If there were something that you could do in less than one minute per patient encounter that could reduce the risk of a health-care-associated complication, would you do it? Of course, and the good news is that this intervention exists: It’s called hand hygiene. The bad news is that we aren’t doing it enough. In fact, among health-care workers, reported rates of compliance with hand-hygiene guidelines are frequently less than 50%. Our patients deserve better than that. Here are some things we should do:
Recognize the importance of hand hygiene. It has been estimated that health-care-associated infections are responsible for 90,000 deaths in the United States each year and for substantial morbidity among the even greater number who acquire an infection but do not die from it. Hand hygiene is perhaps the most important single step each of us can take to prevent the spread of infection within the health-care setting. Know when hand hygiene is necessary.
Detailed guidelines for hand hygiene in health-care settings have been published and are available online (www.cdc.gov/MMWR/preview. Accessed November 12, 2007). A practical approach is to simply remember to clean your hands both before and after contact with a patient or with inanimate objects in the immediate vicinity of a patient, even when gloves have been worn. Items such as infusion pumps, bed rails, stethoscopes, and BP cuffs have all been shown to be commonly contaminated with pathogenic organisms. In one study, making contact with the bed rail and bedside table for just five seconds resulted in bacterial contamination of the hands of more than 50% of the healthcare workers involved (Infect Control Hosp Epidemiol. 2004;25:164-167).
Maintain skin integrity. Adhering to hand-hygiene guidelines will require health-care workers to clean their hands many times each day—sometimes more than 20 times per hour, depending on the setting and type of work being done.
Fortunately, much can be done to maintain skin integrity in the setting of frequent hand-cleaning. Alcohol-based hand sanitizers have been shown to be less damaging to the skin than soap-and-water handwashing. Alcohol-based products are also more effective and require less time than soap and water. Finally, use of skin lotion can reduce the risk of irritant contact dermatitis associated with hand hygiene. Ideally, the lotion should not interfere with the persistent antimicrobial activity of the soap being used.
Intervene. If you see that a health-care worker isn’t practicing proper hand hygiene, make it a teaching opportunity and remind the person to clean his or her hands. All of us would stop a colleague who was about to inadvertently administer the wrong medication or amputate the wrong leg. Why should an oversight in hand hygiene be viewed or treated any differently than a medication error or wrong-side surgery?
Not so long ago, the introduction of glove-use requirements represented a major change in established practice patterns, and many health-care workers made the change kicking and screaming. Since that time, however, the use of gloves for procedures that put us at risk for exposure to blood and other potentially infectious body fluids has become such a standard part of our practice that we rarely even talk about it anymore. I look forward to the day when proper hand hygiene has become such a standard part of our practice that Commentary articles on hand hygiene are no longer necessary. I suspect that our patients feel the same way.