The guideline for hand hygiene in health care institutions gives health-care workers with a review of information pertaining hand washing and hand antisepsis in such institutions. Additionally, it offers specific recommendations on how to improve hand-hygiene practices that minimize pathogen transmission to patients being served (Garner & Favero, 1985). Hand washing has received attention over the years as the most important element and should be the first step in controlling infections. Research shows that properly implemented hand hygiene on its own is capable of reducing the risk of cross-transmission of infection (Daniels & Rees, 1999).
Colonization of hands with pathogens
There is an increasing need for all medical practitioners to keep their hands clean. Microbes colonize human hands. These micro-organisms play a significant role in cross-transmission of pathogenic microorganisms. The two types of bacteria which colonize the hands include; resident flora which inhabits the underside of superficial cells of stratum corneum, and the transient flora which resides in the superficial layers of the skin. Transient flora can be removed easily by hand washing. They spread from the patients to the doctors or doctors can acquire them from their contaminated environments.
Research shows that about 10-skin epithelial cells that shed off on daily basis harbor viable microbes. These microbes get into the immediate surroundings. The report also indicates that the hand contamination is responsible for most cases of cross-contamination and associated infections such as nosocomial infection (Boyce & Pittet, 2002). That necessitates hand hygiene to reduce the prevalence of related infections such as Klebsiella that research showed that its rate of infection reduces significantly with much attention given to hand hygiene.
Many health care facilities have devised their ways of maintaining hand hygiene. Most of the techniques used are governed by the World Health Organization (WHO). Traditionally, hand washing is believed to have been very efficient and hygienic. The hand was being washed with plain water and a non-antimicrobial soap. The method agreed upon for assessing hand-hygiene products expected for use by health-care workers, demands that test volunteer with their hands the traditional way for a minimum of 30 seconds. That has not been the case as research reveals that most of the health-care workers wash their hands for about 15 seconds, leaving their hands still capable of transmitting microorganism to the patients.
Indications for Hand Hygiene during Patient Care
Health-care workers have very many hand washing routines that clearly indicates their effort in maintaining hand hygiene. It is a common practice to get doctors, and other health workers wash their hands due to the following reasons:
Visibly dirty hands or hands contaminated with blood, or any other body fluid.
After using the restroom, hand washing with a non-antimicrobial soap and water is recommended.
Before and after having any meal.
There are circumstances when a hand cannot be physically dirty, but still, a form of cleaning is necessary. In such a situation, an alcohol-based hand wash is routinely used for decontaminating hands before or after any of the following activities:
Having direct contact with the patients
Before donning sterile gloves when inserting intravascular catheter
Before inserting indwelling urinary catheters, peripheral vascular catheter, or any other invasive devices.
After skin contact with the patient
After contact with body fluids or excretion in any way
After contact with medical objects within the vicinity of the patients
After removing gloves.
How to Improve Hand Hygiene
Hand washing as a way of maintaining hand hygiene can take various forms. There are many possibilities from which a medical practitioner can choose. The simplest approach is washing hand using running water, preferably warm, and then drying it with a single use towel. The towel should be disposed of immediately after use. In some case, sophisticated methods such as the use of alcohols, chlorhexidine, chloroxylenol, hexachlorophene, iodine, etc., may be necessary. The method employed depends on the level of contamination, but they all achieve one objective. The hand washing hygiene. The standard quality that all the mentioned hand washing agents should satisfy is that they should have bactericidal, fungicidal, and virucidal activity (Kampf & Kramer, 2004).
Do the following when there is an indication for handwashing and hand antisepsis
Wash hands with running water and non-antibacterial soap when visibly dirty or contaminated with body fluids such as blood.
Use an alcohol-based hand rub when the hand is not physically dirty for routine decontamination of hands.
Decontaminate hand before having direct contact with the patients
Clean hands after removing gloves
Wash hands before and after having a meal, and after visiting the restroom.
Practice surgical hand antisepsis which includes the following:
Remove rings, watches, and bracelets before beginning the surgical hand scrub.
Remove debris from underneath fingernails using a nail cleaner under running water
follow the conditions of use given from the manufacturing company.
When using an antimicrobial soap, scrub hands for a period recommended by the manufacturer usually 2-6 minutes.
Educate health-care worker and make them go through motivational programs as well as encouraging the patients to remind the health-care worker to decontaminate their hands before attending to them.
Administrative measures such as making improved hand-hygiene adherence an institutional priority and providing appropriate support and financial resource should be put in place.
Boyce, M. & Pittet, D. (2002). Guidelines for Hand Hygiene in health-Care Settings. MMWR. Retrieved from https://www.cdc.gov/Mmwr/preview/mmwrhtml/rr5116a1.htm
Mathur, P. (2011). Hand hygiene: back to the basics of infection control. Indian Journal of Medical Research. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958
Kampf, G. & Kramer A. (2004). Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. PubMed. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15489352
Larson, E. & Laughon, B.(1987). Comparison of four antiseptic products containing chlorhexidine gluconate. Antimicrob Agents Chemother 1987;31:1572--4.
Boyce, J. & Pittet, D. (2002). Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Morb Mortal Wkly Rep. 2002;51:144.
Daniels I, Rees B. (1999). Handwashing: simple, but effective. PubMed. Ann R Coll Surg Engl. 1999;81:1178. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10364970
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