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Hand Hygiene
As convenient and effective as alcohol hand rubs appear to be, HCWs still do not
use them or do not use them according to manufacturers' recommendations. Good products
used improperly are just a waste of money.
In a recent self-study, 31 HCWs identified a number of causes for dry hands: frequent
handwashing, weather, harsh scrub solutions, chemicals in gloves, and latex allergies
(Davis-Harper). Despite this self-knowledge, noncompliance with hand hygiene protocols
continues. This is substantiated in the CDC data, which reviewed studies of HCWs’
handwashing opportunities, the duration of the handwashing and the technique. The
hand hygiene practice in the observational studies was poor, with an overall average
of 40% adherence. (MMWR)
The CDC offers the following chart on factors that influence the practice
of hand hygiene.
Observed risk factors for poor adherence to recommended
hand hygiene practices
- Physician status (rather than a nurse)
- Nursing assistant status (rather than a nurse)
- Male sex
- Working in an intensive-care unit
- Working during the week (versus the weekend)
- Wearing gowns/gloves
- Automated sink
- Activities with high risk of cross-transmission
- High number of opportunities for hand hygiene per hour of patient care
Self-reported factors for poor adherence with hand hygiene
- Handwashing agents cause irritation and dryness
- Sinks are inconveniently located/shortage of sinks
- Lack of soap and paper towels
- Often too busy/insufficient time
- Understaffing/overcrowding
- Patient needs take priority
- Hand hygiene interferes with healthcare worker relationships with patients
- Low risk of acquiring infections from patients
- Wearing of gloves/belief that glove use obviates the need for hand hygiene
- Lack of knowledge of guidelines/protocols
- Not thinking about it/forgetfulness
- No role model among colleagues or superiors
- Skepticism regarding the value of hand hygiene
- Disagreement with the recommendations
- Lack of scientific information of definitive impact of improved hand hygiene on
healthcare-associated infection rates
Additional perceived barriers to appropriate hand hygiene
- Lack of active participation in hand hygiene promotion at individual or institutional
level
- Lack of role model for hand hygiene
- Lack of institutional priority for hand hygiene
- Lack of administrative sanction of noncompliers/rewarding compliers
- Lack of institutional safety climate
The CDC has made it easier to get products into the hands of end users at the point
of patient contact by approving alcohol products that meet the monograph, and it
has dropped its egress issues so that dispensers can be wall mounted conveniently.
Some companies have even marketed a point-of-care personal dispenser that the HCW
wears. There really is no excuse not to use these products between patient contacts
as advised by the CDC.
C. diff and Bacillus anthracis (anthrax) – require
non-antimicrobial soap and water or antimicrobial soap and water for handwashing
- The physical action of this type of wash is more effective against these spore formers.
- Alcohols, CHG, iodophors and other antiseptic agents have poor activity against
spores.
Important note:
Also from the CDC concerning hand hygiene practices
with these specific organisms.
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