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Healthcare Hand Hygiene 101

Patrick Boshell
April 03, 2013
Healthcare Hand Hygiene 101

How much do you really know about hand hygiene in a healthcare environment?  We all know that following hand hygiene guidelines helps reduce the incidence of infection.  However, a recent study revealed there is room for improvement in hand hygiene knowledge, particularly in relation to the use of alcohol-based hand rubs. 

More than 1,700 nursing and medical students from 20 universities in Australia, Sweden, Greece and Italy participated in a questionnaire to test their hand hygiene knowledge, beliefs, practices and education.


According to the report, "Many healthcare students lacked knowledge on the indications, benefits and use of alcohol-based hand rubs, indicating that further effort is needed to properly educate students on effective hand hygiene."  The H1N1 influenza pandemic may have been the largest hand hygiene awareness initiative in history, yet the average mark was just 66% on the hand hygiene quiz.


Many of the students believed that hand rubs cause more irritation than soap and water and just under half thought that hand rubs need to be applied for 60-seconds in order to be effective.  As recommended by the World Health Organization (WHO), sufficient alcohol-based hand  sanitizer should be applied to cover all surfaces of the hands and rubbed until dry with the whole procedure lasting just 20-30 seconds.


"With alcoholic hand rubs there seems to be a lack of knowledge as to exactly how effective these chemical agents can be.  All students should be taught that highly effective agents can kill 99.999% of germs in 20 to 30 seconds but that hand washing needs to be applied with visible soils and when C. diff or norovirus are encountered," commented Barry Michaels, an expert in the field of infectious disease investigation, control and prevention.


Additionally, two thirds did not know that hand creams such as pre-work or restore products can be  used as part of a skin care program to minimize skin damage.  "In order to get hand hygiene information to become part of a healthcare provider's knowledge base, multifaceted training programs are required so that each aspect of an effective hand hygiene program is understood from beginning to end," adds Michaels. 


Hospital-acquired infections (HAIs) are the fourth leading cause of death in the U.S., and according to the Centers for Disease Control and Prevention, are responsible for 99,000 deaths per year and result in $35.7 to $45 billion annually in healthcare costs.   


The WHO and CDC Hand Hygiene guidelines encourage healthcare workers to cleanse their hands with alcohol-based hand rubs for a number of reasons including greater efficacy in reducing microbial counts, less time required to perform a hand hygiene action and less skin irritation compared to hand washing based on frequency. 


The hand hygiene guidelines recommend that:


  1. Visibly dirty hands should be washed because hand rubs do not remove soil from hands
  2. Healthcare workers should use hand creams to reduce skin damage and avoid hot water as it dries out the skin
  3. Hands should be rubbed together until dry after applying hand rub
  4. Hands should be dried with a paper towel or single use cloth following hand washing

Finally, if hands are not visibly soiled or contaminated, alcohol based hand rub should be applied according to the WHO 5 Moments.  This approach provides detailed guidance as to exactly when health-care workers shall clean their hands.


So how do we improve healthcare hand hygiene IQ?  According to the report, the most preferred methods for learning about hand hygiene in clinical settings are: lectures, posters and hands on demonstrations - these were all methods considered most effective by students.


"With hand hygiene, in order  to break the chain of infection, frequency is key.  As such training as to knowing exactly when to wash and when to use hand sanitizer are important.   That said, having a systems approach encompasses all aspects of the process; from skin health to  prevention cross-contamination.  Once this is inculcated into a healthcare worker's mind (skin care, hand wash, hand sanitizer) dispenser selection and placement can make this a no-brainer," concludes Michaels.


The overall lesson is that students did prefer personal interaction as oppose to any remote type of learning.  The study went on to suggest that improving teaching methods including personal interaction and developing role plays that build patient advocacy skills were very important. 


Please use the comments section below to share your hand hygiene education success stories.


References: The hand hygiene knowledge, beliefs, practices and education of healthcare students.  CHICA 2012
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