It seems so simple: To stop spreading infection, health care workers must wash their hands.
Yet even after 150 years of demonstrated reduction in health care associated infections through hand hygiene, health care workers who must wash their hands many times a day sometimes do not do it. Perhaps there is no sink nearby, or they are too busy, or the continuous washing irritates their skin.
However, a recently published set of strategies and guidelines may increase adherence to hand-hygiene practices. Epidemiology professor Dr. Allison E. Aiello, of UNC’s Gillings School of Global Public Health, was part of the team that produced the new document.
Dr. Aiello worked with a diverse group of researchers on the study, “Strategies to Prevent Healthcare-Associated Infections Through Hand Hygiene”, published online July 16 in Infection Control and Hospital Epidemiology and in the journal’s September print issue. Members of the research team came from the Centers for Disease Control and Prevention, and hospitals, universities and medical schools in New York, Illinois, Maryland, Michigan, Iowa and Massachusetts.
Even in well-resourced facilities, recommended hand-hygiene practices are followed only about 40 percent of the time, and programs to improve hand hygiene have not been implemented consistently.
Dr. Aiello’s team drew from previous research to come up with recommendations. For instance, alcohol-based hand rubs (ABHRs) with alcohol concentrations between 62 and 95 percent consistently are more effective than plain or antimicrobial soap, except in the case of Clostridium difficile (“C. diff.”) infections, for which hand-washing appears more effective than ABHRs.
However, hand-hygiene products containing the antibacterial chemical triclosan are controversial because they seem no more effective than existing standards of care for hospital hand hygiene, including ABHRs. Triclosan-containing products also have been associated with outbreaks of pseuodomonas bacteria in clinical settings and have been implicated in cross-resistance to antibiotics in the laboratory.
Dr. Aiello and her colleagues offer recommendations both for basic practices and special approaches. They recommend ascertaining hand-hygiene adherence through direct observation and product volume measurement. They recommend against using ABHRs when hands are visibly soiled, and against hot water due to the irritation it causes skin.
The researchers stress accountability by senior leadership in preventing health care associated infections. In addition to ensuring adequate personnel, education and equipment for proper hand-hygiene practices, health care facilities must have a structure for handling continued non-adherence. Dr. Aiello and her team also recommend having clear targets for improving adherence and considering rewards or recognition for units that model good hand-hygiene behavior or improved adherence.
Dr. Aiello will make a presentation about triclosan at a U.S. Food and Drug Administration hearing on topical antiseptics in Silver Spring, MD, on September 3.