Here are 10 things ambulatory surgery centers should know about proper hand hygiene, according to the Centers for Disease Control and Prevention's Guideline for Hand Hygiene in Health-Care Settings.
1. Plan soaps have minimal antimicrobial activity, if any at all. Although washing hands with plain soap can help remove loosely adherent transient flora, which are the organisms most frequently associated with healthcare-associated infections, plain soap fails to remove pathogens from healthcare professionals' hands and can, in fact, lead to increases in bacterial counts on the skin. Plain soap has also been linked to skin irritation and dryness.
2. Alcohol solutions containing 60-90 percent alcohol are most effective in hand hygiene; however, higher concentrations are less effective because proteins are not denatured easily in the absence of water. The addition of chlorhexidine, quaternary ammonium compounds, octenidine or triclosen to alcohol-based solutions can lead to improvements in persistent or residual activity.
3. The effectiveness of alcohol-based hand-hygiene products is affected by a number of factors, including the type of alcohol used, alcohol concentration, volume of alcohol used and whether hands are wet when the alcohol is applied. For example, applying 0.2-0.5 mL of alcohol is not more effective than washing hands with plain soap and water.
4. Because frequent use of alcohol-based solutions can cause skin dryness, healthcare professionals can add emollients, humectants or other skin-conditioning agents in order to reduce or eliminate that effect.
5. Chlorhexidine can substantially improve residual activity in alcohol-based solutions. The combination of low concentrations of chlorhexidine to alcohol-based solutions leads to greater residual activity than just alcohol alone. It has also been shown that aqueous or detergent formulas containing 0.5 or 0.75 percent chlorhexidine are more effective than plain soap.
6. Chlorhexidine gluconate has also been incorporated into other hand-hygiene preparations, such as antiseptic detergent preparations containing 4 percent chlorhexidine gluconate, which is more effective than aqueous or detergent formulas containing 0.5 or 0.75 percent chlorhexidine.
7. There are several strategies for reducing that incidence of skin irritation from use of soaps and detergents, including use of hand lotions and creams that contain humectants and various fats and oils that increase skin hydration and replace altered or depleted skin lips.
8. One key consideration ASCS should make when choosing a particular hand-hygiene product is whether the products will be accepted by staff members and physicians. Products that are not well-accepted can decrease compliance to hand-hygiene protocols. Some characteristics of a hand-hygiene product that should be assessed are its smell, consistency or "feel," color and, for soaps, ease of lathering.
9. There are several observed risk factors for poor adherence to recommended hand-hygiene practices, including gender, working during the week versus the weekend, wearing gowns or gloves, use of automated sinks and a high number of hand hygiene opportunities per hour of patient care. Self-reported risk factors for poor adherence include skin irritation and dryness, shortages or inconveniently located sinks, lack of soap or paper towels, forgetfulness and disagreement with hand hygiene recommendations.
10. Strategies for promotion of hand hygiene include education, routine observation and feedback, accessibility and convenience for hand hygiene adherence, reminders in the workplace and administrative sanctions or rewards.
Read the CDC's Guideline for Hand Hygiene in Health-Care Settings (pdf).
Read other coverage about hand hygiene:
- Hand Hygiene Projects Ongoing at Joint Commission's Center for Transforming Healthcare
- 6 Most Common Misconceptions About Infection Control
- Study Compares Alcohol-Based Hand Rubs to Traditional Hand Washing
1. Plan soaps have minimal antimicrobial activity, if any at all. Although washing hands with plain soap can help remove loosely adherent transient flora, which are the organisms most frequently associated with healthcare-associated infections, plain soap fails to remove pathogens from healthcare professionals' hands and can, in fact, lead to increases in bacterial counts on the skin. Plain soap has also been linked to skin irritation and dryness.
2. Alcohol solutions containing 60-90 percent alcohol are most effective in hand hygiene; however, higher concentrations are less effective because proteins are not denatured easily in the absence of water. The addition of chlorhexidine, quaternary ammonium compounds, octenidine or triclosen to alcohol-based solutions can lead to improvements in persistent or residual activity.
3. The effectiveness of alcohol-based hand-hygiene products is affected by a number of factors, including the type of alcohol used, alcohol concentration, volume of alcohol used and whether hands are wet when the alcohol is applied. For example, applying 0.2-0.5 mL of alcohol is not more effective than washing hands with plain soap and water.
4. Because frequent use of alcohol-based solutions can cause skin dryness, healthcare professionals can add emollients, humectants or other skin-conditioning agents in order to reduce or eliminate that effect.
5. Chlorhexidine can substantially improve residual activity in alcohol-based solutions. The combination of low concentrations of chlorhexidine to alcohol-based solutions leads to greater residual activity than just alcohol alone. It has also been shown that aqueous or detergent formulas containing 0.5 or 0.75 percent chlorhexidine are more effective than plain soap.
6. Chlorhexidine gluconate has also been incorporated into other hand-hygiene preparations, such as antiseptic detergent preparations containing 4 percent chlorhexidine gluconate, which is more effective than aqueous or detergent formulas containing 0.5 or 0.75 percent chlorhexidine.
7. There are several strategies for reducing that incidence of skin irritation from use of soaps and detergents, including use of hand lotions and creams that contain humectants and various fats and oils that increase skin hydration and replace altered or depleted skin lips.
8. One key consideration ASCS should make when choosing a particular hand-hygiene product is whether the products will be accepted by staff members and physicians. Products that are not well-accepted can decrease compliance to hand-hygiene protocols. Some characteristics of a hand-hygiene product that should be assessed are its smell, consistency or "feel," color and, for soaps, ease of lathering.
9. There are several observed risk factors for poor adherence to recommended hand-hygiene practices, including gender, working during the week versus the weekend, wearing gowns or gloves, use of automated sinks and a high number of hand hygiene opportunities per hour of patient care. Self-reported risk factors for poor adherence include skin irritation and dryness, shortages or inconveniently located sinks, lack of soap or paper towels, forgetfulness and disagreement with hand hygiene recommendations.
10. Strategies for promotion of hand hygiene include education, routine observation and feedback, accessibility and convenience for hand hygiene adherence, reminders in the workplace and administrative sanctions or rewards.
Read the CDC's Guideline for Hand Hygiene in Health-Care Settings (pdf).
Read other coverage about hand hygiene:
- Hand Hygiene Projects Ongoing at Joint Commission's Center for Transforming Healthcare
- 6 Most Common Misconceptions About Infection Control
- Study Compares Alcohol-Based Hand Rubs to Traditional Hand Washing