiene measures before and after touching a patient; before touching an invasive device used for patient care; after coming into contact with body fluids, mucous membranes, non-intact skin, or wound dressings; if moving from a contaminated body site to another body site on the same patient; after touching inanimate surfaces and objects in the immediate vicinity; and after removing gloves.
If you’re interested in planning, implementing, and evaluating infection prevention and control measures, consider making this field your career specialty. As a first step, you can develop new skills and empower yourself with knowledge through an online RN to MSN degree with a specialization in infection control from American Sentinel University, an innovative, accredited provider of online nursing degrees.